1 00:00:06,720 --> 00:00:08,039 Hi, Tom. 2 00:00:08,120 --> 00:00:10,350 Thank you for the flowers. They're lovely. 3 00:00:10,880 --> 00:00:11,915 What's the big occasion? 4 00:00:14,000 --> 00:00:15,274 You need to tell him what's going on. 5 00:00:15,480 --> 00:00:17,277 - And frankly, you need to tell me. - Glen, I... 6 00:00:19,120 --> 00:00:20,109 I need to see you. 7 00:00:20,680 --> 00:00:21,669 I can't. 8 00:00:22,440 --> 00:00:23,429 Because of Tom? 9 00:00:24,200 --> 00:00:25,428 Because you're leaving. 10 00:00:35,760 --> 00:00:37,671 Trauma call. Major traffic incident. 11 00:00:37,760 --> 00:00:39,830 Multiple critical injuries imminent. 12 00:00:40,000 --> 00:00:40,989 Trauma call. 13 00:00:41,200 --> 00:00:42,633 - Major traffic incident. - Rhythm check. 14 00:00:42,880 --> 00:00:44,518 - Still in BF. - No pulse. 15 00:00:46,040 --> 00:00:47,758 Back on the chest. Charging? 16 00:00:48,000 --> 00:00:48,989 Yeah. 17 00:00:49,760 --> 00:00:51,352 Everyone except Justin, stand clear. 18 00:00:52,480 --> 00:00:53,674 Look, we need to open his chest. 19 00:00:53,760 --> 00:00:57,275 150 joules selected. Charging. 20 00:01:02,320 --> 00:01:03,753 - Charged. Warning... - Justin, stand clear. 21 00:01:03,880 --> 00:01:07,316 - Stand clear. Warning. Stand clear. - Shocking. Three, two, one, shocking. 22 00:01:07,880 --> 00:01:09,313 Back on the chest. 23 00:01:15,120 --> 00:01:16,155 Rebecca, gown up. 24 00:01:17,560 --> 00:01:19,835 - What size gloves? - Uh, 6, please. 25 00:01:23,880 --> 00:01:24,949 Ever done this before? 26 00:01:25,560 --> 00:01:26,709 - Uh, no. - Okay. 27 00:01:27,440 --> 00:01:29,829 We cut fast and we cut deep, okay? 28 00:01:30,360 --> 00:01:31,395 You follow my lead. 29 00:01:36,000 --> 00:01:37,991 I'm not shaking. It's a cramp. 30 00:01:38,240 --> 00:01:40,390 - Harry, what are you doing? - Just checking for signs of life. 31 00:01:40,480 --> 00:01:41,833 No, he's dead. Move on. 32 00:01:42,120 --> 00:01:44,236 - Harry... - Thoracotomy set, now, please. 33 00:01:44,920 --> 00:01:45,989 We did everything we could. 34 00:01:47,000 --> 00:01:48,956 Time of death, 17:31. 35 00:01:49,400 --> 00:01:51,595 And get the mortuary technicians up here straight away. 36 00:02:00,960 --> 00:02:01,949 Ties. 37 00:02:09,240 --> 00:02:11,151 Carry on with the CPR. I'm gonna work around you. 38 00:02:12,240 --> 00:02:14,037 Trauma call. An estimated further 39 00:02:14,120 --> 00:02:17,317 six to eight critically injured patients, due within the hour. 40 00:02:17,400 --> 00:02:19,038 - Nice. - Trauma call. 41 00:02:19,120 --> 00:02:20,633 Could really do with some more room in here. 42 00:02:20,720 --> 00:02:22,950 ...six to eight critically injured patients, due within the hour. 43 00:02:23,040 --> 00:02:24,029 Blade. 44 00:02:26,040 --> 00:02:27,029 Off the chest. 45 00:02:29,840 --> 00:02:30,829 You ready to go? 46 00:02:32,160 --> 00:02:33,149 Fast and deep. 47 00:02:35,840 --> 00:02:37,796 Due to a major incident, 48 00:02:37,880 --> 00:02:40,872 we're experiencing severe delays in all departments. 49 00:02:41,320 --> 00:02:44,949 We apologise for any inconvenience or distress this may cause. 50 00:02:51,120 --> 00:02:52,235 The shears, please. 51 00:02:59,560 --> 00:03:00,629 Yeah? 52 00:03:06,880 --> 00:03:07,869 Asystole now. 53 00:03:08,000 --> 00:03:08,989 Shit. 54 00:03:09,560 --> 00:03:11,039 Get an aortic clamp ready. 55 00:03:14,240 --> 00:03:15,229 No outputs. 56 00:03:18,560 --> 00:03:19,595 Retractor. 57 00:03:22,560 --> 00:03:25,757 Okay, as soon as we're open, get in there, compress the aorta, yes? 58 00:03:26,440 --> 00:03:27,475 Yeah. 59 00:03:27,720 --> 00:03:28,789 Go, now. 60 00:03:33,920 --> 00:03:36,115 Harry, in my pocket is my mobile. 61 00:03:36,200 --> 00:03:38,270 Call Fiona. Tell her we need more hands down here. 62 00:03:38,360 --> 00:03:40,237 - Yep. - Other pocket. 63 00:03:45,840 --> 00:03:46,829 Okay, clamp it up. 64 00:03:51,440 --> 00:03:53,032 Need her on the phone immediately, please. 65 00:04:00,600 --> 00:04:02,352 Nice. 66 00:04:23,280 --> 00:04:24,269 No nagging doubts. 67 00:04:24,800 --> 00:04:25,835 No, it's time. 68 00:04:26,400 --> 00:04:27,549 It makes sense for us. 69 00:04:32,520 --> 00:04:34,033 - Oh, she's got our coffees. - Okay. 70 00:04:35,900 --> 00:04:43,900 Ripped By mstoll 71 00:04:45,600 --> 00:04:47,909 You have one saved message. 72 00:04:48,120 --> 00:04:50,076 Fiona, it's Harry. We need you in resus. 73 00:04:51,800 --> 00:04:53,199 Due to a major incident, 74 00:04:53,280 --> 00:04:56,033 we're experiencing severe delays in all departments. 75 00:04:56,200 --> 00:04:57,633 We apologise for any... 76 00:04:57,720 --> 00:04:58,869 Constance, how are we doing? 77 00:04:59,120 --> 00:05:01,509 Well, there's three for resus 78 00:05:01,600 --> 00:05:02,589 and plenty more coming. 79 00:05:02,920 --> 00:05:05,480 Okay, erm, let's just start getting them moved through. 80 00:05:05,600 --> 00:05:06,589 Okay, yeah. 81 00:05:10,680 --> 00:05:12,511 Okay, motorcyclist 82 00:05:12,720 --> 00:05:15,154 pulled under a lorry, which started a whole pile-up. 83 00:05:15,760 --> 00:05:18,832 Degloving injuries to his limbs and thorax. He was given 84 00:05:19,240 --> 00:05:21,879 a needle decompression for tension near the thorax at the scene. 85 00:05:22,120 --> 00:05:26,238 - Okay, obs? - Resp's 24, pulse 116. 86 00:05:26,320 --> 00:05:29,517 BP 102 over 70 and low GCS. 87 00:05:29,720 --> 00:05:31,153 Any extra staff here yet? 88 00:05:31,280 --> 00:05:32,269 Leave it with me. 89 00:05:32,680 --> 00:05:34,432 Where's the receiving team? 90 00:05:36,120 --> 00:05:37,109 Uh... 91 00:05:39,120 --> 00:05:40,109 It's just me for now. 92 00:05:40,200 --> 00:05:42,953 We've been through triage, turns out that's just the queue for the queue. 93 00:05:43,080 --> 00:05:45,514 - What? Who's this? - P1 for major incident. 94 00:05:45,600 --> 00:05:47,795 A coach passenger. Leg fractures and chest pain. 95 00:05:51,480 --> 00:05:52,959 - Okay, in here, please. - Uh, right. 96 00:05:53,520 --> 00:05:54,669 I'll try and get some extra hands. 97 00:05:55,160 --> 00:05:56,991 Can staff please ensure 98 00:05:57,080 --> 00:06:00,072 that all working rooms are helped by the triage team, 99 00:06:00,160 --> 00:06:01,513 so that resus and... 100 00:06:01,640 --> 00:06:04,234 Anybody free to give me a hand, please? 101 00:06:04,520 --> 00:06:05,999 Thank you. 102 00:06:06,280 --> 00:06:07,633 Okay, let me get to it. 103 00:06:27,000 --> 00:06:30,310 Quickest way to get his heart started is to get blood in, fast. 104 00:06:49,360 --> 00:06:50,759 Okay, can you just hold this, please? 105 00:06:56,480 --> 00:06:58,232 Okay, thank you. Just cut there, please. 106 00:06:58,360 --> 00:06:59,509 Here. 107 00:07:01,880 --> 00:07:02,915 Thank you. 108 00:07:08,280 --> 00:07:09,759 Thank you. Okay. 109 00:07:11,120 --> 00:07:12,235 - Fine. - Thank you. 110 00:07:12,760 --> 00:07:14,113 Can you take that top off, please? 111 00:07:15,400 --> 00:07:16,435 Okay. 112 00:07:16,960 --> 00:07:19,269 Now, I'm gonna run the blood straight into this line. 113 00:07:19,800 --> 00:07:20,915 And, hopefully, 114 00:07:22,400 --> 00:07:24,834 the volume will get his pulse back up. 115 00:07:25,120 --> 00:07:26,189 Connected. 116 00:07:27,040 --> 00:07:28,553 Get back on the heart massage, please. 117 00:07:31,840 --> 00:07:33,876 Let's get some more O pos from the fridge, please. 118 00:07:36,680 --> 00:07:37,749 No O pos left. 119 00:07:38,080 --> 00:07:39,069 Cross-match? 120 00:07:39,160 --> 00:07:42,072 No, he's out of positive. Antibodies will take longer to match. 121 00:07:42,480 --> 00:07:43,674 Okay, let's get Nicola. 122 00:07:43,800 --> 00:07:45,836 We need to find some O pos from somewhere, please. 123 00:07:45,920 --> 00:07:46,909 Okay. 124 00:07:47,520 --> 00:07:48,748 Lost my address, did you, Justin? 125 00:07:48,880 --> 00:07:51,269 - Uh... - Aw, we got a May Jacks virgin. 126 00:07:51,440 --> 00:07:52,429 Don't worry. This won't hurt much. 127 00:07:53,160 --> 00:07:54,149 He's no virgin. 128 00:07:58,240 --> 00:08:00,674 I'm ready for rays. Stand clear, please. 129 00:08:00,800 --> 00:08:02,233 - Billy. - Don't tell Billy. 130 00:08:07,120 --> 00:08:08,269 Rays in three. 131 00:08:10,760 --> 00:08:13,228 One, two, three, rays. 132 00:08:13,400 --> 00:08:14,389 How's it going? 133 00:08:14,680 --> 00:08:16,318 Looks like it's going to be a busy evening. 134 00:08:16,720 --> 00:08:17,709 Anything I should know. 135 00:08:18,480 --> 00:08:19,549 They're heading for theatre. 136 00:08:20,480 --> 00:08:21,799 Okay, I'm okay. 137 00:08:22,720 --> 00:08:23,914 What happened to you on Wednesday? 138 00:08:24,440 --> 00:08:25,429 It wasn't possible. 139 00:08:26,960 --> 00:08:28,473 Look, there's something I need to speak to you about. 140 00:08:28,680 --> 00:08:30,591 Yes, I need to talk to you too. 141 00:08:31,080 --> 00:08:32,069 Been offered a post... 142 00:08:32,200 --> 00:08:35,590 Sorry, I'm on my own with this guy and I don't know what to do next for him. 143 00:08:35,680 --> 00:08:36,669 Okay. 144 00:08:37,440 --> 00:08:38,429 I'll take this one. 145 00:08:39,000 --> 00:08:40,399 - Sure. - We'll talk later. 146 00:08:40,520 --> 00:08:42,033 - Okay? - Yes, let's. 147 00:08:43,200 --> 00:08:45,236 He's got bilateral femoral fractures and chest pain. 148 00:08:45,440 --> 00:08:48,034 - Okay, is he stable? - Yes, but he's in a lot of pain. 149 00:08:48,120 --> 00:08:49,712 25 seconds to pulse check. 150 00:08:49,880 --> 00:08:52,155 I called the medical registrar because the pain sounds cardiac 151 00:08:52,240 --> 00:08:53,434 but there's no doctor to see him. 152 00:08:53,840 --> 00:08:55,398 - ECG and AD. - Okay. 153 00:08:55,640 --> 00:08:56,868 I'll come as soon as I can. 154 00:08:57,560 --> 00:09:00,518 Let's get him started on morphine and fluid. 155 00:09:00,720 --> 00:09:03,109 And let me know if anything changes, okay? 156 00:09:03,200 --> 00:09:04,189 Okay, thanks. 157 00:09:13,120 --> 00:09:15,076 This is the last of the O pos from theatre. 158 00:09:15,280 --> 00:09:16,269 Oh, that's not enough. 159 00:09:16,680 --> 00:09:18,955 We don't know how long it's gonna take the lab to cross-match him. 160 00:09:19,040 --> 00:09:20,189 I'll send Giles up for more for you. 161 00:09:20,360 --> 00:09:22,954 And the chances of moving that dead body out of here are? 162 00:09:23,040 --> 00:09:24,996 Heart's contracting spontaneously. 163 00:09:25,360 --> 00:09:26,349 Let me see. 164 00:09:29,240 --> 00:09:30,878 - As soon as I can, Glen. - Thank you. 165 00:09:31,040 --> 00:09:32,951 - There's a pulse. - Give me BP. 166 00:09:33,240 --> 00:09:34,593 77 over 48. 167 00:09:34,760 --> 00:09:35,988 - Do we have ROSC? - Yes, we do. 168 00:09:37,200 --> 00:09:39,589 Okay, let's get that blood into him fast, Harry. 169 00:09:40,000 --> 00:09:41,718 And then let's package him for transfer... 170 00:09:42,840 --> 00:09:44,512 Can the clinical lead please contact 171 00:09:44,600 --> 00:09:46,750 the head of human resources immediately? 172 00:09:47,480 --> 00:09:48,595 Blood gasses. 173 00:09:49,400 --> 00:09:51,118 - Can you chase CT? - Mmm-hmm. 174 00:09:54,480 --> 00:09:55,549 You're in there, mate. 175 00:09:56,040 --> 00:09:57,029 You think so? 176 00:09:57,880 --> 00:09:58,949 There's only one way to find out. 177 00:09:59,600 --> 00:10:01,033 Switch. CT. 178 00:10:01,200 --> 00:10:02,349 We'll be there in five minutes. 179 00:10:02,800 --> 00:10:04,995 Harry, go and get started on the patient in A, please. 180 00:10:05,080 --> 00:10:06,433 He's going to Theatre 7. 181 00:10:06,800 --> 00:10:09,234 Rebecca, cardiothoracic general surgery 182 00:10:09,320 --> 00:10:11,117 and your boss will take over from there, yes? 183 00:10:11,680 --> 00:10:12,669 Thank you. 184 00:10:14,920 --> 00:10:16,114 On vent. Sats are good. 185 00:10:17,720 --> 00:10:19,597 Uh, 15 minutes till CT. 186 00:10:19,960 --> 00:10:21,632 - Book it. - Yeah, we'll take it. 187 00:10:22,200 --> 00:10:23,599 I'll do an extended, fast. 188 00:10:23,680 --> 00:10:25,238 Can you get the ultrasound for me, please? 189 00:10:25,600 --> 00:10:27,397 Trauma call. Critically injured arrival 190 00:10:27,480 --> 00:10:28,833 due in the lower ambulance bay. 191 00:10:29,000 --> 00:10:30,558 Trauma call. Critically injured arrival... 192 00:10:30,640 --> 00:10:33,359 Harry, start the primary. I'll be back in a sec. 193 00:10:33,760 --> 00:10:35,352 Justin, keep going with what's prescribed, 194 00:10:35,440 --> 00:10:37,317 but I need another ECG, please. 195 00:10:38,400 --> 00:10:39,389 Okay, tell me the story. 196 00:10:39,480 --> 00:10:42,119 Uh, this one, asthma attack. Resp 33. 197 00:10:42,200 --> 00:10:44,191 - Thank you. - Right, uh, head injury, 198 00:10:44,520 --> 00:10:47,751 lost consciousness now, GCS 14 with neck pain. 199 00:10:48,040 --> 00:10:50,838 Pulse 104, but otherwise he's stable. 200 00:10:51,280 --> 00:10:53,032 - And this one? - Yeah, um... 201 00:10:53,960 --> 00:10:54,949 Needs a tube. 202 00:10:55,320 --> 00:10:56,912 Spinal injury, GCS 8. 203 00:10:57,200 --> 00:10:58,189 Okay. 204 00:10:58,520 --> 00:11:00,750 He goes to ED, the other two stay here. 205 00:11:00,840 --> 00:11:02,637 Harry, leave him. I need you here now. 206 00:11:03,080 --> 00:11:04,274 - Justin, side up. - Yeah. 207 00:11:05,000 --> 00:11:06,433 - Yeah. - This guy goes to bay B. 208 00:11:06,680 --> 00:11:08,113 - Constance is gonna help you with him. - Uh... 209 00:11:08,200 --> 00:11:09,952 - What about... - Don't worry, I've got him sorted. 210 00:11:10,040 --> 00:11:13,510 Listen, we're gonna double-bed the spinal in there. I'll get started. 211 00:11:13,720 --> 00:11:15,312 Rebecca can take over when she gets back. 212 00:11:15,400 --> 00:11:16,799 We really need more hands down here. 213 00:11:16,920 --> 00:11:17,909 Enough! 214 00:11:19,080 --> 00:11:21,036 Glen, everybody's asking me about this. 215 00:11:21,160 --> 00:11:22,798 I've chased it and they're on their way, okay? 216 00:11:29,520 --> 00:11:31,033 Abdomen's distended. 217 00:11:32,000 --> 00:11:33,911 Get more O pos through the rapid infuser quickly, please. 218 00:11:34,000 --> 00:11:34,989 Yeah, it's running. 219 00:11:35,080 --> 00:11:36,593 Theatres are full for half an hour. 220 00:11:36,800 --> 00:11:37,789 Shit. 221 00:11:38,520 --> 00:11:39,555 Yep. 222 00:11:39,640 --> 00:11:40,629 Okay, book it. 223 00:11:40,840 --> 00:11:42,273 Yes, please. Laparotomy. 224 00:11:42,560 --> 00:11:44,039 We'll have to manage him here until then. 225 00:11:48,720 --> 00:11:49,869 Weak radials. 226 00:11:54,440 --> 00:11:56,829 Right ankle pulses are absent. 227 00:11:57,160 --> 00:11:58,752 Right's cold compared to left. 228 00:11:58,840 --> 00:12:00,319 Billy, can you get me the Doppler, please? 229 00:12:00,400 --> 00:12:01,389 Yeah. 230 00:12:03,840 --> 00:12:05,068 Calf's hard and dull. 231 00:12:05,160 --> 00:12:07,628 This guy needs an urgent fasciotomy in theatre. 232 00:12:07,720 --> 00:12:09,915 This can't wait 30 minutes. Ania, call them again. 233 00:12:10,480 --> 00:12:11,629 - Here you go. - Thank you. 234 00:12:13,760 --> 00:12:16,149 Yeah, resus. We now need urgent fasciotomy. 235 00:12:17,080 --> 00:12:18,069 Yes, now. 236 00:12:19,560 --> 00:12:21,596 No DP or PT flow. 237 00:12:23,560 --> 00:12:24,549 Knee... 238 00:12:32,280 --> 00:12:33,349 Triphasic flow. 239 00:12:33,880 --> 00:12:35,632 Billy, can you see if the X-rays are up yet? 240 00:12:35,720 --> 00:12:36,709 Yeah. 241 00:12:37,840 --> 00:12:38,829 - They're up. - Okay. 242 00:12:42,640 --> 00:12:43,709 And no fractures. 243 00:12:44,880 --> 00:12:46,472 - Compartment syndrome? - Yes. 244 00:12:47,320 --> 00:12:49,311 About 90 minutes post-injury. 245 00:12:49,400 --> 00:12:51,391 - No luck with the theatres. - Okay, you're right. 246 00:12:51,800 --> 00:12:54,030 This guy can't wait 30 minutes. He'll lose a leg. 247 00:12:54,120 --> 00:12:56,236 So, you're gonna do it here and 248 00:12:56,520 --> 00:12:59,080 you, Anna, you're gonna assist, so go and scrub up, please. 249 00:13:01,280 --> 00:13:02,269 Now. 250 00:13:03,720 --> 00:13:06,439 - Okay, Ania, come on. - Are you sure about this? 251 00:13:07,280 --> 00:13:09,589 Absolutely. I am not prepared to accept an ischaemic leg. 252 00:13:09,840 --> 00:13:11,432 Time is muscle, as they say. 253 00:13:11,720 --> 00:13:13,278 - You don't see this every day, do you? - Hmm. 254 00:13:17,040 --> 00:13:19,429 Billy, Ramakrishna, let's start getting set up, please. 255 00:13:19,520 --> 00:13:20,509 - Yeah. - On it. 256 00:13:22,760 --> 00:13:23,795 Just gonna feel your chest. 257 00:13:24,760 --> 00:13:26,398 There's a lady outside looking for her husband. 258 00:13:26,560 --> 00:13:28,278 Uh, says he's been here about half an hour. 259 00:13:28,360 --> 00:13:29,998 It's Jim Waters. 260 00:13:31,080 --> 00:13:32,957 Uh, that's Jim Waters. 261 00:13:33,640 --> 00:13:35,517 Oh, God. Okay, um... 262 00:13:36,200 --> 00:13:37,235 Can you talk to her? 263 00:13:37,400 --> 00:13:39,709 Uh, no, no. No, I can't leave this patient. 264 00:13:39,800 --> 00:13:40,789 Don't panic, I'll bring her here. 265 00:13:41,000 --> 00:13:43,389 Well, no, I mean... Give us a minute to get rid of him. 266 00:13:44,040 --> 00:13:45,029 Shit. 267 00:13:46,320 --> 00:13:47,799 Hey, guys, you need to get going. 268 00:13:48,360 --> 00:13:49,998 Now. Let's move this, please. 269 00:13:50,520 --> 00:13:52,511 Constance, can you hook him up to the oxygen when we move there? 270 00:13:52,600 --> 00:13:53,589 Yes. 271 00:13:54,400 --> 00:13:58,188 Okay, we're just gonna put a clean sheet on and we'll move you straight over. 272 00:14:02,040 --> 00:14:03,678 - Billy, my ties. - Yep. 273 00:14:03,840 --> 00:14:04,875 Thanks. 274 00:14:13,040 --> 00:14:14,917 - There you go. - Antiseptic, please, Billy. 275 00:14:15,040 --> 00:14:16,029 Yeah. 276 00:14:24,000 --> 00:14:25,319 Okay, drapes. 277 00:14:25,760 --> 00:14:26,875 Yeah. 278 00:14:32,920 --> 00:14:35,150 - I need you to lift up the leg. - Okay. 279 00:14:35,480 --> 00:14:36,799 Let me help you. 280 00:14:40,600 --> 00:14:42,033 - Another drape, Billy. - Yeah. 281 00:14:52,320 --> 00:14:55,232 Ania, I need you to hold the ankle. I need you to keep it steady. 282 00:14:55,320 --> 00:14:56,309 Okay. 283 00:14:56,400 --> 00:14:58,311 - Billy, will you support the thigh? - Yeah. 284 00:15:00,400 --> 00:15:01,389 Okay. 285 00:15:03,160 --> 00:15:06,675 I'm going to expose the lateral intermuscular septum. 286 00:15:09,120 --> 00:15:10,109 Cutting. 287 00:15:19,040 --> 00:15:20,029 - Oh... - Shit. 288 00:15:20,960 --> 00:15:21,949 Okay... 289 00:15:23,080 --> 00:15:25,435 Now we're secure. Chest is... 290 00:15:28,560 --> 00:15:30,232 Yeah, clear. The BP's in his boots. 291 00:15:30,480 --> 00:15:31,629 Needs his laparotomy, boss. 292 00:15:31,720 --> 00:15:33,836 Let's get the rapid infuser on to maximum, please. 293 00:15:33,920 --> 00:15:34,909 I'll get some blood. 294 00:15:36,040 --> 00:15:38,031 - It's at maximum. - Thank you. Billy? 295 00:15:38,360 --> 00:15:39,349 Yeah, I'm here. 296 00:15:45,240 --> 00:15:46,673 Pulse up. Crisis gone. 297 00:15:47,160 --> 00:15:49,116 Pulse is really weak. BP's gone. 298 00:15:50,680 --> 00:15:52,636 Let's squeeze some blood in through this Venflon. 299 00:15:52,720 --> 00:15:53,709 Go. 300 00:15:54,240 --> 00:15:55,434 - He needs to be in theatre, boss. - I know. 301 00:15:55,680 --> 00:15:57,671 - Billy, on the chest. Thank you. - There's your pads. 302 00:16:01,400 --> 00:16:02,389 - You're okay. - Breathe. 303 00:16:02,520 --> 00:16:03,509 Dr Bennett-Edwardes? 304 00:16:04,200 --> 00:16:05,315 This is Mrs Waters. 305 00:16:10,960 --> 00:16:11,995 - Constance. - Sure. Sure. 306 00:16:18,160 --> 00:16:20,913 I'm very sorry, but I have some bad news for you. 307 00:16:21,960 --> 00:16:22,995 We did our very best, 308 00:16:24,200 --> 00:16:27,431 but your husband's injuries were too severe for us to help him. 309 00:16:28,960 --> 00:16:31,428 And I'm afraid he died a short while ago. 310 00:16:34,320 --> 00:16:35,799 I'm terribly sorry for your loss. 311 00:16:38,040 --> 00:16:39,029 I... 312 00:16:41,240 --> 00:16:42,719 Let's get you a seat. 313 00:16:44,320 --> 00:16:47,437 - My Jim! - It's all right... 314 00:16:47,560 --> 00:16:49,118 We'll get you sat down. 315 00:16:50,320 --> 00:16:51,639 It's all right. 316 00:16:58,080 --> 00:16:59,559 Thank you. 317 00:17:03,440 --> 00:17:04,429 Pulse check, please. 318 00:17:08,800 --> 00:17:10,313 BP's back. It's weak, but it's there. 319 00:17:10,400 --> 00:17:12,595 Good. Let's keep going on the rapid infuser, please. 320 00:17:12,680 --> 00:17:13,669 Yeah. 321 00:17:15,720 --> 00:17:16,709 Another one for you. 322 00:17:17,640 --> 00:17:18,629 Okay. 323 00:17:22,520 --> 00:17:23,589 I don't have another reg. 324 00:17:24,120 --> 00:17:25,792 And besides, all the trauma bays are busy. 325 00:17:26,960 --> 00:17:28,313 Congratulations on your news, by the way. 326 00:17:30,400 --> 00:17:31,389 Thank you. 327 00:17:31,600 --> 00:17:33,591 And we're sure ED can't take her? 328 00:17:33,680 --> 00:17:34,795 She needs to be in here. 329 00:17:36,400 --> 00:17:37,389 Okay. 330 00:17:43,880 --> 00:17:45,029 This way, please. 331 00:17:51,480 --> 00:17:52,469 Harry. 332 00:17:54,440 --> 00:17:57,000 - Okay, let's hear it. - Okay, Mavis, 82. 333 00:17:57,520 --> 00:17:59,476 Just discharged from ED at 4 hours 334 00:17:59,560 --> 00:18:02,074 to keep beds free for the major incident patients. 335 00:18:02,240 --> 00:18:04,310 Collapsed in the car park with difficulty breathing. 336 00:18:04,400 --> 00:18:05,992 Looks like she's got a NOF fracture. 337 00:18:06,160 --> 00:18:08,754 Okay, Harry, I need you to take care of her for me, please. 338 00:18:09,120 --> 00:18:10,951 - Yes? - Uh, yes, of course. 339 00:18:11,080 --> 00:18:12,069 Thank you. 340 00:18:13,800 --> 00:18:14,835 Hi. 341 00:18:16,720 --> 00:18:19,439 - Tell me. - BP rising. It's 88 over 44. 342 00:18:20,360 --> 00:18:22,476 Let's get back to the fasciotomy, please. 343 00:18:27,480 --> 00:18:29,357 I'm starting the medial incision. 344 00:18:31,480 --> 00:18:32,469 Cutting. 345 00:18:34,840 --> 00:18:36,034 - Could you sign this, please? - Oh, yeah, sure. 346 00:18:37,880 --> 00:18:38,869 Is this the guy? 347 00:18:39,200 --> 00:18:41,031 Uh, yes. Known asthmatic. Thanks. 348 00:18:41,280 --> 00:18:42,793 Uh, brought him from the incident. 349 00:18:42,880 --> 00:18:46,156 Uh, tachypneic, tachycardic on arrival and unable to speak. 350 00:18:46,240 --> 00:18:47,878 He's been given back-to-back nebs, 351 00:18:48,160 --> 00:18:51,232 steroids and... Uh, yes. This one. 352 00:18:52,120 --> 00:18:55,271 Ipratropium. Uh, just started on magnesium, 353 00:18:55,360 --> 00:18:57,635 um, but his odds have worsened, despite treatment. 354 00:18:57,800 --> 00:18:59,756 Why on earth did you wait so long to give him magnesium? 355 00:18:59,960 --> 00:19:01,393 That's what turns these ones around. 356 00:19:01,840 --> 00:19:03,671 He might have avoided a tube. 357 00:19:03,760 --> 00:19:07,150 The line was really difficult. I was drawing stuff up myself, um... 358 00:19:08,760 --> 00:19:09,988 I'm really sorry. I should've done better. 359 00:19:10,160 --> 00:19:11,149 Get over here and help. 360 00:19:14,680 --> 00:19:16,591 Mavis, I'm gonna be back in just one minute, okay? 361 00:19:16,680 --> 00:19:17,908 Nurse, could you watch her? 362 00:19:25,120 --> 00:19:26,155 Can we get some help here? 363 00:19:28,000 --> 00:19:28,989 Help. 364 00:19:31,040 --> 00:19:32,029 Some help, please. 365 00:19:33,200 --> 00:19:35,270 Go. I'll be fine here. 366 00:19:39,120 --> 00:19:40,792 Well, can't you find an alternative route? 367 00:19:41,920 --> 00:19:44,036 All right, all right. We'll see you when we see you. 368 00:19:44,200 --> 00:19:45,997 Due to a major incident, 369 00:19:46,080 --> 00:19:49,072 we're experiencing severe delays in all departments. 370 00:19:49,560 --> 00:19:53,030 We apologise for any inconvenience or distress this may cause. 371 00:19:55,960 --> 00:19:57,279 The major incident has shut the motorway. 372 00:19:57,360 --> 00:19:58,634 Extra staff are stuck in gridlock. 373 00:19:58,720 --> 00:20:00,631 - What's he doing? - Oh, yeah. 374 00:20:00,920 --> 00:20:02,717 Turns out, he refused to go quietly. 375 00:20:03,200 --> 00:20:04,758 So, they had to promote him. 376 00:20:09,520 --> 00:20:11,317 - Clive. - Nicola. 377 00:20:12,280 --> 00:20:13,918 I hope you don't mind us commandeering your office. 378 00:20:14,080 --> 00:20:16,674 David, Ruth. This is Mrs Hicklin. 379 00:20:17,800 --> 00:20:21,110 Uh, we're struggling to move patients to CT, theatres or the wards. 380 00:20:21,200 --> 00:20:22,189 Yes, it's in hand. 381 00:20:22,680 --> 00:20:25,592 I'll try to clear the decks elsewhere, but I can't empty the hospital entirely. 382 00:20:26,440 --> 00:20:27,668 Do we not have any space? 383 00:20:27,760 --> 00:20:30,069 All I can see is that you're coping admirably. 384 00:20:30,800 --> 00:20:32,995 Especially after all the marvellous changes you brought in. 385 00:20:39,920 --> 00:20:42,798 And after all that, it turns out I had it on me all along. 386 00:20:46,000 --> 00:20:47,194 You're so funny. 387 00:20:47,600 --> 00:20:48,874 You make me laugh so much. 388 00:20:49,360 --> 00:20:50,349 Lovely, Billy. 389 00:20:51,320 --> 00:20:53,117 Well, what do you say to a night out? 390 00:20:53,520 --> 00:20:56,910 You, me, some dinner. Lots of laughs. 391 00:20:57,400 --> 00:20:58,913 Yeah, that'll be lovely. 392 00:20:59,160 --> 00:21:01,799 Um, but as friends, right? Cos you know I have a boyfriend. 393 00:21:03,920 --> 00:21:07,310 Yeah, of course, you... You thought I meant, um... 394 00:21:08,320 --> 00:21:10,515 - Nah, just as friends is cool. - Okay. 395 00:21:10,880 --> 00:21:12,757 Due to a major incident, 396 00:21:12,880 --> 00:21:14,996 we're experiencing severe delays... 397 00:21:15,120 --> 00:21:18,749 Billy. Billy. With me, now, please. Bay C. 398 00:21:27,560 --> 00:21:28,549 BP's still dropping. 399 00:21:28,640 --> 00:21:31,916 Systolic 84, pulse is 1-2-9 and that is getting worse. 400 00:21:32,040 --> 00:21:34,508 Look, look, look, this is new. All this bruising. 401 00:21:36,840 --> 00:21:39,274 Retroperitoneal bleeds more extensive. 402 00:21:40,720 --> 00:21:42,790 - Ania, can you chase theatre again? - Yeah. 403 00:21:42,880 --> 00:21:44,836 - We need to move him now. - Don't bother. 404 00:21:44,960 --> 00:21:48,270 Main theatre's full. I'll see how long they're gonna take in trauma theatre. 405 00:21:53,320 --> 00:21:56,471 Excuse me, sorry. Coming through. Mind your backs, please. Backs. 406 00:21:56,560 --> 00:21:57,549 - Sorry. - Hey! 407 00:21:57,640 --> 00:21:59,995 Mind your backs, sorry. I've got to get through. 408 00:22:00,080 --> 00:22:01,274 Sorry, love. 409 00:22:09,040 --> 00:22:12,237 Sorry to disturb, Mr Street. Just wondering how long you're gonna be. 410 00:22:12,320 --> 00:22:15,869 You're the third person to ask me that. It takes as long as it takes. 411 00:22:17,160 --> 00:22:18,957 I don't know what his problem is. 412 00:22:19,040 --> 00:22:21,600 Obviously regularly gets his digits inside a bird. 413 00:22:34,320 --> 00:22:38,074 Got a three-month contract to continue working here. 414 00:22:38,160 --> 00:22:40,515 But what about your Army deployment? 415 00:22:40,600 --> 00:22:42,079 I've deferred it. 416 00:22:45,480 --> 00:22:47,072 Here's her bloods. 417 00:22:48,800 --> 00:22:53,157 Right, high potassium's not helping. Erm, okay, 10 mil of calcium chloride, 418 00:22:53,280 --> 00:22:56,352 - then magnesium and insulin dextrose. - Mmm-hmm. 419 00:22:56,440 --> 00:22:58,431 She's still in VT with output. 420 00:22:58,520 --> 00:23:00,511 Can I have help with her airway, please? 421 00:23:00,600 --> 00:23:03,637 I'm busy with your other patient. 422 00:23:03,720 --> 00:23:06,188 Calcium chloride, 10 mil, going in. 423 00:23:08,880 --> 00:23:12,236 Okay, erm, can we have another synchronised shot, please? 424 00:23:12,320 --> 00:23:14,959 Shouldn't we wait until the amiodarone's gone through? 425 00:23:17,600 --> 00:23:19,431 You know, it's nearly run through 426 00:23:19,520 --> 00:23:21,431 and the calcium should stabilise her heart temporarily. 427 00:23:26,000 --> 00:23:27,638 Yes, this is Glen Boyle, trauma consultant. 428 00:23:27,720 --> 00:23:31,030 I need a theatre for an emergency laparotomy, please. 429 00:23:31,120 --> 00:23:34,351 May Jacks. MO 0005. 430 00:23:34,440 --> 00:23:37,113 Well, it's an emergency. So, yes, I need it now. 431 00:23:37,200 --> 00:23:39,031 Okay, understood. 432 00:23:39,120 --> 00:23:41,076 - News? - Another 15 minutes, at best. 433 00:23:41,160 --> 00:23:42,878 But Street knows about him 434 00:23:42,960 --> 00:23:46,077 and Nicola's trying to find a theatre upstairs. 435 00:23:46,160 --> 00:23:47,912 BP is still abysmal. 436 00:23:49,240 --> 00:23:53,119 Okay, let's keep transfusing him. Aim for 90 systolic. 437 00:23:53,200 --> 00:23:54,713 CT and theatre were busy, 438 00:23:54,800 --> 00:23:57,268 so let's get Shelley down here to redo the X-rays. 439 00:23:57,360 --> 00:24:00,670 Justin, you can do that. Call up to X-rays, please. 440 00:24:00,760 --> 00:24:03,069 - Erm, Billy, can you... - I'm busy. 441 00:24:06,440 --> 00:24:07,759 Thank you. 442 00:24:08,120 --> 00:24:11,192 Due to a major incident, we're experiencing severe delays 443 00:24:11,280 --> 00:24:12,554 in all departments. 444 00:24:13,000 --> 00:24:15,070 We apologise for any inconvenience... 445 00:24:15,160 --> 00:24:17,913 Justin here. Can... Hi, Shelley. 446 00:24:18,000 --> 00:24:20,798 Yeah, fine. 447 00:24:20,880 --> 00:24:23,952 Can we get more X-rays in resus Bay C, please? Thanks. 448 00:24:29,280 --> 00:24:30,429 Glen. 449 00:24:33,480 --> 00:24:36,552 We have a prolonged entrapment on its way. Low GCS. 450 00:24:37,120 --> 00:24:38,758 Techs intubated him on scene. 451 00:24:38,840 --> 00:24:41,400 I've cleared an ED cubicle and stocked it with resus equipment. 452 00:24:41,480 --> 00:24:44,756 - So we can use it as an extra resus bay. - And what about those extra hands? 453 00:24:44,840 --> 00:24:48,276 - Clive won't reallocate on-site staff. - Clive? 454 00:24:48,360 --> 00:24:50,794 Yeah, he's been moved up to management. 455 00:24:50,880 --> 00:24:51,869 Yeah, I know. 456 00:24:51,960 --> 00:24:55,032 And what I need is for you to cope until people start arriving. 457 00:24:55,120 --> 00:24:57,111 I've got the on-call surgical SHO coming. 458 00:24:57,200 --> 00:25:00,670 And we can ask Dominic to help when he has handed over the asthma patient. 459 00:25:00,760 --> 00:25:02,671 So, can you spare anyone? 460 00:25:04,200 --> 00:25:05,758 Oh, shit! 461 00:25:06,080 --> 00:25:08,150 - Do I have a choice? - Thanks, Glen. 462 00:25:08,280 --> 00:25:11,636 BP's dropping again. It's 68 over 34. 463 00:25:11,720 --> 00:25:13,358 Shit, he's oozing from his lines. 464 00:25:13,440 --> 00:25:15,874 Give him calcium and more clotting factors, please. 465 00:25:15,960 --> 00:25:17,518 He's cold. Can we have a Bair Hugger, please? 466 00:25:17,600 --> 00:25:18,669 Yeah. 467 00:25:19,640 --> 00:25:22,996 Yeah, Switch, get me theatres, please. 468 00:25:23,080 --> 00:25:27,278 Okay, this is Glen Boyle. May Jacks. MO 0005. 469 00:25:27,360 --> 00:25:29,715 He has deteriorated since the last time I called. 470 00:25:29,800 --> 00:25:32,360 I really need to bring him up now. 471 00:25:32,440 --> 00:25:36,149 Coagulopathic, yes. Transfusing, yes. 472 00:25:37,360 --> 00:25:38,793 Okay, thank you. 473 00:25:38,880 --> 00:25:41,792 Okay, let's prep for transfer. They're gonna be another five. 474 00:25:41,880 --> 00:25:44,075 But we'll continue the transfusions as we go. 475 00:25:44,160 --> 00:25:45,912 I'm gonna need to check on the other bays, 476 00:25:46,000 --> 00:25:47,991 but give me a shout if anything changes. 477 00:25:48,080 --> 00:25:49,672 Do you want me to carry on with the X-rays? 478 00:25:49,760 --> 00:25:51,557 - Yes, please. - Okay. 479 00:25:51,640 --> 00:25:54,712 - Harry, update, please. - Uh, yeah. 480 00:25:54,800 --> 00:25:56,836 Uh, this one is medical. 481 00:25:56,960 --> 00:25:59,349 This lady's back in sinus and the medics are taking her. 482 00:25:59,640 --> 00:26:00,629 Okay, good. 483 00:26:02,080 --> 00:26:04,958 I heard your news. Well done. 484 00:26:05,040 --> 00:26:07,156 I hope you had more luck than I did choosing the right one. 485 00:26:07,720 --> 00:26:08,789 Thank you. 486 00:26:08,880 --> 00:26:12,395 Harry, Constance, with me, please. Anna, here. 487 00:26:14,000 --> 00:26:16,958 Need you to go with Harry and Constance to the ED monitor bay. 488 00:26:17,040 --> 00:26:20,316 There'll be a surgeon there and I will send Dominic over ASAP. Go. 489 00:26:21,480 --> 00:26:24,278 - Um, it's Ania. - Right. 490 00:26:26,240 --> 00:26:27,798 - Harry? - Hmm. 491 00:26:27,880 --> 00:26:30,235 Need you to take the lead on a prolonged entrapment. 492 00:26:30,320 --> 00:26:32,436 - No, I... - Listen, if there's a problem, 493 00:26:32,520 --> 00:26:35,478 - you know you can call me. Yes? - Yes. 494 00:26:36,040 --> 00:26:37,553 And thank you. 495 00:26:39,200 --> 00:26:41,236 - I'm ready for rays. - Thanks. 496 00:26:51,680 --> 00:26:53,159 Rays in three. 497 00:26:54,360 --> 00:26:56,669 One, two, three, rays. 498 00:26:59,400 --> 00:27:00,753 Cubicle 4, please. 499 00:27:03,840 --> 00:27:07,355 Hey! Er, handover first, and then we'll put him on the trolley. 500 00:27:07,440 --> 00:27:09,635 Shouldn't we wait for the trauma team leader? 501 00:27:09,720 --> 00:27:11,756 - That's me. - Oh. 502 00:27:11,840 --> 00:27:14,479 Okay, well, I've got a male in his late 30s. 503 00:27:14,560 --> 00:27:16,994 Came off his motorbike during the major incident. 504 00:27:17,080 --> 00:27:20,675 He was trapped in a lateral position between two vehicles for an hour. 505 00:27:20,760 --> 00:27:23,433 He was able to tell me that he hadn't been KO'd 506 00:27:23,520 --> 00:27:25,397 and that he had a pain in his chest. 507 00:27:25,480 --> 00:27:27,994 Tubed at the scene, as he had difficulty breathing. 508 00:27:28,080 --> 00:27:30,310 We needed lots of PEEP and a high flow of oxygen 509 00:27:30,400 --> 00:27:32,118 to keep his sats acceptable. 510 00:27:32,200 --> 00:27:35,556 Er, equal air entry but bilateral surgical emphysema 511 00:27:35,640 --> 00:27:37,119 and rib fractures. 512 00:27:37,200 --> 00:27:40,909 And the surgical emphysema has extended to his upper chest and neck 513 00:27:41,000 --> 00:27:42,718 since intubation. 514 00:27:42,800 --> 00:27:46,236 He had bilateral thoracotomies. Circulation is stable. 515 00:27:46,320 --> 00:27:48,709 Pelvis and legs seem to have escaped major damage. 516 00:27:48,800 --> 00:27:49,835 Okay, great. Thanks. 517 00:27:49,920 --> 00:27:50,909 Let's move him across 518 00:27:51,000 --> 00:27:53,560 and I'll manage him on vent until the anaesthetist arrives. 519 00:27:54,400 --> 00:27:56,595 - Can you help us with this one? - Yeah, sure. 520 00:27:56,680 --> 00:27:59,274 On three. One, two, three. 521 00:27:59,800 --> 00:28:01,074 I got it. 522 00:28:01,160 --> 00:28:03,594 That was trauma theatre. Street's been delayed. 523 00:28:03,680 --> 00:28:05,193 You're gonna have to get started on your own. 524 00:28:05,280 --> 00:28:07,874 - You're not coming? - I can't. I'm needed in resus. 525 00:28:10,080 --> 00:28:12,878 - You'll be okay from here, yes? - I will. 526 00:28:12,960 --> 00:28:15,349 - About extending your contract... - Yeah. 527 00:28:15,440 --> 00:28:19,115 Make sure it's the right move. Don't mess up your only career. 528 00:28:19,200 --> 00:28:21,270 - We need to go. - Yeah. 529 00:28:31,360 --> 00:28:33,476 Equal bilateral air entry. 530 00:28:35,040 --> 00:28:36,678 That feels weird. 531 00:28:37,880 --> 00:28:41,793 Er, I mean, surgical emphysema and... 532 00:28:44,200 --> 00:28:46,156 Bilateral rib fractures. 533 00:28:48,200 --> 00:28:50,077 The abdomen is not distended. 534 00:28:52,960 --> 00:28:54,552 Why are his sats dropping? 535 00:28:54,840 --> 00:28:56,637 Oh, shit! The tube's come out! 536 00:28:57,320 --> 00:28:59,356 - Collar blocks off. - I'll go get help. 537 00:29:02,240 --> 00:29:04,629 - Got it? - C-spine mobilisation, here. 538 00:29:04,720 --> 00:29:06,039 - Okay. - Bag and mask, please. 539 00:29:20,600 --> 00:29:21,794 Come on. 540 00:29:23,440 --> 00:29:24,714 Guedel. 541 00:29:27,560 --> 00:29:29,232 Come on. 542 00:29:45,400 --> 00:29:47,834 His chest is not moving and his sats aren't going up. 543 00:29:47,920 --> 00:29:50,878 Er, check the thoracostomy, see if they're open. 544 00:29:54,120 --> 00:29:56,236 And then a laryngoscope in a tube, please. 545 00:29:56,640 --> 00:29:58,312 Shit. 546 00:30:01,680 --> 00:30:04,035 Come on, come on, the sats are dropping. 547 00:30:14,520 --> 00:30:15,669 Erm... 548 00:30:16,800 --> 00:30:18,358 I can't see anything. 549 00:30:18,440 --> 00:30:21,352 It's surgical emphysema. Tube. 550 00:30:24,520 --> 00:30:27,432 Okay, I think I can... Come on. 551 00:30:27,520 --> 00:30:29,636 I... 552 00:30:29,720 --> 00:30:32,154 Oh, shit, I can't... 553 00:30:32,240 --> 00:30:34,310 Oh, shit! I've made him bleed. 554 00:30:37,920 --> 00:30:39,194 Come on. 555 00:30:47,080 --> 00:30:48,718 - Constance? - Yes? 556 00:30:48,800 --> 00:30:49,994 - Quick track... - Hang on a sec! 557 00:30:50,080 --> 00:30:52,275 Easy. Let's try and get this tube in him. 558 00:30:52,520 --> 00:30:53,509 Here, let me. 559 00:30:54,080 --> 00:30:57,038 - His sats are 61. He needs a cric. - Just a sec... 560 00:30:58,840 --> 00:31:00,637 - He needs an airway, Dominic! - Hang on. 561 00:31:00,720 --> 00:31:03,598 - Surgical emphysema's in the way. - No, his sats are still falling! 562 00:31:03,680 --> 00:31:06,240 - If you don't stop, he's gonna die. - Damn it! 563 00:31:06,320 --> 00:31:08,356 Stop! He's can't intubate, can't ventilate. 564 00:31:08,440 --> 00:31:10,954 Move! We do this now. Blade. 565 00:31:41,240 --> 00:31:44,550 Put it in. Cuff up and ventilate. Cuff up and tie. 566 00:31:45,120 --> 00:31:46,473 Hold this, please. 567 00:31:57,840 --> 00:31:59,478 Ventilating. 568 00:32:02,440 --> 00:32:04,271 Sats rising. 569 00:32:11,000 --> 00:32:13,389 Roberts out. Scissors. 570 00:32:17,840 --> 00:32:19,796 Splenectomy is complete. Packs. 571 00:32:27,320 --> 00:32:30,118 - Two in. - Two in. Eight in total. 572 00:32:30,200 --> 00:32:32,350 BP's still dropping. Systolic is 70. 573 00:32:33,600 --> 00:32:35,875 Okay, moving onto the retroperitoneal bleed. 574 00:32:35,960 --> 00:32:38,269 - Erm, hang on. - Yes? 575 00:32:38,360 --> 00:32:40,237 Shouldn't we examine the rest of the abdomen, first? 576 00:32:40,320 --> 00:32:42,356 - We have to address this bleed. - Yeah, but protocol is... 577 00:32:42,440 --> 00:32:43,793 Ramakrishna! 578 00:32:43,880 --> 00:32:47,077 We don't have a consultant present, so someone has to lead, yes? 579 00:32:50,920 --> 00:32:52,319 Thank you. 580 00:32:59,040 --> 00:33:02,476 Evidence of an expanding retroperitoneal haematoma. 581 00:33:02,560 --> 00:33:04,710 BP's still dropping. Systolic is now 67. 582 00:33:04,800 --> 00:33:07,268 - Okay, let me see the pelvic X-rays. - Yeah. 583 00:33:08,680 --> 00:33:11,399 - Four out. - Four out, four in. 584 00:33:11,480 --> 00:33:13,072 Okay. 585 00:33:13,160 --> 00:33:16,675 No pelvic fractures evident. So the haematoma is 586 00:33:16,760 --> 00:33:19,320 - probably venous in origin. Agreed? - Agreed. 587 00:33:21,360 --> 00:33:23,032 Forceps, McIndoes. 588 00:33:24,000 --> 00:33:25,228 Before you do that, can I just say something? 589 00:33:25,320 --> 00:33:26,309 Quickly. 590 00:33:26,400 --> 00:33:27,549 Given there is no consultant present, 591 00:33:27,640 --> 00:33:29,153 shouldn't we be treating this a bit more conservatively? 592 00:33:29,240 --> 00:33:32,516 - His BP is still falling. He can't wait. - Yeah, I'm just saying, 593 00:33:32,600 --> 00:33:36,115 if the bleed is venous, why do you want to risk opening him up further? 594 00:33:40,480 --> 00:33:43,313 Okay, I'll do some extra peritoneal packing. 595 00:33:43,400 --> 00:33:46,312 That should stabilise him until Street gets here. 596 00:33:46,400 --> 00:33:47,913 Lane's forceps. 597 00:33:49,800 --> 00:33:50,915 Pack. 598 00:34:06,280 --> 00:34:08,794 - Six in. - Six in. Ten in total. 599 00:34:09,720 --> 00:34:10,869 Okay. 600 00:34:11,920 --> 00:34:13,592 - BP? - It's holding. 601 00:34:17,200 --> 00:34:18,428 Holding. 602 00:34:20,840 --> 00:34:22,353 Holding. 603 00:34:24,280 --> 00:34:26,077 Oh! Come on! 604 00:34:26,160 --> 00:34:29,436 - Forceps, McIndoes, now! - Dropping, systolic is 64. 605 00:34:35,360 --> 00:34:37,078 Massive arterial bleed. Suction. 606 00:34:37,240 --> 00:34:38,434 - Billy, whack it in. - Yes. 607 00:34:41,800 --> 00:34:44,109 Okay, I can't see a thing here. I need another suction. 608 00:34:44,200 --> 00:34:46,077 Suction. Quickly. 609 00:34:47,360 --> 00:34:49,032 I can't see anything. Quickly. 610 00:34:53,680 --> 00:34:55,193 I can't locate the bleed. 611 00:34:55,280 --> 00:34:57,953 - It's got to be in the pelvis. - But there's no fracture. 612 00:34:59,520 --> 00:35:02,080 - Shit! Hosing. - BP's dropping. Billy, whack it in. 613 00:35:02,160 --> 00:35:04,594 - Yes, yes, we're on it. - Packs. And again. 614 00:35:05,880 --> 00:35:08,314 - Where's Street? - Okay, systolic is 60. 615 00:35:10,360 --> 00:35:12,316 Billy, faster with the blood. 616 00:35:12,400 --> 00:35:15,312 Belmont's going full tilt. Systolic is 57. It's dropping. 617 00:35:16,600 --> 00:35:18,431 53. Shit, he's crashing. 618 00:35:21,400 --> 00:35:23,391 - Fiona? - Glen, I need your help. 619 00:35:23,480 --> 00:35:25,516 I can't control this retroperitoneal bleed. 620 00:35:25,800 --> 00:35:26,915 - Where's Street? 621 00:35:27,360 --> 00:35:30,716 He's not here. I can't control this. I need you in theatre now. 622 00:35:30,800 --> 00:35:32,279 Bay B, please. 623 00:35:32,360 --> 00:35:34,954 I've got seven patients in here. Three of them are unstable. 624 00:35:35,040 --> 00:35:37,031 There's absolutely no way I can leave. I'm sorry. 625 00:35:37,200 --> 00:35:41,113 - Glen, I'm losing him. - Just tell me exactly what's happening. 626 00:35:41,200 --> 00:35:44,476 Okay, I've packed him but his BP is still falling. 627 00:35:44,560 --> 00:35:46,232 Systolic pressure is around 50. 628 00:35:46,320 --> 00:35:47,958 He's hosing into the retroperitoneum, 629 00:35:48,040 --> 00:35:49,598 but it doesn't make any sense. 630 00:35:49,680 --> 00:35:52,877 There are no torn vessels and the pelvis is intact. 631 00:35:52,960 --> 00:35:55,235 And we're absolutely sure it's not a fracture? 632 00:35:55,320 --> 00:35:58,790 - I'm looking at the X-ray right now. - Hold on, hold on. 633 00:35:59,720 --> 00:36:01,597 - Stop. - Yeah, where are we taking him? 634 00:36:01,680 --> 00:36:03,750 Okay, in there, we'll double-bed him. 635 00:36:05,160 --> 00:36:08,038 The X-ray, is the pelvic binder on? 636 00:36:09,480 --> 00:36:11,869 - Yes. - Okay, listen, erm... 637 00:36:13,000 --> 00:36:15,468 - Put me on speaker. - Okay, you heard him. 638 00:36:18,480 --> 00:36:21,711 - Okay, go ahead. - Okay, everybody listen to me. 639 00:36:21,800 --> 00:36:24,314 If this is what I think it is, then we had this at Bastion. 640 00:36:24,400 --> 00:36:26,960 The chances are, the pelvis is fractured. 641 00:36:27,040 --> 00:36:29,554 It's just that the binder has reduced it, so we can't see the break. 642 00:36:29,640 --> 00:36:31,392 But it is there. 643 00:36:31,480 --> 00:36:33,994 And X-rays are too low res to reveal it. 644 00:36:34,120 --> 00:36:36,918 - Shit, we skipped CT. - Yeah. 645 00:36:37,000 --> 00:36:39,468 - Analgesic. - Uh, morphine. 646 00:36:39,560 --> 00:36:42,870 - Ten milligrams? Okay. - Yeah. 2.5 at a time, yes? Go. 647 00:36:42,960 --> 00:36:44,791 This is what you need to do. 648 00:36:44,880 --> 00:36:46,677 You need to unpack, get in there, 649 00:36:46,760 --> 00:36:49,433 and clamp off one of the internal iliac arteries. 650 00:36:49,520 --> 00:36:52,273 And if you can't determine which one, well, 651 00:36:52,360 --> 00:36:54,635 - you're gonna have to do them both. - Both of them? 652 00:36:54,720 --> 00:36:57,473 Yeah, I know, it's crap. But yes. 653 00:36:57,760 --> 00:36:59,079 Okay, I've got it. 654 00:36:59,160 --> 00:37:00,912 Good. Take me off speaker, please. 655 00:37:01,000 --> 00:37:03,514 Stop. Go. 656 00:37:03,600 --> 00:37:06,068 You're off speaker. 657 00:37:06,160 --> 00:37:09,835 You're more important to me than the Army is. Okay? 658 00:37:11,040 --> 00:37:12,473 That's why I'm staying. 659 00:37:14,520 --> 00:37:15,919 I have to go. 660 00:37:16,560 --> 00:37:18,551 I'll speak to you later, and good luck. 661 00:37:20,440 --> 00:37:21,429 Thank you. 662 00:37:28,520 --> 00:37:29,714 Right. 663 00:37:31,080 --> 00:37:33,071 We're unpacking. 664 00:37:33,160 --> 00:37:35,037 And this is gonna be fast. 665 00:37:35,960 --> 00:37:38,679 - Is everybody ready? - Yes, Ms Lomas. 666 00:37:38,760 --> 00:37:40,557 Ready. 667 00:37:40,640 --> 00:37:42,870 Ramakrishna? 668 00:37:42,960 --> 00:37:44,996 Okay, let's do this. 669 00:37:48,240 --> 00:37:49,639 Unpacking. 670 00:37:55,040 --> 00:37:56,314 Four out. 671 00:37:56,520 --> 00:37:58,078 - Ten in. - Shit. 672 00:37:58,160 --> 00:37:59,275 Okay. 673 00:38:00,240 --> 00:38:01,958 Okay, get in there with suction. 674 00:38:05,200 --> 00:38:06,952 Okay, I can't get to it. The vessels have collapsed. 675 00:38:07,040 --> 00:38:08,268 Get me another suction! 676 00:38:11,000 --> 00:38:14,037 Okay. I have the common iliac bifurcation. 677 00:38:15,120 --> 00:38:17,509 Searching for the internal iliacs. 678 00:38:17,600 --> 00:38:21,513 Okay, let's be ready with McIndoes, Dardick, sling and Lahey. 679 00:38:28,280 --> 00:38:31,158 How's it going? What happened? 680 00:38:31,240 --> 00:38:34,357 He was can't intubate, can't ventilate, so he needed a cric. Otherwise, stable. 681 00:38:35,000 --> 00:38:37,594 Okay, well done, Dominic. Is he going to CT? 682 00:38:38,680 --> 00:38:41,797 - Yes, I just need to book him in first. - Well, then get him booked in! 683 00:38:41,880 --> 00:38:44,474 Once he's done in CT, you get him to resus Bay C, okay? 684 00:38:44,560 --> 00:38:46,516 Yes, Mrs Hicklin. 685 00:38:54,400 --> 00:38:56,197 Dardick. 686 00:38:59,560 --> 00:39:02,279 That's the right internal iliac artery clamped. 687 00:39:03,800 --> 00:39:05,028 Come on. 688 00:39:05,120 --> 00:39:07,588 No good, he's still hosing. Give me another suction. 689 00:39:07,680 --> 00:39:09,477 Eric, blood, please. 690 00:39:10,560 --> 00:39:13,472 Systolic's 50. We're pouring in, but it's no use. 691 00:39:13,560 --> 00:39:16,233 We'll have to clamp the other artery. Lahey and sling. 692 00:39:21,920 --> 00:39:22,909 Quick! 693 00:39:32,360 --> 00:39:33,759 Got it. 694 00:39:38,000 --> 00:39:40,798 Okay, clamped. Let's get his volume up. 695 00:39:40,880 --> 00:39:42,711 It's happening. 696 00:39:52,840 --> 00:39:54,717 Systolic's still 50. 697 00:39:56,040 --> 00:39:58,679 Come on, come on... 698 00:40:10,960 --> 00:40:12,757 Rising. 55. 699 00:40:17,760 --> 00:40:21,116 Systolic's still rising. Now 60. 700 00:40:29,640 --> 00:40:31,437 65. 701 00:40:32,600 --> 00:40:36,388 - Gen surge consultant. - Scrubbing in. 702 00:40:44,160 --> 00:40:45,752 Thank you. 703 00:40:45,840 --> 00:40:47,956 We've got another P1 coming in now. 704 00:40:48,040 --> 00:40:51,077 I've found you an anaesthetist and a gen surge reg. 705 00:40:51,160 --> 00:40:52,957 Good. This way. 706 00:40:53,800 --> 00:40:56,189 Go and get ready in Bay A, please. 707 00:40:56,600 --> 00:40:59,034 Erm, two theatres are clear 708 00:40:59,120 --> 00:41:02,351 and a CT list has been cancelled, so we can start moving patients 709 00:41:02,440 --> 00:41:04,670 - that are coming in now. - Okay. 710 00:41:04,760 --> 00:41:07,479 - Thank you very much for today. - You're welcome. 711 00:41:07,560 --> 00:41:09,710 I'm glad you're staying. 712 00:41:16,120 --> 00:41:18,475 Erm, is there any news on his ITU bed? 713 00:41:18,560 --> 00:41:20,869 Bed's free, they're sending a team down to transfer him now. 714 00:41:20,960 --> 00:41:23,713 - Great. Okay, everyone happy? - How could we not be happy? 715 00:41:23,800 --> 00:41:26,553 It's easy to manage patients that are completely stable. 716 00:41:26,640 --> 00:41:29,279 Well, at least I did something when you lost his AOA. 717 00:41:29,360 --> 00:41:31,237 You did the cric, Harry? 718 00:41:36,240 --> 00:41:38,231 I threw a lot at you today. 719 00:41:38,480 --> 00:41:40,596 Very impressed. 720 00:41:40,760 --> 00:41:42,716 Yeah, well done, Harry. 721 00:41:45,560 --> 00:41:47,755 - Did we win? - Yes. 722 00:41:47,840 --> 00:41:50,149 Good. 723 00:41:50,240 --> 00:41:52,629 - Can we talk... - I hear congratulations are in order. 724 00:41:52,720 --> 00:41:54,438 When's the big day? 725 00:41:57,320 --> 00:41:59,311 I asked him not to say anything. 726 00:41:59,400 --> 00:42:00,799 Have you got the ring? Can we see? 727 00:42:01,040 --> 00:42:02,758 Come on, show the ring. 728 00:42:05,120 --> 00:42:06,553 Ooh! 729 00:42:06,640 --> 00:42:07,789 Put it on, I wanna see! 730 00:42:07,880 --> 00:42:08,869 Go on, go on! 731 00:42:09,120 --> 00:42:11,350 - Oh! - It looks beautiful. 732 00:42:11,760 --> 00:42:14,035 - It is gorgeous. - Congratulations. 733 00:42:15,920 --> 00:42:18,753 But we've got another patient coming in. ETA is five minutes. 734 00:42:18,840 --> 00:42:21,718 So if we can go and get prepared in Bay A, please. 735 00:42:22,600 --> 00:42:24,670 - Mmm! - Please. 736 00:42:32,720 --> 00:42:34,517 - I'm so... - Yeah. 737 00:42:37,700 --> 00:42:45,700 Ripped By mstoll