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1
00:00:03,000 --> 00:00:04,640
Clive and Nicola, they're, er...
2
00:00:04,760 --> 00:00:06,080
defensive.
3
00:00:07,280 --> 00:00:09,640
I'd like to discuss the major
transfusion protocol.
4
00:00:09,800 --> 00:00:12,000
You run the trauma call,
I run the entire department.
5
00:00:13,200 --> 00:00:14,720
You mentioned Lorraine's illness.
6
00:00:14,880 --> 00:00:17,240
I was just wondering
where you got that from. Hmm?
7
00:00:19,440 --> 00:00:21,560
Seven, eight, nine...
8
00:00:21,680 --> 00:00:22,680
Arsehole!
9
00:00:24,080 --> 00:00:25,240
Blade.
10
00:00:25,360 --> 00:00:27,280
Glen... Just do as you're told.
11
00:00:28,640 --> 00:00:32,160
You called, told me you needed me,
and I came running.
12
00:00:44,680 --> 00:00:46,760
LOUD GUNFIRE
13
00:00:46,880 --> 00:00:48,800
MEN YELLING
14
00:00:50,120 --> 00:00:51,880
RECORDING OF GUNFIRE AND YELLING
15
00:01:02,480 --> 00:01:04,680
HE SIGHS
16
00:01:04,800 --> 00:01:06,920
BEEPER ALERT
17
00:01:07,080 --> 00:01:09,720
RECORDING: Attend emergency
department. Trauma call.
18
00:01:09,840 --> 00:01:11,520
Attend emergency department.
19
00:01:42,160 --> 00:01:43,640
Will you get him out?!
20
00:01:43,760 --> 00:01:45,120
Starting the clock.
21
00:01:47,400 --> 00:01:49,400
You've got your hands full here.
22
00:01:49,560 --> 00:01:52,360
Bunch of pricks! That's the spirit,
my friend. You're idiots!
23
00:01:52,520 --> 00:01:56,480
Patient hypotensive at the scene
with a suspected fractured pelvis.
24
00:01:56,600 --> 00:01:58,160
I've activated a code red.
25
00:01:58,320 --> 00:02:01,400
No ID, so he's in the system
as Mike Oscar. What mechanism?
26
00:02:01,560 --> 00:02:04,240
He was found bound and gagged
with a ligature around his neck.
27
00:02:04,360 --> 00:02:06,320
Let's get ready to transfer, please.
28
00:02:06,440 --> 00:02:08,200
Slide, one, two, three.
29
00:02:08,320 --> 00:02:10,000
Giles will liaise with the police.
30
00:02:11,160 --> 00:02:13,680
Have Gen, Surg and Cardiothoracics
been fast bleeped?
31
00:02:13,800 --> 00:02:15,120
Yes, that's all done.
32
00:02:15,280 --> 00:02:18,080
One minute hatred,
the next minute dogs on heat.
33
00:02:18,200 --> 00:02:19,680
And where's orthopaedics?
34
00:02:19,880 --> 00:02:21,520
Afternoon off,
it's her baby's birthday.
35
00:02:21,680 --> 00:02:23,600
Can we fast bleep
the other orthopod, please?
36
00:02:23,720 --> 00:02:25,240
REBECCA: I don't care.
37
00:02:25,400 --> 00:02:27,920
No nuts on the table,
no nuts in the party bags.
38
00:02:28,040 --> 00:02:30,400
Just no nuts, Magda.
39
00:02:30,520 --> 00:02:32,920
Oh, that bloody clown.
40
00:02:34,240 --> 00:02:35,400
Great.
41
00:02:37,520 --> 00:02:38,880
Sorry.
42
00:02:39,040 --> 00:02:41,960
I'm still here, but then
three more hours and I'm gone.
43
00:02:42,120 --> 00:02:44,400
Part-timers.
Suspected fractured pelvis.
44
00:02:44,520 --> 00:02:46,080
Move the scoop on your count.
45
00:02:46,200 --> 00:02:48,080
Unclip top and bottom, go on three.
46
00:02:48,200 --> 00:02:50,560
One, two, three.
47
00:02:50,680 --> 00:02:52,600
Brace. One, two, three, go on three.
48
00:02:52,720 --> 00:02:54,200
One, two, three.
49
00:02:54,320 --> 00:02:55,680
Thank you.
50
00:02:55,800 --> 00:02:57,760
I'd prescribe a nice chest drain.
51
00:02:57,880 --> 00:02:59,480
What's that smell? Really?
52
00:02:59,640 --> 00:03:01,880
I'm not keen on his perfume.
I think it's from an animal.
53
00:03:02,040 --> 00:03:04,480
Jacket's covered in crap, too.
That's cows.
54
00:03:04,640 --> 00:03:07,120
Everyone got goggles?
You might want to double glove.
55
00:03:07,240 --> 00:03:09,160
You requested a general surgeon?
56
00:03:09,280 --> 00:03:10,680
Appreciate you coming.
57
00:03:10,800 --> 00:03:12,160
Situation understood.
58
00:03:14,360 --> 00:03:15,880
Let's do the handover.
59
00:03:16,040 --> 00:03:18,080
Nerys, will you scribe, please?
Yeah, of course.
60
00:03:18,200 --> 00:03:19,760
Harry, Venflon, please. Yep.
61
00:03:21,320 --> 00:03:23,360
QUIETLY: You and her back on, then?
62
00:03:23,520 --> 00:03:27,000
Male, estimate early 20s.
Call was made at 12.28.
63
00:03:27,120 --> 00:03:29,600
Ambulance arrived on scene at 12.40.
64
00:03:29,760 --> 00:03:32,720
Patient was found by a worker
on a landfill site
65
00:03:32,880 --> 00:03:35,320
hands tied, ligature marks
around neck and gagged.
66
00:03:35,440 --> 00:03:36,760
Unknown mechanism.
67
00:03:36,920 --> 00:03:40,360
Best guess, violent assault,
blunt instrument. Whack.
68
00:03:40,480 --> 00:03:42,240
Semi-conscious at scene.
69
00:03:42,400 --> 00:03:45,920
Multiple soft tissue injuries,
lacerations, grazes, haematomas.
70
00:03:46,080 --> 00:03:49,080
Airway blocked with a piece
of fabric, which we cleared.
71
00:03:49,200 --> 00:03:50,920
Old bit of rag stuffed down there.
72
00:03:51,040 --> 00:03:52,200
I pulled it out.
73
00:03:52,320 --> 00:03:53,640
Oh, good thinking, Bob(!)
74
00:03:53,760 --> 00:03:55,280
Trachea deviated to the right.
75
00:03:55,440 --> 00:03:57,640
Diminished breath sounds
on both sides.
76
00:03:57,760 --> 00:03:59,440
Left side tension pneumothorax.
77
00:03:59,600 --> 00:04:01,840
Abdomen is soft,
suspected pelvic fracture.
78
00:04:01,960 --> 00:04:05,640
Pulse 110. BP 89 over 59. GCS 8.
79
00:04:05,800 --> 00:04:09,000
Needle decompression and oxygen
for tension pneumothorax,
80
00:04:09,120 --> 00:04:10,640
and pelvic binder.
81
00:04:10,800 --> 00:04:13,600
500ml bag of normal saline
running in.
82
00:04:13,720 --> 00:04:15,240
Thank you.
83
00:04:15,360 --> 00:04:16,840
Go on, bugger off, please.
84
00:04:16,960 --> 00:04:18,120
FIONA: I'll do the primary.
85
00:04:18,280 --> 00:04:20,200
Cardiothoracics attending,
if needed.
86
00:04:20,320 --> 00:04:22,120
Your presence is appreciated.
87
00:04:22,280 --> 00:04:24,040
I hope this is
a good use of my time.
88
00:04:25,880 --> 00:04:27,200
Airway?
89
00:04:27,320 --> 00:04:28,560
Ligature marks round the neck.
90
00:04:28,720 --> 00:04:31,160
PATIENT GASPS FOR BREATH
Breathing is noisy.
91
00:04:32,960 --> 00:04:35,440
There's no surgical emphysema.
Sats are low.
92
00:04:35,600 --> 00:04:38,200
Pulses are bounding
but his pressure's well down.
93
00:04:39,360 --> 00:04:41,200
Let's get him a Bair Hugger, please.
94
00:04:41,360 --> 00:04:43,320
Poor expansion on right,
percussion dull...
95
00:04:43,480 --> 00:04:45,240
Poor expansion on left,
percussion dull.
96
00:04:45,400 --> 00:04:47,880
Airway's compromised.
There's something in the oropharynx.
97
00:04:48,000 --> 00:04:49,280
No, we cleared what was in there.
98
00:04:49,440 --> 00:04:52,160
I think he may have...
PATIENT COUGHS WETLY
99
00:04:52,280 --> 00:04:54,040
..swallowed some.
100
00:04:54,160 --> 00:04:55,440
Better out than in.
101
00:04:57,920 --> 00:05:00,640
Can't see anything with this blood
pouring down his throat.
102
00:05:00,800 --> 00:05:03,160
Get a tampon for the epistaxis,
please.
103
00:05:06,440 --> 00:05:08,400
He coughed something up.
104
00:05:08,520 --> 00:05:09,920
Excuse me, ladies.
105
00:05:10,040 --> 00:05:11,360
Looks like a piece of cloth.
106
00:05:11,520 --> 00:05:14,600
The police will need to see it. Bag
that up. Stick it with his clothes.
107
00:05:14,760 --> 00:05:16,480
I'll take it through
when there's a minute.
108
00:05:16,640 --> 00:05:19,080
It appears I'm not needed.
Bleep me if that changes.
109
00:05:19,240 --> 00:05:21,120
Hey! We haven't even
done the CT yet.
110
00:05:21,240 --> 00:05:23,000
I'm surprised she lasted this long.
111
00:05:23,120 --> 00:05:24,680
We good to go now?
112
00:05:24,840 --> 00:05:27,600
Yeah, you go. Get cleaned up, Bob.
I can smell you from here.
113
00:05:27,720 --> 00:05:29,360
Can we complete the primary, please?
114
00:05:29,520 --> 00:05:32,680
There's a number on the skin
under his arm.
115
00:05:32,800 --> 00:05:34,920
"365-995."
116
00:05:35,040 --> 00:05:36,840
Like cattle branding.
117
00:05:37,000 --> 00:05:39,840
Let's make sure we mention that
to the police. Yeah, course.
118
00:05:39,960 --> 00:05:41,200
Abdomen is soft.
119
00:05:44,640 --> 00:05:47,960
Pelvis feels unstable
on stress assessment.
120
00:05:48,080 --> 00:05:50,160
Possibly SIJ instability.
121
00:05:54,040 --> 00:05:55,360
No other major limb trauma.
122
00:05:55,520 --> 00:05:58,880
Six units blood, O positive.
Four units of FFP,
123
00:05:59,000 --> 00:06:00,640
plus two units of platelets, please.
124
00:06:00,760 --> 00:06:02,200
Justin. On it.
125
00:06:02,320 --> 00:06:03,640
Sats are still low.
126
00:06:03,800 --> 00:06:06,760
Sats are below 90%. Let's get
bilateral chest drains in, please.
127
00:06:06,880 --> 00:06:08,880
Me. I'll do the other.
128
00:06:09,000 --> 00:06:10,680
Slow and steady wins the race.
129
00:06:10,800 --> 00:06:12,320
Rebecca, can I have a hand, please?
130
00:06:16,640 --> 00:06:19,640
I'm not happy with his airway.
I need to RSI. OK.
131
00:06:23,960 --> 00:06:25,560
Bio-Sats, 250-100. Yep.
132
00:06:25,720 --> 00:06:27,760
Can you sort that side for me,
please, love?
133
00:06:27,920 --> 00:06:32,400
Thiopentone, 250 milligrams,
suxamethonium, 100 milligrams.
134
00:06:32,520 --> 00:06:33,960
Tie us, please.
135
00:06:34,080 --> 00:06:35,640
One second.
136
00:06:35,760 --> 00:06:37,040
250 thio.
137
00:06:39,360 --> 00:06:40,880
Justin?
138
00:06:41,000 --> 00:06:42,360
Ties, please.
139
00:06:44,920 --> 00:06:47,040
Sux, 100.
140
00:06:47,160 --> 00:06:49,280
Thanks.
141
00:06:49,400 --> 00:06:51,080
How long before we can intubate?
142
00:06:54,200 --> 00:06:55,560
About a minute.
143
00:06:55,680 --> 00:06:56,880
Everyone, stand by.
144
00:06:58,560 --> 00:07:01,520
I'd like imaging of his pelvis.
It sounds like a fracture.
145
00:07:01,680 --> 00:07:03,880
We will get straight
to CT as soon as.
146
00:07:05,720 --> 00:07:07,120
(So...
147
00:07:07,280 --> 00:07:09,600
(you and her -
how'd you pull that off?)
148
00:07:09,720 --> 00:07:10,800
(Shut up.)
149
00:07:12,320 --> 00:07:15,280
Get the GlideScope ready
in case we need it. Yep, on it.
150
00:07:18,360 --> 00:07:20,560
I'll try the laryngoscope first.
151
00:07:35,840 --> 00:07:38,800
OK. That's time.
152
00:07:38,920 --> 00:07:39,840
OK.
153
00:07:49,200 --> 00:07:50,840
Sats are still falling.
154
00:07:55,000 --> 00:07:58,240
That's not working.
We'll try the GlideScope, please.
155
00:08:08,360 --> 00:08:09,960
There's loads of oedema.
156
00:08:10,080 --> 00:08:11,760
Can't get a view.
157
00:08:11,880 --> 00:08:13,680
Can't see much of the epiglottis.
158
00:08:16,280 --> 00:08:18,720
Let's try a blind bougie.
159
00:08:18,840 --> 00:08:20,400
Thank you.
160
00:08:23,520 --> 00:08:25,200
Excuse me.
161
00:08:33,680 --> 00:08:35,920
(It's not going in the trachea.)
162
00:08:38,440 --> 00:08:40,520
No, it's not going in the trachea.
163
00:08:40,640 --> 00:08:42,720
Course of action? Bagging.
164
00:08:42,840 --> 00:08:44,480
Tell me how the chest drains are.
165
00:08:44,600 --> 00:08:46,560
Swinging and bubbling.
166
00:08:46,720 --> 00:08:48,400
ALARM BEEPS
Sats are below 60%.
167
00:08:49,840 --> 00:08:51,600
Let's try two person. Yep.
168
00:08:54,320 --> 00:08:55,560
Anything?
169
00:08:55,680 --> 00:08:57,000
No, it's not going in.
170
00:08:57,160 --> 00:08:59,200
OK. Let's try a Guedel airway,
please.
171
00:09:05,040 --> 00:09:06,920
Come on!
172
00:09:07,040 --> 00:09:08,400
Can I have a gown, please?
173
00:09:10,080 --> 00:09:11,680
OK, go, go.
174
00:09:11,800 --> 00:09:13,840
Sats below 50%. Come on.
175
00:09:16,160 --> 00:09:17,920
It's also not happening. OK.
176
00:09:27,480 --> 00:09:30,400
I don't think you're moving any air.
Can't intubate. Can't ventilate.
177
00:09:30,560 --> 00:09:33,000
He needs a crike. Yep.
I need a crike kit now, please.
178
00:09:33,120 --> 00:09:34,520
Yes!
179
00:09:34,640 --> 00:09:36,360
Harry? Ties, please.
180
00:09:39,600 --> 00:09:41,160
Thank you.
181
00:09:41,320 --> 00:09:43,400
There's lots of swelling
and bruising.
182
00:09:43,520 --> 00:09:45,040
It's OK. I've got it.
183
00:09:46,760 --> 00:09:48,360
Let's have the blade.
184
00:10:04,640 --> 00:10:06,240
The forceps.
185
00:10:11,880 --> 00:10:14,400
There we go.
186
00:10:14,520 --> 00:10:16,440
Let's have the bougie.
187
00:10:16,560 --> 00:10:18,000
Thank you.
188
00:10:24,160 --> 00:10:25,600
Trach.
189
00:10:34,800 --> 00:10:36,400
OK, bougie out.
190
00:10:36,520 --> 00:10:38,520
I've got it.
191
00:10:38,640 --> 00:10:40,560
OK, hold till we secure.
192
00:10:40,680 --> 00:10:42,720
Safe hands. Cuff up. Thanks.
193
00:10:47,560 --> 00:10:48,960
Cuff.
194
00:10:49,080 --> 00:10:50,120
Yep.
195
00:10:52,960 --> 00:10:55,360
Breath.
LOW HISS OF AIR
196
00:10:55,520 --> 00:10:57,320
Breath.
LOW HISS OF AIR
197
00:10:59,000 --> 00:11:00,560
Patient's ventilated.
198
00:11:00,680 --> 00:11:03,200
Sats are rising. Good.
199
00:11:03,360 --> 00:11:06,120
I'll do a subclavian line.
Thank you.
200
00:11:06,240 --> 00:11:07,800
Suture, please.
201
00:11:09,360 --> 00:11:11,040
Could you? Yep.
202
00:11:13,560 --> 00:11:15,440
He's warmed up.
203
00:11:15,560 --> 00:11:16,680
That was fast.
204
00:11:16,800 --> 00:11:18,400
Let's get the Bair Hugger off
205
00:11:18,560 --> 00:11:21,720
and give him a 250ml bolus
of saline, please. Yep.
206
00:11:21,880 --> 00:11:25,440
And when the subclavian line is
ready, let's do the usual bloods.
207
00:11:25,560 --> 00:11:28,680
So that's FBC, U&E, EtOH,
208
00:11:28,800 --> 00:11:31,960
crossmatch, teg, LFTs and VBGs.
209
00:11:34,480 --> 00:11:36,160
Lots of blood on that blanket.
210
00:11:38,880 --> 00:11:41,520
Let's clean up these lacerations
and compress.
211
00:11:41,640 --> 00:11:44,680
Pulse 113, BP 88 over 58. Falling.
212
00:11:44,800 --> 00:11:46,640
OK. We need to get blood in.
213
00:11:46,800 --> 00:11:49,560
We will transfuse through the
subclavian line when it's clear.
214
00:11:49,720 --> 00:11:54,040
So, that's platelets, FFP
and let's get in one gram of TXA.
215
00:11:54,160 --> 00:11:55,600
And, please...
216
00:11:55,720 --> 00:11:57,360
let's move on this.
217
00:11:57,480 --> 00:11:59,320
VBGs and samples ready to go.
218
00:11:59,440 --> 00:12:01,120
Nerys. I'll sort it.
219
00:12:01,280 --> 00:12:03,280
Harry, will you put the blood
in for me, please?
220
00:12:03,400 --> 00:12:04,840
Er, yep. These are flushed.
221
00:12:04,960 --> 00:12:06,760
TXA going in through the Venflon.
222
00:12:09,320 --> 00:12:12,000
Tachycardic. BP 80 over 50.
223
00:12:12,120 --> 00:12:14,320
It's too low.
224
00:12:14,440 --> 00:12:16,440
And he's clammy.
225
00:12:16,560 --> 00:12:18,320
Tell me his temperature, please?
226
00:12:25,000 --> 00:12:28,320
39.7. He's cooking.
227
00:12:28,440 --> 00:12:30,360
Yeah. Bollocks.
228
00:12:30,480 --> 00:12:32,040
Looks like he's septic.
229
00:12:47,874 --> 00:12:51,034
What's your instinct? Is he septic
or is it internal haemorrhaging?
230
00:12:51,154 --> 00:12:52,514
Probably both,
231
00:12:52,634 --> 00:12:54,834
but that'll be me being pessimistic.
232
00:12:54,954 --> 00:12:56,434
Not like you, then(!)
233
00:12:59,434 --> 00:13:01,914
So, er...
how'd you get her back then?
234
00:13:02,034 --> 00:13:03,674
Trade secrets, Billy.
235
00:13:03,794 --> 00:13:05,274
Right.
236
00:13:17,754 --> 00:13:19,594
Thank you.
237
00:13:23,754 --> 00:13:25,514
Sliding up on three.
238
00:13:25,634 --> 00:13:27,354
One, two, three.
239
00:13:27,474 --> 00:13:28,874
Thanks very much.
240
00:13:30,314 --> 00:13:32,354
Please be careful with the drips.
241
00:13:32,474 --> 00:13:35,394
Non-essential people may leave us.
242
00:13:35,514 --> 00:13:37,274
That's me, you...
243
00:13:37,434 --> 00:13:40,034
KNOCKS ON GLASS
..and you.
244
00:13:40,154 --> 00:13:41,554
That's harsh.
245
00:13:50,674 --> 00:13:52,514
Control scan.
246
00:13:54,234 --> 00:13:57,634
MOBILE RINGS
Oh, for God's sake...
247
00:13:57,794 --> 00:14:00,314
What is it? Yes to Hula Hoops,
no to Wotsits.
248
00:14:06,354 --> 00:14:08,314
Control scan complete.
249
00:14:08,434 --> 00:14:10,554
Scanning head.
250
00:14:10,714 --> 00:14:12,634
I don't care how much
make-up he's got,
251
00:14:12,794 --> 00:14:14,754
he can get changed
in the downstairs toilet.
252
00:14:15,874 --> 00:14:17,314
He's a clown.
253
00:14:18,794 --> 00:14:21,274
BRIAN: Head scan complete.
254
00:14:21,394 --> 00:14:23,074
(Sorry.)
255
00:14:23,234 --> 00:14:25,634
There's no obvious
intracranial haemorrhage.
256
00:14:28,234 --> 00:14:30,594
Nobody touch any buttons.
257
00:14:30,714 --> 00:14:32,034
BOTH: Sorry.
258
00:14:37,714 --> 00:14:40,114
Does Clive know you brought
the other consultants down
259
00:14:40,274 --> 00:14:42,074
for the trauma call?
He's fine with it.
260
00:14:43,554 --> 00:14:45,234
Clive's all right. Is he?
261
00:14:47,194 --> 00:14:48,554
Ask Lorraine.
262
00:14:48,674 --> 00:14:50,034
I don't know her.
263
00:14:50,154 --> 00:14:51,434
I do know him.
264
00:14:51,554 --> 00:14:52,794
Be careful.
265
00:14:52,914 --> 00:14:54,154
You don't know what he's like.
266
00:14:54,274 --> 00:14:55,674
Oh, come on.
267
00:14:55,834 --> 00:14:58,634
You said you wanted this
to be just about work.
268
00:14:58,794 --> 00:15:01,834
So can we focus on the patient
in front of us?
269
00:15:01,954 --> 00:15:03,194
Please?
270
00:15:04,434 --> 00:15:06,354
OK.
271
00:15:06,474 --> 00:15:08,074
Excuse me.
272
00:15:12,794 --> 00:15:15,194
I've got the VBG results.
..piss up in a brewery!
273
00:15:15,314 --> 00:15:16,354
How'd he get in here?
274
00:15:16,514 --> 00:15:18,754
Stopping scan!
He must've followed me in!
275
00:15:18,874 --> 00:15:20,114
Get him out of there!
276
00:15:20,274 --> 00:15:22,594
I'm not lying in a bed where people
try to look up my arse!
277
00:15:22,754 --> 00:15:25,114
Security to CT scanner.
Why have you got that bucket?
278
00:15:25,274 --> 00:15:27,314
Mr Devlin, you've got
to stay off this fracture!
279
00:15:27,434 --> 00:15:28,994
..haematology results will be ready,
280
00:15:29,154 --> 00:15:31,634
but I'm looking at it now,
there's nothing.
281
00:15:31,754 --> 00:15:32,914
Oh, yeah, I see it, thanks.
282
00:15:33,074 --> 00:15:34,914
Conscious patients
are a pain in the arse.
283
00:15:35,074 --> 00:15:37,994
Unpleasant, unprofessional!
Just a moment, please.
284
00:15:38,154 --> 00:15:40,914
VBG results and some from
haematology. Thank you.
285
00:15:41,034 --> 00:15:43,434
INR 4 and he's also thrombocytopenic.
286
00:15:43,554 --> 00:15:45,514
And there's a leukocytosis.
287
00:15:45,634 --> 00:15:47,434
Let's try again, shall we?
288
00:15:50,594 --> 00:15:53,554
So, apparently this is where
all the action is.
289
00:15:53,674 --> 00:15:56,234
Starting contrast run.
290
00:16:03,234 --> 00:16:05,274
The abdomen is clear.
291
00:16:05,394 --> 00:16:07,154
That's me off the hook.
292
00:16:07,314 --> 00:16:10,114
Bleep me if anything changes.
Thank you. We'll be in touch.
293
00:16:10,234 --> 00:16:11,954
Just a minute.
294
00:16:12,074 --> 00:16:13,954
There it is.
295
00:16:14,114 --> 00:16:16,474
That's an open book
pelvic fracture confirmed.
296
00:16:16,634 --> 00:16:20,954
It's a pelvic haematoma, but
there's no active extravasations.
297
00:16:21,074 --> 00:16:22,714
Thank you.
298
00:16:22,834 --> 00:16:24,194
So, how are we doing?
299
00:16:24,354 --> 00:16:27,034
Well, we have a fractured pelvis
so we're going to theatre.
300
00:16:27,194 --> 00:16:29,554
I'll go prep. Nerys Merrick,
trauma nurse practitioner.
301
00:16:29,714 --> 00:16:32,554
Could you fast bleep trauma theatre?
No abdominal complications?
302
00:16:32,714 --> 00:16:36,794
No. I'm a precautionary measure.
But happy to attend.
303
00:16:36,954 --> 00:16:38,674
Glen will do a first-class job.
Mmm.
304
00:16:38,794 --> 00:16:40,194
I'd better push off.
305
00:16:42,114 --> 00:16:43,874
Can we get ready for theatre, please?
306
00:16:43,994 --> 00:16:45,434
Can I get 30 seconds?
307
00:16:45,554 --> 00:16:47,514
Absolutely.
308
00:17:00,114 --> 00:17:02,674
Mrs Murkherjee from Cardiothoracics
has been complaining
309
00:17:02,834 --> 00:17:05,314
to her line manager
about the new policy.
310
00:17:05,474 --> 00:17:08,394
Now he's phoned me and I've told him
there is no new policy.
311
00:17:08,554 --> 00:17:10,914
I just asked for Gen, Surg
and Cardiothoracics
312
00:17:11,074 --> 00:17:13,114
to routinely attend
all major trauma calls.
313
00:17:13,234 --> 00:17:14,874
Yeah, so I see.
314
00:17:14,994 --> 00:17:16,354
You didn't run it past me?
315
00:17:17,514 --> 00:17:20,194
We could wait months
for a rubber stamp,
316
00:17:20,354 --> 00:17:23,194
or we implement it
and we start saving lives now.
317
00:17:23,314 --> 00:17:24,754
I know where you're coming from.
318
00:17:24,914 --> 00:17:27,474
But this is the stuff
of nightmarish hospital politics
319
00:17:27,634 --> 00:17:30,034
and it's best left to me.
Just seems obvious.
320
00:17:30,154 --> 00:17:31,594
Doesn't it?
321
00:17:33,794 --> 00:17:36,474
Look, I'll handle it
this time, but, er...
322
00:17:36,594 --> 00:17:38,594
next time, talk to me.
323
00:17:38,714 --> 00:17:40,154
You know where I am.
324
00:17:46,114 --> 00:17:47,674
Mr Boyle, before you go,
325
00:17:47,834 --> 00:17:50,274
I have an admin query
for our files, about your CV.
326
00:17:50,394 --> 00:17:52,034
We're having difficulty verifying
327
00:17:52,194 --> 00:17:53,954
your dates of deployment
in Camp Bastion.
328
00:17:54,114 --> 00:17:56,074
Oh, I really don't
have time for this.
329
00:17:56,234 --> 00:17:58,354
Did you come straight to us
from active service?
330
00:17:58,474 --> 00:18:00,154
Glen, we need you in here.
331
00:18:00,314 --> 00:18:03,634
Whatever it says on the form.
Sorry, dying man waiting for me.
332
00:18:05,994 --> 00:18:07,754
He's sweating buckets.
333
00:18:07,914 --> 00:18:10,234
Check his temperature again, please.
Yep.
334
00:18:15,234 --> 00:18:16,594
Up to 40.
335
00:18:16,714 --> 00:18:18,514
He looks flushed. Face and neck.
336
00:18:18,674 --> 00:18:21,994
Pulse 114, BP 86 over 56.
That's still low.
337
00:18:22,114 --> 00:18:23,634
I've ordered more Pack B bloods,
338
00:18:23,794 --> 00:18:26,034
but I'm not sure if he's
responding to blood or fluids.
339
00:18:26,154 --> 00:18:27,554
High temp, low BP.
340
00:18:27,714 --> 00:18:30,274
We need to get him open
and deal with the haematoma ASAP.
341
00:18:30,434 --> 00:18:32,394
It may not be the cause
of his problems. OK.
342
00:18:32,554 --> 00:18:34,714
I think we need further
investigations. I agree.
343
00:18:34,874 --> 00:18:36,634
Police update.
What have you got for us?
344
00:18:36,794 --> 00:18:39,234
I passed on the information
about the unusual branding marks
345
00:18:39,394 --> 00:18:41,274
on the patient's arm.
And what did they say?
346
00:18:41,434 --> 00:18:45,034
Well, it can be characteristic
of trafficking from East Africa.
347
00:18:45,154 --> 00:18:46,994
A mark of ownership. OK...
348
00:18:47,154 --> 00:18:50,194
People get brought over for
slave labour, often in agriculture.
349
00:18:50,354 --> 00:18:53,234
So someone's exploited this guy
and then they tried to kill him?
350
00:18:55,674 --> 00:18:57,594
We don't know how long
he's been in the country.
351
00:18:57,754 --> 00:19:00,514
The police are anxious for any news.
Tell them they're in the loop.
352
00:19:00,674 --> 00:19:03,354
And if anything comes up about his
ID... You'll be the first to know.
353
00:19:03,514 --> 00:19:06,194
Thank you. We shouldn't rule out
an imported existing condition.
354
00:19:06,354 --> 00:19:09,274
I think we need to get him back into
resus. The fracture is the priority.
355
00:19:09,434 --> 00:19:11,314
This patient needs to go
to theatre now.
356
00:19:11,474 --> 00:19:14,474
We'll put an ex-fix over his pelvis
and see how he responds.
357
00:19:14,634 --> 00:19:18,194
If he's unstable, then we'll need to
pack the pelvis. OK then, let's go.
358
00:19:25,994 --> 00:19:29,034
Oh, no, you pissing don't,
you minges!
359
00:19:29,194 --> 00:19:32,394
Mr Devlin, I thought we'd sorted
this. Can you step aside, please?
360
00:19:32,514 --> 00:19:33,954
That's what you want.
361
00:19:34,114 --> 00:19:36,634
Come on! That is enough, you've
got to watch that fracture!
362
00:19:36,794 --> 00:19:39,714
Mr Devlin, this isn't
helping anyone. Up yours!
363
00:19:39,834 --> 00:19:41,634
SICKENING CRUNCH
364
00:19:43,354 --> 00:19:45,794
Your problem, Harry.
Let's move around him.
365
00:19:45,954 --> 00:19:48,994
Just stay still, Mr Devlin.
It's all right.
366
00:19:50,074 --> 00:19:52,394
Cheers, Nerys.
367
00:19:52,514 --> 00:19:54,154
What's all that?
368
00:19:54,274 --> 00:19:55,914
Gin-breath man.
369
00:19:56,034 --> 00:19:57,954
Twat. Right, let's take him through.
370
00:19:58,074 --> 00:19:59,594
It's changing.
371
00:20:04,194 --> 00:20:05,994
Lesions are becoming confluent.
372
00:20:07,914 --> 00:20:09,994
And the rash on his arm
is looking purpuric.
373
00:20:11,714 --> 00:20:14,834
Pulse 114, BP 86 over 56.
374
00:20:14,994 --> 00:20:16,994
Can we lift him up
to look at his back?
375
00:20:17,114 --> 00:20:19,074
No more than 20 degrees. OK.
376
00:20:24,674 --> 00:20:26,034
We're rolling on three.
377
00:20:26,154 --> 00:20:27,834
One, two, three.
378
00:20:34,274 --> 00:20:36,554
Thank you. Back on three.
One, two, three.
379
00:20:38,234 --> 00:20:40,114
It's spreading very fast.
380
00:20:40,274 --> 00:20:42,474
Right, they're ready
to get him on the table.
381
00:20:42,594 --> 00:20:44,154
No, can we just wait a moment?
382
00:20:50,554 --> 00:20:52,154
Everybody take a step back.
383
00:20:56,074 --> 00:20:57,634
Let's check his eyes.
384
00:21:06,354 --> 00:21:08,554
He's bleeding in the sclera.
385
00:21:08,674 --> 00:21:10,714
So if he's recently arrived...
386
00:21:10,874 --> 00:21:12,914
I've got a house full of kids
this afternoon.
387
00:21:13,034 --> 00:21:14,754
We need to call a microbiologist.
388
00:21:14,874 --> 00:21:16,514
We need them here right away.
389
00:21:16,634 --> 00:21:18,314
You think it's a haemorrhagic virus?
390
00:21:18,434 --> 00:21:19,834
What's the procedure?
391
00:21:21,554 --> 00:21:23,434
This is Mrs Hicklin.
392
00:21:23,554 --> 00:21:25,954
We need full barrier precautions.
393
00:21:26,114 --> 00:21:28,634
With immediate effect,
we're in lockdown.
394
00:21:42,134 --> 00:21:45,214
The on-call microbiologist -
put me through, please.
395
00:21:48,134 --> 00:21:51,774
I need to know where we stand on
the possible haemorrhagic virus -
396
00:21:51,894 --> 00:21:54,014
what our risk of infection is.
397
00:21:54,134 --> 00:21:56,174
And the expert will tell us.
398
00:21:56,334 --> 00:21:59,934
But right now, you need to
operate on his pelvis. OK?
399
00:22:00,054 --> 00:22:02,894
Trauma theatre. This is urgent!
400
00:22:03,014 --> 00:22:06,014
Dr Howe? Where is he?
401
00:22:06,134 --> 00:22:08,574
Yes, I do, immediately, please!
402
00:22:10,294 --> 00:22:13,134
The microbiologist
serves three different centres.
403
00:22:13,254 --> 00:22:14,694
He's at a different hospital.
404
00:22:14,854 --> 00:22:17,214
That could be 60 minutes plus.
Well, we're not waiting.
405
00:22:17,334 --> 00:22:18,974
Dr Howe is Wes Howe, isn't he?
406
00:22:19,134 --> 00:22:21,134
That's what the technician
called him.
407
00:22:21,254 --> 00:22:22,774
Justin's friendly with Wes.
408
00:22:23,854 --> 00:22:25,254
OK.
409
00:22:25,374 --> 00:22:26,774
I'll find Justin.
410
00:22:29,814 --> 00:22:32,454
TANNOY: 'You have entered
an infection control area.
411
00:22:32,614 --> 00:22:34,774
'Strictly authorised
personnel only.'
412
00:22:38,854 --> 00:22:41,054
Have you seen Justin? No.
413
00:22:52,894 --> 00:22:55,294
So in the light of a possible
haemorrhagic virus,
414
00:22:55,454 --> 00:22:57,814
surgery is a clear
health and safety issue.
415
00:22:59,654 --> 00:23:01,254
I'm not willing to participate.
416
00:23:01,414 --> 00:23:03,654
But you've got two hours
left on your shift!
417
00:23:03,814 --> 00:23:05,814
I'll catch up with some
admin off site.
418
00:23:05,934 --> 00:23:07,854
Rebecca, where are you going?
419
00:23:08,014 --> 00:23:10,254
Look, Giles will inform
my department superior.
420
00:23:10,374 --> 00:23:11,814
He'll get you a substitute.
421
00:23:11,974 --> 00:23:14,214
We're just about to start
the operation.
422
00:23:14,334 --> 00:23:17,534
I can't take the risk. Not with kids.
423
00:23:17,694 --> 00:23:20,054
Look, I understand where
you're coming from, I...
424
00:23:20,214 --> 00:23:23,774
No offence, but you don't.
I'm sorry.
425
00:23:23,894 --> 00:23:25,054
Mrs Osgood...
426
00:23:27,694 --> 00:23:29,494
I'll call upstairs.
427
00:23:29,614 --> 00:23:31,254
Have you seen Justin?
428
00:23:39,014 --> 00:23:41,894
Justin? Do you know Wes Howe?
429
00:23:42,014 --> 00:23:43,494
What?
430
00:23:43,654 --> 00:23:46,414
Look, we're just into
the same music. Wes is...
431
00:23:46,534 --> 00:23:48,734
It doesn't matter. We need a favour.
432
00:23:48,894 --> 00:23:52,174
We urgently need a clinical picture
for the trauma patient.
433
00:23:52,294 --> 00:23:54,294
Can you call Wes? Please?
434
00:23:54,414 --> 00:23:56,214
Yeah, OK. Thank you.
435
00:24:00,534 --> 00:24:02,574
We're an orthopod short.
436
00:24:02,734 --> 00:24:05,854
Tell me you're joking. The part-timer
just became a no-timer.
437
00:24:05,974 --> 00:24:07,374
Oh, great(!)
438
00:24:07,494 --> 00:24:09,174
So, how long for a replacement?
439
00:24:09,334 --> 00:24:12,374
Calls have been made.
Do we postpone?
440
00:24:12,494 --> 00:24:14,214
No time. No choice.
441
00:24:14,334 --> 00:24:16,254
He needs this ex-fix immediately.
442
00:24:16,374 --> 00:24:17,854
This is life-saving.
443
00:24:22,014 --> 00:24:24,174
He needs us to start now.
Where's Rebecca?
444
00:24:24,294 --> 00:24:26,214
We will be proceeding without her.
445
00:24:26,334 --> 00:24:28,054
Yummy Mummies who you can't sack.
446
00:24:29,214 --> 00:24:33,054
I need a pelvic external fixator
seven and a major O tray, please.
447
00:24:33,174 --> 00:24:34,374
Let's do the WHO.
448
00:24:34,534 --> 00:24:36,614
I'm Glen Boyle.
I'm the trauma consultant.
449
00:24:36,734 --> 00:24:38,294
Fiona Lomas, trauma fellow.
450
00:24:38,454 --> 00:24:40,734
Ramakrishna Chandramohan,
anaesthetics registrar.
451
00:24:40,854 --> 00:24:42,694
Billy Finlay, anaesthetic ODP.
452
00:24:42,814 --> 00:24:44,654
Debbie Wong, theatre scrub nurse.
453
00:24:44,774 --> 00:24:46,254
Heather Dooley, staff nurse.
454
00:24:46,374 --> 00:24:47,974
Jason Marshall, staff nurse.
455
00:24:48,094 --> 00:24:49,814
Shelley Imms, radiographer.
456
00:24:49,974 --> 00:24:52,054
Bruce Corby,
rapid infuser operator.
457
00:24:52,214 --> 00:24:56,214
Patient's name is Mike Oscar.
Date of birth 1/1/1900.
458
00:24:56,334 --> 00:24:58,174
The patient has an unknown infection
459
00:24:58,334 --> 00:25:00,654
that may or may not be
a haemorrhagic virus.
460
00:25:00,774 --> 00:25:02,334
We have all been exposed.
461
00:25:02,494 --> 00:25:04,934
But if there's anyone else here
who feels they can't take part
462
00:25:05,094 --> 00:25:07,574
in this operation
and they need to leave,
463
00:25:07,694 --> 00:25:09,254
you should do so now.
464
00:25:14,574 --> 00:25:16,174
Thank you.
465
00:25:16,294 --> 00:25:17,894
Drapes, please.
466
00:25:18,054 --> 00:25:22,054
This operation is to perform an
external fixation of the pelvis
467
00:25:22,214 --> 00:25:25,094
for which I have signed
a consent form four.
468
00:25:25,254 --> 00:25:29,494
The patient has been given one gram
of tranexamic acid in resus.
469
00:25:29,654 --> 00:25:33,534
The critical step in the operation
will be the placing of the ex-fix.
470
00:25:33,654 --> 00:25:35,134
There should be minimal blood loss,
471
00:25:35,294 --> 00:25:38,294
but if the patient is still
unstable, he'll need packing.
472
00:25:38,454 --> 00:25:40,894
He's got no urine output,
so I am going to put in a vascath
473
00:25:41,054 --> 00:25:42,734
which I can use as
a volume line afterward.
474
00:25:42,894 --> 00:25:44,974
He's been transfused blood
and blood products.
475
00:25:45,134 --> 00:25:47,534
And we are expecting
crossmatch from Blood Bank.
476
00:25:47,654 --> 00:25:49,494
I've got Dr Howe on Skype.
477
00:25:49,654 --> 00:25:52,494
Thank you. Put on a hat
and come through.
478
00:25:52,654 --> 00:25:55,134
Can we try and patch him up
to one of the monitors, please?
479
00:25:55,254 --> 00:25:56,614
Yep.
480
00:26:04,654 --> 00:26:06,494
My name is Fiona Lomas.
481
00:26:06,614 --> 00:26:08,214
Do you know where we're at, Dr Howe?
482
00:26:08,374 --> 00:26:10,534
Wes. Mrs Hicklin has given me
the basics.
483
00:26:10,694 --> 00:26:12,774
Apologies for the virtual presence,
I'm off site.
484
00:26:12,934 --> 00:26:15,254
It would be really great
to get your take.
485
00:26:15,374 --> 00:26:17,014
Let me have a look at the rash.
486
00:26:22,134 --> 00:26:23,894
It's evolving quickly.
487
00:26:24,014 --> 00:26:25,334
Closer, please.
488
00:26:29,374 --> 00:26:31,414
OK, yep.
489
00:26:31,574 --> 00:26:35,294
Patient is shocked, has leukocytosis
and thrombocytopenia.
490
00:26:35,454 --> 00:26:37,494
OK. Can I see the teg?
Yeah, it should be up now.
491
00:26:39,894 --> 00:26:42,134
Yeah.
492
00:26:42,254 --> 00:26:44,214
OK, Fiona? Yes?
493
00:26:44,374 --> 00:26:46,254
Have you taken barrier precautions?
Yes. Good.
494
00:26:46,414 --> 00:26:48,374
Worst case scenario,
it's a haemorrhagic virus.
495
00:26:48,534 --> 00:26:50,774
Could be a staph sepsis
or pneumococcus.
496
00:26:50,894 --> 00:26:52,574
I can short cut with a sample.
497
00:26:52,694 --> 00:26:53,974
OK, what do you need?
498
00:26:54,134 --> 00:26:57,174
I need you to scrape a skin lesion
with the point of a sterile needle
499
00:26:57,334 --> 00:26:59,614
until blood starts to appear,
then blot the blood
500
00:26:59,774 --> 00:27:01,974
onto a microscopic slide
and allow it to dry.
501
00:27:02,094 --> 00:27:03,734
Sterile needle and slide, please.
502
00:27:03,894 --> 00:27:06,334
We've got slides. Thank you.
Get it straight up to the lab
503
00:27:06,494 --> 00:27:09,574
and I'll process it as soon as I get
there. What else should we be doing?
504
00:27:09,734 --> 00:27:12,454
Usual supportive measures.
Give him ceftriaxone
505
00:27:12,574 --> 00:27:14,174
and two grams IV stat.
506
00:27:14,294 --> 00:27:16,054
And I can't be sure what it is yet,
507
00:27:16,214 --> 00:27:18,374
so give him a slug
of vancomycin as well.
508
00:27:18,534 --> 00:27:20,974
Let's get two grams
ceftriaxone IV stat
509
00:27:21,094 --> 00:27:23,494
and one gram vancomycin IV, please.
510
00:27:23,654 --> 00:27:26,094
What about fluids? Fluids as usual.
Keep them coming.
511
00:27:26,214 --> 00:27:27,534
Same with the blood products.
512
00:27:27,694 --> 00:27:30,734
But we will need to start inotropes
if fluids don't pick things up.
513
00:27:30,854 --> 00:27:32,814
Let that dry.
514
00:27:34,574 --> 00:27:38,054
Which personnel should we list
for prophylactic antibiotics?
515
00:27:38,174 --> 00:27:39,414
Sorry, I didn't catch that.
516
00:27:39,574 --> 00:27:41,694
Who else needs
prophylactic antibiotics?
517
00:27:41,854 --> 00:27:44,254
Anyone exposed to body fluids
or aerosols directly
518
00:27:44,414 --> 00:27:46,894
who wasn't wearing personal
protection equipment.
519
00:27:47,054 --> 00:27:50,014
Give them ciprofloxacin,
500 milligrams. One dose.
520
00:27:50,134 --> 00:27:51,814
Not perfect, but it helps.
521
00:27:51,934 --> 00:27:53,734
I've called the paramedics in.
522
00:27:53,894 --> 00:27:55,574
The cardiothoracic
and general surgeons
523
00:27:55,734 --> 00:27:57,854
were both exposed
to aerosols in resus.
524
00:27:57,974 --> 00:27:59,214
And Rebecca.
525
00:27:59,374 --> 00:28:01,774
I'll contact them.
Nerys will distribute the cipro.
526
00:28:01,934 --> 00:28:03,934
OK, all sounds good.
Let's see at the next stage.
527
00:28:04,094 --> 00:28:06,934
And I'll report this to the Health
Protection Unit, OK? Thank you.
528
00:28:07,094 --> 00:28:11,574
Pulse is 120, BP 80 over 60.
He's pyrexial, over 40.
529
00:28:11,694 --> 00:28:13,134
Justin.
530
00:28:13,254 --> 00:28:14,774
Hi, Wes. I'm Glen Boyle.
531
00:28:14,934 --> 00:28:18,014
The patient has a pelvic fracture
with contained haemorrhage
532
00:28:18,174 --> 00:28:20,854
requiring urgent surgery and
we were just about to get started.
533
00:28:21,014 --> 00:28:23,014
Well, the coagulopathy
means that any bleed
534
00:28:23,134 --> 00:28:24,694
could lead to exsanguination. Yep.
535
00:28:24,854 --> 00:28:27,174
Let me see what bugs I can find,
I'll get back to you, OK?
536
00:28:27,294 --> 00:28:28,694
OK. I appreciate it.
537
00:28:28,854 --> 00:28:30,894
The minute you hear
anything back from him,
538
00:28:31,054 --> 00:28:33,934
you bring the news
straight in here. Sure.
539
00:28:34,094 --> 00:28:36,934
He's burning up.
Nothing is improving it.
540
00:28:38,054 --> 00:28:40,814
OK, let's get the C-Arm in, please.
541
00:28:40,934 --> 00:28:42,454
What do you think?
542
00:28:42,574 --> 00:28:44,294
It's the ex-fix or we lose him.
543
00:28:47,294 --> 00:28:48,894
Can we arc it, please?
544
00:28:50,654 --> 00:28:51,774
That's good.
545
00:28:53,414 --> 00:28:55,414
OK to rays? Yep.
546
00:28:56,494 --> 00:28:57,814
Rays.
547
00:28:59,054 --> 00:29:01,614
BEEPING
Rays off.
548
00:29:01,734 --> 00:29:03,454
Thank you.
549
00:29:03,574 --> 00:29:04,734
Blade, please.
550
00:29:07,134 --> 00:29:09,014
KNOCKING ON WINDOW
551
00:29:09,134 --> 00:29:11,374
Glen, you got a sec? No.
552
00:29:11,494 --> 00:29:13,334
It's not Ebola, is it?
553
00:29:13,454 --> 00:29:15,094
Might be. Might not be...
554
00:29:15,254 --> 00:29:17,294
Well, I can fight most infections,
but that...
555
00:29:17,454 --> 00:29:20,454
Talk to Nerys about prophylactic
antibiotics. Now piss off, Bob.
556
00:29:22,054 --> 00:29:23,574
And focus.
557
00:29:33,974 --> 00:29:35,694
The Spencer Wells, please.
558
00:29:38,534 --> 00:29:39,934
Thank you.
559
00:29:46,374 --> 00:29:49,174
OK, I'll need a drill with a 150 pin
560
00:29:49,334 --> 00:29:51,814
and a drill sleeve, please.
Give me a hand.
561
00:29:53,094 --> 00:29:54,854
Just there.
562
00:29:54,974 --> 00:29:56,374
Thank you.
563
00:30:01,894 --> 00:30:03,814
Take a shot, please.
564
00:30:03,934 --> 00:30:05,774
Rays.
565
00:30:05,934 --> 00:30:07,774
BEEPING
Rays off.
566
00:30:07,894 --> 00:30:09,294
OK. Thank you.
567
00:30:12,494 --> 00:30:13,934
DRILLING
568
00:30:20,134 --> 00:30:22,054
Let's get the T-handle, please.
569
00:30:27,414 --> 00:30:28,694
Thank you.
570
00:30:34,494 --> 00:30:36,014
Let's have another shot.
571
00:30:36,134 --> 00:30:38,454
OK. Rays.
572
00:30:38,614 --> 00:30:40,334
BEEPING
Rays off.
573
00:30:40,454 --> 00:30:42,414
Good. I'm going to need another pin.
574
00:30:54,294 --> 00:30:56,174
OK, need you again.
575
00:30:56,294 --> 00:30:58,774
Open, just there.
576
00:30:58,894 --> 00:31:00,054
Thank you.
577
00:31:02,774 --> 00:31:04,454
Let's have another shot.
578
00:31:04,574 --> 00:31:06,134
Rays.
579
00:31:06,334 --> 00:31:08,414
BEEPING
Rays off.
580
00:31:08,534 --> 00:31:09,934
Thank you.
581
00:31:19,814 --> 00:31:22,054
Let's have the T-handle, please.
582
00:31:22,174 --> 00:31:23,654
Pulse is rising.
583
00:31:25,374 --> 00:31:26,494
BP dropping.
584
00:31:29,054 --> 00:31:30,414
Another shot.
585
00:31:30,534 --> 00:31:31,734
Rays.
586
00:31:31,854 --> 00:31:33,774
Push the Belmont, please. Yep.
587
00:31:37,694 --> 00:31:39,254
ALARM BLARES
588
00:31:39,374 --> 00:31:40,574
OK, he's crashing.
589
00:31:40,734 --> 00:31:42,934
Is it blood loss? Yes, we're
losing lots of blood fast.
590
00:31:43,094 --> 00:31:45,734
Can you see where these crossmatch
bloods have got to, please?
591
00:31:45,894 --> 00:31:48,334
OK, let's repeat the teg.
We need to open him up.
592
00:31:49,734 --> 00:31:51,174
Blood Bank?
593
00:31:51,334 --> 00:31:53,254
This is the ODP in trauma theatre.
Come on.
594
00:31:53,414 --> 00:31:56,294
We need Pack C, ASAP.
ALARM CONTINUES
595
00:32:00,214 --> 00:32:01,974
Still crashing.
596
00:32:02,134 --> 00:32:04,894
Let's prep for a full laparotomy
for PPP.
597
00:32:05,974 --> 00:32:07,494
Come on!
598
00:32:15,474 --> 00:32:18,994
BP's still very low,
his numbers are crap. Blade.
599
00:32:19,114 --> 00:32:20,554
Cutting.
600
00:32:46,634 --> 00:32:47,634
Mayo.
601
00:33:03,194 --> 00:33:04,514
Balfour, please.
602
00:33:05,794 --> 00:33:06,954
Thank you.
603
00:33:10,194 --> 00:33:11,754
Morris retractors, please.
604
00:33:16,034 --> 00:33:17,554
Suction, please.
605
00:33:20,394 --> 00:33:22,114
It's no better.
606
00:33:22,234 --> 00:33:24,114
OK, I can see the pelvic haematoma.
607
00:33:28,714 --> 00:33:30,914
Receptor, please.
608
00:33:31,034 --> 00:33:32,354
Here.
609
00:33:34,194 --> 00:33:35,594
Suction.
610
00:33:35,754 --> 00:33:38,554
I'm going to need swabs,
one at a time. Hit me.
611
00:33:41,234 --> 00:33:42,434
Hit me.
612
00:33:45,154 --> 00:33:46,314
Hit me.
613
00:33:48,034 --> 00:33:49,154
Hit me.
614
00:33:49,314 --> 00:33:50,474
GLOVE TEARS
Agh, sh...!
615
00:33:53,234 --> 00:33:54,354
Hmm...
616
00:33:56,514 --> 00:33:58,394
Glen, the glove is torn.
617
00:33:58,514 --> 00:33:59,954
It's just a nick.
618
00:34:02,074 --> 00:34:04,114
See to it.
619
00:34:04,234 --> 00:34:05,714
Gloves.
620
00:34:22,594 --> 00:34:23,874
OK to proceed?
621
00:34:27,234 --> 00:34:28,594
Hit me.
622
00:34:33,234 --> 00:34:34,914
Hit me.
623
00:34:35,034 --> 00:34:37,114
5-packs in. Any improvement?
624
00:34:37,274 --> 00:34:39,714
No. I've given him a second dose
of tranexamic acid.
625
00:34:39,834 --> 00:34:41,114
And he's still crashing.
626
00:34:43,434 --> 00:34:45,994
Bleeding is continuing
through the packs.
627
00:34:46,154 --> 00:34:50,354
We've got an active arterial bleed
in a branch of the internal iliac.
628
00:34:50,474 --> 00:34:51,754
It didn't show on the CT scan.
629
00:34:51,914 --> 00:34:53,794
It must've blown off a clot.
It's a rupture.
630
00:34:53,954 --> 00:34:55,994
Push the Belmont.
I'm going to need to ligate.
631
00:34:56,154 --> 00:34:58,234
Get some suction in here, please.
New teg.
632
00:34:58,354 --> 00:34:59,674
Should be on the system.
633
00:34:59,794 --> 00:35:01,314
Let's see it.
634
00:35:01,474 --> 00:35:04,114
That's the previous one.
The new one... Lahey.
635
00:35:04,234 --> 00:35:05,834
Old, new.
636
00:35:06,994 --> 00:35:09,514
Old, new.
637
00:35:11,114 --> 00:35:12,954
He's doing really well(!)
638
00:35:13,074 --> 00:35:14,594
So much more deranged.
639
00:35:14,714 --> 00:35:17,074
2.0 Vicryl, please. BP still falling.
640
00:35:17,234 --> 00:35:19,514
We need to reverse
this man's coagulopathy,
641
00:35:19,674 --> 00:35:22,314
otherwise he's going to bleed out
very, very quickly.
642
00:35:22,434 --> 00:35:24,354
He needs cryo, platelets and FFP.
643
00:35:24,474 --> 00:35:25,954
They're in Pack C.
644
00:35:27,314 --> 00:35:28,834
It's not here yet.
645
00:35:28,954 --> 00:35:30,394
Where the hell is Pack C?!
646
00:35:36,994 --> 00:35:39,914
Blood Bank, please.
647
00:35:40,074 --> 00:35:42,434
Yes, this is the ODP
in the trauma theatre again.
648
00:35:42,554 --> 00:35:44,154
We're still waiting for Pack C!
649
00:35:46,034 --> 00:35:47,394
They're refusing to bring it.
650
00:35:47,554 --> 00:35:49,594
They're waiting for advice
from their line manager
651
00:35:49,754 --> 00:35:52,114
on whether to go near
an infection area. You're joking.
652
00:35:52,274 --> 00:35:55,154
Tell them you'll meet them
at the infection barrier.
653
00:36:03,874 --> 00:36:07,554
TANNOY: The trauma department
is an infection control area.
654
00:36:07,674 --> 00:36:09,634
Strictly authorised personnel only.
655
00:36:24,114 --> 00:36:25,674
Do you want me to sign for it?
656
00:36:27,354 --> 00:36:28,834
Knobhead.
657
00:36:28,954 --> 00:36:30,474
Suction, please, and packs.
658
00:36:33,474 --> 00:36:35,394
Got it. Well done. Hit me.
659
00:36:38,834 --> 00:36:41,794
I'm your orthopod consultant,
Joseph Whitnell.
660
00:36:41,954 --> 00:36:44,594
Substitute for the reluctant
Mrs Osgood.
661
00:36:44,754 --> 00:36:47,114
We've abandoned the ex-fix
at the moment.
662
00:36:47,274 --> 00:36:50,034
We've got an internal iliac bleed
and some other issues.
663
00:36:50,194 --> 00:36:51,994
I'll come through.
Oh, no, listen, Joseph.
664
00:36:52,114 --> 00:36:53,234
We've got a pathogen in here
665
00:36:53,394 --> 00:36:55,474
and there's no point
in exposing anyone else to it.
666
00:36:55,634 --> 00:36:58,274
We'll need to fix the fracture.
I'll take full precautions.
667
00:37:00,314 --> 00:37:01,914
Microbiology results.
668
00:37:02,034 --> 00:37:03,554
Come on through.
669
00:37:10,874 --> 00:37:12,194
What can you tell us, Wes?
670
00:37:12,314 --> 00:37:13,754
OK, so I found the bugs.
671
00:37:13,914 --> 00:37:15,754
Good news, ruled out
a haemorrhagic virus.
672
00:37:15,874 --> 00:37:17,314
It's only meningococcal sepsis.
673
00:37:18,554 --> 00:37:20,954
Great news.
But we should treat this seriously.
674
00:37:21,074 --> 00:37:23,314
Continue ceftriaxone, two grams BD.
675
00:37:23,474 --> 00:37:26,794
And make sure that someone is
getting those prophylaxis sorted.
676
00:37:26,954 --> 00:37:30,074
Once you're done, get him up to ITU
and I'll be there as soon as I can.
677
00:37:30,194 --> 00:37:32,234
OK? OK. Scissors.
678
00:37:32,354 --> 00:37:33,914
Ligation is completed.
679
00:37:34,074 --> 00:37:36,034
Seems as if the bleeding
is under control.
680
00:37:36,154 --> 00:37:37,394
Pulse rate 110.
681
00:37:37,554 --> 00:37:40,394
Large swabs, please.
Thank you, Wes. Yep.
682
00:37:40,514 --> 00:37:42,434
Thanks for doing that. No problem.
683
00:37:42,554 --> 00:37:44,554
Give me the Robinson tube.
684
00:37:44,674 --> 00:37:46,354
Numbers are improving slowly.
685
00:37:47,874 --> 00:37:49,314
Give me a Spencer, please.
686
00:37:50,834 --> 00:37:53,034
Systolic up to 100. Come on.
687
00:37:53,154 --> 00:37:54,994
That's it, my friend.
688
00:37:55,154 --> 00:37:58,394
I think the coagulopathy is being
corrected by the blood products.
689
00:37:58,514 --> 00:37:59,794
Morris out.
690
00:38:02,274 --> 00:38:03,354
ALARM STOPS
691
00:38:05,194 --> 00:38:06,554
He's stabilising.
692
00:38:07,874 --> 00:38:09,234
Piece of piss, this game.
693
00:38:09,354 --> 00:38:11,394
That's terrific news.
694
00:38:11,514 --> 00:38:12,994
I'll finish the ex-fix for you.
695
00:38:13,154 --> 00:38:17,314
Yeah, I'll just go and organise
a side room in ITU. Thank you.
696
00:38:17,434 --> 00:38:18,794
Listen, everyone.
697
00:38:20,314 --> 00:38:21,994
I think we got there.
698
00:38:22,114 --> 00:38:23,474
We saved him and...
699
00:38:25,234 --> 00:38:26,714
..I just wanted to say thank you.
700
00:38:29,954 --> 00:38:32,194
Hi, it's Ramakrishna
in trauma theatre.
701
00:38:32,354 --> 00:38:34,594
Can I have a side room
for Mike Oscar, please?
702
00:38:34,754 --> 00:38:37,394
JOSEPH: Can I have
the CT image on screen, please?
703
00:38:46,274 --> 00:38:47,914
That's blood.
704
00:38:49,834 --> 00:38:51,834
Is it yours or the patient's?
705
00:39:21,474 --> 00:39:23,194
Is it cut?
706
00:39:26,554 --> 00:39:28,114
Not my blood.
707
00:39:31,114 --> 00:39:32,634
We get a result?
708
00:39:33,994 --> 00:39:35,474
Yes, he's come through it.
709
00:39:38,114 --> 00:39:40,754
Pre the diagnosis,
we had to take both the general
710
00:39:40,914 --> 00:39:44,154
and cardiothoracic consultants
temporarily off duty,
711
00:39:44,274 --> 00:39:46,154
down to possible exposure.
712
00:39:46,274 --> 00:39:47,954
They both missed their clinics.
713
00:39:48,114 --> 00:39:50,194
That's down to unnecessary
trauma attendance.
714
00:39:50,314 --> 00:39:52,354
It's not ideal, is it?
715
00:39:52,474 --> 00:39:54,394
No, I suppose not.
716
00:39:54,554 --> 00:39:56,874
But, you know, on a case-by-case
basis, this is going...
717
00:39:57,034 --> 00:40:00,234
You've put me right in the middle
of the schedule managers.
718
00:40:01,794 --> 00:40:04,754
But the most important thing
is that the patient didn't die.
719
00:40:06,194 --> 00:40:09,874
And that's down to your intervention
and the team's hard work.
720
00:40:09,994 --> 00:40:11,194
Thanks.
721
00:40:13,394 --> 00:40:14,554
Fiona...
722
00:40:17,874 --> 00:40:19,714
..Glen's just a locum.
723
00:40:19,874 --> 00:40:21,914
He's here one day,
he's gone tomorrow.
724
00:40:23,314 --> 00:40:24,914
You know how we do things here.
725
00:40:25,034 --> 00:40:26,794
But he has a point!
726
00:40:26,914 --> 00:40:28,434
Sorry, excuse me.
727
00:40:31,314 --> 00:40:32,754
It's your career.
728
00:40:43,594 --> 00:40:44,954
So, he's doing well.
729
00:40:45,114 --> 00:40:47,154
Ramakrishna will take him
to ITU when they're done.
730
00:40:47,274 --> 00:40:49,354
I'll let Dr Howe know. Mr Boyle...
731
00:40:49,514 --> 00:40:51,234
We re-checked
the Camp Bastion dates.
732
00:40:51,394 --> 00:40:53,674
There's a three-month gap
between your deployment
733
00:40:53,794 --> 00:40:54,954
and your arrival here.
734
00:40:57,674 --> 00:40:59,034
Is there?
735
00:40:59,194 --> 00:41:01,274
For the records,
can you account for the time?
736
00:41:03,194 --> 00:41:04,954
I can, yes.
737
00:41:08,194 --> 00:41:10,474
We need to write up our notes.
738
00:41:10,594 --> 00:41:11,954
Good.
739
00:41:15,594 --> 00:41:17,074
You all right?
740
00:41:20,154 --> 00:41:21,794
Our patient will live to testify
741
00:41:21,954 --> 00:41:23,874
against the people
who did that to him.
742
00:41:25,794 --> 00:41:27,234
Very all right.
743
00:41:36,994 --> 00:41:39,354
Remember to take the...
744
00:41:39,474 --> 00:41:40,674
cipro.
745
00:41:40,794 --> 00:41:42,314
Yes.
746
00:41:42,434 --> 00:41:43,794
Thanks.
747
00:41:43,914 --> 00:41:45,714
And I wanted to apologise.
748
00:41:47,554 --> 00:41:49,874
For what?
749
00:41:50,034 --> 00:41:53,034
You've been dealing with
the hospital protocols.
750
00:41:53,154 --> 00:41:54,834
All that crap.
751
00:41:56,954 --> 00:41:58,754
And I don't want you
to feel compromised.
752
00:41:58,914 --> 00:42:01,714
I don't want it to be
professionally difficult for you.
753
00:42:03,314 --> 00:42:04,674
But it's working.
754
00:42:06,474 --> 00:42:08,834
You're making the team a unit.
755
00:42:11,834 --> 00:42:13,474
Seems so.
756
00:42:19,114 --> 00:42:21,074
Look...
757
00:42:21,194 --> 00:42:22,954
maybe I've been a bit defensive.
758
00:42:24,674 --> 00:42:26,514
There's...
759
00:42:26,674 --> 00:42:29,194
no reason why we can't talk
to each other more.
760
00:42:31,594 --> 00:42:32,994
Good.
761
00:42:33,114 --> 00:42:34,154
BUTTON BEEPS
762
00:42:40,754 --> 00:42:44,114
I'm actually heading back
to my digs.
763
00:42:44,234 --> 00:42:45,634
Yeah.
764
00:43:01,594 --> 00:43:03,954
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765
00:43:04,074 --> 00:43:06,234
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