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1
00:00:01,000 --> 00:00:05,120
WWW.MY-SUBS.CO
2
00:00:03,320 --> 00:00:05,200
HEARTBEAT PUMPS
3
00:00:05,320 --> 00:00:06,320
I'm not leaving.
4
00:00:06,400 --> 00:00:07,520
But you will,
5
00:00:07,600 --> 00:00:09,200
because that's what you do.
6
00:00:09,400 --> 00:00:12,120
WOMAN ON PHONE: 'It's official,
you can return to active service.'
7
00:00:13,920 --> 00:00:15,720
Don't. Glen Boyle's in there.
8
00:00:18,920 --> 00:00:20,600
We couldn't have gone back to yours.
9
00:00:20,720 --> 00:00:22,320
It wasn't that I didn't want to.
10
00:00:22,400 --> 00:00:23,320
Didn't?
11
00:00:25,720 --> 00:00:26,920
This can't be easy for you.
12
00:00:30,720 --> 00:00:32,320
If anyone even sees us...
13
00:00:32,400 --> 00:00:35,120
FAST-PACED MUSIC PLAYS
14
00:00:45,720 --> 00:00:48,320
ALARM BELL RINGS
15
00:00:55,920 --> 00:00:58,800
'Trauma call to Thames
lower ambulance bay.
16
00:00:58,920 --> 00:01:01,200
'Trauma call to Thames
lower ambulance bay.'
17
00:01:24,800 --> 00:01:26,520
Are you stuck? Yeah, I'm stuck.
18
00:01:26,600 --> 00:01:28,800
SHE LAUGHS
Help me.
19
00:01:28,920 --> 00:01:30,120
OK.
20
00:01:31,200 --> 00:01:32,200
Yeah. Yeah.
21
00:01:56,800 --> 00:01:59,520
OVER SPEAKER: The lower ambulance bay
is a restricted area.
22
00:01:59,720 --> 00:02:02,400
Essential personnel only.
23
00:02:02,520 --> 00:02:05,320
The lower ambulance bay
is a restricted area.
24
00:02:05,400 --> 00:02:07,520
Essential personnel only.
25
00:02:17,920 --> 00:02:19,520
Not exactly in a hurry,
are they?
26
00:02:19,600 --> 00:02:21,320
Must be a slow bleed. Huh.
27
00:02:31,920 --> 00:02:33,320
You OK? Yeah.
28
00:02:36,320 --> 00:02:38,600
Can we get these sides down,
please? Yeah.
29
00:02:40,200 --> 00:02:43,120
POLICEMAN SHOUTS INSTRUCTIONS
30
00:02:47,320 --> 00:02:49,120
You're the one who found him? Yeah.
31
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He's my son.
32
00:02:53,720 --> 00:02:55,400
I'm Glen Boyle. Frank Howker.
33
00:02:55,520 --> 00:02:56,920
I'm the trauma consultant.
34
00:02:57,000 --> 00:02:58,320
Frank...
35
00:02:58,400 --> 00:03:00,000
I need you to stay here, please.
36
00:03:01,520 --> 00:03:02,720
Thank you.
37
00:03:02,800 --> 00:03:03,720
Stepping up.
38
00:03:10,800 --> 00:03:12,200
Fiona.
39
00:03:12,320 --> 00:03:13,200
Yeah.
40
00:03:36,720 --> 00:03:39,600
Oh...
Patient is impaled at three points.
41
00:03:45,920 --> 00:03:47,320
He's got a pulse.
42
00:03:47,400 --> 00:03:49,800
Somebody start the clock, please.
43
00:03:49,920 --> 00:03:52,400
We can't move him
until the fire team get here...
44
00:03:52,520 --> 00:03:54,720
So we're going to have
to stabilise him where he is.
45
00:03:54,800 --> 00:03:56,520
Let's set up the kit on the trolley.
46
00:03:58,000 --> 00:03:59,920
Constance, scissors, please.
47
00:04:01,000 --> 00:04:02,120
Here you go.
48
00:04:04,320 --> 00:04:06,200
All right to come up, boss?
One at a time.
49
00:04:11,200 --> 00:04:14,000
Mark, I need you to make some
room for me here, please. OK.
50
00:04:14,120 --> 00:04:15,120
Yep.
51
00:04:15,200 --> 00:04:17,920
LORRY CLANGS
Whoa.
52
00:04:18,000 --> 00:04:19,720
Be careful, guys.
53
00:04:19,800 --> 00:04:21,120
Excuse me.
54
00:04:21,320 --> 00:04:23,320
Thank you.
SHE LAUGHS
55
00:04:30,520 --> 00:04:32,400
Shit a brick.
56
00:04:32,520 --> 00:04:33,720
Going to need to RSI.
57
00:04:33,800 --> 00:04:35,600
Definitely going to need some
volume as well.
58
00:04:35,800 --> 00:04:37,920
An RSI kit, please.
O positive on the blood, please.
59
00:04:38,000 --> 00:04:41,000
Constance, a Venflon, please.
On its way.
60
00:04:41,200 --> 00:04:42,200
Thank you.
61
00:04:47,800 --> 00:04:49,920
No chest movement on the right side.
62
00:04:50,120 --> 00:04:54,720
I'm doing a needle decompression to
relieve the tension pneumothorax.
63
00:04:56,800 --> 00:04:58,920
FRANK BREATHES HEAVILY
Oh, God.
64
00:05:00,120 --> 00:05:03,320
Frank. Is there any way you
can stabilise this lorry?
65
00:05:03,400 --> 00:05:05,720
I can bring the legs down.
That would help, please.
66
00:05:05,800 --> 00:05:07,320
OK. Thank you.
67
00:05:09,000 --> 00:05:12,800
So heart rate's 125, BP is 78/56.
68
00:05:12,920 --> 00:05:14,520
Sats are 80%.
69
00:05:14,720 --> 00:05:16,720
ENGINE STARTS
70
00:05:16,800 --> 00:05:19,120
Going to need to tube him
and he definitely needs volume.
71
00:05:19,200 --> 00:05:21,120
Harry, IV access on the left
for RSI drugs.
72
00:05:21,320 --> 00:05:24,320
I'm Dr Chandramohan,
can you hear me? Blood out.
73
00:05:24,400 --> 00:05:28,120
O pos through the Venflon
and a trauma line in, please.
74
00:05:28,320 --> 00:05:31,120
No eye opening, E1.
75
00:05:31,200 --> 00:05:33,400
No verbal response, E1.
76
00:05:33,520 --> 00:05:36,720
Abnormal flexion in response
to pain, so that's M3.
77
00:05:36,800 --> 00:05:38,720
GCS is five.
78
00:05:38,800 --> 00:05:40,800
SUCCS 100mg
79
00:05:41,000 --> 00:05:44,520
and let's play it safe and give him
250mg of thiopentone as well.
80
00:05:47,320 --> 00:05:48,720
Sharps bin, please.
81
00:05:54,000 --> 00:05:56,320
OK...
MACHINE WHIRS
82
00:05:58,320 --> 00:06:01,400
Can you fill these up and run them?
83
00:06:03,600 --> 00:06:04,720
Whoa, whoa!
84
00:06:04,800 --> 00:06:05,800
Frank.
85
00:06:05,920 --> 00:06:08,200
It's really important that this
lorry doesn't move.
86
00:06:08,320 --> 00:06:10,600
I know. It's OK.
87
00:06:10,720 --> 00:06:13,320
SIREN RINGS
88
00:06:27,800 --> 00:06:30,000
OK, let's get that vehicle
stabilised.
89
00:06:32,000 --> 00:06:33,600
Nice and gently, please, guys.
90
00:06:35,320 --> 00:06:37,320
OK, I'm going to do
a formal thoracostomy.
91
00:06:37,520 --> 00:06:39,200
Can I have the kit, please,
Constance? Yes.
92
00:06:39,320 --> 00:06:41,120
I'm doing a trauma line.
93
00:06:41,320 --> 00:06:42,600
On VET.
94
00:06:42,720 --> 00:06:44,120
Curtis Taylor, station manager.
95
00:06:44,320 --> 00:06:46,800
Glenn Boyle, trauma team leader.
Aw, shit.
96
00:06:47,000 --> 00:06:49,200
We need to get him off this lorry...
Are you OK? Yeah.
97
00:06:49,320 --> 00:06:52,120
..and our priority is that these
spikes don't move inside him.
98
00:06:52,320 --> 00:06:53,920
BPGs!
99
00:06:54,120 --> 00:06:56,920
Lactate 12, pH 7.19.
100
00:06:57,120 --> 00:06:59,520
Dismantling it would be best,
but those bolts are rusted in.
101
00:06:59,600 --> 00:07:00,520
That's 15 minutes.
102
00:07:00,720 --> 00:07:02,520
We can cut,
but there could be some movement.
103
00:07:02,720 --> 00:07:03,720
He doesn't have 15 minutes.
104
00:07:03,920 --> 00:07:05,920
You're going to have to cut.
Get the cutting gear!
105
00:07:06,000 --> 00:07:08,520
I want one of O pos, one of FFP
106
00:07:08,720 --> 00:07:11,000
to go straight in as soon as
Harry's ready. I'll go.
107
00:07:18,120 --> 00:07:19,120
Where are we?
108
00:07:19,320 --> 00:07:23,120
OK, sats at 84%,
heart rate is 102...
109
00:07:23,200 --> 00:07:25,520
BP is 89/65.
110
00:07:26,800 --> 00:07:29,320
Need to hurry, please.
Thoracostomy's completed.
111
00:07:31,520 --> 00:07:33,320
FFP and blood in. Good.
112
00:07:37,720 --> 00:07:38,920
Frank...
113
00:07:39,000 --> 00:07:40,720
You should go inside.
114
00:07:40,800 --> 00:07:42,320
Nicola? Yeah.
115
00:07:42,400 --> 00:07:45,120
I want to stay. We're going to do
our very best for him. And they are.
116
00:07:45,200 --> 00:07:47,400
Lydia, can you get him into
the relatives room, please?
117
00:07:47,520 --> 00:07:49,320
Make him comfortable.
118
00:07:49,400 --> 00:07:50,600
Let's make some space.
119
00:07:52,320 --> 00:07:53,720
Over to you.
120
00:07:53,800 --> 00:07:55,120
OK, we need to get on with this.
121
00:07:56,400 --> 00:07:58,320
Can somebody help me here, please?
122
00:08:00,400 --> 00:08:03,400
OK. Spikes that have penetrated.
123
00:08:03,520 --> 00:08:06,600
One, two, three. Yes?
124
00:08:08,200 --> 00:08:09,320
Yep.
125
00:08:14,600 --> 00:08:16,120
Steady.
126
00:08:22,800 --> 00:08:25,520
Ready. Watch your eyes. Cutting.
Cutting.
127
00:08:25,600 --> 00:08:27,600
MACHINE STARTS
128
00:08:32,520 --> 00:08:34,520
METAL CLANGS
129
00:08:36,120 --> 00:08:38,600
Fiona, can you get a hand on
that spike, please? Yeah.
130
00:08:39,920 --> 00:08:40,800
He's stable.
131
00:08:43,720 --> 00:08:44,920
Ready.
132
00:08:45,000 --> 00:08:46,200
Cutting!
133
00:08:49,120 --> 00:08:51,520
METAL CLANGS
134
00:08:52,800 --> 00:08:53,920
Yeah, stable.
135
00:08:57,600 --> 00:08:59,000
Cutting.
136
00:09:02,320 --> 00:09:04,920
METAL CLANGS
137
00:09:05,000 --> 00:09:05,920
Pulse check.
138
00:09:12,920 --> 00:09:14,120
OK, stable.
139
00:09:14,200 --> 00:09:15,800
Release the spikes, please.
140
00:09:15,920 --> 00:09:17,720
Just in.
141
00:09:17,800 --> 00:09:19,200
Scoop in now.
142
00:09:19,320 --> 00:09:21,120
That's it? Yes.
143
00:09:22,200 --> 00:09:23,200
Thank you.
144
00:09:25,320 --> 00:09:28,120
So we are bracing to the patient's
right on three.
145
00:09:28,200 --> 00:09:30,200
One, two, three.
146
00:09:30,320 --> 00:09:32,520
Back on three. One, two, three.
147
00:09:32,600 --> 00:09:34,200
That's great.
148
00:09:34,320 --> 00:09:35,320
Coming in.
149
00:09:35,400 --> 00:09:37,200
Bracing to the patient's left
this time.
150
00:09:37,320 --> 00:09:38,520
One, two, three.
151
00:09:42,120 --> 00:09:43,720
OK, we're in. Back on three.
152
00:09:43,800 --> 00:09:45,520
One, two, three.
153
00:09:45,600 --> 00:09:47,200
Great.
154
00:09:47,400 --> 00:09:50,200
Next step is a short lift
just to the foot of the truck.
155
00:09:51,520 --> 00:09:53,720
On three. One, two, three.
156
00:09:55,720 --> 00:09:57,920
Whoa.
MONITOR BEEPS
157
00:09:58,120 --> 00:10:00,920
Put him down. Put him down.
158
00:10:01,000 --> 00:10:02,920
Don't go back any further.
159
00:10:03,120 --> 00:10:06,600
Heart rate's through the roof.
BP's 53/46. He's losing blood.
160
00:10:06,720 --> 00:10:07,600
Get blood in, please.
161
00:10:07,800 --> 00:10:09,520
OK, there's no bleeding from
the chest area.
162
00:10:09,720 --> 00:10:10,600
It must be lower down.
163
00:10:10,720 --> 00:10:13,120
Do a left anterolateral thoracotomy
and clamp the aorta.
164
00:10:13,320 --> 00:10:14,800
Get me the kit, extra gloves!
165
00:10:14,920 --> 00:10:16,120
Quick as we can!
166
00:10:18,120 --> 00:10:19,000
Mr Boyle. Yes.
167
00:10:29,800 --> 00:10:30,800
Give me the blade.
168
00:10:32,120 --> 00:10:33,600
Give me the blade, please! Yes, yes.
169
00:10:35,320 --> 00:10:36,320
Thank you.
170
00:10:37,520 --> 00:10:39,200
Good to cut? Yeah, yeah, yeah.
Cutting.
171
00:10:50,120 --> 00:10:51,120
Scissors.
172
00:10:56,120 --> 00:10:57,920
Thank you. Blood going. Ready.
173
00:10:59,920 --> 00:11:00,920
Give me that.
174
00:11:04,720 --> 00:11:06,000
Let's get the aortic clamp.
175
00:11:09,200 --> 00:11:10,520
Thank you.
176
00:11:13,600 --> 00:11:15,520
Aorta...is clamped.
177
00:11:17,000 --> 00:11:20,000
OK, let's cover him up,
keep him warm. BP's stabilising.
178
00:11:20,120 --> 00:11:22,320
OK, we're on the clock,
we need to go.
179
00:11:22,520 --> 00:11:23,800
Ramakrishna, on your call.
180
00:11:23,920 --> 00:11:25,800
One, two, three, lift.
181
00:11:26,000 --> 00:11:29,400
Bring the trolley in, please.
Stop there, down. Down.
182
00:11:29,520 --> 00:11:30,600
Reposition.
183
00:11:32,920 --> 00:11:33,920
Sort these lines out.
184
00:11:34,120 --> 00:11:35,520
Mind your backs there. Heads.
185
00:11:37,920 --> 00:11:39,520
Got it? Yeah.
186
00:11:39,600 --> 00:11:41,200
On three. One, two, three.
187
00:11:46,320 --> 00:11:47,920
Ania, Justin, Constance.
188
00:11:48,000 --> 00:11:50,600
You manage the spikes, please.
ALL: Yeah.
189
00:11:50,720 --> 00:11:51,720
OK, let's go.
190
00:11:53,320 --> 00:11:55,120
Guys. Thank you very much.
191
00:11:55,320 --> 00:11:57,320
Our pleasure. Yes, thank you.
192
00:12:00,120 --> 00:12:01,800
Good luck with this one. Thank you.
193
00:12:04,600 --> 00:12:05,600
On the spikes...
194
00:12:17,200 --> 00:12:19,320
Hit the button, please.
195
00:12:19,400 --> 00:12:20,720
LIFT ANNOUNCER: Doors closing.
196
00:12:23,120 --> 00:12:25,000
MONITOR BEEPS
We've lost the output.
197
00:12:25,120 --> 00:12:26,200
Check the LV, please.
198
00:12:30,800 --> 00:12:32,200
We've got something here.
Blood in.
199
00:12:32,320 --> 00:12:33,720
Let's try and get some volume.
200
00:12:36,400 --> 00:12:37,720
LIFT ANNOUNCER: Ground floor.
201
00:12:38,920 --> 00:12:39,920
Jesus Christ.
202
00:12:40,120 --> 00:12:42,800
Harry, keep the blood going.
Go away!
203
00:12:42,920 --> 00:12:44,200
Nice and easy, please.
204
00:12:50,400 --> 00:12:52,800
Keep it steady, please.
205
00:12:52,920 --> 00:12:55,000
Harry... Tom? ..stay on the blood.
Hi.
206
00:12:56,200 --> 00:13:02,720
Yeah, I was just wondering about tonight. But
I didn't know we'd anything planned. I'm going
to take you for dinner.
207
00:13:15,720 --> 00:13:17,600
Seems like a bit of a long shot.
208
00:13:23,000 --> 00:13:24,720
I've seen people survive worse.
209
00:13:35,320 --> 00:13:36,720
How's Tom?
210
00:13:36,800 --> 00:13:38,920
What do you mean?
You know what I mean.
211
00:13:39,000 --> 00:13:40,400
Tom isn't your concern.
212
00:13:41,800 --> 00:13:43,400
You need to tell him
what's going on.
213
00:13:43,600 --> 00:13:45,600
And frankly... Glenn, I...
..you need to tell me.
214
00:13:45,800 --> 00:13:48,200
SPEAKING ON PHONE: And I love you
too, Danny. Bye-bye.
215
00:14:04,400 --> 00:14:05,600
Let's do the hoops.
216
00:14:05,800 --> 00:14:08,000
I'm Glen Boyle,
I'm the trauma consultant.
217
00:14:08,200 --> 00:14:09,920
Fiona Lomas, trauma fellow.
218
00:14:10,000 --> 00:14:12,200
Ramakrishna Chandramohan,
anaesthetics registrar.
219
00:14:12,400 --> 00:14:13,920
Bruce Corby, rapid infuser operator.
220
00:14:14,000 --> 00:14:16,120
Billy Finlay, anaesthetic ODP.
221
00:14:16,200 --> 00:14:17,720
Debbie Wong, scrub nurse.
222
00:14:17,800 --> 00:14:20,200
Patient is major trauma,
Edward Howker.
223
00:14:20,320 --> 00:14:22,920
Date of birth is 17/07/77.
224
00:14:23,000 --> 00:14:25,600
Aorta has been clamped for...
eight minutes 30.
225
00:14:25,720 --> 00:14:28,720
Consent form four signed to do
a thoracotomy, a laparotomy
226
00:14:28,800 --> 00:14:29,920
for haemorrhage control.
227
00:14:43,600 --> 00:14:44,600
Good.
228
00:14:44,720 --> 00:14:46,120
16 minutes gone.
229
00:14:46,200 --> 00:14:48,800
I'm going to complete the clamshell
to find and fix the bleed.
230
00:14:50,520 --> 00:14:51,600
Blade, please.
231
00:14:57,000 --> 00:14:58,000
Cutting.
232
00:14:59,200 --> 00:15:00,320
Ready to cut.
233
00:15:24,720 --> 00:15:26,600
Vacuum those, please.
234
00:15:26,800 --> 00:15:27,720
Thank you.
235
00:15:41,520 --> 00:15:42,600
Shears.
236
00:15:45,600 --> 00:15:46,600
Thank you.
237
00:15:50,600 --> 00:15:52,800
BODY PART CRUNCHES
238
00:15:57,800 --> 00:15:59,000
Spreaders.
239
00:16:02,800 --> 00:16:05,200
And let's be really careful
placing these, please.
240
00:16:21,320 --> 00:16:23,800
A spike has gone through
the diaphragm
241
00:16:24,000 --> 00:16:25,920
and is crushing the IVC.
242
00:16:26,120 --> 00:16:28,520
Sats dropping,
end tidal CO2 is dropping.
243
00:16:29,600 --> 00:16:32,000
There's a small tear in the IVC.
244
00:16:32,120 --> 00:16:33,120
Satinsky, please.
245
00:16:34,200 --> 00:16:35,400
I'll try and clamp it.
246
00:16:40,120 --> 00:16:42,400
MONITOR BEEPS
Christ.
247
00:16:42,520 --> 00:16:44,000
Sats level to 79%.
248
00:16:45,120 --> 00:16:47,200
This spike's in the way,
I'm going to have to pack it.
249
00:16:47,320 --> 00:16:48,200
Hit me.
250
00:16:51,800 --> 00:16:52,800
Hit me.
251
00:16:54,000 --> 00:16:55,600
Two packs in.
252
00:16:55,720 --> 00:16:57,920
OK, the pack's controlling
the bleed...
253
00:16:58,000 --> 00:17:00,120
but keep the blood going, please.
254
00:17:00,320 --> 00:17:02,800
The aortic clamp's been on for...?
11 minutes. 11 minutes.
255
00:17:03,000 --> 00:17:05,800
Right, I'm going to do a laparotomy
to control the haemorrhage
256
00:17:06,000 --> 00:17:08,800
so we can take the clamp off
and reperfuse his lower half.
257
00:17:08,920 --> 00:17:09,920
Blade, please.
258
00:17:11,320 --> 00:17:12,320
Thank you.
259
00:17:13,920 --> 00:17:15,720
OK to cut, Mr Boyle.
260
00:17:15,800 --> 00:17:17,200
Thank you.
261
00:17:46,120 --> 00:17:47,320
McIndoes, please.
262
00:17:50,000 --> 00:17:51,200
Thank you.
263
00:17:54,520 --> 00:17:56,320
Forceps in bleed, please.
264
00:18:01,000 --> 00:18:05,400
MACHINES BEEP STEADILY
265
00:18:05,600 --> 00:18:06,800
Sutures, please.
266
00:18:11,320 --> 00:18:13,400
Just hold it here. Thank you.
267
00:18:26,400 --> 00:18:28,000
Scissors, please.
268
00:18:31,800 --> 00:18:33,400
HE SIGHS
269
00:18:33,520 --> 00:18:34,600
Cut.
270
00:18:37,400 --> 00:18:38,520
Thank you.
271
00:18:41,000 --> 00:18:42,520
Cut, please.
272
00:18:42,600 --> 00:18:44,200
Balfour retractors, please.
273
00:18:47,400 --> 00:18:48,600
Thank you.
274
00:18:56,320 --> 00:18:57,400
Oh.
275
00:19:07,200 --> 00:19:08,520
I need suction.
276
00:19:16,320 --> 00:19:17,600
Where are we?
277
00:19:17,800 --> 00:19:22,000
The heart rate is 109.
Sats 87. BP's 88/64.
278
00:19:28,400 --> 00:19:32,120
The top spike has gone through the
liver on its way to the diaphragm.
279
00:19:33,600 --> 00:19:35,400
No sign of haemorrhage
from the liver.
280
00:19:37,600 --> 00:19:39,800
That's cardiothoracics
coming in now.
281
00:19:43,600 --> 00:19:47,000
The middle spike has perforated
the hilum of the left kidney.
282
00:19:47,120 --> 00:19:49,200
Evidence of extensive bleeding.
283
00:19:49,400 --> 00:19:51,200
BBG.
284
00:19:51,320 --> 00:19:54,920
Lactate 18, pH 7.13.
285
00:19:55,120 --> 00:19:57,600
We've got to get this clamp off
and reperfuse his organs.
286
00:19:57,800 --> 00:20:00,000
OK, we will take in the kidney,
tie off the renal vessels
287
00:20:00,200 --> 00:20:01,720
and we'll bin it later, yes?
288
00:20:03,800 --> 00:20:06,000
There is no access with
the spike in place.
289
00:20:08,400 --> 00:20:12,400
Let's disinfect the middle spike
please, Billy. Get ready to pull it.
290
00:20:12,520 --> 00:20:14,520
Me? Scrub up, please.
291
00:20:15,520 --> 00:20:16,600
All right.
292
00:20:19,400 --> 00:20:20,400
No pressure.
293
00:20:30,600 --> 00:20:32,120
D-do I need to gown up?
294
00:20:32,320 --> 00:20:34,600
No, that's not sterile.
It's covered in cow shit.
295
00:20:34,720 --> 00:20:35,600
Let's go.
296
00:20:41,400 --> 00:20:43,120
HE EXHALES
297
00:20:55,320 --> 00:20:56,800
Hey. Look at me.
298
00:21:05,600 --> 00:21:06,920
Nice and gently.
299
00:21:08,120 --> 00:21:09,720
Like...
300
00:21:09,800 --> 00:21:11,320
Excalibur.
301
00:21:11,400 --> 00:21:12,720
Yeah.
302
00:21:12,800 --> 00:21:14,600
Pull.
303
00:21:14,720 --> 00:21:17,600
HE STRAINS
304
00:21:17,720 --> 00:21:18,800
Harder.
305
00:21:19,920 --> 00:21:21,400
Harder.
306
00:21:21,600 --> 00:21:25,800
Stop. He can't move. Yeah, I know
but it's not bloody shifting.
307
00:21:25,920 --> 00:21:27,920
HE GROANS
308
00:21:30,400 --> 00:21:31,600
Step, please.
309
00:21:37,800 --> 00:21:39,520
This one sounds interesting.
310
00:21:42,200 --> 00:21:46,200
The thoracic aortic clamp has been
in place for... 16 minutes.
311
00:21:46,400 --> 00:21:49,520
The middle spike has perforated
the hilum of the left kidney.
312
00:21:49,600 --> 00:21:52,320
We need to ligate the left renal
vessels before we can take
313
00:21:52,520 --> 00:21:53,720
the aortic clamp off.
314
00:21:53,920 --> 00:21:55,720
But in order to get
access to the vessels
315
00:21:55,920 --> 00:21:58,520
we need to pull this middle spike.
Better get on with it.
316
00:21:58,720 --> 00:22:00,920
The spike is firmly embedded
so if you could monitor
317
00:22:01,120 --> 00:22:03,920
the tissues at the top spike while
we pull the middle one, please.
318
00:22:04,000 --> 00:22:05,400
Thank you.
319
00:22:05,520 --> 00:22:06,520
Just pull it out.
320
00:22:09,120 --> 00:22:10,520
Harder.
321
00:22:12,720 --> 00:22:15,000
Stop! Bleed from the IVC.
322
00:22:15,120 --> 00:22:16,120
Pack!
323
00:22:22,400 --> 00:22:23,920
Packs are controlling the bleed.
324
00:22:24,000 --> 00:22:25,400
One pack in.
325
00:22:25,600 --> 00:22:29,000
Go, Billy. No, don't move it at all.
We have to pull it out.
326
00:22:29,120 --> 00:22:32,120
I understand but
the movement made the tear open.
327
00:22:32,320 --> 00:22:34,120
Any more movement could
extend the tear.
328
00:22:34,320 --> 00:22:35,800
We can leave the clamp where it is.
329
00:22:36,000 --> 00:22:38,720
In which case, he dies in the ITU
tonight of organ failure.
330
00:22:38,920 --> 00:22:40,920
Or we give him a chance
and take a risk.
331
00:22:45,600 --> 00:22:46,800
OK. Thank you.
332
00:22:48,120 --> 00:22:49,000
Billy?
333
00:22:50,200 --> 00:22:51,400
Pull it out.
334
00:22:53,120 --> 00:22:54,800
But...
335
00:22:54,920 --> 00:22:56,200
I don't want to kill him.
336
00:22:59,520 --> 00:23:00,920
OK, I'll take over.
337
00:23:04,120 --> 00:23:05,120
Sorry.
338
00:23:07,320 --> 00:23:10,800
STEADY BEEPING CONTINUES
339
00:23:24,320 --> 00:23:25,320
Be ready.
340
00:23:26,920 --> 00:23:28,000
OK.
341
00:23:35,920 --> 00:23:36,920
Thank you.
342
00:23:49,400 --> 00:23:52,320
Packs are controlling the bleed.
You can relax now.
343
00:23:52,400 --> 00:23:55,400
He's no worse. Heart rate is 105.
344
00:23:55,520 --> 00:23:58,800
Sats are 88. BP is 87/63.
345
00:23:58,920 --> 00:24:01,920
Gloves. Size eight, please. And
then let's sort out that kidney
346
00:24:02,000 --> 00:24:03,920
and reperfuse his organs. ASAP.
347
00:24:09,120 --> 00:24:13,920
Coming up to 26 minutes. I'm going
to ligate the renal vessels.
348
00:24:14,120 --> 00:24:16,000
We're a pair of hands short.
349
00:24:16,120 --> 00:24:18,720
Can you retract the
small bowel for me?
350
00:24:18,800 --> 00:24:20,600
Under the circumstances. Hmm.
351
00:24:20,720 --> 00:24:21,720
Thank you.
352
00:24:25,120 --> 00:24:26,200
Excuse me.
353
00:24:29,720 --> 00:24:31,320
Forceps and McIndoes, please.
354
00:24:44,920 --> 00:24:45,800
Clamp.
355
00:24:52,120 --> 00:24:53,920
Renal artery is clamped.
356
00:24:55,400 --> 00:24:56,320
Clamp.
357
00:25:03,800 --> 00:25:05,320
The renal vein is clamped.
358
00:25:07,600 --> 00:25:08,720
Forceps.
359
00:25:27,600 --> 00:25:28,600
Scissors, please.
360
00:25:33,720 --> 00:25:36,200
The renal artery is ligated.
361
00:25:36,320 --> 00:25:38,000
Tie, please.
362
00:25:41,120 --> 00:25:42,200
Forceps, please.
363
00:25:53,400 --> 00:25:57,520
27 minutes gone. That's 20 minutes
now with the aortic clamp on.
364
00:25:59,320 --> 00:26:00,320
Scissors, please.
365
00:26:05,520 --> 00:26:06,720
The renal vein is ligated.
366
00:26:06,800 --> 00:26:08,600
Nice work.
367
00:26:08,800 --> 00:26:12,000
I'm going to move the aortic
clamp infrarenally.
368
00:26:12,120 --> 00:26:13,320
Thank you.
369
00:26:20,520 --> 00:26:22,720
OK, the aorta has
been clamped infrarenally.
370
00:26:22,920 --> 00:26:26,320
Fiona will remove the thoracic
aortic clamp on my say so.
371
00:26:26,400 --> 00:26:29,120
Let's get ready, please.
And let me know when you are.
372
00:26:29,200 --> 00:26:30,320
Increase the blood. Yep.
373
00:26:40,600 --> 00:26:41,720
Yep.
374
00:26:44,920 --> 00:26:47,520
OK, BP rising. 102/85. Ready.
375
00:26:47,720 --> 00:26:49,920
Good. Let's release the clamp
by half.
376
00:26:55,800 --> 00:26:57,600
Unclamped by a half. Thank you.
377
00:27:02,600 --> 00:27:04,920
BP dropping.
MACHINES BEEP RAPIDLY
378
00:27:05,000 --> 00:27:06,920
Bleed from the IVC. Shit!
379
00:27:07,000 --> 00:27:08,800
Pack. Increase the blood, Billy.
380
00:27:11,320 --> 00:27:12,400
Pack.
381
00:27:15,200 --> 00:27:16,320
Two packs in.
382
00:27:16,400 --> 00:27:18,000
Five packs total.
383
00:27:18,200 --> 00:27:21,920
Packing isn't controlling the bleed.
We have to reclamp the aorta.
384
00:27:22,120 --> 00:27:25,320
That's a long time for the aorta to
be clamped. Better than being dead.
385
00:27:25,520 --> 00:27:28,000
Let's fully re-clamp
the aorta, please.
386
00:27:29,200 --> 00:27:30,600
Fully re-clamped.
387
00:27:30,720 --> 00:27:32,200
Reduce the blood pressure.
388
00:27:34,520 --> 00:27:38,600
Tear is slightly bigger. I'm going
to clamp the IVC and fix it.
389
00:27:38,720 --> 00:27:40,200
Vascular clamp.
390
00:27:40,320 --> 00:27:42,920
I'll pull the top spike,
give you a little bit more room.
391
00:27:46,520 --> 00:27:49,120
OK, I'm going
to pull it out my half a centimetre.
392
00:27:49,320 --> 00:27:50,920
Are you ready? Ready.
393
00:27:51,000 --> 00:27:52,120
Pulling.
394
00:27:54,120 --> 00:27:56,920
I can't quite see what's
happening. Slowly.
395
00:27:57,000 --> 00:27:58,200
Yeah.
396
00:27:58,400 --> 00:28:01,120
It seems to be pulling the IVC.
Back up.
397
00:28:01,320 --> 00:28:02,400
Stop.
398
00:28:03,520 --> 00:28:04,720
Swab and forceps.
399
00:28:14,120 --> 00:28:15,120
It's hooked.
400
00:28:17,200 --> 00:28:18,920
It's torn the IVC.
401
00:28:19,120 --> 00:28:20,120
Shit.
402
00:28:21,920 --> 00:28:25,120
The tear is approximately 2cm.
403
00:28:25,200 --> 00:28:27,320
MACHINE BEEPS RAPIDLY
404
00:28:27,400 --> 00:28:28,800
Oh, come on! BP crashing.
405
00:28:28,920 --> 00:28:30,400
The aortic clamp is in place.
406
00:28:33,320 --> 00:28:35,800
There's back bleeding
into the liver. Pack.
407
00:28:41,200 --> 00:28:42,600
One pack in.
408
00:28:42,720 --> 00:28:45,000
Six packs total. Billy? Yes.
409
00:28:45,120 --> 00:28:48,200
Mrs Murkherjee, I need you to
compress the IVC
410
00:28:48,400 --> 00:28:51,000
to stop the back bleeding.
I can close the tear
411
00:28:51,120 --> 00:28:53,400
but I can't compress the IVC with
the spike in the way.
412
00:28:53,600 --> 00:28:55,320
I can't pull it out
and I can't clamp it.
413
00:28:55,520 --> 00:28:57,800
I can't pull the hook through
the liver. It will destroy it.
414
00:28:58,000 --> 00:29:01,000
There is no possibility of him
getting a liver transplant tonight.
415
00:29:02,320 --> 00:29:05,200
Maybe you can open the liver
and lift the spike. No.
416
00:29:05,320 --> 00:29:06,400
He'll bleed to death.
417
00:29:09,800 --> 00:29:13,120
Let's face it,
we can't proceed surgically.
418
00:29:13,320 --> 00:29:14,520
We've reached the end.
419
00:29:19,520 --> 00:29:20,520
Hello.
420
00:29:22,320 --> 00:29:23,800
Please take a seat.
421
00:29:29,000 --> 00:29:31,320
One of the spikes
went through Edward's liver.
422
00:29:32,600 --> 00:29:35,800
In order to save his life, obviously
we need to remove the spike.
423
00:29:37,120 --> 00:29:40,120
But pulling it out will almost
certainly destroy his liver.
424
00:29:42,520 --> 00:29:46,920
I'm afraid there's no tissue
match for an available donor liver.
425
00:29:47,000 --> 00:29:50,120
And any further efforts we make run
the risk of killing him, Frank.
426
00:29:55,520 --> 00:29:56,720
Y-you're giving up?
427
00:29:58,120 --> 00:30:00,920
It's an impossible
dilemma for a surgeon.
428
00:30:03,720 --> 00:30:04,920
So you're giving up?!
429
00:30:09,200 --> 00:30:11,200
All we can do is tidy this up.
430
00:30:18,800 --> 00:30:21,320
'Dr Green...
Please leave a message.' Shit.
431
00:30:23,120 --> 00:30:25,800
Hi, boss. If you get this message in
the next few minutes, can you
432
00:30:25,920 --> 00:30:28,120
come down to trauma theatre cos
I think this one's going
433
00:30:28,320 --> 00:30:29,520
to go tits up on the table.
434
00:30:35,520 --> 00:30:36,920
Glen?
435
00:30:37,120 --> 00:30:40,720
I'm going to need tying.
Orthopaedic instrument set.
436
00:30:40,800 --> 00:30:42,520
OK. What are we going to do?
437
00:30:42,720 --> 00:30:45,120
I'm going to try
and cut the tip off of the spike.
438
00:30:48,120 --> 00:30:50,600
Largest K-wire cutter
you've got, please!
439
00:30:50,720 --> 00:30:51,800
OK.
440
00:30:56,320 --> 00:30:57,600
Look, I'm sorry to interrupt
441
00:30:57,800 --> 00:30:59,720
but that is not a healthy
colour for bowel.
442
00:31:01,000 --> 00:31:03,600
Look, we are losing the bowel.
We need to get a move on.
443
00:31:13,520 --> 00:31:15,120
Thank you.
444
00:31:15,320 --> 00:31:17,120
I need space on your left, please.
445
00:31:17,200 --> 00:31:19,120
There is no space.
446
00:31:19,200 --> 00:31:22,800
Stick a hand in. Retract the liver
and the diaphragm, please.
447
00:31:23,000 --> 00:31:25,120
If you damage the IVC,
he will die on the table.
448
00:31:25,320 --> 00:31:26,400
Mind your fingers.
449
00:31:26,520 --> 00:31:28,000
This is pointless!
450
00:31:28,120 --> 00:31:29,400
Just hold on a few seconds.
451
00:31:29,600 --> 00:31:32,520
His organs have had no
profusion for a protracted period.
452
00:31:32,600 --> 00:31:34,120
Do you think we have a few seconds?
453
00:31:35,520 --> 00:31:36,600
Come on!
454
00:31:39,520 --> 00:31:41,200
Fiona, help me, please.
455
00:31:45,800 --> 00:31:46,920
Come on.
456
00:31:57,600 --> 00:31:58,720
Dish.
457
00:32:01,520 --> 00:32:02,920
Let's pull the spike.
458
00:32:03,000 --> 00:32:05,520
Can you see if I damaged the IVC?
459
00:32:05,720 --> 00:32:06,600
Thank you.
460
00:32:11,320 --> 00:32:12,320
Good.
461
00:32:14,720 --> 00:32:15,720
Got it.
462
00:32:25,320 --> 00:32:26,720
Someone take this.
463
00:32:28,520 --> 00:32:29,920
We've got a bleed in the liver.
464
00:32:30,120 --> 00:32:31,320
Hit me.
465
00:32:35,800 --> 00:32:36,800
Hit me.
466
00:32:39,120 --> 00:32:40,920
Two packs in. Eight packs total.
467
00:32:41,120 --> 00:32:44,320
The IVC is clamped. We've got
control of the hepatic bleed.
468
00:32:44,520 --> 00:32:45,920
OK, let's fix the tear
469
00:32:46,000 --> 00:32:48,520
and finally get this bloody
aortic clamp off, eh?
470
00:32:48,600 --> 00:32:49,720
I can't.
471
00:32:51,800 --> 00:32:55,200
Cutting off the hook made
a 3cm diameter hole in the IVC.
472
00:32:56,600 --> 00:32:59,320
Stitching it would only stenos
the IVC completely.
473
00:33:05,720 --> 00:33:06,720
Patch it.
474
00:33:10,520 --> 00:33:12,520
I honestly don't think
I could do it in time.
475
00:33:23,600 --> 00:33:24,920
We've come this far.
476
00:33:26,600 --> 00:33:28,000
Can we at least try?
477
00:33:35,520 --> 00:33:37,720
20mm vasa tunica sheet.
478
00:33:37,920 --> 00:33:38,920
Thank you.
479
00:33:40,920 --> 00:33:43,200
I'll need more access to
the chest, please.
480
00:33:44,400 --> 00:33:45,800
It's a contaminated wound.
481
00:33:45,920 --> 00:33:48,920
We'll need to revise later to
a full autologous graft.
482
00:34:00,600 --> 00:34:03,000
Double-ended
fibro-prolene and forceps.
483
00:34:12,600 --> 00:34:13,800
Help me guide it down, please.
484
00:34:24,720 --> 00:34:25,720
APGs.
485
00:34:38,920 --> 00:34:41,400
Lactating 19, pH 6.97.
486
00:34:41,520 --> 00:34:43,600
OK, it's down to minutes, at best.
487
00:34:46,600 --> 00:34:48,000
Does anyone have a condom?
488
00:34:51,000 --> 00:34:54,720
I'm going to improvise a balloon
tamponade for the liver.
489
00:34:54,800 --> 00:34:55,720
Anyone?
490
00:34:55,920 --> 00:34:58,320
(Give him the one you've had
in your wallet since school.)
491
00:35:00,200 --> 00:35:02,400
Locker 54. The key is in my pocket.
492
00:35:12,600 --> 00:35:13,920
Did you get all that?
493
00:35:14,000 --> 00:35:16,720
Locker 54. Miss Lomas' condoms.
494
00:35:16,920 --> 00:35:18,120
Now, please!
495
00:35:22,920 --> 00:35:24,320
ETA, please?
496
00:35:24,400 --> 00:35:25,520
Three minutes.
497
00:35:25,720 --> 00:35:27,320
I need you to do it in two.
498
00:35:29,000 --> 00:35:31,520
I can't do it. You can do it.
499
00:35:31,600 --> 00:35:32,600
You can.
500
00:35:37,320 --> 00:35:40,200
Miss Lomas' condoms for Mr Boyle.
501
00:35:40,320 --> 00:35:42,200
Billy. Quick as you can, please.
502
00:35:46,120 --> 00:35:49,120
Not my size. I use extra large.
503
00:35:49,320 --> 00:35:50,920
Billy! Never mind.
504
00:35:53,000 --> 00:35:54,920
Nice flowers, by the way, Miss Lomas.
505
00:36:01,920 --> 00:36:04,120
Fold the catheter, please.
506
00:36:04,200 --> 00:36:06,800
Put a syringe in sterile water.
507
00:36:06,920 --> 00:36:08,200
Just here, Billy. Yeah.
508
00:36:17,200 --> 00:36:18,400
Tie.
509
00:36:22,320 --> 00:36:23,400
Thank you.
510
00:36:30,800 --> 00:36:31,800
Cut.
511
00:36:43,520 --> 00:36:45,320
Three packs out.
512
00:36:45,400 --> 00:36:46,520
Five packs total.
513
00:36:46,720 --> 00:36:48,320
Balloon going in.
514
00:36:54,800 --> 00:36:55,920
Syringe, please.
515
00:36:59,920 --> 00:37:01,720
With any luck,
the condom will expand
516
00:37:01,800 --> 00:37:03,320
and seal the tear in the liver.
517
00:37:06,000 --> 00:37:07,200
There you go.
518
00:37:09,200 --> 00:37:11,720
Beep the hepatobiliary
surgeon, please.
519
00:37:14,520 --> 00:37:15,800
Hi, this is trauma theatre.
520
00:37:16,000 --> 00:37:18,600
Could you beep the hepatobiliary
surgeon, please?
521
00:37:18,720 --> 00:37:21,120
OK, I need to get this clamp off.
522
00:37:21,320 --> 00:37:22,200
Now!
523
00:37:27,120 --> 00:37:28,520
Scissors, please.
524
00:37:37,120 --> 00:37:38,320
Done.
525
00:37:38,400 --> 00:37:39,720
Good work.
526
00:37:39,800 --> 00:37:41,000
If it doesn't come apart.
527
00:37:41,120 --> 00:37:44,920
OK, I'm going to take
the clamps on the IVC off first.
528
00:37:45,000 --> 00:37:46,120
You ready?
529
00:37:59,720 --> 00:38:00,720
Yeah.
530
00:38:03,600 --> 00:38:06,400
Balloon seems to be holding.
531
00:38:06,520 --> 00:38:08,720
Be ready for the aortic clamp.
532
00:38:08,920 --> 00:38:10,920
Ready. OK.
533
00:38:11,120 --> 00:38:13,720
I'm going to take it off by a half.
Ready?
534
00:38:16,720 --> 00:38:17,920
Here.
535
00:38:30,920 --> 00:38:31,920
BP dropping.
536
00:38:33,120 --> 00:38:34,920
Fill 'em up, Billy. Blood and FOP.
537
00:38:37,800 --> 00:38:38,920
Holding.
538
00:38:41,000 --> 00:38:43,000
Climbing slightly.
539
00:38:43,120 --> 00:38:45,720
OK. I'm going
to take it three quarters.
540
00:38:46,920 --> 00:38:48,000
Now.
541
00:38:51,400 --> 00:38:53,600
MACHINE BEEPS RAPIDLY
542
00:38:53,720 --> 00:38:54,920
Dropping.
543
00:38:57,720 --> 00:38:58,800
Come on.
544
00:38:58,920 --> 00:39:01,400
IRREGULAR BEEPS
Shit.
545
00:39:01,600 --> 00:39:04,320
Broadening QRS complex. We've got
to get his potassium down,
546
00:39:04,520 --> 00:39:07,600
otherwise he's going to arrest.
Need 10ml of 10% calcium chloride.
547
00:39:07,720 --> 00:39:08,720
Yep.
548
00:39:09,920 --> 00:39:14,000
Thank you. And 20ml of 50% glucose
solution with ten units of insulin.
549
00:39:14,120 --> 00:39:15,120
Yep.
550
00:39:16,600 --> 00:39:18,000
Slow bolus, Billy.
551
00:39:18,200 --> 00:39:20,320
Let's get some
bicarb for his acidosis.
552
00:39:23,320 --> 00:39:27,400
RAPID BEEPING CONTINUES
553
00:39:29,800 --> 00:39:31,120
Yeah? Yep.
554
00:39:33,000 --> 00:39:34,200
Ten seconds, boss.
555
00:39:37,200 --> 00:39:38,920
OK, glucose-insulin solution
is running.
556
00:39:39,120 --> 00:39:41,520
OK, I'm going
to take the clamp fully off. Go.
557
00:39:46,520 --> 00:39:48,400
The aorta is fully unclamped.
558
00:39:52,520 --> 00:39:53,520
Dropping.
559
00:39:55,200 --> 00:39:56,400
Dropping.
560
00:40:01,200 --> 00:40:02,200
Dropping.
561
00:40:12,600 --> 00:40:13,520
Dropping.
562
00:40:24,320 --> 00:40:25,320
Holding.
563
00:40:33,400 --> 00:40:34,400
Holding.
564
00:40:40,320 --> 00:40:41,320
Climbing.
565
00:40:44,320 --> 00:40:47,000
BEEPING SLOWS
566
00:40:48,400 --> 00:40:49,920
ECG returning to normal.
567
00:40:50,120 --> 00:40:54,920
Maintaining BP 88/53.
Heart rate 112. Sats 97.
568
00:40:57,600 --> 00:40:59,120
Is it me or did we just save him?
569
00:41:02,800 --> 00:41:03,920
Well done.
570
00:41:07,520 --> 00:41:08,920
That's good work, everyone.
571
00:41:12,800 --> 00:41:13,800
Really.
572
00:41:19,120 --> 00:41:20,200
It's great work.
573
00:41:22,120 --> 00:41:25,320
Let's have a full set
of bloods, please, ABG...
574
00:41:26,520 --> 00:41:30,200
Dionysus Stematelayos.
Consultant hepatobiliary surgeon.
575
00:41:34,000 --> 00:41:35,520
Let's do the swap.
576
00:41:35,600 --> 00:41:37,520
Is that...a condom?
577
00:41:40,720 --> 00:41:41,920
CAMERA CLICKS
578
00:41:49,800 --> 00:41:53,120
What's his haemo-dynamic?
He's stable. He's looking good.
579
00:41:55,000 --> 00:41:55,920
Thank you.
580
00:42:00,000 --> 00:42:00,920
I need to see you.
581
00:42:03,320 --> 00:42:04,520
Now, if I can.
582
00:42:06,320 --> 00:42:07,400
I can't.
583
00:42:09,000 --> 00:42:10,800
Because of Tom?
584
00:42:10,920 --> 00:42:12,320
Because you're leaving.
585
00:42:17,000 --> 00:42:18,720
I'm going to need some eyes, please.
586
00:42:24,120 --> 00:42:25,200
Hey.
587
00:42:28,200 --> 00:42:29,600
You saved him.
588
00:42:29,720 --> 00:42:30,920
Yes.
589
00:42:31,000 --> 00:42:32,000
Wow.
590
00:42:39,000 --> 00:42:40,800
Lieutenant Colonel Bryan, please.
591
00:42:42,920 --> 00:42:45,920
Um... Can you put me
through to her answering machine?
592
00:42:47,000 --> 00:42:50,120
Hi, Tom. Thank you for the flowers.
593
00:42:50,200 --> 00:42:51,200
They're lovely.
594
00:42:52,720 --> 00:42:55,800
So, what's the big occasion?
595
00:42:57,920 --> 00:42:59,720
Yes, Jane. This is Glen Boyle.
596
00:42:59,920 --> 00:43:02,320
I just wanted to talk
to you about my redeployment.
597
00:43:03,520 --> 00:43:06,000
I'm not absolutely sure I'm
ready to come back.
598
00:43:07,200 --> 00:43:10,400
I've been offered a chance to extend
my contract at City General and...
599
00:43:18,720 --> 00:43:20,200
..I have decided to stay.
600
00:43:51,600 --> 00:43:54,600
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601
00:43:54,720 --> 00:43:57,600
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