1 00:00:04,520 --> 00:00:06,158 This is Mrs Rappaport. 2 00:00:06,240 --> 00:00:08,196 I'm the consultant on call for major trauma. 3 00:00:09,360 --> 00:00:10,475 Resources are stretched. 4 00:00:10,880 --> 00:00:13,348 Well, then, some of us need to raise their game. 5 00:00:13,440 --> 00:00:14,759 Where is this going exactly? 6 00:00:16,000 --> 00:00:17,115 What's happened to Lorraine? 7 00:00:17,880 --> 00:00:19,199 Who's covering? 8 00:00:19,280 --> 00:00:21,236 It's in your best interest to stay out of this, 9 00:00:21,320 --> 00:00:23,231 so stay out of this. 10 00:00:24,040 --> 00:00:25,519 You're the last person I want to call, but... 11 00:00:25,680 --> 00:00:27,398 You're the only one who can help. 12 00:00:27,480 --> 00:00:29,550 I think my boss just got suspended. 13 00:00:30,360 --> 00:00:32,396 (THEME SONG PLAYING) 14 00:00:35,300 --> 00:00:43,300 Ripped By mstoll 15 00:00:44,760 --> 00:00:46,398 (SIREN WAILING) 16 00:00:48,400 --> 00:00:50,755 AUTOMATED VOICE: Trauma call, attend emergency department. 17 00:00:50,960 --> 00:00:53,758 Trauma call, attend emergency department. 18 00:01:01,000 --> 00:01:02,672 (CONTINUES WAILING) 19 00:01:09,040 --> 00:01:10,553 She went off a couple of minutes ago. 20 00:01:10,720 --> 00:01:12,517 (RAPID BEEPING) 21 00:01:16,040 --> 00:01:17,155 Shit! 22 00:01:18,480 --> 00:01:20,869 Let's get her inside. Move. Move! 23 00:01:21,160 --> 00:01:23,833 Right. Mid-forties female. Next-door neighbour at 4:30... 24 00:01:24,040 --> 00:01:25,473 Not now, lovey. Wait till we're inside. 25 00:01:25,560 --> 00:01:27,073 - Sorry, Nerys. - Is this the... 26 00:01:27,240 --> 00:01:28,275 Yes. 27 00:01:29,040 --> 00:01:30,439 Have you got who's trauma consultant, today? 28 00:01:30,520 --> 00:01:32,875 Uh, that information's not come through yet. 29 00:01:32,960 --> 00:01:33,949 Call Clive, please. 30 00:01:34,200 --> 00:01:35,189 Colleague call. 31 00:01:35,280 --> 00:01:37,714 Dr Archerfield, please attend trauma resus, urgently. 32 00:01:38,160 --> 00:01:40,879 - Starting the clock. Critical airway. - (BEEPS) 33 00:01:40,960 --> 00:01:43,269 Okay, uh, straight into the bay. No handover. 34 00:01:43,880 --> 00:01:45,279 Where's Dr Chandramohan? 35 00:01:45,360 --> 00:01:47,078 - On study leave, today. - Who's covering? 36 00:01:47,160 --> 00:01:48,309 - Dr Busby. - Fast bleep him. 37 00:01:48,400 --> 00:01:49,628 - We need an anaesthetist. - PARAMEDIC: On three... 38 00:01:49,720 --> 00:01:51,756 One, two, three. 39 00:01:54,240 --> 00:01:55,958 What's with the whole Elephant Man thing? 40 00:01:56,040 --> 00:01:58,110 - (GASPS) Right. - Oh, my God. 41 00:01:58,360 --> 00:01:59,429 JUSTIN: Bloody hell. 42 00:01:59,520 --> 00:02:01,431 Can you fast bleep Dr Busby for me, please. 43 00:02:01,520 --> 00:02:04,193 - FIONA: And Dr Archerfield. - Hmm? 44 00:02:04,680 --> 00:02:06,796 All right, 100% oxygen and bag as best you can. 45 00:02:06,960 --> 00:02:08,109 I don't know if you can hear me, 46 00:02:08,200 --> 00:02:10,077 but we're going to do something to help you breathe. 47 00:02:10,520 --> 00:02:12,476 Thio, sux, 'scope, bougie, narrow tube. 48 00:02:12,680 --> 00:02:14,193 Don't be daft. You'll never get a tube in. 49 00:02:14,640 --> 00:02:16,551 - MRS HICKLIN: Cannot intubate. - Okay. 50 00:02:16,640 --> 00:02:17,834 Fiona! 51 00:02:17,920 --> 00:02:19,558 DR HARRY: Uh, could you fast bleep Dr Barnby, please? 52 00:02:19,920 --> 00:02:22,115 - Busby. - Busby, sorry and Dr Archerfield. 53 00:02:22,280 --> 00:02:23,315 To trauma resus. 54 00:02:23,520 --> 00:02:24,748 - Well? - DR HARRY: Thanks. 55 00:02:26,000 --> 00:02:27,035 Yep. Put the call out. 56 00:02:27,320 --> 00:02:29,436 - FIONA: Getting any in? - The wood's in the way. 57 00:02:29,520 --> 00:02:31,078 - What is it? - Fence post. 58 00:02:31,560 --> 00:02:32,834 She fell out a window. 59 00:02:35,720 --> 00:02:37,517 Poor ventilation across both lung fields. 60 00:02:37,600 --> 00:02:39,431 - Cannot ventilate. - Give me a sat. 61 00:02:39,520 --> 00:02:40,794 Yeah, just in a second. 62 00:02:44,880 --> 00:02:46,233 Okay. Okay? 63 00:02:46,600 --> 00:02:47,999 (MONITOR BEEPING) 64 00:02:48,080 --> 00:02:49,195 Yep. 65 00:02:50,480 --> 00:02:52,789 Oxygen saturation 60%. Shit. 66 00:02:53,120 --> 00:02:54,758 Fence post. 60%. 67 00:02:54,840 --> 00:02:57,229 This is a situation, cannot intubate, cannot ventilate. 68 00:02:57,520 --> 00:02:58,839 She needs a tracheotomy. 69 00:02:58,920 --> 00:03:00,956 Nerys, can you write that down, as stated by me. 70 00:03:01,040 --> 00:03:02,871 And the time is... 71 00:03:02,960 --> 00:03:05,520 - One minute, twenty seconds. - Yeah. 72 00:03:05,600 --> 00:03:09,229 BILLY: Oxygen saturation now 50%%, and falling. 73 00:03:09,640 --> 00:03:12,552 - Cannot intubate, cannot ventilate. - (BEEPING RAPIDLY) 74 00:03:12,840 --> 00:03:14,558 You've covered your arse. Now let's do it. 75 00:03:14,920 --> 00:03:16,478 DR HARRY: Looks like Clive isn't joining us. 76 00:03:16,560 --> 00:03:18,278 Nerys, nice and calmly, 77 00:03:18,800 --> 00:03:21,314 - please, get a QuickTrach ready to go. - Well, yeah. 78 00:03:21,760 --> 00:03:23,910 BILLY: Uh, thiopentone and suxamethonium doses? 79 00:03:24,240 --> 00:03:26,356 - 200, 100... - BILLY: Got it. 80 00:03:26,960 --> 00:03:29,235 MRS HICKLIN: Let's get the blocks off. Harry, can you give me a hand? 81 00:03:29,320 --> 00:03:31,072 - I'll give inline immobilisation. - (JUSTIN GRUNTS) 82 00:03:31,160 --> 00:03:32,593 (MONITOR BEEPING) 83 00:03:44,040 --> 00:03:45,029 Thiopentone. 84 00:03:48,560 --> 00:03:50,073 Flush. Sux. 85 00:03:50,720 --> 00:03:52,438 Thiopentone 200 milligrams, 86 00:03:52,520 --> 00:03:54,954 suxamethonium 100 milligrams, given. 87 00:03:56,760 --> 00:03:57,909 Flush. 88 00:04:01,080 --> 00:04:02,798 QuickTrach to me right now, please. 89 00:04:03,080 --> 00:04:04,559 Shitting shit! 90 00:04:07,280 --> 00:04:09,555 It's coming up to two minutes thirty, no airway. 91 00:04:09,640 --> 00:04:11,790 - Anyone heard from the anaesthetist? - It's just us. 92 00:04:13,480 --> 00:04:16,074 Okay. Step away. 93 00:04:18,440 --> 00:04:20,510 - (PATIENT GROANING) - FIONA: Shit, she's not under. 94 00:04:21,240 --> 00:04:23,390 Ketamine 30 milligrams, now, Billy! 95 00:04:23,480 --> 00:04:26,119 - BILLY: Yep, yep, yep. - It's all right. It's okay, yeah? 96 00:04:26,360 --> 00:04:28,112 BILLY: I'm drawing it. FIONA: Billy! Come on, quicker! 97 00:04:28,200 --> 00:04:30,509 I'm coming, I'm coming, I'm drawing. One second. 98 00:04:30,600 --> 00:04:32,238 FIONA: Come on, Billy! Come on! 99 00:04:32,320 --> 00:04:33,594 - (GROANING) - FIONA: Come on... 100 00:04:34,280 --> 00:04:36,316 - Come on, Billy. Give it! - MRS HICKLIN: Stay still, stay still. 101 00:04:36,400 --> 00:04:39,870 Now coming up to three minutes. Still no airway. 102 00:04:39,960 --> 00:04:41,837 MRS HICKLIN: Good girl, come on, that's it. 103 00:04:41,920 --> 00:04:43,717 You'll be fine. It's okay, it's okay. 104 00:04:43,920 --> 00:04:48,198 - Come on, darling, here we go. - BILLY: Ketamine 30 milligrams, given. 105 00:04:48,400 --> 00:04:50,595 FIONA: Okay, she's under. Step away. 106 00:04:56,680 --> 00:04:58,716 You have done this before? 107 00:05:04,840 --> 00:05:05,875 I have now. 108 00:05:08,800 --> 00:05:10,074 I'm getting air. 109 00:05:10,240 --> 00:05:12,196 (MONITOR BEEPING RAPIDLY) 110 00:05:19,520 --> 00:05:21,556 Thanks, Billy. Sorry. 111 00:05:21,880 --> 00:05:23,029 Water off a duck's back. 112 00:05:23,440 --> 00:05:24,589 I'll hold the trach in place. 113 00:05:24,840 --> 00:05:26,876 Attach the strap and loop it around her neck, will you? 114 00:05:26,960 --> 00:05:28,313 BILLY: Bagging. 115 00:05:29,760 --> 00:05:31,113 It's okay. 116 00:05:32,440 --> 00:05:35,750 JUSTIN: Oxygen and saturation climbing, now 70%. 117 00:05:36,240 --> 00:05:37,878 Yeah, yeah, under the hood. That's it. 118 00:05:38,040 --> 00:05:39,792 - Strap's on. - Okay. 119 00:05:42,840 --> 00:05:43,909 Sats now 80%. 120 00:05:48,040 --> 00:05:50,031 MRS HICKLIN: 90%. Good. 121 00:05:50,440 --> 00:05:52,271 Airway secure. Scoop out. 122 00:05:53,560 --> 00:05:55,073 Thanks, Justin. 123 00:05:56,120 --> 00:05:57,473 Brace. 124 00:05:58,560 --> 00:05:59,959 Brace. 125 00:06:00,040 --> 00:06:01,712 FIONA: Okay, let's get the blocks back in, Justin, please. 126 00:06:01,800 --> 00:06:03,028 - JUSTIN: Yep, I'll do blocks. - (SIGHS) 127 00:06:03,120 --> 00:06:04,235 DR HARRY: Yeah, I'll help with the blocks. 128 00:06:06,240 --> 00:06:07,559 Well done. 129 00:06:07,880 --> 00:06:09,029 I'm not covering my arse, 130 00:06:09,120 --> 00:06:11,350 I'm helping my colleagues make the right decision at the right time. 131 00:06:11,440 --> 00:06:12,429 Stress of the moment. 132 00:06:12,960 --> 00:06:14,188 Mmm-hmm. 133 00:06:14,280 --> 00:06:15,349 - Blocks in? - They're in. 134 00:06:15,440 --> 00:06:17,749 MRS HICKLIN: Can someone cut her out of her clothes, please? 135 00:06:17,840 --> 00:06:18,909 Yep. Excuse me, love. 136 00:06:19,000 --> 00:06:20,035 Oi, oi, oi... 137 00:06:20,120 --> 00:06:21,314 Airways secure. 138 00:06:23,720 --> 00:06:25,517 MRS HICKLIN: We have a female, mid-forties... 139 00:06:28,160 --> 00:06:30,151 Ventilating both lungs. 140 00:06:31,360 --> 00:06:33,191 Strong pulses. Good blood pressure. 141 00:06:36,520 --> 00:06:37,794 If only it was always this easy. 142 00:06:38,720 --> 00:06:40,233 (ALL CHUCKLING) 143 00:06:42,240 --> 00:06:43,355 Oh! Here he is. 144 00:06:44,760 --> 00:06:47,877 Ah. Good of you to join us, Dr Busby. 145 00:06:48,120 --> 00:06:49,951 Shit. The call said 10 minutes. 146 00:06:50,040 --> 00:06:51,553 MALE PARAMEDIC: She went off, in the back of the truck. 147 00:06:51,680 --> 00:06:53,238 It didn't get updated till the last minute. 148 00:06:53,320 --> 00:06:54,389 I never got the update. 149 00:06:54,480 --> 00:06:57,313 - Well, let's not discuss it now. - BUSBY: Okay. Ah... 150 00:06:57,520 --> 00:07:01,069 The trach will tide us over until we get ENT involved. 151 00:07:01,960 --> 00:07:05,077 Sats normalising. Nice job on the QuickTrach. 152 00:07:05,480 --> 00:07:06,799 Thank you. 153 00:07:08,480 --> 00:07:10,789 Can we have the handover now, please? 154 00:07:10,880 --> 00:07:13,348 PARAMEDIC: The patient is female, believed to be mid-forties, 155 00:07:13,520 --> 00:07:15,238 but we don't have an ID yet. 156 00:07:15,360 --> 00:07:16,998 999 call was made by the next-door neighbour, 157 00:07:17,080 --> 00:07:18,638 but he couldn't ID the patient. 158 00:07:18,720 --> 00:07:20,950 Said he didn't know her name. She kept herself to herself. 159 00:07:21,040 --> 00:07:22,712 This was at 4:30. 160 00:07:22,800 --> 00:07:26,395 Neighbour heard a crash and saw her lying in her back garden. 161 00:07:26,480 --> 00:07:27,833 Ah, first-floor window was open 162 00:07:27,920 --> 00:07:30,275 and he thinks she was cleaning the windows. 163 00:07:30,440 --> 00:07:33,512 She landed on a fence post, hence the penetrating mandibular injury. 164 00:07:33,720 --> 00:07:35,915 No other major injuries apparent on examination. 165 00:07:36,000 --> 00:07:38,673 Uh, she was semiconscious at the scene, GCS 11. 166 00:07:39,040 --> 00:07:41,508 En route, she started to have difficulty with the airway. 167 00:07:41,600 --> 00:07:43,795 She wouldn't take a Guedel and there was difficulty bagging. 168 00:07:43,880 --> 00:07:46,269 - Primark. - Important medical information, that is. 169 00:07:46,360 --> 00:07:48,237 - Don't be silly. Concentrate. - Sorry. 170 00:07:49,000 --> 00:07:50,399 MRS HICKLIN: Thank you. Any questions? 171 00:07:50,480 --> 00:07:52,550 - Any analgesia given? - No, due to the GCS. 172 00:07:52,640 --> 00:07:54,596 No, she's been given 30 milligrams of Ketamine here. 173 00:07:54,880 --> 00:07:55,915 She has stuff in her pockets. 174 00:07:56,000 --> 00:07:57,911 All right, let's do a BA3, then. 175 00:07:58,000 --> 00:08:01,470 BILLY: She's also had 200 of thio and 100 of sux. 176 00:08:01,560 --> 00:08:02,959 BUSBY: Thanks, Billy. 177 00:08:03,040 --> 00:08:04,951 - Mobile phone. - Mobile phone. 178 00:08:05,040 --> 00:08:06,951 Anything with a name? 179 00:08:07,120 --> 00:08:08,997 - No, no credit cards. - Tesco Club Card? 180 00:08:09,680 --> 00:08:11,636 - Oh! Dry cleaning ticket. - Dry cleaning ticket. 181 00:08:14,560 --> 00:08:15,549 - Fruit... - Fruit pastilles. 182 00:08:17,360 --> 00:08:19,078 BOTH: Fruit pastilles. 183 00:08:19,160 --> 00:08:21,549 Can you sign off on the paperwork with Nerys for me, please? 184 00:08:25,560 --> 00:08:28,120 - Sorry, she needs to complete a PS20. - Huh? 185 00:08:28,200 --> 00:08:31,954 - Major Trauma Patient Experience Survey. - She's unconscious. 186 00:08:35,400 --> 00:08:37,118 Right, can someone do bloods? Harry? 187 00:08:37,200 --> 00:08:39,111 Yeah. Sure, no problem. 188 00:08:43,320 --> 00:08:45,709 - So, you're Harry? - Yep, that's me. 189 00:08:46,800 --> 00:08:48,313 Dominic. Dom. 190 00:08:48,680 --> 00:08:49,669 (CLEARS THROAT) 191 00:08:50,840 --> 00:08:51,829 Hi, Dom, nice to meet you. 192 00:08:53,880 --> 00:08:55,029 So, you're trauma team leader now? 193 00:08:55,720 --> 00:08:57,950 - Now? No. - Instead of Lorraine. 194 00:09:04,680 --> 00:09:05,669 Shall I do these? 195 00:09:06,280 --> 00:09:07,713 Billy can do those for you. 196 00:09:08,520 --> 00:09:10,078 (SIGHS) All right. 197 00:09:14,040 --> 00:09:16,998 This fullness in the abdomen could be fluid. 198 00:09:17,080 --> 00:09:19,548 Let's get O-neg on standby and GandS and TEG, 199 00:09:19,640 --> 00:09:21,312 - as well as the usual bloods. - Yeah. 200 00:09:21,400 --> 00:09:22,958 - Can you run off a VBG? - Yep. 201 00:09:23,040 --> 00:09:24,917 And can someone call CT straight away, please? 202 00:09:25,000 --> 00:09:25,989 I'll call them. 203 00:09:26,080 --> 00:09:29,356 Uh, I'd love images of her pelvis and legs. 204 00:09:29,480 --> 00:09:30,469 X-rays now? 205 00:09:30,920 --> 00:09:32,797 If the scanner's free, I'd prefer a CT. 206 00:09:36,640 --> 00:09:38,835 MRS HICKLIN: Time is coming up to eight minutes. 207 00:09:38,920 --> 00:09:41,229 - Eight minutes, Mark. - (BILLY WHISTLING) 208 00:09:46,480 --> 00:09:48,550 - That's you done. Thank you, bye. - BOTH: Thanks, Nerys. 209 00:09:48,880 --> 00:09:50,438 CHANDRAMOHAN: (ON ANSWERING MACHINE) Leave a message for 210 00:09:50,520 --> 00:09:52,750 Dr Ramakrishnan Chandramohan, Anaesthetics Registrar. 211 00:09:52,840 --> 00:09:53,829 - (SIGHS DEEPLY) - You know you want to. 212 00:09:53,920 --> 00:09:56,115 - (BEEPS) - Hey. It's me, Harry. 213 00:09:56,200 --> 00:09:58,668 Um, what's this about study leave? 214 00:09:58,960 --> 00:10:00,109 This is Mrs Hicklin. 215 00:10:00,200 --> 00:10:02,873 Uh, we've got major trauma Foxtrot Bravo for a top-to-toe. 216 00:10:02,960 --> 00:10:03,949 No major limb trauma. 217 00:10:05,200 --> 00:10:07,031 Thank you. Yeah, they can take her right away. 218 00:10:07,120 --> 00:10:09,554 Great. I'll see you there. 219 00:10:10,880 --> 00:10:12,154 Yeah. 220 00:10:13,560 --> 00:10:15,710 Yes. Well, well, let's just keep at it, shall we? 221 00:10:21,280 --> 00:10:22,474 (BEEPS) 222 00:10:34,360 --> 00:10:36,157 - Clive. - Hi, Fiona. 223 00:10:36,520 --> 00:10:38,317 They put out a call for you. 224 00:10:38,400 --> 00:10:41,597 Yep, I'm sorry, I'm snowed under. How's it going? 225 00:10:41,680 --> 00:10:43,557 - Patient's stable. - Mmm-hmm. 226 00:10:43,640 --> 00:10:44,629 Uh, I saw earlier, 227 00:10:44,720 --> 00:10:46,870 Lorraine's name's not on the rota for today. 228 00:10:46,960 --> 00:10:48,439 - No. - I tried calling her in the week 229 00:10:48,520 --> 00:10:50,556 but she hasn't got back to me. 230 00:10:50,640 --> 00:10:53,359 Yes, well she's still feeling under the weather, poor thing. 231 00:10:53,440 --> 00:10:55,032 If you speak to her, give her my best, will you? 232 00:10:55,120 --> 00:10:56,678 Yeah... Okay. 233 00:10:56,760 --> 00:11:00,150 So, we haven't got a trauma consultant. 234 00:11:00,240 --> 00:11:03,835 No, there is, uh, somebody coming in. Isn't he here yet? 235 00:11:03,920 --> 00:11:05,114 No. 236 00:11:05,800 --> 00:11:08,633 A major trauma case needs a trauma team leader. 237 00:11:08,720 --> 00:11:11,234 Yep, well I'm here if you need me. 238 00:11:11,320 --> 00:11:14,278 - I'm sure you can cope. - Okay. 239 00:11:30,800 --> 00:11:34,076 (ECHOES) Trauma call, attend emergency department. 240 00:11:35,760 --> 00:11:37,352 Fiona! You better come quick. 241 00:11:46,240 --> 00:11:48,356 Stop messing about with the blood gas and get back over here. 242 00:11:50,280 --> 00:11:52,953 FIONA: Let's keep filling her up and try to get her BP back. 243 00:11:53,040 --> 00:11:54,792 Surgical airway is established, 244 00:11:54,880 --> 00:11:56,950 there's apparent haemostasis in the mandible, 245 00:11:57,120 --> 00:12:00,908 so I propose we leave for a MaxFax opinion once she's stable. 246 00:12:04,960 --> 00:12:05,995 As I've said, 247 00:12:06,080 --> 00:12:09,311 once we have a CT we can send to MaxFax and ENT, 248 00:12:09,400 --> 00:12:11,789 but right now our priority is addressing the low BP 249 00:12:11,880 --> 00:12:14,314 - by pushing the blood transfusion. - NERYS: Agreed. 250 00:12:22,440 --> 00:12:23,793 Uh, did we get gases? 251 00:12:23,880 --> 00:12:25,871 - Uh... - I'm the trauma consultant. 252 00:12:25,960 --> 00:12:27,871 Most likely, this is an internal haemorrhage, 253 00:12:27,960 --> 00:12:30,872 so we need to find the bleeding and stop it before it kills her. 254 00:12:31,280 --> 00:12:34,352 Let's run a unit of O-neg into each of the Venflons, please. 255 00:12:34,440 --> 00:12:35,919 - MRS HICKLIN: We're doing that. - Then have another one 256 00:12:36,000 --> 00:12:37,194 ready to go up straight after. 257 00:12:37,600 --> 00:12:41,673 Plus two units of FFP, continuing at a ratio of 3:2. 258 00:12:41,760 --> 00:12:43,557 And let's give her a gram of TXA. 259 00:12:44,480 --> 00:12:47,040 We're already 20 minutes into our golden hour, so... 260 00:12:48,040 --> 00:12:49,678 Right now, please. 261 00:12:50,040 --> 00:12:51,109 Who's he? 262 00:12:51,200 --> 00:12:52,758 Nerys, uh, get another 263 00:12:52,840 --> 00:12:54,273 - two units of O-neg from the fridge. - Yep. 264 00:12:54,360 --> 00:12:56,157 - Get them running ASAP. - Who are you, please? 265 00:12:56,920 --> 00:12:59,388 Glen Boyle, locum trauma consultant. 266 00:12:59,960 --> 00:13:01,439 Pleased to meet you. You are? 267 00:13:01,920 --> 00:13:03,911 Nicola Hicklin. Nurse consultant. 268 00:13:04,040 --> 00:13:06,429 I'm the Deputy Clinical Lead in this department. 269 00:13:06,520 --> 00:13:07,919 You should've introduced yourself earlier. 270 00:13:08,960 --> 00:13:10,712 Uh, BP's still down. 271 00:13:10,920 --> 00:13:13,992 So, let's get the transfusions going. Pressure bags, please. 272 00:13:14,240 --> 00:13:15,992 - Yep. - GLEN: Anyone called a Code Red? 273 00:13:16,720 --> 00:13:18,631 - No. - Well, let's make the call, 274 00:13:18,720 --> 00:13:19,948 or call Blood Bank 275 00:13:20,120 --> 00:13:23,078 and request 12 units of cross-match or O-neg, 276 00:13:23,160 --> 00:13:24,832 whichever is most quickly available, 277 00:13:24,920 --> 00:13:28,037 eight of FFP and four of platelets, please. 278 00:13:28,480 --> 00:13:30,038 Okay. You need to sign in. 279 00:13:31,520 --> 00:13:32,589 There? 280 00:13:36,120 --> 00:13:37,519 Do we have the bloods yet? 281 00:13:37,600 --> 00:13:39,431 Uh, sent off about five minutes ago. 282 00:13:39,520 --> 00:13:40,555 MRS HICKLIN: This is Mrs Hicklin. 283 00:13:40,760 --> 00:13:43,433 I need the following to trauma resus, re-patient... 284 00:13:43,520 --> 00:13:44,748 ...EtOH and TEG. 285 00:13:44,840 --> 00:13:47,479 Christ, EtOH, I'd forget me head, me. 286 00:13:48,000 --> 00:13:49,115 Tranexamic acid. 287 00:13:49,200 --> 00:13:51,509 NERYS: One gram IV bolus. Infusion to follow. 288 00:13:51,600 --> 00:13:53,955 - Need more access. Yep. - I'll do a trauma line. 289 00:13:54,320 --> 00:13:56,231 And let me know when that's done, please. 290 00:13:56,320 --> 00:13:59,153 Hello, this is William Finlay, ODP, I would like to request an EtOH. 291 00:13:59,240 --> 00:14:00,559 - GLEN: I can't... - lf you're not on the system yet, 292 00:14:00,640 --> 00:14:02,312 just choose "temporary staff" from the dropdown list. 293 00:14:02,520 --> 00:14:03,555 - Temporary? - Yep. 294 00:14:15,400 --> 00:14:16,753 Excuse me. 295 00:14:17,040 --> 00:14:18,678 You were going to show us her VBGs? 296 00:14:18,840 --> 00:14:19,955 Oh. 297 00:14:23,400 --> 00:14:24,719 Thank you. 298 00:14:25,880 --> 00:14:27,199 Who's he? 299 00:14:30,720 --> 00:14:31,709 Glen Boyle. 300 00:14:34,920 --> 00:14:36,319 FIONA: Thanks. 301 00:15:05,520 --> 00:15:06,919 - Trauma line's in. - Thank you. 302 00:15:07,000 --> 00:15:09,673 Let's run two more units of O-neg through the trauma line 303 00:15:09,760 --> 00:15:11,716 and two of FFP through the Venflons, 304 00:15:11,800 --> 00:15:13,552 once the first two units of O-neg are through. 305 00:15:13,800 --> 00:15:15,791 - More or less through now. - GLEN: Crack on. 306 00:15:16,080 --> 00:15:17,593 - You are? - Justin. 307 00:15:23,040 --> 00:15:25,190 Blood pressure's moved up now 100 over 80. 308 00:15:25,280 --> 00:15:26,395 Sats remain good. 309 00:15:26,480 --> 00:15:28,232 GLEN: Airway stable pending ENT? 310 00:15:28,320 --> 00:15:30,231 - JUSTIN: Just about. - Then... 311 00:15:30,320 --> 00:15:31,309 Let's get her a CT. 312 00:15:32,280 --> 00:15:34,475 - Okay, but I'd rather... - Then... 313 00:15:34,560 --> 00:15:36,312 Let's get her a CT. 314 00:15:37,160 --> 00:15:39,230 - I'll call them. - Thank you. 315 00:15:40,160 --> 00:15:41,513 - Who's he? - I... 316 00:15:43,200 --> 00:15:44,633 Glen Boyle. 317 00:15:45,480 --> 00:15:47,072 Miss Lomas, trauma fellow. 318 00:15:47,280 --> 00:15:48,554 We've got a major for you. 319 00:15:48,640 --> 00:15:49,709 MRS HICKLIN: Thank you. 320 00:15:49,800 --> 00:15:50,994 Thanks. 321 00:15:51,880 --> 00:15:53,199 CT can take her now. 322 00:15:53,280 --> 00:15:55,555 - JUSTIN: Blood running in fast now. - Cheers. 323 00:15:55,720 --> 00:15:58,518 BP's coming up a little more. Now 105. 324 00:15:59,240 --> 00:16:00,514 Then let's get her a CT. 325 00:16:00,600 --> 00:16:02,556 - Harry, take the drip stand, will you? - Yep, on it. 326 00:16:02,640 --> 00:16:03,914 MRS HICKLIN: Justin. 327 00:16:04,000 --> 00:16:05,035 Finish that for me. 328 00:16:05,120 --> 00:16:07,998 - JUSTIN: Reconnect the ventilator... - When did you start? 329 00:16:08,080 --> 00:16:09,399 GLEN: Today. NERYS: Justin, grab this, please. 330 00:16:09,480 --> 00:16:11,311 MRS HICKLIN: So, you're not Lorraine Rappaport's replacement? 331 00:16:11,400 --> 00:16:13,709 Who? No. Temporary. 332 00:16:13,800 --> 00:16:15,995 - How long are you here for? - Not sure. Just filling in. 333 00:16:16,280 --> 00:16:18,157 You do know that we're a centre of excellence? 334 00:16:18,720 --> 00:16:20,597 - Absolutely. - We're the referral centre 335 00:16:20,680 --> 00:16:22,238 for major trauma for the whole region. 336 00:16:24,120 --> 00:16:25,394 I got it. 337 00:16:27,400 --> 00:16:28,389 Get a move on, please. 338 00:16:57,480 --> 00:17:00,358 - How's it going? - Great. 339 00:17:01,440 --> 00:17:03,237 These trauma calls! 340 00:17:04,480 --> 00:17:05,993 Yeah, I know. 341 00:17:14,400 --> 00:17:17,198 - You'll have to back up. - You'll have to back up. 342 00:17:20,920 --> 00:17:22,148 (BEEPS) 343 00:17:24,320 --> 00:17:26,356 We're here, Brian, if you could open the doors for us, please. 344 00:17:28,240 --> 00:17:29,229 (BEEPS) 345 00:17:38,360 --> 00:17:40,032 BILLY: Get it right here. That's it. 346 00:17:40,240 --> 00:17:42,595 You looked as if you'd seen a ghost. 347 00:17:42,680 --> 00:17:45,319 - Could've warned me. - I should have. 348 00:17:47,280 --> 00:17:49,430 - I should've called. - No. Really? 349 00:17:51,120 --> 00:17:52,269 Sorry. 350 00:17:53,640 --> 00:17:57,235 I thought you would have grown out of trying to catch me off guard. 351 00:18:02,160 --> 00:18:03,798 It's good to see you. 352 00:18:06,280 --> 00:18:07,679 You too. 353 00:18:08,640 --> 00:18:09,868 (DOOR LOCK BEEPS) 354 00:18:11,760 --> 00:18:14,991 - Sorry. Um, scan's about to start. - Thank you. 355 00:18:15,680 --> 00:18:18,911 We've been trying to enact a major transfusion protocol, 356 00:18:19,000 --> 00:18:22,356 but some of the haematology consultants insist on it going through them. 357 00:18:22,440 --> 00:18:23,714 Well, then someone needs to speak up. 358 00:18:23,800 --> 00:18:25,950 Someone already did. 359 00:18:26,040 --> 00:18:27,678 Lorraine Rappaport. 360 00:18:28,880 --> 00:18:31,519 Hence the vacancy you've just filled. 361 00:18:37,880 --> 00:18:39,108 (BEEPS) 362 00:18:46,840 --> 00:18:48,034 (BEEPS) 363 00:18:51,040 --> 00:18:52,314 The orthopod, where is she? 364 00:18:52,480 --> 00:18:54,994 - Rebecca? Must've gone back to the ward. - (CHUCKLES) 365 00:18:55,240 --> 00:18:56,593 (WHISPERING) Back in a mo. I'm busting. 366 00:18:56,680 --> 00:18:58,159 FIONA: Usual story, once we reach CT, 367 00:18:58,240 --> 00:19:00,231 they start catching up with their normal jobs. 368 00:19:00,360 --> 00:19:01,873 Small subdural. 369 00:19:02,280 --> 00:19:03,599 We're going to need a neuro opinion. 370 00:19:03,800 --> 00:19:06,314 - (BOTH CHUCKLING) - You really are new, aren't you? 371 00:19:09,240 --> 00:19:10,275 BRIAN: Are you chewing? 372 00:19:11,760 --> 00:19:13,398 (SWALLOWS) No. 373 00:19:15,760 --> 00:19:18,433 I'm going to connect up the contrast and start the body scan. 374 00:19:18,680 --> 00:19:20,079 Nobody press any buttons. 375 00:19:25,800 --> 00:19:27,552 Don't worry about Brian. His bark's worse than his bite. 376 00:19:29,240 --> 00:19:30,514 What a relief. 377 00:19:30,600 --> 00:19:32,113 BRIAN: Patient secure. Let's get ready to scan. 378 00:19:32,200 --> 00:19:35,829 I don't know if you know, but I teach an intubation tutorial. 379 00:19:35,920 --> 00:19:39,310 - Really? - BRIAN: Starting contrast run. 380 00:19:46,760 --> 00:19:48,671 - Stop the scan! - Uh, stopping. 381 00:19:50,800 --> 00:19:52,791 What's going on in there? 382 00:19:54,200 --> 00:19:57,351 He's heard that if he gives you extra teaching, 383 00:19:57,720 --> 00:19:59,790 you're bound to put out. 384 00:20:00,440 --> 00:20:03,477 - BRIAN: Dr Busby. - Keep your hair on, Brian. 385 00:20:05,520 --> 00:20:07,238 BRIAN: I... I cannot work like this. 386 00:20:07,320 --> 00:20:09,436 - (STAMMERING) This is anarchy. - Sorry. 387 00:20:13,960 --> 00:20:15,837 - What happened to blondie? - BRIAN: Scanning. 388 00:20:19,400 --> 00:20:20,389 The police just called. 389 00:20:20,480 --> 00:20:22,311 They went to the house and obtained an ID on the patient, 390 00:20:22,400 --> 00:20:24,675 but on the system she'll still be Foxtrot Bravo. 391 00:20:24,920 --> 00:20:27,514 - Okay. - Small contrast extravasations. 392 00:20:27,760 --> 00:20:30,797 FIONA: No tamponade or thoracic aortic rupture. 393 00:20:30,880 --> 00:20:33,189 - Fruit pastille? - No. 394 00:20:33,400 --> 00:20:36,153 GLEN: Okay, so now we know, if there is a haemorrhage, 395 00:20:36,240 --> 00:20:37,878 it's in the abdomen. 396 00:20:37,960 --> 00:20:39,075 I'll go and see if there's any progress 397 00:20:39,160 --> 00:20:40,354 - on tracking down next of kin. - Thanks. 398 00:20:40,560 --> 00:20:41,993 What's that around the liver? 399 00:20:42,080 --> 00:20:43,672 GLEN: It's a bit of this, it's a bit of that, 400 00:20:43,920 --> 00:20:45,399 nothing major. 401 00:20:48,520 --> 00:20:50,511 Shit, she's haemorrhaging! 402 00:20:50,840 --> 00:20:53,195 FIONA: Left renal tear plus various intraperitoneal 403 00:20:53,280 --> 00:20:54,269 extravasations. 404 00:20:54,360 --> 00:20:55,588 Fast bleep the trauma theatre. 405 00:20:55,760 --> 00:20:57,113 I want her ready to cut in 10 minutes. 406 00:20:57,200 --> 00:20:59,555 - I'll fast bleep the general surgeons. - GLEN: And chase the blood bank. 407 00:20:59,640 --> 00:21:00,629 Excuse me? 408 00:21:00,840 --> 00:21:03,479 This patient needs to go to theatre to stop the internal bleeding. 409 00:21:03,560 --> 00:21:05,437 I'd be more comfortable if it went through Clive. 410 00:21:05,640 --> 00:21:08,108 - Clive? - Clive Archerfield. He's in the ED. 411 00:21:09,480 --> 00:21:10,708 Right. 412 00:21:12,040 --> 00:21:13,393 Fiona Lomas, trauma fellow. 413 00:21:13,480 --> 00:21:15,630 Would you kindly fast bleep the trauma theatre staff 414 00:21:15,720 --> 00:21:18,188 and the general surgeon on-call, straight away please? 415 00:21:18,640 --> 00:21:20,232 And put me through to blood bank again. 416 00:21:21,440 --> 00:21:23,237 MAN: (OVER PA) Would the on-call general surgeons 417 00:21:23,320 --> 00:21:24,878 please report to trauma theatre. 418 00:21:25,200 --> 00:21:28,192 That's on-call general surgeons to trauma theatre, please. 419 00:21:28,960 --> 00:21:30,109 CLIVE: Yeah, as well as the Nof, 420 00:21:30,200 --> 00:21:32,316 I want your X-ray with Jessica, her blood's done. 421 00:21:32,400 --> 00:21:34,595 So there's no delay, when the orthopods take her up to the ward. 422 00:21:34,680 --> 00:21:35,908 She's been here two hours already so... 423 00:21:36,160 --> 00:21:37,957 Sorry, I'm in a hurry. Glen Boyle. 424 00:21:38,120 --> 00:21:40,918 - Trauma locum. - Ah, Clive Archerfield. 425 00:21:41,000 --> 00:21:42,877 My patient needs an urgent laparotomy 426 00:21:42,960 --> 00:21:44,632 and, apparently, I need to ask for your approval. 427 00:21:45,000 --> 00:21:47,116 - That hasn't come from me. - Good. Thanks. 428 00:21:47,200 --> 00:21:50,397 But also, I'd like to discuss the major transfusion protocol. 429 00:21:50,480 --> 00:21:52,311 Yep, sure. I'll fix a time. 430 00:21:52,400 --> 00:21:56,234 No, it's not working today so it needs fixing today. 431 00:21:56,320 --> 00:22:00,029 Look, uh, you run the trauma call, I run the entire department, 432 00:22:00,280 --> 00:22:02,271 so, leave it with me. 433 00:22:03,760 --> 00:22:04,988 Thanks. 434 00:22:06,240 --> 00:22:09,437 REGISTRAR: We're receiving a pleomorphic xanthoastrocytoma from the Children's. 435 00:22:10,040 --> 00:22:12,634 It's an acute neurosurgical referral. 436 00:22:12,720 --> 00:22:16,315 Someone just needs to tell me if the patient is in transit or not. 437 00:22:16,400 --> 00:22:19,073 - You're the neurosurgical reg? - Guilty. 438 00:22:19,160 --> 00:22:20,991 Any chance you could take a look at a CT for me? 439 00:22:21,200 --> 00:22:22,758 (CHUCKLES) No. 440 00:22:22,840 --> 00:22:25,559 I'm the consultant on-call for major trauma. 441 00:22:25,640 --> 00:22:27,870 You could be George Clooney. You'd still have to email it. 442 00:22:27,960 --> 00:22:28,949 - DR HARRY: Uh... - Hey! 443 00:22:29,040 --> 00:22:30,678 He's new. Hi! 444 00:22:30,960 --> 00:22:32,029 Hi. 445 00:22:33,480 --> 00:22:35,675 We're the tertiary referral centre for neuro. 446 00:22:36,240 --> 00:22:37,958 The other hospitals complain of favouritism 447 00:22:38,040 --> 00:22:40,429 if we provide a faster service for intramural referrals. 448 00:22:40,880 --> 00:22:42,757 - Uh... - The thing is, hombre, 449 00:22:43,400 --> 00:22:44,799 we're not that into head injuries. 450 00:22:46,480 --> 00:22:47,754 (CHUCKLES) 451 00:22:48,600 --> 00:22:49,828 Oh, you're taking the piss. 452 00:22:49,920 --> 00:22:52,036 I couldn't help but overhear, 453 00:22:52,120 --> 00:22:53,235 let me get you on a system 454 00:22:53,320 --> 00:22:56,039 and, uh, let's find this patient of yours. 455 00:22:56,120 --> 00:22:57,599 Oh, thanks. 456 00:22:58,200 --> 00:23:00,191 Okay, let's get moving. We're taking her to theatre. 457 00:23:00,280 --> 00:23:01,395 Yeah. 458 00:23:02,600 --> 00:23:03,953 MRS HICKLIN: I am not happy with this at all. 459 00:23:04,040 --> 00:23:05,632 - With what? - Him! 460 00:23:06,040 --> 00:23:07,393 Well, he's the trauma consultant. 461 00:23:07,480 --> 00:23:08,549 Locum consultant. 462 00:23:08,640 --> 00:23:10,312 Breezes in and we don't know the first thing about him. 463 00:23:11,680 --> 00:23:14,069 This patient needs opening up right away 464 00:23:14,160 --> 00:23:16,594 or she's going to bleed to death. 465 00:23:17,880 --> 00:23:19,154 BUSBY: Let's get the blood delivered to theatre. 466 00:23:19,240 --> 00:23:20,275 Yep. 467 00:23:22,200 --> 00:23:24,475 BUSBY: Okay, one, two, three. 468 00:23:24,840 --> 00:23:27,229 FIONA: Come on, let's get moving. 469 00:23:33,640 --> 00:23:35,870 (ALL TALKING INDISTINCTLY) 470 00:23:59,000 --> 00:24:00,479 FIONA: Hello, Switch, this is Theatre. 471 00:24:00,560 --> 00:24:02,790 We have fast bleeped the general surgeons. 472 00:24:02,880 --> 00:24:05,110 Can you chase them, please? 473 00:24:26,680 --> 00:24:30,229 MAN: (ON PA) On-call general surgeons please report to trauma theatre. 474 00:24:30,320 --> 00:24:34,154 That's on-call general surgeons to trauma theatre, please. 475 00:24:37,080 --> 00:24:38,513 Re next of kin, 476 00:24:38,600 --> 00:24:40,431 there's a grown-up daughter, name of Rachel, 477 00:24:40,520 --> 00:24:41,919 coming up from London. 478 00:24:42,000 --> 00:24:43,069 Thanks. 479 00:24:56,480 --> 00:25:00,359 JUSTIN: I've not had a good day. MAN: Good shot. Straight through. 480 00:25:01,520 --> 00:25:04,318 How far away is general surgery, please? 481 00:25:04,400 --> 00:25:05,389 It's a big hospital. 482 00:25:06,280 --> 00:25:09,431 Can you fast bleep the general surgeons again, please? 483 00:25:09,520 --> 00:25:10,919 Thank you. 484 00:25:16,680 --> 00:25:18,591 (INDISTINCT MURMURING) 485 00:25:23,960 --> 00:25:25,279 BP's still dropping. 486 00:25:36,560 --> 00:25:38,073 No. Can't wait. 487 00:25:38,760 --> 00:25:41,957 Scrub in, please. We need to stop the haemorrhage. 488 00:25:43,320 --> 00:25:45,356 DALISAY: Would you like me to prep? 489 00:25:45,440 --> 00:25:46,714 GLEN: Please do. 490 00:26:04,720 --> 00:26:06,676 Is it always like this? 491 00:26:07,000 --> 00:26:08,433 Lorraine told Clive, over and over 492 00:26:08,600 --> 00:26:11,194 that other specialities should automatically come to the trauma calls. 493 00:26:11,680 --> 00:26:15,195 And you think I can change things when this Lorraine couldn't? 494 00:26:15,280 --> 00:26:16,508 You... 495 00:26:17,560 --> 00:26:19,835 You're a bull in a china shop. 496 00:26:27,160 --> 00:26:30,994 Um, the neurosurgical registrar just reviewed the CT scans for us. 497 00:26:31,280 --> 00:26:33,635 - You're kidding. - I have my moments. 498 00:26:33,720 --> 00:26:35,153 - GLEN: Let's hear it. - Uh... 499 00:26:35,240 --> 00:26:37,310 Insignificant subdural haematoma. 500 00:26:37,400 --> 00:26:39,550 No gross brain injury visible on the CT. 501 00:26:39,640 --> 00:26:41,392 No other morphological changes visible. 502 00:26:41,640 --> 00:26:44,234 No neurosurgical intervention is indicated at this time. 503 00:26:44,320 --> 00:26:46,550 Good. Thanks. Well done. 504 00:26:46,640 --> 00:26:47,709 Do my ties, please. 505 00:26:50,440 --> 00:26:52,476 Gen surg are operating on another... 506 00:26:54,000 --> 00:26:56,355 You shouldn't be here. Return to seeing patients in the ED. 507 00:26:56,440 --> 00:26:57,634 Yes, sorry, Mrs Hicklin. 508 00:26:57,960 --> 00:26:59,279 It's okay. 509 00:27:00,360 --> 00:27:02,476 May I ask, what on earth are you doing? 510 00:27:03,280 --> 00:27:05,350 If we do not stop the internal haemorrhage, 511 00:27:05,680 --> 00:27:08,069 organ damage will be irreversible and fatal. 512 00:27:08,800 --> 00:27:10,950 There's a reason why this is called the Golden Hour. 513 00:27:11,040 --> 00:27:12,393 So, I'm going to get started 514 00:27:12,480 --> 00:27:15,233 and the general surgeons can muck in when they get here. 515 00:27:15,400 --> 00:27:17,834 - I'm not happy. - And why are you not happy? 516 00:27:17,920 --> 00:27:19,148 What exactly do you mean 517 00:27:19,240 --> 00:27:20,912 when you've described yourself as a "trauma surgeon"? 518 00:27:21,440 --> 00:27:24,591 What I mean is I've practised all over the world, 519 00:27:24,680 --> 00:27:27,148 in the Forces and civilian hospitals. 520 00:27:27,240 --> 00:27:30,118 I specialise in critical injuries. 521 00:27:30,880 --> 00:27:33,792 Unfortunately, too many trauma services in this country 522 00:27:33,880 --> 00:27:37,634 are formed from a jumble of general surgeons and orthopods. 523 00:27:37,760 --> 00:27:39,637 MRS HICKLIN: We provide a major trauma service 524 00:27:39,720 --> 00:27:41,039 of dedicated professionals 525 00:27:41,120 --> 00:27:43,588 in which the general surgeons perform the laparotomies. 526 00:27:43,680 --> 00:27:45,511 I'm comfortable in the abdomen. 527 00:27:46,080 --> 00:27:47,308 We've only got your word for that. 528 00:27:47,680 --> 00:27:49,671 Then you should write in the patient's notes 529 00:27:49,760 --> 00:27:52,991 that you are blocking a lifesaving procedure. 530 00:27:57,040 --> 00:27:58,712 MRS HICKLIN: You're very quiet. 531 00:28:00,880 --> 00:28:02,279 I hope the procedure goes well. 532 00:28:03,280 --> 00:28:05,919 Call me if there is anything you need. 533 00:28:12,200 --> 00:28:13,519 Thank you. 534 00:28:16,080 --> 00:28:18,514 Bull one, china shop nil. 535 00:28:25,120 --> 00:28:26,269 Where to? 536 00:28:26,360 --> 00:28:28,430 I'm Glen Boyle. I'm the trauma consultant. 537 00:28:28,520 --> 00:28:31,432 - Sister Dalisay Guinto, Scrub Nurse. - Dominic Busby, gas reg. 538 00:28:31,520 --> 00:28:33,590 Billy Finlay, anaesthetic ODP. 539 00:28:33,880 --> 00:28:35,472 Armin Khular, ODP. 540 00:28:35,640 --> 00:28:37,119 Alex Badger, staff nurse. 541 00:28:37,200 --> 00:28:39,077 Clara Lloyd, staff nurse. 542 00:28:39,160 --> 00:28:40,878 Polly Mason, documentation nurse. 543 00:28:41,120 --> 00:28:43,270 Fiona Lomas, trauma fellow. 544 00:28:43,560 --> 00:28:45,152 Charlotte Grace, circulating. 545 00:28:45,480 --> 00:28:47,755 And can we confirm who the patient is, please? 546 00:28:47,840 --> 00:28:50,195 Major trauma Foxtrot Bravo. 547 00:28:50,320 --> 00:28:52,470 Date of Birth 1-1-1900. 548 00:28:53,680 --> 00:28:55,033 GLEN: Thank you. 549 00:29:00,800 --> 00:29:03,439 Okay, I've signed a consent form four. 550 00:29:03,520 --> 00:29:07,229 I'm performing a laparotomy to arrest a life threatening haemorrhage. 551 00:29:07,320 --> 00:29:09,788 - Everyone good with that? - ALL: Yes. 552 00:29:16,520 --> 00:29:18,795 - GLEN: Are we ready? - Ready, Mr Boyle. 553 00:29:19,360 --> 00:29:20,509 Blade. 554 00:29:22,800 --> 00:29:23,789 Is she okay to cut? 555 00:29:24,400 --> 00:29:25,515 Okay. 556 00:29:31,200 --> 00:29:32,474 Cutting. 557 00:30:07,480 --> 00:30:09,311 - (MONITOR BEEPING) - Shit. Suction. 558 00:30:09,400 --> 00:30:11,834 - Vacuum. - Pressure's dropping like a stone. 559 00:30:12,040 --> 00:30:14,110 Packs. I can't see a thing. 560 00:30:14,200 --> 00:30:16,714 FIONA: I'm trying. BOYLE: Then try harder! 561 00:30:23,280 --> 00:30:24,349 Here. 562 00:30:24,440 --> 00:30:26,635 FIONA: Five packs in the abdomen. Five in. 563 00:30:27,880 --> 00:30:29,154 Ring. 564 00:30:29,760 --> 00:30:31,557 (SUCTION GURGLING) 565 00:30:42,800 --> 00:30:43,915 You know what I'm going to say... 566 00:30:45,040 --> 00:30:46,871 - So don't say it. - I've got to say it. 567 00:30:49,880 --> 00:30:51,472 BP's dropping, sats are dropping. 568 00:30:51,800 --> 00:30:53,552 (RAPID BEEPING) 569 00:30:55,520 --> 00:30:58,512 Okay. Okay. I need an aortic clamp. 570 00:30:58,960 --> 00:31:00,393 I, don't, uh... 571 00:31:00,560 --> 00:31:03,313 - I need an aortic clamp. - Right, uh, yes... 572 00:31:03,400 --> 00:31:04,594 I need an aortic clamp. 573 00:31:04,680 --> 00:31:06,511 - We don't have... - I need an aortic clamp. 574 00:31:10,040 --> 00:31:11,871 Upstairs theatres! Go! 575 00:31:13,800 --> 00:31:15,074 - (GRUNTS) - Careful! 576 00:31:15,160 --> 00:31:17,993 - BP's 65 over 38. - More packs, please. Now. 577 00:31:25,160 --> 00:31:29,278 Hands. Get your hands in there, press down on the bleed. 578 00:31:32,880 --> 00:31:34,598 (BEEPING CONTINUES) 579 00:31:39,680 --> 00:31:40,795 Okay. 580 00:31:41,920 --> 00:31:43,273 - BP... - We can see. 581 00:31:43,520 --> 00:31:44,839 Five more in the abdomen. 582 00:31:44,960 --> 00:31:45,949 Ten in. 583 00:31:46,440 --> 00:31:47,668 (CONTINUES BEEPING) 584 00:31:50,840 --> 00:31:52,478 (PHONE RINGING) 585 00:31:53,840 --> 00:31:54,829 Turn it off! 586 00:32:02,440 --> 00:32:04,715 - Shit, sorry. - It's okay. 587 00:32:07,480 --> 00:32:08,959 (RAPID BEEPING) 588 00:32:10,080 --> 00:32:13,117 BUSBY: Pressure's falling. Packs not working. 589 00:32:18,400 --> 00:32:20,311 We unpack quadrant by quadrant 590 00:32:20,480 --> 00:32:22,118 and we deal with the bleeds as we get to them. 591 00:32:22,960 --> 00:32:24,439 Starting with the left upper quadrant. 592 00:32:24,560 --> 00:32:25,629 Okay? 593 00:32:37,400 --> 00:32:38,389 Spleen's haemorrhaging. 594 00:32:38,560 --> 00:32:41,199 There's an expanding retroperitoneal haematoma. 595 00:32:41,360 --> 00:32:42,475 Shit! Repack. 596 00:32:42,560 --> 00:32:43,879 Pressure's dropping again. 597 00:32:46,400 --> 00:32:47,833 The spleen is controllable. 598 00:32:48,400 --> 00:32:49,913 It's the renal bleed that's killing her. 599 00:32:51,680 --> 00:32:53,511 I really need that clamp. 600 00:32:54,160 --> 00:32:56,674 BUSBY: She's going down. BOYLE: Here, pressure. 601 00:32:57,320 --> 00:32:59,550 - BUSBY: We're losing her! - (SIGHING) 602 00:33:02,200 --> 00:33:04,270 GLEN: Okay, she needs more blood. Let's fill her up. 603 00:33:04,640 --> 00:33:06,119 Code was called 30 minutes ago. 604 00:33:06,200 --> 00:33:08,555 This is trauma theatre, for patient Foxtrot Bravo. 605 00:33:08,640 --> 00:33:10,676 We are still waiting on... 606 00:33:11,000 --> 00:33:13,878 Twelve units, eight of FFP, four of platelets. 607 00:33:14,160 --> 00:33:16,913 12 units of cross-match, eight units of fresh frozen plasma 608 00:33:17,000 --> 00:33:18,718 and four units of platelets. 609 00:33:18,800 --> 00:33:19,835 Thank you. 610 00:33:20,320 --> 00:33:21,514 I've got the aortic clamp. 611 00:33:21,600 --> 00:33:24,910 To me! Quickly! To me. Quickly! 612 00:33:26,840 --> 00:33:28,592 Okay, so we can clamp off the aorta 613 00:33:28,680 --> 00:33:30,159 and stop all the bleeding in the lower body. 614 00:33:30,680 --> 00:33:32,591 That means unpacking her to get the clamp on. 615 00:33:33,440 --> 00:33:34,873 Yes, it does. 616 00:33:36,600 --> 00:33:38,192 - (PHONE RINGING) - Oh, for Christ's sake! 617 00:33:38,280 --> 00:33:40,475 - Whose phone is that? - BILLY: Uh, must be the patient's. 618 00:33:45,040 --> 00:33:46,109 Uh... 619 00:33:47,080 --> 00:33:48,513 There's a text trail here. 620 00:33:49,040 --> 00:33:50,951 - Later. - You ought to know what it says. 621 00:33:52,400 --> 00:33:54,470 The last text she sent was to someone called Rachel. 622 00:33:54,720 --> 00:33:56,631 - That's her daughter. - Can we do this later? 623 00:33:56,720 --> 00:33:58,119 No, we do it now, quickly. 624 00:33:58,240 --> 00:34:01,038 "I'm sorry. I miss him so much. 625 00:34:01,600 --> 00:34:03,955 "I love you with all my heart, but he was my baby. 626 00:34:04,400 --> 00:34:07,597 "I thought one day I'd get over it, but I never will. 627 00:34:07,680 --> 00:34:11,275 "I'm sorry. I love you. Mum." 628 00:34:15,840 --> 00:34:17,193 She jumped. 629 00:34:21,480 --> 00:34:22,799 GLEN: When I say "go", we rip out the packs 630 00:34:22,880 --> 00:34:25,553 and we open up the retroperitoneal space. 631 00:34:25,640 --> 00:34:28,029 - You got it? - Yes. 632 00:34:31,120 --> 00:34:32,678 GLEN: Pressure. 633 00:34:37,640 --> 00:34:39,676 GLEN: Shit. Go. BUSBY: Pressure dropping. 634 00:34:39,840 --> 00:34:41,478 (RAPID BEEPING) 635 00:34:42,840 --> 00:34:45,229 BOYLE: Suction! FIONA: Five packs out, two in. 636 00:34:46,720 --> 00:34:48,278 (SUCTION GURGLING) 637 00:34:51,360 --> 00:34:54,079 GLEN: I need more suction if I'm going to see what I'm doing here. 638 00:34:54,160 --> 00:34:55,149 BUSBY: Still falling. 639 00:34:57,200 --> 00:34:58,599 Okay. 640 00:35:02,040 --> 00:35:04,918 Doing a medial rotation to access the aorta. 641 00:35:05,040 --> 00:35:06,951 (SUCTION GURGLING) 642 00:35:13,760 --> 00:35:15,512 GLEN: Shit! Where is it? 643 00:35:15,640 --> 00:35:17,119 Let's get the blood out of there, please. 644 00:35:17,200 --> 00:35:18,679 Clear the blood. 645 00:35:22,240 --> 00:35:24,310 I can't locate the aorta! 646 00:35:24,400 --> 00:35:25,913 No, I can't do this blind. 647 00:35:26,080 --> 00:35:29,231 I need you to clear the field with suction. 648 00:35:33,760 --> 00:35:36,115 - Okay, clamp. - FIONA: Have you got it? 649 00:35:36,760 --> 00:35:38,239 GLEN: Yes, I've got it. 650 00:35:39,120 --> 00:35:40,553 Okay, clamp. 651 00:35:55,480 --> 00:35:57,198 - Clamp on. - Is it on? 652 00:35:57,320 --> 00:35:59,356 Yeah. Numbers? Quickly. 653 00:36:00,040 --> 00:36:01,871 BUSBY: Still falling, 50 over 20. 654 00:36:12,400 --> 00:36:13,719 Hold on, wait a minute. 655 00:36:18,000 --> 00:36:19,433 BP climbing. 656 00:36:21,640 --> 00:36:22,959 Good work. 657 00:36:23,400 --> 00:36:24,992 BP 70 over 45. 658 00:36:25,160 --> 00:36:28,152 Okay, let's mop up, suction and swabs, please. 659 00:36:30,760 --> 00:36:32,716 Okay, we've got haemostasis. 660 00:36:32,840 --> 00:36:35,354 Okay, BP now 100 over 70. 661 00:36:36,160 --> 00:36:37,354 Good. 662 00:36:37,960 --> 00:36:40,599 (SIGHS) I'm going to ligate the left renal artery. 663 00:36:41,200 --> 00:36:42,758 Dardik. 664 00:36:44,160 --> 00:36:45,957 - Thank you. - (CHUCKLES) 665 00:36:48,160 --> 00:36:51,152 GLEN: Renal artery clamped above the rupture. 666 00:36:52,440 --> 00:36:54,032 Hold that clamp. 667 00:36:55,240 --> 00:36:57,276 FIONA: Got it. GLEN: 2-0 tie, please. 668 00:36:58,680 --> 00:36:59,749 Thank you. 669 00:37:05,440 --> 00:37:07,271 ROBERT: Sorry, we had someone on the table. 670 00:37:07,360 --> 00:37:08,395 GLEN: Are you the general surgeon? 671 00:37:10,240 --> 00:37:11,673 - Robert Street. - Glen Boyle. 672 00:37:11,840 --> 00:37:16,072 The abdominal aorta is cross-clamped. 673 00:37:16,160 --> 00:37:19,311 The left renal artery has been ligated. 674 00:37:19,480 --> 00:37:23,792 The patient is currently awaiting a splenectomy and a nephrectomy. 675 00:37:24,360 --> 00:37:25,713 Hemodynamically stable. 676 00:37:25,800 --> 00:37:28,519 - The patient's settled. - Okey dokey. 677 00:37:28,600 --> 00:37:31,068 - Thanks, I'll take it from here. - Are we done? 678 00:37:31,360 --> 00:37:32,679 You're done. Good work. 679 00:37:34,680 --> 00:37:35,795 Thank you very much, everybody. 680 00:37:37,240 --> 00:37:38,559 BUSBY: Thanks, guys. 681 00:37:42,520 --> 00:37:45,557 BILLY: That's Haematology. ROBERT: Good, we can fill her up. 682 00:37:45,640 --> 00:37:47,232 Thanks, mate. 683 00:37:47,320 --> 00:37:49,038 ROBERT: Let's get those transfusions running. 684 00:37:49,120 --> 00:37:51,350 Let's run him. Three, two, one. 685 00:38:49,760 --> 00:38:51,034 (BEEPS) 686 00:39:06,120 --> 00:39:08,315 Do you want to grab a coffee? 687 00:39:09,360 --> 00:39:13,239 Thanks for what you did, but best not. 688 00:39:15,600 --> 00:39:18,433 - No one knows you called me, do they? - No. 689 00:39:20,040 --> 00:39:23,635 Clive and Nicola, they're, um, defensive. 690 00:39:25,320 --> 00:39:27,231 Well, it's a state-of-the-art unit and no-one thought 691 00:39:27,320 --> 00:39:29,151 to stock the theatre with an aortic clamp. 692 00:39:30,520 --> 00:39:33,114 Every speciality under the sun and not one of them are available 693 00:39:33,200 --> 00:39:34,394 to attend the trauma call. 694 00:39:34,480 --> 00:39:36,789 I'd say they've got a lot to be defensive about. 695 00:39:36,880 --> 00:39:38,632 Now you might understand why I called you. 696 00:39:38,720 --> 00:39:41,029 Yeah, now you don't think that was such a good idea. 697 00:39:41,120 --> 00:39:42,951 - I didn't say that. - No? 698 00:39:43,480 --> 00:39:44,833 (BEEPS) 699 00:39:53,040 --> 00:39:55,031 Let's set aside the you-and-me part. 700 00:39:56,400 --> 00:39:57,469 As a registrar, 701 00:39:58,680 --> 00:40:02,434 receiving critically injured patients on a day-to-day basis, 702 00:40:02,760 --> 00:40:04,432 I'm glad you came. 703 00:40:18,400 --> 00:40:19,549 (BEEPS) 704 00:40:25,920 --> 00:40:28,559 The set-up here, the NHS politics, it's... 705 00:40:28,640 --> 00:40:30,358 It's difficult. Give me Helmand any time. 706 00:40:30,440 --> 00:40:32,556 So, why did you come, then? 707 00:40:32,640 --> 00:40:33,675 I thought you needed me. 708 00:40:33,760 --> 00:40:36,115 - This unit needs you. - Right. 709 00:40:36,200 --> 00:40:38,998 - I should think this through. - You own me. 710 00:40:39,880 --> 00:40:41,677 You mean, I "owe" you. 711 00:40:42,600 --> 00:40:43,919 That's what I said. 712 00:40:48,480 --> 00:40:50,516 - Good work. Well done. - Thank you. 713 00:40:50,600 --> 00:40:52,955 - Thanks. - Yeah, she's in trauma theatre. 714 00:40:53,040 --> 00:40:55,793 That's MaxFax and ENT. Here to take care of the fence post. 715 00:40:56,920 --> 00:40:59,878 I'd better get in there and make sure they don't step on each other's toes. 716 00:41:01,000 --> 00:41:02,638 - ARCHERFIELD: Very good work. - Cheers. 717 00:41:03,320 --> 00:41:06,915 Have you got a moment to speak to the patient's daughter? 718 00:41:07,000 --> 00:41:08,991 - You're Rachel? - Yes. 719 00:41:09,280 --> 00:41:11,999 Mr Boyle and Ms Lomas are the trauma surgeons. 720 00:41:12,200 --> 00:41:13,679 Hello, Rachel. 721 00:41:13,760 --> 00:41:15,796 So we've done our part successfully. 722 00:41:15,880 --> 00:41:18,997 Your mum was in a bad way, but now she's stable. 723 00:41:19,080 --> 00:41:21,753 All being well, she should make a full recovery. 724 00:41:22,400 --> 00:41:24,675 We'll show you to our relatives' room. 725 00:41:24,920 --> 00:41:26,717 - Thank you. - If you wouldn't mind, Natasha... 726 00:41:27,760 --> 00:41:30,354 Sorry, Fiona, can you complete the trauma record? 727 00:41:30,840 --> 00:41:32,193 No problem. 728 00:41:33,720 --> 00:41:34,994 Thank you. 729 00:41:35,480 --> 00:41:37,232 - Good outcome. - Yeah. 730 00:41:37,960 --> 00:41:40,155 There's a motorcyclist on his way into us, 731 00:41:40,960 --> 00:41:43,030 severe lower limb injuries, 732 00:41:43,400 --> 00:41:44,913 ETA 15. 733 00:42:13,760 --> 00:42:15,716 Mmm-hmm. Yeah... 734 00:42:39,640 --> 00:42:42,632 WOMAN: (OVER PA) Trauma call, ETA 14 minutes. 735 00:42:42,720 --> 00:42:45,598 Trauma call, ETA 14 minutes. 736 00:42:46,680 --> 00:42:47,795 Well? 737 00:42:51,120 --> 00:42:52,553 Bring it on. 738 00:42:55,400 --> 00:43:03,400 Ripped By mstoll 739 00:43:10,560 --> 00:43:12,596 (THEME SONG PLAYING) 740 00:43:12,646 --> 00:43:17,196 Repair and Synchronization by Easy Subtitles Synchronizer 1.0.0.0