I thought you'd have gone.
I don't think either of us wants history to repeat itself.
You're making it very difficult for Lorraine.
She's a good surgeon.
Maybe we need better than good right now.
...that mean you're gonna go without your...
Harry wanted to do a psych assessment,
but Clive insisted that she be discharged to meet the four-hour target.
Who's that supporting the head? Not Harry by any chance?
Yeah, that's right.
One of our regs smashed it last month.
I'm making this work.
Yes, of course, but you have to understand that...
I'm not going anywhere, Fi.
I'm not leaving.
Ripped By mstoll
I'll lead. Mrs Rappaport will assist.
Okay.
On my count of three, raise. One, two, three, go.
Okay. We're gonna both scrub in.
MAN ON TANNOY Trauma call. Emergency department.
Trauma call. Emergency department.
- ETA imminent. - Others are on their way.
Starting clock.
Brakes on.
Hey. Starting overhead camera.
It's on.
Transfer on three. One, two, three!
Okay.
Sarah, you okay to stay?
I'll call down one of the regs to cover resus.
Thank you. Lorraine?
- Yeah? - If you're on your own,
- you need to check in with Clive. - Yeah, right.
Glen?
Okay, so, it's Kevin Parrish, he's a butcher. Knife slips...
What the hell was that about?
I felt like she was trying to make a point.
She's an experienced consultant, and this situation is humiliating.
Yeah?
But there's more, isn't there?
Okay.
The patient last week who jumped...
- Yeah. - I found out
it was Clive who discharged her, not Harry.
- And you told Lorraine? - Yes, I did.
Because she has a right to defend herself.
Yeah, and you think if Lorraine stays, then that's me gone.
Trauma call. Attend, emergency department.
Okay. 20s, female, she was a passenger
in the front seat of a minicab.
- Two-vehicle RTC. - Okay, thanks.
Let's get this scoop off.
Right. Raise on three.
One, two, three!
Patient's jacket on the side.
- Ana. - That ours as well?
No, that's the minicab driver. He's not major trauma.
Harry, take him to ED,
- would you, please? - Ana!
Is Billy back yet? I'm starving.
Argh! Bloody hell, she's here already?
I am Dr Bennett-Edwardes. I'm gonna be examining you.
- Is she going to be okay? - Er, they need to assess her.
Yeah, do you think she'll be okay?
Try to stay calm, sir. She's going to be fine.
Heart rate's jumped.
She's awake!
Whoa! Whoa!
- Whoa, whoa, whoa! - Hold her down!
Calm down.
Argh!
Oh, that's got to hurt!
Five milligrams of midazolam.
I'm on it.
I'm Mrs Nicola Hicklin.
Bollocks!
You're at City General Hospital.
You've been in an accident.
- Oh! - Jesus!
Want help?
Get hold of her! Get hold of her!
- She's pulled off the Venflon! - I'll get another one.
I take it this is our patient.
Now, calm down. Come on!
Do we have a name?
Ana. I'm not sure she speaks English.
I was hoping for a 10-minute kip in the office chair.
You'd be so lucky.
Midazolam, and she pulled out the line.
Lie down, please!
Ana!
Ana, it's okay. You're okay.
My name is Fiona.
We're going to try and help you. We're going to help you. You're okay.
- Just hold her still. - You're okay.
Hi, love.
It's okay. It's okay.
- Ahhh! - Oh!
- And for your next trick... - It's okay, Ana.
It's okay. Shh!
- You're okay. - Another grey
- Venflon, please, Nerys. - Coming up!
Bloody well hold her still.
It's okay. It's okay.
Let's try again, shall we? Crap veins.
- Can anyone tell me what's going on? - We've got an agitated patient.
You're okay.
- Where's Lorraine? - In theatre.
It's okay, Ana.
- Midazolam is going in. - Okay.
It'll kick in in about 20 seconds.
It's okay, Ana. You're okay.
It's okay. It's okay.
Okay.
Okay, done.
Let's stop pissing around, and get her hooked up and intubated.
Clock's ticking.
Are you okay?
I've been called to a serious case review.
About what?
Complaint. An internal complaint.
Mrs Rappaport, who's supervising this operation?
It's a vascular case. I don't need supervision.
This trauma department is a leech on resources.
Two patients, 20 staff!
Yeah, but just so long as she gets what she needs.
And she's got the gall to report me for seeing the bigger picture.
Do you want me to call someone down to supervise her?
No.
Leave it.
I'm just going to go with the excuse that you lost your phone.
Erm, it's been a crazy week, sorry. Shit's all over the place.
Airways are cool.
Good.
- Excuse me, you are? - Lola.
- You okay to do the handover now? - Yup.
Okay. Female, 20s,
involved in RTC at 2:45 a.m.
Involving two vehicles. Er, she was
- the front seat passenger in a minicab. - You all right?
And sustained contusions to the front and left of face.
Er, possible fractures of the left humerus.
GCS, 9 to 12 on scene,
deteriorated en route. Heart rate on scene was 120
and it was creeping up on the way in.
Er, BP on scene was 90 over 65.
It's going down.
Er, we inserted IV access to the right arm,
which she pulled out.
- Have given oxygen, fluids, no meds. - Thank you.
Okay. Let's get her out her clothes. Top half first, please.
Let's take blood. Usual suspects,
FBC, U&E, TEG and cross-match,
ETOH, VBGs and Beta-HCG, please.
Wrist fracture's highly unstable.
Seatbelt sign.
Cool.
Trachea, central.
No obvious flail chest.
Nosh.
Any belongings?
Er, yeah, there's couple of bags in the truck. I'll go and get them.
Good luck.
Equal air entry. Chest clear.
Couple of left-sided rib fractures.
Need a hand there, Sister Campbell?
Just offering my services.
- Be my guest. - Okay.
Pupils, please.
Thank you.
Abdomen is distended, rigid.
Pupils are...
Reactive, but unequal. Left 3 mill, right 5 mill.
Intracranial bleed?
It fits with fluctuating consciousness.
Pelvis is stable.
BP remains low.
Still want to get a CT of the head.
Can we call CT and neuro, please?
Whoopee! Neuro.
This is Mrs Hicklin, resus.
Can you fast bleep the on-call neurosurgeon for us, please?
Thank you.
Ah! That's lovely, that!
Erm...
If you don't need me for the arm just yet,
they've got proximal radius fracture in the ED.
- Go. - Thank you.
This is Mrs Hicklin.
We need to bring major trauma Foxtrot Echo down to CT
- in the next 15 minutes. - Oh.
Sorry.
Did her hand just move?
The amount of sedation she's had, she's not moving anywhere.
I can see you've got the touch.
- Great. CT will be ready for us. - Thank you.
She's peripherally shut down. I can't get access here.
- Well, keep trying. - She's got really crap veins.
Heart's racing. 159, 160. Whoa!
Whoa, whoa, whoa. Help, Billy, up.
She's going to self-extubate!
Oh! Okay!
Okay! Okay!
- Oh! - Okay. Okay.
I need sweeps and a tourniquet, now.
Someone grab Rebecca!
Okay. It's okay, Ana. It's okay.
- Two more. Open them, ready to go. - It's okay, Ana. It's okay.
- Can you take this, please? - Yeah.
- Billy, pressure! - Yeah. Got it!
- Thank you. - You're okay, Ana.
- You're okay. - Okay, I've prepped for going in.
Okay. Lift. Easy. Keep the pressure on.
- Got it! - Got it!
We've got about 60 minutes before this needs to come off!
Someone get me a pen, please.
Altered conscious level.
- Agitation. - Right.
I want to get her to CT right now!
We need to know if this is a head injury.
Time, 3:43 a.m.
Oh, come on! Shit!
- VT. - Here.
There's no output. It's a shockable rhythm.
- Justin, compressions. - Yeah.
Charge to 150.
150 units selected.
Charging.
- Charged. - It's shocking in three, two, one.
- Stand clear. Warning. - Everybody clear!
- Stand clear. - Shocking.
Airway secured, again.
Okay.
Coming up on two minutes. Let's charge to 150.
Let's pause before shocking to check the pulse.
150 units selected.
- Charging. - Harry, go and get yourself cleaned up.
- Can you get me a scrub top, please? - Sure.
Charged. Warning. Stand clear.
Warning. Stand clear.
Pulse check.
Oh. Hold the shock.
- Sinus rhythm. - Nice.
Albeit tachy at 140.
You've so got to find a new tune.
Let's put up an infusion of hypertonic for the head injury,
- help reduce any intracranial pressure. - Okay.
BP is still dropping.
She's got to be losing volume somewhere.
I agree.
Call in a Code Red.
Let's grab Pack A and run one unit of O-neg through the Venflon, please.
Nurse, trauma line kit, please.
We're going to be in CT in five, but can you run a trauma line, please?
Okay. Nurse, trauma line kit, please.
I'm on it.
- Calling through to blood bank. - Thank you.
Box splint to go.
Don't ask.
It's Sister Campbell. We have a Code Red in resus.
Yeah. Patient reference Foxtrot Echo.
From Pack B, we need six units of O-neg,
four of FFP,
and two of platelets.
- You know there's no circulation? - Brachial rupture.
I'm going to need to pull this.
Yeah.
- I just do the trauma line first? - Mmm-hmm.
Let's get it up.
Try to grow up.
Sorry.
Hey, erm, O-neg, dated and checked.
O-neg, dated and checked.
I need antibiotic, 1.2 gram bolus of,
augmenting dressings, drape and gloves, please.
- Yeah, on the way. - Cheers.
Administering one gram TXA. One to follow through infusion.
Have we got that line yet?
It's coming.
- There you go. - Thank you.
Oh, Harry,
can you get some gauze and assist Rebecca, please?
Yeah.
1.2 grams given.
Good.
Okay. This trauma line's good to go.
She looks flushed.
- Can we take her temperature? - Yep.
Body core, 38.7.
Okay. We don't need the Bair Hugger,
- but can you keep checking on her? - Yeah.
BP coming up.
- It's 87 over 60. - Good.
She's responding to blood products.
- What if she has? - Has what?
Shagged the neuro reg?
If you could support the shoulder and could you give traction, please?
- Ask her. - Yeah, but do you think I should?
Man, you ask her
it would mean you don't trust her.
There's no coming back from that.
Yeah, you're right.
You ask her.
No.
No. No, no, no, no way.
Box splint, please.
We really want to be in CT now.
I'll do the honours.
Ugh! Now I see the suitcase.
Oh, it's your lucky day. It's locked.
Could be a bomb.
Quick as we can!
One locked suitcase.
Justin, can you see
- if there's any hint of her next of kin? - Yeah.
Thanks, Lola.
Let's go.
Erm, sorry.
Erm, if the brachial is transected, I need to ex fix before it's repaired.
Could you give me a shout before you go to theatre, please?
- Yes. - Thank you.
You know, I'm here because you wanted me here.
You're here because I needed someone to fill in for Lorraine.
- Bollocks! - I was upset!
And I needed you.
I thought I could do this.
That we could work together.
- I thought I'd be okay with this. - And you're not?
So I'm supposed to just leave.
I'm not leaving.
But you will.
Because that's what you do.
You'll leave when it suits you,
when people come to rely on you.
- When I've... - Hey.
I'm sorry, Fi.
- I don't suppose you speak Spanish. - No.
What?
Come here.
Yeah. You could be in luck.
That one looks like a British number.
Oh, yeah. Thanks.
Hmm.
Hi, this is Staff Nurse Costello calling from City General Hospital.
Er, I'm trying to trace contacts for...
- Sorry. Garcia. - Ana Garcia.
We need to lose the tourniquet before we do the contrast scan.
Yes?
BP steadying at 98,
but heart rate tachycardic at 140.
It's too high.
Pupils are still dilated, uneven.
Anyone who's not needed,
can we please head back to ED?
Yeah. You can stay.
So you got stuck on the graveyard shift as well, huh?
Stuck? Forced.
I don't work Thursdays. I never work Thursdays!
Everyone knows that,
and still they call in sick!
- And what happened to the counselling? - It didn't work.
Hi.
Shall we?
Of course. Of course.
Starting control scan.
Query intracranial and abdominal haemorrhage.
There's also a left-sided brachial rupture.
We need to include in the contrast scan.
Head injury, huh?
Looks like we could be in for a cheeky visit from neuro.
Some right bobby-dazzlers in neuro though, eh?
Control scan complete.
What's that?
Ah!
- Could we maybe do that later? - Could people not touch the screen?
- Shit. - Why? What are they?
She's packing drugs.
And my guess is one of the packets is leaking.
Head CT's clear. There is no intracranial bleed.
It's got to be the drugs.
Better cancel the neuro before they get here then?
Brachial is completely transected.
It needs to be re-vascularised, or she'll lose the arm.
This is Mrs Hicklin. I'd like to cancel the neurosurgical opinion in CT.
- Oh, that doesn't look good. - Pull bowel enhancement.
Ischaemia would explain the shock.
The drugs are causing splanchnic vasoconstriction.
We need to get her into theatre right now, come on.
Er, Mrs Rappaport's patient is still on the table, they reckon
- another 10 or 20 minutes. - Oh, come on.
- We need to open a second theatre. - Okay,
and in the meantime take her back to resus
and do a tox screen of bloods and urine.
I want to know exactly what's going on here.
Okay, boss, on it.
Nurse, liaise with Giles, call around for theatre staff.
Don't worry about who's on call just get whoever lives closest.
Billy, Theatre 8, get the anaesthetic machine set up.
Constance, Justin, go with him. We need to set up
- for a laparotomy. - I'll notify police of events.
- Thank you. - I'll check in with Lorraine
see if she can free up a circulation nurse who can assist.
What?
I should have been there for you. I should have.
I, erm...
I messed up.
We both did.
It's not that terrible having me here, is it?
If you're not working tomorrow night maybe you could come over.
I'm shattered, it's been a long week.
But you still have to eat. I could make you something.
You don't cook.
Okay, what is it?
- What? - You, avoiding me all night.
Billy acting like a weirdo.
Shit!
She's burning up.
40.1.
Okay, do the tox and grab a cooling blanket
- on the way back. - Yeah, sure.
Shit!
If you're looking for the emergency department, it's the other way.
Er, just wanted to check on...
- Is she going to be okay? - Who are you?
I was driving her. Minicab.
- It was my fault. - We're doing the best we can
for her but, erm, you shouldn't be in here.
Really, I need you to leave.
Whoa! Whoa! Whoa! It's all right, mate.
Lorraine has freed up a circulating nurse.
Carly's on her way.
- We've got a few more to try. - Good.
Hi, this is Giles Dhilon, trauma at CGH.
Yeah, we, yeah... I appreciate it's late, but...
The police will be here in the next 10 minutes.
Okay.
I'll get the patient. Take her up to theatre.
- Okay. - Nice, hung up.
We're gonna need to bring her...
Jesus!
The police are on their way.
Ramakrishna?
Hey!
Ramakrishna!
Shit! Shit! Shit! Shit!
I need you to get help. Harry!
Move!
- Help! - What?
- Harry, what's wrong? - Harry, what...
Let him go, he's got a knife!
- Get in here! - Call security.
Harry?
- Scrubs and face shield, now. - Oh, my God!
A large right-sided retroperitoneal haematoma
and it's displacing the right colon. She needs more blood.
- Can you put it up, please? - Yeah.
BP's sliding, 67 over 43.
I'm okay, I'm okay.
We need to get this patient to theatre,
or she's not going to be okay. Harry, need you here.
Got it.
Okay, put your hand in over mine.
- Er... - Come on.
We don't have much time. You can do it.
All the way down.
- Can you feel the aorta? - No.
Okay, under my fist.
Yes, I got that. I've got the pulse.
Okay on three, I'm going to remove my hand.
- Okay. - And I need you to keep
the pressure up on it. Are you ready?
- Yes. - One, two, three.
- Got it. - Got it?
- Mmm-hmm. - Good.
The minicab driver?
Nerys, get the blood products from the fridge,
and load them on the trolley, please.
Yeah, yeah.
You two, one on either side of the trolley, now.
Yeah, sure.
Nicola, I need you to stay with Ramakrishna.
- Okay. - Ring the theatre, tell them
we're on our way and they need to prep for an IVC repair.
And we need an anaesthetist.
- We good to go? - Yes.
Yeah, let's go.
It's okay. It's okay.
Billy? Billy, it's Mrs Hicklin.
You need to prep for an IVC repair
and we need to get a hold of another anaesthetist.
Say that again.
Yeah.
Yeah, yeah, I've got that.
- Whoa! - You okay?
- Yeah, got it, got it. - Grab the doors.
Through. Move the operating table.
We can't move them across together
so we're going to leave the patient on the resus trolley.
- There. - Anaesthetic's here.
- We've got it from here, thanks. - Will the two of you
stay on the doors, please. Let's get her hooked up.
Can someone turn that off?
We have a young female, 20s, packing cocaine.
Ruptured the contents of the ischemic bowel.
She's also been attacked by a knife.
There are multiple lacerations to the small bowel
and a zone 1 vascular injury with expanding haematoma.
And, also, I suspect damage to the IVC.
So the only thing keeping this woman alive right now is Harry.
- I'll start to cut. - Thank you.
BP's 62 over 40 and heading south.
Saturation's only 80%.
We're going to extend the incision to get access.
I'm going to clamp the aorta and isolate the retroperitoneal bleed.
Let's get that set up, we need blood in her now.
- Yeah. - Okay, let's do the who.
I'm Glen Boyle, trauma consultant.
- Fiona Lomas, trauma fellow. - Harry Bennett-Edwardes, EM SHO.
Dominic Busby, anaesthetic registrar.
Billy Finley, anaesthetic ODP.
- Carly Osmond, scrub nurse. - Heather Duley, support nurse.
Daisy McDonald, documentation nurse.
Daniel Insalaco, rapid infuser operator.
Trauma patient, Miss Ana Garcia.
DOB, 14/04/1992.
Consent form four signed. Laparotomy plus proceed
repair of inferior vena cava.
Blade, please. Scalpel.
- Okay to cut. - She's not getting any better.
- I'm cutting. - BP's still sliding.
59 over 33. Heart rate 120.
- Let's push the blood. - Yeah.
Keep the pressure on the aorta.
- Yeah, there's still a pulse. - We need swabs to pack up.
Can you get them ready, please?
57, 55. Heart rate's 150. Push it.
Yeah.
A retractor and swabs, please.
54. 53. We need more volume.
- Can't push it any further. - Heart rate's still climbing.
Okay, I get the picture. Shit! Glen!
Oh, come on. Okay, let's switch.
Somebody tie me, please.
- She's in VT, we're losing her. - Duley, defib now.
- You okay, Harry? - Yeah.
- Quick as we can, please. - Yeah.
- 100... - Stand clear.
- Warning, stand clear. - Shocking.
Hand, straight back in.
- Got it? - Yeah, got it.
Still in VT. Some output. Shock her again?
No. We need to control the bleed, she's got no volume.
Pack the quadrants. More packs, please.
One.
Two.
Three.
Four.
Five.
Six.
Seven.
Eight.
Nine.
- Ten. - Ten packs in.
- I'm going to clamp the aorta
above your hand. Harry, you okay?
- OK. - Let's have the supraceliac.
- In VT For 60 seconds. - Thank you.
Hold still.
Steady.
Okay, clamps on. Let's release the pressure, nice and slowly.
Good.
- Aortic pulse above the clamp. - Should be glad of that.
Harry, you did really well.
Let's fit the retractor, please. Give me a large.
Thank you.
There you go.
Let's have a dish. Okay.
I need suction.
I can't see a thing in here.
- Shall I control the IVC? - Okay.
I'll clear the way.
- You should be in ED. - I'm fine.
Well, you're no use in here.
So go and get yourself some rest.
Thank you.
Harry, go on, get yourself cleaned up.
Looks like the man's having a bad day.
How you doing?
You look almost as bad as me. You did well.
Want to come over?
- Hmm? - No.
Look I need to ask you, you and this neurosurgeon...
- Did you? - No!
No.
When you say "no" that means nothing happened between you, right?
Keep up the suction.
Got it.
- Okay, I've got control. - Okay, I'm gonna clamp off the IVC
make it easy to do the repair. Satinskys, please.
Thank you.
One.
Two. Done.
Numbers going the right way. You gonna shock her again?
Let's fill her up a bit more, first, please.
- 150. - Ready when you are.
- Charging. - Okay, we're shocking.
Electrodes connected. Diagnosing rhythm.
Ventricular tachycardia. Advising, 150.
Two synchronised shocks.
- Clear, three, two, one. - Warning. Stand clear. Warning.
Shocking.
Looks like we've got sinus.
Output good.
- That's good. - Yes!
Okay. We're back in the game.
I'm going to extend the wound.
- Pots, please. - I've got it.
Thank you.
And, suction.
- Shit! - What?
Back wall of the IVC's punctured.
Okay, I'm gonna need you to hold it open.
Forceps, please.
BP's holding at 62 over 40.
5/0 double-ended proline, please.
- There? - Yeah.
I'll have to blend it. Okay.
What's he doing here?
Someone's been attacked in his department, on his shift.
I imagine he's having kittens, wouldn't you?
Lining up the scapegoats, no doubt.
How could she have been attacked in resus, where was everyone?
There were rallying staff to open up this theatre.
'Cause the trauma theatre was blocked?
The previous case was in there, yes.
Exterior wall sutured.
- You can let it go now. - Okay.
Thank you.
- Are we winning? - Suturing IVC.
Flush, please.
BP's falling again. 56 systolic.
Nearly there.
Billy, metaraminol, half a milligram bolus.
Yeah.
BP 54 over 34.
Distal clamp off.
Put up an extra two units of blood, two FFP.
Only one pair of hands, bud.
Releasing Satinsky clamp.
Repair looks fine.
Metaraminol, half-milligram bolus given.
- Taking off aortic clamp. - Let's go nice and slow.
Releasing halfway.
Keep pushing the blood as the clamp comes off.
Yeah.
Here we go, 68 over 27.
The repair looks good.
Releasing to three quarters.
BP dropping to 59 over 24.
Okay.
Take it off.
Clamp off.
Steady.
ST depression. She's showing signs of cardiac ischaemia.
Okay, let's get the rest of the drugs out before they kill her.
Nice work.
Saline, please.
Kidney dish. Soft bowel clamps and swabs, please.
Thank you.
Push this through.
- The numbers are looking a lot better. - Nice.
I'll tell you what, I wish I had a stomach full of cocaine.
Thank you.
Well, you look like crap.
Cheers.
It's not been one of my best nights.
Oh, I don't know.
I'd say she was lucky to have you here.
What the hell's happened? Someone said a patient
- was attacked in resus. - A knife attack.
Hospital security nabbed him outside.
- Can you give us a minute? - Yeah.
We were forced to leave the patient unattended
while they opened a second theatre.
Theatres get blocked, it happens.
You were in breach of your supervisory directive.
- I'm a vascular consultant. - Operating without supervision.
You'll be charged with serious professional misconduct.
- You're destroying my career? - You put in a complaint about me.
You put hospital targets above patient welfare.
And then you tried to let an SHO
- take the fall... - This conversation is over.
You're over.
Fiona?
Yeah, sorry.
Can we fast bleep Rebecca Osgood
to ex fix the arm and we're gonna need a radiographer, please.
Dish.
Ripped By mstoll