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1
00:00:15,725 --> 00:00:17,885
'Trauma call,
attend emergency department.
2
00:00:18,273 --> 00:00:21,353
'Trauma call, attend emergency...'
Whoa! Sorry, Billy. Bad luck!
3
00:00:24,166 --> 00:00:26,486
Morning. Full English, please.
4
00:00:28,246 --> 00:00:31,086
'Trauma call, attend emergency...'
5
00:00:31,092 --> 00:00:33,852
That's us, Justin. Awesome!
6
00:00:48,612 --> 00:00:50,452
'Trauma call,
attend emergency department.
7
00:00:50,612 --> 00:00:52,692
'Trauma call,
attend emergency department.'
8
00:00:55,812 --> 00:00:59,212
You're all right.
We're going to take care of you.
9
00:00:59,332 --> 00:01:00,652
Stay calm.
10
00:01:23,252 --> 00:01:25,372
Sorry, early.
11
00:01:25,492 --> 00:01:28,012
Sorry... Oh, sorry.
12
00:01:31,532 --> 00:01:33,332
Hi. Morning. Morning.
13
00:01:36,652 --> 00:01:40,052
'Major trauma, ETA one minute.
Major trauma, ETA one minute.'
14
00:01:40,172 --> 00:01:41,492
Thanks, Justin.
15
00:01:49,292 --> 00:01:51,232
Thanks. Er, Harry.
16
00:01:51,282 --> 00:01:52,682
Fiona.
17
00:01:56,562 --> 00:01:58,922
6, 6.5?
18
00:01:59,042 --> 00:02:01,562
Bit harsh. Tube.
19
00:02:01,682 --> 00:02:02,882
6.5.
20
00:02:07,402 --> 00:02:09,082
Hi, everyone. Morning.
21
00:02:19,858 --> 00:02:21,458
Here we go.
22
00:02:26,237 --> 00:02:34,023
Subtitles by MemoryOnSmells
http://UKsubtitles.ru.
23
00:02:38,498 --> 00:02:39,938
'Level six.
24
00:02:41,418 --> 00:02:42,618
'Level five.
25
00:02:42,738 --> 00:02:44,298
'Level four.'
26
00:02:53,178 --> 00:02:55,058
Oh, shit!
27
00:02:55,218 --> 00:02:58,498
Shit! Let's go, let's go!
Here we go. Let's go!
28
00:02:58,618 --> 00:03:01,058
Get the door! Coming through!
29
00:03:02,578 --> 00:03:05,378
We're taking you straight through
to our resus room.
30
00:03:13,658 --> 00:03:14,778
This way.
31
00:03:16,658 --> 00:03:18,938
Starting the clock.
Ejected passenger,
32
00:03:19,058 --> 00:03:21,498
found unconscious, pulse 130 weak,
33
00:03:21,658 --> 00:03:24,658
BP 90/70.
Diminished breath sounds on the left.
34
00:03:24,818 --> 00:03:27,579
Let's move the scoop on your count.
OK, unclip top and bottom, please.
35
00:03:27,738 --> 00:03:29,898
Clear a space around him.
Oh, sorry.
36
00:03:30,058 --> 00:03:32,058
Everyone ready? Yeah.
One, two, three.
37
00:03:34,018 --> 00:03:35,418
Thank you. One, two, three.
38
00:03:36,938 --> 00:03:39,898
Great, well done. Mate,
has he got thoracostomies? No.
39
00:03:40,058 --> 00:03:42,978
Massive haematemesis,
scarlet yawn... Suction...
40
00:03:44,698 --> 00:03:46,418
One conversation at a time, please.
41
00:03:46,538 --> 00:03:47,978
Sorry. Sorry.
42
00:03:48,138 --> 00:03:51,058
OK, great. All right, mate,
all right, we're sorting you out.
43
00:03:53,578 --> 00:03:56,018
Mate, you're in the emergency
department at CGH.
44
00:03:56,178 --> 00:03:57,778
I'm Dr Chandramohan,
an anaesthetist.
45
00:03:57,938 --> 00:04:01,298
I need to look down your throat. I'm
just going to take this strap off.
46
00:04:01,418 --> 00:04:02,698
Leg support, please.
47
00:04:02,818 --> 00:04:04,658
Blocks coming off. Thanks.
48
00:04:04,818 --> 00:04:07,858
Sir, I'm just going to hold your
head to keep it still.
49
00:04:09,138 --> 00:04:10,178
Sorry I'm late.
50
00:04:11,898 --> 00:04:15,058
Nice of orthopaedics to show up.
Airway clear. Resps 30.
51
00:04:15,218 --> 00:04:18,498
Sir, my name is Fiona Lomas,
I'm the trauma registrar.
52
00:04:18,658 --> 00:04:20,618
We're going to do our best to get
you better.
53
00:04:20,778 --> 00:04:22,858
Tachypneic, decent pulses.
OK, thank you.
54
00:04:23,018 --> 00:04:26,298
OK, nice and quiet everyone while we
listen to the handover, thanks.
55
00:04:26,458 --> 00:04:29,338
Trauma Air Service arrived on the
scene at 6:45am after an RTC
56
00:04:29,458 --> 00:04:31,298
called in at 6:30am.
57
00:04:31,498 --> 00:04:34,538
Multiple vehicles involved
in a collision on the Kingsgate underpass.
58
00:04:34,698 --> 00:04:36,938
Patient was found on the roadside
after having been
59
00:04:37,058 --> 00:04:38,578
an ejected passenger from a bus.
60
00:04:38,738 --> 00:04:42,258
Multiple soft tissue injuries, lacs,
grazes, haematomas, top to toe.
61
00:04:42,418 --> 00:04:45,498
There is a lac on the interior chest
wall, left wrist is fractured,
62
00:04:45,618 --> 00:04:47,018
left tib is an open fracture.
63
00:04:47,178 --> 00:04:49,098
Diminished breath sounds
on the left.
64
00:04:49,258 --> 00:04:51,898
100% oxygen given via mask
at the scene.
65
00:04:52,058 --> 00:04:55,538
Haematemesis in the service lift
and corridor. Thank you very much.
66
00:04:55,698 --> 00:04:58,698
Can you sign off some paperwork with
Nerys? Come and sign your lives away.
67
00:05:00,138 --> 00:05:03,418
I could act as... scribe
if you'd like.
68
00:05:06,618 --> 00:05:08,338
Acch...
69
00:05:09,738 --> 00:05:12,458
Need to tube him. Fiona.
70
00:05:16,818 --> 00:05:20,258
Dullness to percussion on left side.
He needs a thoracostomy. Yeah.
71
00:05:20,418 --> 00:05:22,698
Sir, we're going to do something
to help your breathing.
72
00:05:22,858 --> 00:05:26,378
Justin, thoracostomies. Oh, right!
Trachea deviated to right.
73
00:05:26,538 --> 00:05:29,698
Loads more on the way. First of many,
apparently. Oh, great! Oh, great!
74
00:05:29,818 --> 00:05:31,738
OK, let's get him intubated.
75
00:05:33,858 --> 00:05:36,898
Oh, what now? VT. Carotid output.
76
00:05:37,018 --> 00:05:38,618
Femoral output, defibbing.
77
00:05:38,778 --> 00:05:41,538
Off the chest, please, Justin,
VT with output. All right.
78
00:05:41,698 --> 00:05:45,338
Shockable rhythm, no CPR.
Sync shock 150 joules.
79
00:05:47,578 --> 00:05:51,138
'150 joules selected.
Charging.'
80
00:05:52,818 --> 00:05:56,658
OK, everyone, clear. Oxygen away.
Away. Shocking on three.
81
00:05:56,778 --> 00:05:57,978
One, two, three.
82
00:06:00,698 --> 00:06:02,098
Still in VT.
83
00:06:03,178 --> 00:06:04,578
Output.
84
00:06:04,698 --> 00:06:06,138
Damn it!
85
00:06:06,298 --> 00:06:10,178
Charging. 'Charging.'
Shocking on three. One, two, three.
86
00:06:12,218 --> 00:06:13,658
Shit!
87
00:06:13,778 --> 00:06:15,818
Come on! Output. Charging.
88
00:06:15,978 --> 00:06:19,618
'Charging.'
Shocking on three. One, two, three.
89
00:06:23,258 --> 00:06:27,738
Sinus rhythm. Good output.
OK. We have ROSC.
90
00:06:27,858 --> 00:06:29,178
Well done. Thank you.
91
00:06:31,138 --> 00:06:32,418
Well done.
92
00:06:32,578 --> 00:06:35,978
OK, I'll do the thoracostomies
to help with his breathing.
93
00:06:36,138 --> 00:06:40,258
Give him, um, Ramakrishna?
30 of ket? Ketamine.
94
00:06:40,418 --> 00:06:43,578
OK, and I'll pause for a top-up
if he protests too much.
95
00:06:46,138 --> 00:06:49,658
There's an open tib that needs IV
Augmentin? Thank you, in a minute.
96
00:06:51,698 --> 00:06:53,578
Phones off, please.
97
00:06:53,738 --> 00:06:56,658
Mate, just going to give you
something to take the edge off.
98
00:07:02,298 --> 00:07:03,778
Can you bring me the trolley please?
99
00:07:03,938 --> 00:07:05,738
Try looking in the pockets
of her coat.
100
00:07:11,938 --> 00:07:14,618
Well, he's not protesting,
I think we're all right. Yep.
101
00:07:17,698 --> 00:07:21,298
Pulse 130, BP 80/65.
102
00:07:21,458 --> 00:07:23,698
I think he'd benefit from
some more blood. OK.
103
00:07:23,858 --> 00:07:26,258
Thank you. Constance,
could you, please? Yep.
104
00:07:26,418 --> 00:07:29,858
Let's keep a close eye on the BP,
please.
105
00:07:30,018 --> 00:07:33,578
Thank you. No response to
trap pinch. One. GCS?
106
00:07:33,698 --> 00:07:37,018
Four. Four with sedation. Sorry.
107
00:07:39,138 --> 00:07:43,498
Bilateral thoracostomy patent.
Time for drains? Sats 88.
108
00:07:43,658 --> 00:07:47,018
Prefer to get him under first.
OK. That's the lads off.
109
00:07:47,178 --> 00:07:50,898
OK, thanks, guys, have a good one.
See you next time, lads.
110
00:07:51,058 --> 00:07:53,018
I thought he was sedated?
111
00:07:53,138 --> 00:07:54,858
He was. He was.
112
00:07:54,978 --> 00:07:56,658
Suction. OK.
113
00:07:59,978 --> 00:08:02,498
Need to RSI, Billy.
Yeah, I'm on it, I'm on it.
114
00:08:02,618 --> 00:08:04,538
OK, do it fast, please.
115
00:08:04,658 --> 00:08:06,138
BP's dropping.
116
00:08:12,938 --> 00:08:16,698
Severely hypotensive, no radial
pulse. We need to get a tube in.
117
00:08:16,858 --> 00:08:19,258
Yeah. I can't get a tube in
with the BP down this low.
118
00:08:19,418 --> 00:08:22,098
OK, blood straight away,
just squeeze it in. Justin! Quickly.
119
00:08:22,258 --> 00:08:24,498
We need to get this
blood pressure up.
120
00:08:24,658 --> 00:08:27,018
Sir, we're going to clear
your throat.
121
00:08:27,178 --> 00:08:29,458
Please try to be calm
so we can help you.
122
00:08:29,658 --> 00:08:32,858
The sats are going down,
we really need to get the tube in.
..sake, I'm trying.
123
00:08:44,736 --> 00:08:46,576
Clock's ticking,
fast as you can, please.
124
00:08:49,196 --> 00:08:50,516
I've got a radial pulse.
125
00:08:50,636 --> 00:08:52,076
OK, you've got enough pressure,
126
00:08:52,236 --> 00:08:54,476
you need to get the tube in, please.
OK, here we go.
127
00:08:55,636 --> 00:08:58,596
Are you the new SHO?
Er, yeah, everyone calls me Harry.
128
00:08:58,756 --> 00:09:00,876
OK, can you give me
inline C-spine immobilisation
129
00:09:01,036 --> 00:09:03,636
while we take the blocks off,
please?
130
00:09:03,756 --> 00:09:04,876
No, get your hands in there!
131
00:09:07,036 --> 00:09:08,196
OK. Hold tight.
132
00:09:08,316 --> 00:09:09,516
That's it.
133
00:09:09,636 --> 00:09:11,916
Ohhh... Jesus.
134
00:09:12,036 --> 00:09:13,596
You got him? Yeah.
135
00:09:13,716 --> 00:09:15,236
Ta.
136
00:09:15,356 --> 00:09:17,196
Hold tight. Yeah.
137
00:09:21,756 --> 00:09:24,516
Thiopentone, 250mg. OK.
138
00:09:24,636 --> 00:09:27,396
Thio, 250. Going in.
139
00:09:30,116 --> 00:09:32,556
Going in.
Just sending you off to sleep, mate.
140
00:09:45,596 --> 00:09:48,356
Finally, some peace and quiet.
141
00:09:48,476 --> 00:09:51,796
Sux 100, going in.
142
00:09:54,836 --> 00:09:57,156
We use sux in trauma
cos it works fast.
143
00:09:57,316 --> 00:09:59,356
That's not the only thing
around here.
144
00:10:03,636 --> 00:10:05,316
Takes a while
to paralyse the patient.
145
00:10:11,356 --> 00:10:12,756
Here we go.
146
00:10:24,836 --> 00:10:26,516
OK, yeah. Suction.
147
00:10:30,996 --> 00:10:34,036
Make sure you do ABGs and an ECG.
Yes, Dr Archerfield.
148
00:10:34,156 --> 00:10:36,876
All those staff to one patient.
149
00:10:37,036 --> 00:10:39,236
No, that's a trauma call,
critical injuries.
150
00:10:39,356 --> 00:10:41,516
It's madness.
151
00:10:45,276 --> 00:10:47,316
This guy feels cold.
Did we get a temperature?
152
00:10:47,476 --> 00:10:50,596
Not that anyone's given me.
How long till they scooped him?
153
00:10:50,756 --> 00:10:53,676
They were there in 15 minutes,
scooped after 25.
154
00:10:53,796 --> 00:10:56,276
Carotid core, 36.1.
155
00:10:56,436 --> 00:10:58,996
Yeah, he's cold for someone
they scooped inside 30 minutes.
156
00:10:59,116 --> 00:11:01,876
15 and 25 is 40. 40 minutes then.
157
00:11:02,036 --> 00:11:04,796
How much blood is left in the
fridge? We're down to three bags.
158
00:11:13,636 --> 00:11:16,956
Intrathoracic haemorrhage,
get me a swab, please.
159
00:11:18,076 --> 00:11:21,356
OK, here we go. I'm calling a code.
We need more blood. Another Venflon?
160
00:11:21,516 --> 00:11:24,196
Yes, and a trauma line.
I can do Venflon.
161
00:11:24,356 --> 00:11:28,636
Sister Merrick, resus, we're coding.
Tranexamic acid, please. Coming up.
162
00:11:28,796 --> 00:11:31,756
Let's stop this haemorrhage.
Major transfusion protocol.
163
00:11:31,916 --> 00:11:34,116
No, no, don't put me
through to blood bank.
164
00:11:34,276 --> 00:11:36,556
Oh, I know you don't need me
to say this, everyone,
165
00:11:36,676 --> 00:11:38,076
but nice and fast, please.
166
00:11:38,196 --> 00:11:39,316
Crosscheck.
167
00:11:39,476 --> 00:11:41,676
O pos, dated and checked.
Crosschecked.
168
00:11:43,796 --> 00:11:45,356
No, I know, I'm still holding.
169
00:11:50,303 --> 00:11:54,583
Two units of O pos remaining.
TXA, 1g IV, 1g infusion to follow.
170
00:11:54,703 --> 00:11:56,223
Yes, this is Mrs Rappaport,
171
00:11:56,383 --> 00:11:58,863
I'm the consultant on call
for major trauma
172
00:11:59,023 --> 00:12:02,103
and we have just enacted
the major transfusion protocol.
173
00:12:02,263 --> 00:12:05,583
You send us 12 units
of O positive immediately.
174
00:12:05,703 --> 00:12:08,143
Eight of FFP and four of platelets.
175
00:12:08,263 --> 00:12:10,663
'Do you have authorisation?' What?
176
00:12:10,823 --> 00:12:14,183
I make that the third unit of blood
now. One unit of O pos.
177
00:12:14,303 --> 00:12:16,183
OK, then, please put me through.
178
00:12:16,303 --> 00:12:18,143
No, thank you!
179
00:12:18,303 --> 00:12:21,903
Let's put the next unit of O pos
through the trauma line
180
00:12:22,063 --> 00:12:24,103
and pressure on
the thoracostomy bleed.
181
00:12:24,223 --> 00:12:25,743
Harry, pressure, please.
182
00:12:31,023 --> 00:12:33,583
OK, let's take bloods as I do
the trauma line.
183
00:12:38,143 --> 00:12:41,903
Oh, hi, yes, this is Lorraine
Rappaport, consultant on call...
184
00:12:42,063 --> 00:12:44,303
Let's have another bag of O pos
from the store, please.
185
00:12:44,463 --> 00:12:47,703
We have a major trauma patient in
recess and blood bank won't enact
186
00:12:47,863 --> 00:12:50,903
the major transfusion protocol
without your say-so.
187
00:12:51,063 --> 00:12:53,703
No, we haven't measured
the patient's Hb,
188
00:12:53,863 --> 00:12:56,463
and if we did, it would be normal
because the concentration
189
00:12:56,623 --> 00:12:59,023
of haemoglobin in his blood
won't have changed.
190
00:12:59,183 --> 00:13:01,983
But what has changed is he has
a lot less blood circulating
191
00:13:02,143 --> 00:13:06,423
than he did half an hour ago. And if
we don't transfuse him, he will die.
192
00:13:06,543 --> 00:13:08,423
Excuse me... Thank you.
193
00:13:10,183 --> 00:13:11,583
Sorry...
194
00:13:25,983 --> 00:13:27,783
Sorry! Yes.
195
00:13:27,943 --> 00:13:31,263
This thoracostomy's
really bleeding. He's bleeding out.
196
00:13:32,623 --> 00:13:34,263
We need more blood, we're losing him.
197
00:13:34,423 --> 00:13:36,463
What the hell's going on
in this guy's chest?
198
00:13:36,623 --> 00:13:39,703
We need someone to do a chest drain,
please. Me.
199
00:13:39,863 --> 00:13:42,703
We have a volunteer.
Justin, get on that bleed now.
200
00:13:45,343 --> 00:13:49,023
Swap gloves, eye guards, gown. I want
you ready to go in two minutes.
201
00:13:57,623 --> 00:13:59,383
Billy, where are those blood gases?
202
00:14:01,423 --> 00:14:05,503
PaO2, 5.3.
PaCO2, 4.5.
203
00:14:05,623 --> 00:14:08,343
PH, 7.1. Lactate, 8.
204
00:14:08,463 --> 00:14:09,983
Base excess, -6.
205
00:14:10,103 --> 00:14:11,223
Thank you.
206
00:14:11,343 --> 00:14:13,343
Airway secure. Patient ventilated.
207
00:14:13,463 --> 00:14:15,103
O pos transfusing, bloods away,
208
00:14:15,263 --> 00:14:17,703
patient maintaining sats
and blood pressure.
209
00:14:17,863 --> 00:14:21,583
Anything outstanding? Anaesthetists,
happy? Over the moon. Good.
210
00:14:21,703 --> 00:14:25,063
Elapsed time, 11 minutes 30.
211
00:14:25,183 --> 00:14:26,503
BP's down.
212
00:14:28,503 --> 00:14:31,903
Keep squeezing the blood in, please.
That's it through now. Thank you.
213
00:14:32,063 --> 00:14:34,903
You've got to start that chest drain
now, please.
214
00:14:36,783 --> 00:14:42,583
This an RTA? First of multiple
casualties. Is that me done?
215
00:14:42,703 --> 00:14:45,103
I thought trauma was mainly RTAs?
216
00:14:45,263 --> 00:14:48,023
Why are you doing the drain?
You're the new SHO.
217
00:14:48,143 --> 00:14:49,863
Yeah, everyone calls me Harry.
218
00:14:50,023 --> 00:14:52,383
I'm Mrs Hicklin,
everyone calls me Mrs Hicklin.
219
00:14:53,663 --> 00:14:57,463
I'm Ramakrishna. Yeah, it's mainly
car crashes and stabbings. Thanks.
220
00:14:59,143 --> 00:15:01,423
There's a bit of resistance. Push.
221
00:15:01,543 --> 00:15:03,023
Cardiac kebab, here we come.
222
00:15:03,143 --> 00:15:04,663
Just push.
223
00:15:04,783 --> 00:15:06,263
Ugh!
224
00:15:06,383 --> 00:15:08,903
Ooh, God! Oh, OK. Is that good?
225
00:15:09,063 --> 00:15:12,583
Yes, yes, that's exactly what
we expect. Suture it, please.
226
00:15:12,703 --> 00:15:13,763
Er, yes.
227
00:15:13,823 --> 00:15:16,623
Can someone please phone ahead to CT,
let them know we're on our way?
228
00:15:16,783 --> 00:15:19,623
And blood bank will be delivering
some blood very soon.
229
00:15:19,783 --> 00:15:22,463
If they're not here in the next two
minutes, we need to chase them.
230
00:15:22,583 --> 00:15:24,463
I'll call CT and blood bank.
231
00:15:26,223 --> 00:15:27,823
Is this anyone's Twix?
232
00:15:30,863 --> 00:15:35,063
Are we getting x-rays for the wrist
and tibia? Wait for the CT.
233
00:15:35,183 --> 00:15:36,703
Yeah, sorry. Um...
234
00:15:36,863 --> 00:15:40,423
I could reduce the tibia now?
Sure. OK.
235
00:15:40,583 --> 00:15:46,423
Shall we replace the TXA infusion?
Oh, yes, of course, yes, thank you.
236
00:16:08,423 --> 00:16:10,143
Justin, can you expose the leg,
please?
237
00:16:13,063 --> 00:16:14,823
Just a sec.
238
00:16:14,983 --> 00:16:16,943
Cheers. Prick.
239
00:16:17,063 --> 00:16:18,703
Nice one.
240
00:16:19,823 --> 00:16:21,383
Traction?
241
00:16:23,023 --> 00:16:25,263
Yes, this is Mrs Hicklin.
242
00:16:25,423 --> 00:16:29,223
We'll be bringing major trauma,
Mike Alpha, for CT, very shortly.
243
00:16:29,343 --> 00:16:30,743
Will you be ready for us?
244
00:16:30,863 --> 00:16:32,023
Good.
245
00:16:32,143 --> 00:16:33,663
Thank you.
246
00:16:34,783 --> 00:16:37,623
O positive, FFP
and platelets for Mike Alpha.
247
00:16:37,783 --> 00:16:41,663
Great. let's get a couple of bags
of this O pos up immediately, please.
248
00:16:41,783 --> 00:16:43,663
Patient Mike Alpha. O positive.
249
00:16:43,783 --> 00:16:46,103
Has anyone seen my cardie?
250
00:16:46,223 --> 00:16:47,943
And a Twix?
251
00:16:51,663 --> 00:16:53,383
Sorry.
252
00:16:53,543 --> 00:16:56,743
OK, soon as the blood's up,
transfer to CT.
253
00:16:56,863 --> 00:16:58,303
You can leave that.
254
00:17:03,343 --> 00:17:07,103
Nerys, this TXA is ready to go up.
Yep, course.
255
00:17:11,583 --> 00:17:13,383
I'm so sorry that's taken so long.
256
00:17:13,543 --> 00:17:15,983
Make sure those x-rays are uploaded
straight away
257
00:17:16,143 --> 00:17:18,303
because the patient's been here
for three hours.
258
00:17:19,743 --> 00:17:23,783
Lorraine. How's it going?
Trauma call. Anything juicy?
259
00:17:23,943 --> 00:17:26,903
We agreed that the major
transfusion protocol was to be
260
00:17:27,063 --> 00:17:29,463
enacted by the trauma team leader.
Absolutely.
261
00:17:29,623 --> 00:17:33,143
So why, then, yet again, am I
talking to a haematology consultant
262
00:17:33,303 --> 00:17:35,503
who pompously asks me
the patient's Hb?
263
00:17:35,663 --> 00:17:37,143
Agreeing to the protocol
is one thing,
264
00:17:37,303 --> 00:17:39,263
getting the departments
to put it into practice
265
00:17:39,423 --> 00:17:41,783
is completely different.
You said it had been agreed.
266
00:17:41,943 --> 00:17:44,103
They're territorial,
and I'm stuck in the middle.
267
00:17:44,223 --> 00:17:46,543
No, I am, and the patient is.
268
00:17:46,703 --> 00:17:49,903
I can see you're upset...
This used to be a bog standard A&E.
269
00:17:50,063 --> 00:17:51,903
Oh... We are now
a major trauma centre...
270
00:17:52,063 --> 00:17:54,263
Hold on, I resent that description.
271
00:17:54,423 --> 00:17:57,303
We USED to be the best-performing
unit in the region.
272
00:17:57,463 --> 00:17:59,943
Now we take more patients overall,
more critical patients,
273
00:18:00,063 --> 00:18:01,263
resources are stretched.
274
00:18:01,383 --> 00:18:03,903
Supposedly, we're not doing as well.
275
00:18:06,223 --> 00:18:09,103
Well, then, some of us
need to raise their game.
276
00:18:17,583 --> 00:18:19,343
Where is this going exactly?
277
00:18:37,456 --> 00:18:38,576
Good morning.
278
00:18:38,612 --> 00:18:42,052
I will be ready to start the scan in
approximately one and a half minutes.
279
00:18:42,213 --> 00:18:44,613
Thank you, Brian.
He's already bled 1000mls.
280
00:18:44,772 --> 00:18:46,612
He's coagulopathic
because he's cold. Cold.
281
00:18:46,772 --> 00:18:49,372
So if he was on the road
for longer than 40 minutes...
282
00:18:52,092 --> 00:18:54,732
Wait, let's deal with
the coagulopathy.
283
00:18:54,852 --> 00:18:56,852
I want FFP and platelets up now.
284
00:19:00,932 --> 00:19:02,372
Where's our leader got to?
285
00:19:10,012 --> 00:19:13,092
Can someone just please go and check
that Lorraine's on her way back?
286
00:19:13,252 --> 00:19:14,892
Kill the alarm.
287
00:19:15,012 --> 00:19:16,292
Nerys.
288
00:19:16,452 --> 00:19:19,812
Will you bring either Mrs Rappaport
or Dr Archerfield?
289
00:19:19,972 --> 00:19:22,652
Just right now, please.
Yes, Mrs Hicklin. Shit, he's in VF.
290
00:19:22,772 --> 00:19:24,572
Billy. Yeah.
291
00:19:26,252 --> 00:19:28,012
No output.
292
00:19:30,652 --> 00:19:32,492
Fail. Back into resus.
293
00:19:32,652 --> 00:19:35,572
Slowly with CPR.
Fast, and we'll do it there.
294
00:19:35,692 --> 00:19:37,172
Quickly, let's go.
295
00:19:45,132 --> 00:19:47,372
Careful. Get the door.
296
00:19:51,852 --> 00:19:55,092
Yeah, got that, got that.
Justin, take over compressions.
297
00:19:58,892 --> 00:20:02,012
'Connect electrodes.
Electrodes connected.
298
00:20:02,132 --> 00:20:03,212
'Diagnosing rhythm.
299
00:20:03,332 --> 00:20:05,212
'Ventricular fibrillation.
300
00:20:05,332 --> 00:20:08,732
'Advising 150 joules.
301
00:20:08,852 --> 00:20:12,372
'150 joules selected.
302
00:20:12,492 --> 00:20:13,732
'Charging.'
303
00:20:15,332 --> 00:20:16,812
Justin, off the chest.
304
00:20:16,932 --> 00:20:18,572
Shocking, three, two, one.
305
00:20:24,132 --> 00:20:27,852
Two minutes of CPR to come
at 31 minutes.
306
00:20:28,012 --> 00:20:31,092
Adrenaline and amiodarone
on standby, please. Yeah.
307
00:20:31,252 --> 00:20:34,692
Where's Lorraine? Lorraine wasn't
there. Well, where is she?
308
00:20:34,852 --> 00:20:38,412
I don't know. Fetch Clive, then.
He wasn't there either.
309
00:20:45,812 --> 00:20:48,052
CPR counting towards two minutes.
310
00:20:48,212 --> 00:20:51,372
Then get ready to give
another 150 biphasic.
311
00:20:51,532 --> 00:20:55,372
After that, be ready with adrenaline
1mg, amiodarone, 300mg.
312
00:20:58,172 --> 00:21:00,932
Staying alive, staying alive...
313
00:21:02,452 --> 00:21:05,652
'Hello, this is Lorraine Rappaport.
Please leave a message.'
314
00:21:05,812 --> 00:21:08,532
Lorraine, it's Fiona.
Please call me right back.
315
00:21:09,732 --> 00:21:11,412
I need you here, boss.
316
00:21:20,812 --> 00:21:22,532
Absolutely starving.
317
00:21:22,692 --> 00:21:25,132
I missed breakfast because of this.
You shouldn't have a...
318
00:21:25,252 --> 00:21:26,852
One minute to go.
319
00:21:27,012 --> 00:21:30,052
Ordered it, then the beeper went.
It's just sat there then?
320
00:21:30,212 --> 00:21:32,292
I don't know, I didn't pay for it,
so I doubt it.
321
00:21:32,452 --> 00:21:34,292
Not good for your insides.
322
00:21:34,412 --> 00:21:36,332
Staying alive, staying alive...
323
00:21:38,303 --> 00:21:40,103
You're in a bit earlier, aren't you?
324
00:21:40,263 --> 00:21:43,143
The Fiesta didn't start
this morning so I was a bit late.
325
00:21:43,263 --> 00:21:44,903
40 seconds to go.
326
00:22:19,863 --> 00:22:21,583
Coming up to two minutes.
327
00:22:25,183 --> 00:22:27,463
Check pulses, stop compressions.
328
00:22:29,463 --> 00:22:31,023
No pulse.
329
00:22:31,143 --> 00:22:32,223
Still VF. Justin.
330
00:22:34,263 --> 00:22:35,623
'Charging.'
331
00:22:39,823 --> 00:22:41,703
'Charged.' Everybody clear.
332
00:22:41,823 --> 00:22:43,823
Justin, off the chest.
333
00:22:43,943 --> 00:22:46,903
Shocking in three, two, one.
334
00:22:48,703 --> 00:22:52,263
'Diagnosing rhythm.' Sinus rhythm.
335
00:22:52,423 --> 00:22:55,783
Follow the guidelines, please,
Justin. Sorry, Mrs Hicklin.
336
00:23:00,463 --> 00:23:02,463
I'm hearing heart sounds.
We might have ROSC.
337
00:23:02,583 --> 00:23:05,423
Justin, stop for a second. Stop.
338
00:23:08,743 --> 00:23:11,423
Output.
339
00:23:13,423 --> 00:23:15,863
Thank you. Good job. We have ROSC.
340
00:23:15,983 --> 00:23:18,023
Put the bloods up, please.
341
00:23:18,143 --> 00:23:20,503
All right, now what? CT.
342
00:23:20,663 --> 00:23:23,583
You're happy the patient's
stable enough to be moved?
343
00:23:23,743 --> 00:23:26,383
Lorraine wanted a CT next.
That was before he arrested.
344
00:23:26,543 --> 00:23:28,503
We need to know what's going on
in the chest.
345
00:23:28,663 --> 00:23:31,863
That's a decision for the trauma
team leader. Lorraine isn't here.
346
00:23:37,263 --> 00:23:38,703
So, someone needs to lead.
347
00:23:44,023 --> 00:23:45,423
CT.
348
00:23:47,983 --> 00:23:49,903
Take two, let's get him ready to go.
349
00:23:51,543 --> 00:23:53,503
Let's get him on
the fourth floor.
350
00:23:54,703 --> 00:23:58,143
'Hello, this is Lorraine Rappaport.
Please leave a message.'
351
00:23:58,303 --> 00:24:02,063
Lorraine, the patient just had
a VF arrest. I've no idea why.
352
00:24:02,223 --> 00:24:04,823
I'm really worried
I'm missing something here.
353
00:24:06,103 --> 00:24:09,343
We're going to take him to CT.
I'll see you there.
354
00:24:34,983 --> 00:24:37,583
Are you doing anything
about the wrist and tib?
355
00:24:37,743 --> 00:24:41,903
We need to fix the chest first. OK.
I'll be on the ward if you need me.
356
00:24:42,023 --> 00:24:44,103
She's got the right idea.
357
00:24:44,263 --> 00:24:48,143
What? Not being here
if all this goes tits-up. Smart.
358
00:24:53,463 --> 00:24:55,583
Shall we try again? Sorry, Brian.
359
00:25:17,263 --> 00:25:20,263
Patient clock synchronised.
On three. One, two, three.
360
00:25:20,383 --> 00:25:21,543
Well done.
361
00:25:23,263 --> 00:25:25,383
Brian Zhao, CT radiographer
362
00:25:25,543 --> 00:25:28,143
and deputy assistant
department coordinator?
363
00:25:29,303 --> 00:25:30,663
For you.
364
00:25:30,783 --> 00:25:32,383
Lorraine?
365
00:25:32,503 --> 00:25:34,543
..Oh, just a second.
366
00:25:37,743 --> 00:25:39,863
All the results you've got please.
367
00:25:43,463 --> 00:25:45,543
Er... Nobody touch any buttons.
368
00:25:49,703 --> 00:25:51,583
One, two, three.
369
00:25:53,223 --> 00:25:54,823
Thank you. Bye.
370
00:26:04,623 --> 00:26:07,703
D'you know what? What?
371
00:26:07,863 --> 00:26:09,943
I think we're going to lose this one.
372
00:26:10,063 --> 00:26:11,903
Control scan.
373
00:26:17,223 --> 00:26:19,663
Have I missed anything?
Just starting.
374
00:26:19,823 --> 00:26:22,223
Starting head scan.
Where's Lorraine?
375
00:26:22,343 --> 00:26:23,383
Hmm?
376
00:26:23,503 --> 00:26:25,223
She's not with you?
377
00:26:25,383 --> 00:26:28,023
Head scan complete.
Nobody touch any buttons.
378
00:26:30,543 --> 00:26:31,863
Right, your head is NAD,
379
00:26:32,023 --> 00:26:34,583
you've got no obvious
intracranial lesions or bleeding.
380
00:26:34,703 --> 00:26:36,223
Are you happy, Fiona?
381
00:26:36,343 --> 00:26:37,623
Here.
382
00:26:41,703 --> 00:26:42,703
Right.
383
00:26:47,863 --> 00:26:49,303
Contrast run.
384
00:26:51,343 --> 00:26:52,783
Tube's in the right place.
385
00:26:57,223 --> 00:27:00,343
If I'd messed up the tube, he'd be
on his way to pathology outpatients.
386
00:27:00,503 --> 00:27:03,223
I really wish I'd had more practice
at it.
387
00:27:03,383 --> 00:27:07,743
We could find some time this week.
Only if it's not too much trouble.
388
00:27:07,863 --> 00:27:09,623
I'll find a way to fit you in.
389
00:27:13,863 --> 00:27:15,263
Back to the ED.
390
00:27:15,423 --> 00:27:18,703
And you. I really wanted to
see this case through.
391
00:27:18,863 --> 00:27:21,983
When we lose you to a major trauma,
patients stack up.
392
00:27:23,063 --> 00:27:24,263
Right.
393
00:27:26,183 --> 00:27:28,143
Best bit's over anyway.
394
00:27:29,143 --> 00:27:30,863
Left side's filled with blood again.
395
00:27:31,023 --> 00:27:33,623
We've got an uncontrolled
intrathoracic haemorrhage.
396
00:27:33,743 --> 00:27:35,663
Where is Lorraine? I told you,
397
00:27:35,823 --> 00:27:37,783
I don't know.
398
00:27:37,943 --> 00:27:41,143
Clive Archerfield.
Yeah, thanks for getting back to me.
399
00:27:41,263 --> 00:27:44,143
If you need me, I'm in ED. Hello.
400
00:27:44,263 --> 00:27:45,863
Yes, sorry about that.
401
00:27:45,983 --> 00:27:47,743
Yes, we're being advised...
402
00:27:52,663 --> 00:27:55,623
Streaks! Metal!
Who put metal in my machine?
403
00:27:55,743 --> 00:27:57,463
Going in. Er, clear to enter.
404
00:28:12,903 --> 00:28:16,343
What's that? Manifestly,
it is the blade of a knife.
405
00:28:17,663 --> 00:28:19,263
Is it penetrating the heart?
406
00:28:37,183 --> 00:28:39,183
OK. Turn. Yeah.
407
00:28:40,542 --> 00:28:42,342
Got it? Open the door.
408
00:28:42,462 --> 00:28:43,622
Clear the bay!
409
00:28:48,262 --> 00:28:51,582
Get all the monitors back
as they were. Defib on standby.
410
00:28:51,742 --> 00:28:55,422
Can you see if the ED reg can help?
Let's get these bags up.
411
00:28:58,222 --> 00:29:02,342
..not rude to you, OK?
Justin, back to resus.
412
00:29:02,462 --> 00:29:04,222
Thank you!
413
00:29:04,342 --> 00:29:06,982
Yes, Harry, and you. Yes! Um...
414
00:29:07,142 --> 00:29:09,262
Can you get the reg
to sign off on this?
415
00:29:09,382 --> 00:29:10,582
Thank you.
416
00:29:18,182 --> 00:29:20,262
The reg coming? Just me.
417
00:29:20,422 --> 00:29:22,902
They're never going to give you
the reg.
418
00:29:23,022 --> 00:29:24,622
Too busy keeping admissions moving.
419
00:29:24,782 --> 00:29:26,942
He seems to be maintaining
a blood pressure.
420
00:29:27,102 --> 00:29:30,302
Let's keep transfusing him
while we chase cardiothoracics.
421
00:29:31,742 --> 00:29:33,382
Hello, switch, it's Sister Merrick.
422
00:29:33,542 --> 00:29:36,982
Please can you fast bleep
cardiothoracic again for us? Thanks.
423
00:29:37,142 --> 00:29:40,982
Cardiothoracic's fast bleeped.
Told you, car crashes AND stabbings.
424
00:29:43,782 --> 00:29:45,502
Where's Lorraine? I don't know.
425
00:29:47,862 --> 00:29:50,942
We're fine here. Grab a coffee
or something, you look like shit.
426
00:29:51,102 --> 00:29:52,502
Dr Chandramohan,
427
00:29:52,662 --> 00:29:54,582
using strong language
in front of a patient?
428
00:29:54,702 --> 00:29:55,942
He's unconscious.
429
00:29:57,062 --> 00:29:59,902
Police are already checking
the traffic cams to establish
430
00:30:00,062 --> 00:30:02,782
the cause of the accident.
No-one was ejected from the bus.
431
00:30:02,942 --> 00:30:05,462
There was a body in the road
which caused vehicles to swerve
432
00:30:05,622 --> 00:30:07,542
and that's how the
collisions happened.
433
00:30:07,702 --> 00:30:09,382
They now think our patient
must have fallen
434
00:30:09,542 --> 00:30:11,542
or been thrown from a bridge
following an assault.
435
00:30:11,662 --> 00:30:13,542
Thanks, Giles. You're welcome.
436
00:30:14,782 --> 00:30:18,862
Cardiothoracics will be here in
five minutes. Good. What did I say?
437
00:30:19,022 --> 00:30:22,102
Too cold just to have been there
since the crash? Oh, genius!
438
00:30:44,062 --> 00:30:45,342
He's bleeding out.
439
00:30:47,742 --> 00:30:48,902
No output.
440
00:30:49,062 --> 00:30:52,902
PEA. No compressions,
there's a knife in the heart.
441
00:30:53,022 --> 00:30:54,542
We need to stop this bleeding.
442
00:30:54,702 --> 00:30:57,742
Cardiothoracics needs to stop
this bleeding. They're not here.
443
00:30:59,422 --> 00:31:00,702
No BP.
444
00:31:00,822 --> 00:31:02,902
Clamshell. Brilliant!
445
00:31:05,182 --> 00:31:06,702
I'll find Clive.
446
00:31:12,622 --> 00:31:13,942
Bag him, please. Yeah.
447
00:31:25,302 --> 00:31:27,782
Take this.
448
00:31:27,902 --> 00:31:29,382
What, me? Yes.
449
00:32:18,862 --> 00:32:20,862
OK to cut?
450
00:32:20,982 --> 00:32:23,062
It's not my call.
451
00:32:24,702 --> 00:32:26,942
Cutting. Shit, shit...
452
00:32:44,462 --> 00:32:45,902
Oh, my God...
453
00:32:47,382 --> 00:32:49,462
Harry, get in here.
454
00:32:51,902 --> 00:32:54,062
Grab the wound edges,
and pull apart.
455
00:33:03,902 --> 00:33:05,542
Mind your fingers.
456
00:33:23,302 --> 00:33:25,302
Hold it open.
457
00:33:31,622 --> 00:33:33,782
Turn the lever.
458
00:33:35,342 --> 00:33:36,742
Other way.
459
00:33:38,542 --> 00:33:40,702
That's it. Wider.
460
00:33:45,582 --> 00:33:47,342
Suction.
461
00:34:05,622 --> 00:34:06,942
Do this.
462
00:34:18,102 --> 00:34:19,502
I can feel the knife.
463
00:34:32,622 --> 00:34:36,462
Switching. Justin, bring
the light over, will you? Yeah.
464
00:34:37,822 --> 00:34:39,662
Contractions but no output.
465
00:34:51,542 --> 00:34:55,022
The blade has made a tiny hole
in the ventricular wall.
466
00:34:55,182 --> 00:34:57,782
Any bigger, he'd be long dead.
Yeah, he's got all the luck.
467
00:35:00,102 --> 00:35:01,902
I need scissors.
468
00:35:06,142 --> 00:35:09,422
Listen, love, you can't do this
without a consultant here.
469
00:35:09,582 --> 00:35:12,222
Best wait for Clive.
Or cardiothoracics.
470
00:35:14,182 --> 00:35:15,702
He can't wait.
471
00:35:24,702 --> 00:35:26,262
Heart exposed.
472
00:35:44,022 --> 00:35:47,462
Keep the suction going, clear as
much blood as you can. Suture.
473
00:35:47,582 --> 00:35:48,782
Justin, wait.
474
00:35:59,422 --> 00:36:01,822
I need you to do something
very important for me.
475
00:36:03,902 --> 00:36:08,302
I need you to put your finger in
this hole in the patient's heart.
476
00:36:08,462 --> 00:36:10,502
Will you do that for me, please?
Harry?
477
00:36:45,302 --> 00:36:46,822
OK.
478
00:36:48,822 --> 00:36:50,262
Oh, my God...
479
00:37:36,542 --> 00:37:38,102
Finger out.
480
00:37:50,222 --> 00:37:51,662
That's got it.
481
00:37:55,982 --> 00:37:57,822
Another bag of blood up, please.
482
00:38:20,422 --> 00:38:23,302
Still no output. Give it a minute.
483
00:38:42,862 --> 00:38:44,142
Got a pulse.
484
00:38:54,302 --> 00:38:55,822
Cardiothoracics are here.
485
00:39:02,902 --> 00:39:05,182
Good. Who did this?
486
00:39:09,102 --> 00:39:11,782
Let's transfer to theatre
and complete the repair job.
487
00:39:11,942 --> 00:39:15,902
Sister Merrick, TNP. We need trauma
theatre staff fast bleeped.
488
00:39:16,022 --> 00:39:17,262
Thank you.
489
00:39:21,462 --> 00:39:25,502
You just helped save his life.
Thank you.
490
00:39:25,662 --> 00:39:29,742
Orthopaedics, Sister Merrick, resus.
Mike Alpha is ready for you now.
491
00:39:29,862 --> 00:39:31,142
Thank you.
492
00:39:48,262 --> 00:39:52,422
You shouldn't have done that.
You're right. Clive should have.
493
00:39:52,582 --> 00:39:56,222
Clive has a responsibility
to this entire department.
494
00:39:56,382 --> 00:40:00,862
It supersedes the needs of
individual cases. Two questions.
495
00:40:02,022 --> 00:40:04,822
What's happened to Lorraine?
Not your concern.
496
00:40:04,982 --> 00:40:08,862
And the other question?
Who's covering?
497
00:40:09,022 --> 00:40:12,382
It's in your best interest to stay
out of this, so stay out of this.
498
00:40:16,342 --> 00:40:19,302
Hi, Mum? You won't believe what
I've just been doing.
499
00:40:22,702 --> 00:40:24,342
No, no, I'm fine.
500
00:40:29,902 --> 00:40:33,022
'Colleague announcement.
Multiple incoming casualties.
501
00:40:33,182 --> 00:40:35,462
'Will trauma team
please return to resus.'
502
00:40:37,302 --> 00:40:40,662
'Colleague announcement.
Multiple incoming casualties.
503
00:40:40,822 --> 00:40:43,862
'Will trauma team
please return to resus.'
504
00:41:18,662 --> 00:41:21,022
Morning, sir. Morning.
505
00:41:26,102 --> 00:41:27,662
'Hello, this is Glen Boyle.
506
00:41:27,822 --> 00:41:29,862
'I can't take your call,
please leave a message.'
507
00:41:31,222 --> 00:41:32,862
It's me. I...
508
00:41:35,942 --> 00:41:38,742
You're the last person
I want to call, but...
509
00:41:38,862 --> 00:41:41,142
You're the only one who can help.
510
00:41:42,902 --> 00:41:45,022
I think my boss just got suspended.
511
00:41:48,022 --> 00:41:50,822
Hi, Glen. Come in.
512
00:41:50,942 --> 00:41:52,222
Thanks.
513
00:41:54,902 --> 00:41:56,302
Good to see you again.
514
00:42:07,542 --> 00:42:09,102
How are you?
515
00:42:14,502 --> 00:42:16,782
You could have opened with
an easier one.
516
00:42:28,822 --> 00:42:32,142
Whatever the grown-ups think,
that was the dog's bollocks.
517
00:42:46,262 --> 00:42:47,782
Right here.
518
00:42:51,822 --> 00:42:53,022
Who's leading?
519
00:43:08,542 --> 00:43:11,622
OK, let's get him wired up,
let's get to work.
520
00:43:21,502 --> 00:43:24,782
What's with the whole
Elephant Man thing? Right.
521
00:43:24,902 --> 00:43:26,302
Oh, my God.
522
00:43:26,462 --> 00:43:29,502
A major trauma case
needs a trauma team leader.
523
00:43:29,662 --> 00:43:31,822
Somebody coming in,
isn't he here yet?
524
00:43:31,942 --> 00:43:33,742
It's good to see you.
525
00:43:37,022 --> 00:43:38,982
I've practised all over the world.
526
00:43:39,142 --> 00:43:42,502
In the forces,
and civilian hospitals.
527
00:43:42,622 --> 00:43:44,302
I specialise in critical injuries.
528
00:43:51,769 --> 00:44:36,746
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