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Would you like to inspect the original subtitles? These are the user uploaded subtitles that are being translated: 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 Subtitles by Red Bee Media Ltd 765 00:43:04,074 --> 00:43:06,234 accessibility@bskyb.com 54900

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