1
00:00:04,200 --> 00:00:06,668
Clive and Nicola,
they're, um, defensive.
2
00:00:08,400 --> 00:00:10,914
I'd like to discuss
the major transfusion protocol.
3
00:00:11,000 --> 00:00:12,956
You run the trauma call,
I run the entire department.
4
00:00:14,760 --> 00:00:16,113
He mentioned Lorraine's illness.
5
00:00:16,200 --> 00:00:17,952
I was just wondering
where you got that from.
6
00:00:18,040 --> 00:00:19,109
Hmm?
7
00:00:20,840 --> 00:00:22,159
Seven, eight, nine.
8
00:00:22,880 --> 00:00:23,869
Arsehole.
9
00:00:25,840 --> 00:00:27,159
- Blade.
- Glen.
10
00:00:27,240 --> 00:00:28,559
Just do as you're told.
11
00:00:30,000 --> 00:00:32,434
You called, told me you needed me,
12
00:00:32,520 --> 00:00:33,873
and I came running.
13
00:00:36,500 --> 00:00:44,500
Ripped By mstoll
14
00:01:08,520 --> 00:01:10,192
Attend emergency department.
15
00:01:10,280 --> 00:01:12,635
Trauma call,
attend emergency department.
16
00:01:42,120 --> 00:01:43,269
Five minutes.
17
00:01:43,360 --> 00:01:45,271
- Will you get him out?
- I'm not staying in that...
18
00:01:45,360 --> 00:01:46,873
Starting the clock.
19
00:01:47,120 --> 00:01:48,519
I'm not a bloody cripple,
20
00:01:48,600 --> 00:01:50,511
- so stop treating me like one.
- You got your hands full here.
21
00:01:50,600 --> 00:01:52,875
- You bunch of pricks!
- That's the spirit, my friend.
22
00:01:53,760 --> 00:01:57,719
Patient hypotensive at the scene
with a suspected fractured pelvis.
23
00:01:57,800 --> 00:01:59,518
I've activated a Code Red.
24
00:01:59,600 --> 00:02:01,318
No ID, so he's in the system
25
00:02:01,400 --> 00:02:02,594
- as Mike Oscar.
- What mechanism?
26
00:02:03,080 --> 00:02:05,514
He was found bound and gagged
with a ligature around his neck.
27
00:02:05,600 --> 00:02:07,192
Let's get ready to transfer, please.
28
00:02:07,280 --> 00:02:09,510
Slide one, two, three.
29
00:02:09,600 --> 00:02:11,158
Giles will liaise with the police.
30
00:02:12,560 --> 00:02:15,154
A gen surgeon
cardiothoracic's been fast bleeped.
31
00:02:15,240 --> 00:02:16,389
Yeah, it's all done.
32
00:02:16,480 --> 00:02:19,233
One minute hatred,
the next minute dogs on heat.
33
00:02:19,320 --> 00:02:20,673
And where's orthopaedics?
34
00:02:21,040 --> 00:02:22,837
Uh, afternoon off, sir, baby's birthday.
35
00:02:22,920 --> 00:02:24,956
Can we fast bleep
the other orthopod, please?
36
00:02:25,040 --> 00:02:26,359
No, I don't care.
37
00:02:26,440 --> 00:02:28,590
No nuts on the table,
no nuts in the party bags.
38
00:02:29,640 --> 00:02:30,868
Just no nuts, Magda!
39
00:02:31,880 --> 00:02:34,235
Oh, I forgot that bloody clown.
40
00:02:35,600 --> 00:02:36,669
Okay, great.
41
00:02:38,200 --> 00:02:39,189
Sorry.
42
00:02:40,120 --> 00:02:42,759
I'm still here, but then
three more hours and I'm gone.
43
00:02:43,120 --> 00:02:44,314
Part-timers.
44
00:02:44,400 --> 00:02:45,799
Suspected fractured pelvis.
45
00:02:45,880 --> 00:02:47,518
- Remove the scoop on your count.
- Okay.
46
00:02:47,600 --> 00:02:51,832
So, unclip top and bottom.
Go on three. One, two, three.
47
00:02:51,920 --> 00:02:55,549
Brace, one, two, three.
Go on three. One, two, three.
48
00:02:55,640 --> 00:02:56,868
Thank you.
49
00:02:57,120 --> 00:02:58,712
I'd prescribe a nice chest drain.
50
00:02:58,800 --> 00:03:00,472
- What's this smell?
- Really?
51
00:03:00,560 --> 00:03:01,834
Not keen on his perfume.
52
00:03:02,240 --> 00:03:04,515
- I think it's from an animal.
- His jacket's covered in crap, too.
53
00:03:04,600 --> 00:03:06,033
- That's cows.
- Oh...
54
00:03:06,120 --> 00:03:07,872
Everyone got goggles?
You might wanna double glove.
55
00:03:08,640 --> 00:03:10,710
You requested a general surgeon.
56
00:03:10,800 --> 00:03:12,074
Appreciate you coming.
57
00:03:12,160 --> 00:03:13,559
Situation understood?
58
00:03:15,520 --> 00:03:16,999
Let's do the handover.
59
00:03:17,080 --> 00:03:18,798
- Nerys, will you scribe please?
- Yeah, of course.
60
00:03:18,880 --> 00:03:21,235
- Harry, Venflon, please.
- Yup.
61
00:03:22,560 --> 00:03:23,959
You and her back on then?
62
00:03:24,680 --> 00:03:26,636
"Male, estimate early 20s.
63
00:03:26,720 --> 00:03:31,236
"Call was made at 12:28.
Ambulance arrived on scene at 12:40.
64
00:03:31,320 --> 00:03:33,993
"Patient was found by a worker
on a landfill site.
65
00:03:34,080 --> 00:03:37,993
"Hands tied, ligature marks around neck
and gagged. Unknown mechanism."
66
00:03:38,080 --> 00:03:41,914
Best guess, violent assault.
Blunt instrument, whack.
67
00:03:42,000 --> 00:03:43,558
"Semiconscious at scene,
68
00:03:43,640 --> 00:03:47,349
"multiple soft tissue injuries and
lacerations, grazes, haematomas.
69
00:03:47,440 --> 00:03:50,557
"Airway blocked with
a piece of fabric, which we cleared."
70
00:03:50,640 --> 00:03:53,108
Yeah, old bit of rag stuffed down there.
I brought it out.
71
00:03:53,600 --> 00:03:54,919
Oh, good thinking, Bob.
72
00:03:55,120 --> 00:03:56,439
"Trachea deviated to the right.
73
00:03:56,520 --> 00:03:58,829
"Diminished breath sounds on both sides.
74
00:03:58,920 --> 00:04:00,592
"Left side tension pneumothorax.
75
00:04:00,680 --> 00:04:03,513
"Abdomen is soft,
suspected pelvic fracture.
76
00:04:03,600 --> 00:04:06,068
"Pulse 110. BP 89 over 59.
77
00:04:06,160 --> 00:04:07,434
"GCS, eight.
78
00:04:07,520 --> 00:04:10,114
"Needle decompression
and oxygen for potential pneumothorax,
79
00:04:10,280 --> 00:04:11,599
"and pelvic binder.
80
00:04:12,000 --> 00:04:14,309
"500 mil bag of normal saline
running in."
81
00:04:15,440 --> 00:04:17,510
- Thank you.
- Go on, bugger off, please.
82
00:04:18,320 --> 00:04:19,389
I'll do the primary.
83
00:04:19,600 --> 00:04:21,352
Cardiothoracics attending if needed.
84
00:04:21,560 --> 00:04:23,039
Your presence is appreciated.
85
00:04:23,480 --> 00:04:25,550
I hope this is a good use of my time.
86
00:04:27,400 --> 00:04:28,435
Airway.
87
00:04:28,520 --> 00:04:29,919
Ligature marks around the neck.
88
00:04:30,160 --> 00:04:31,991
Breathing is noisy.
89
00:04:33,000 --> 00:04:33,989
Um...
90
00:04:34,360 --> 00:04:36,430
- There's no surgical emphysema.
- Sats are low.
91
00:04:36,920 --> 00:04:39,434
Pulses are bounding,
but his pressure is well down.
92
00:04:40,360 --> 00:04:41,634
Let's get him a Bair Hugger, please.
93
00:04:42,520 --> 00:04:44,431
Poor expansion on right,
percussion dull.
94
00:04:44,800 --> 00:04:46,552
Poor expansion on left, percussion dull.
95
00:04:46,640 --> 00:04:49,074
His airway's compromised.
There's something in the oropharynx.
96
00:04:49,160 --> 00:04:50,388
No, we cleared what was in there.
97
00:04:50,720 --> 00:04:51,869
Well, I think he may have...
98
00:04:51,960 --> 00:04:53,871
Swallowed some.
99
00:04:55,560 --> 00:04:56,549
Better out than in.
100
00:04:57,680 --> 00:04:58,749
Well...
101
00:04:59,320 --> 00:05:01,709
I can't see anything with this blood
pouring down his throat.
102
00:05:02,360 --> 00:05:04,316
- Get a tampon for the epistaxis, please.
- Yeah.
103
00:05:07,920 --> 00:05:09,069
He coughed something up.
104
00:05:09,920 --> 00:05:12,309
- Excuse me, ladies.
- Looks like a piece of cloth.
105
00:05:13,240 --> 00:05:14,275
The police will need to see it.
106
00:05:14,600 --> 00:05:15,749
Bag that up, stick it with his clothes.
107
00:05:15,840 --> 00:05:17,034
I'll take it through
when there's a minute.
108
00:05:17,120 --> 00:05:18,348
- Okay.
- It appears I'm not needed,
109
00:05:18,440 --> 00:05:19,668
bleep me if that changes.
110
00:05:19,760 --> 00:05:22,228
Hey, we haven't even done the CT yet!
111
00:05:22,640 --> 00:05:24,119
I'm surprised she lasted this long.
112
00:05:24,400 --> 00:05:25,594
Yeah, we're good to go, Nerys?
113
00:05:26,160 --> 00:05:28,674
Yeah, you go get cleaned up, Bob.
I can smell you from here.
114
00:05:28,800 --> 00:05:30,279
Can we complete the primary, please?
115
00:05:30,680 --> 00:05:33,592
There's a number on the skin
under his arm.
116
00:05:34,240 --> 00:05:36,390
"3-6-5-9-9-5."
117
00:05:36,680 --> 00:05:38,159
Like cattle branding.
118
00:05:38,600 --> 00:05:40,113
Just make sure
we mention that to the police.
119
00:05:40,200 --> 00:05:41,235
Yeah, of course.
120
00:05:41,320 --> 00:05:42,799
Abdomen is soft.
121
00:05:45,880 --> 00:05:48,792
Pelvis feels unstable
on stress assessment.
122
00:05:49,440 --> 00:05:51,237
Possibly SIJ instability.
123
00:05:55,240 --> 00:05:56,355
No other major limb trauma.
124
00:05:56,800 --> 00:05:59,030
Six units of blood, O positive,
125
00:05:59,120 --> 00:06:01,759
four units of FFP
plus two units of platelets, please.
126
00:06:02,000 --> 00:06:03,149
- Justin.
- On it.
127
00:06:03,400 --> 00:06:04,549
Sats are still low.
128
00:06:04,960 --> 00:06:06,154
Sats are below 90%,
129
00:06:06,320 --> 00:06:08,197
let's get bilateral
chest drains in, please.
130
00:06:08,280 --> 00:06:09,918
- Me.
- I'll do the other.
131
00:06:10,280 --> 00:06:12,077
Slow and steady wins the race.
132
00:06:12,280 --> 00:06:14,111
Rebecca, can I have
a hand, please? Just...
133
00:06:18,160 --> 00:06:20,355
I'm not happy with his airway.
I need to RSI.
134
00:06:20,680 --> 00:06:21,669
Okay.
135
00:06:25,200 --> 00:06:26,838
- Thio, Sux, 250, 100.
- Yeah.
136
00:06:26,920 --> 00:06:28,751
Justin, can you sort
that side for me, please, love?
137
00:06:28,840 --> 00:06:30,831
Thiopental, 250 milligrams.
138
00:06:31,080 --> 00:06:33,071
Suxamethonium, 100 milligrams.
139
00:06:34,600 --> 00:06:36,079
- Tie us, please.
- One second.
140
00:06:36,880 --> 00:06:38,359
250 Thio...
141
00:06:40,840 --> 00:06:43,354
Justin, ties, please.
142
00:06:44,000 --> 00:06:45,069
Flush.
143
00:06:46,240 --> 00:06:48,151
Sux, 100.
144
00:06:49,160 --> 00:06:50,434
- Flush.
- Thanks.
145
00:06:50,880 --> 00:06:52,279
How long before we can intubate?
146
00:06:53,920 --> 00:06:56,150
Uh, in about a minute.
147
00:06:56,880 --> 00:06:58,074
Everyone, stand by.
148
00:06:59,720 --> 00:07:02,632
I'd like an image of his pelvis.
It sounds like a fracture.
149
00:07:03,120 --> 00:07:05,156
We will get straight to CT as soon as.
150
00:07:07,000 --> 00:07:08,797
So, uh, you and her...
151
00:07:09,880 --> 00:07:11,632
- How'd you pull it off?
- Shut up.
152
00:07:13,880 --> 00:07:15,518
Um, get the GlideScope ready,
in case we need it.
153
00:07:15,680 --> 00:07:16,908
Yup, on it.
154
00:07:17,480 --> 00:07:18,469
Yeah.
155
00:07:20,160 --> 00:07:21,354
He is good, but...
156
00:07:37,680 --> 00:07:40,672
- Okay, that's time.
- Okay.
157
00:07:50,840 --> 00:07:51,909
Sats are still falling.
158
00:07:56,600 --> 00:07:59,592
Well, that's not working.
Can we try the GlideScope, please?
159
00:08:09,760 --> 00:08:11,239
There's loads of oedema.
160
00:08:11,600 --> 00:08:14,558
I can't get a view.
Can't see much of the epiglottis.
161
00:08:16,680 --> 00:08:18,796
Hmm. Let's try plan bougie.
162
00:08:20,200 --> 00:08:21,474
Thank you.
163
00:08:25,120 --> 00:08:26,599
Excuse me.
164
00:08:35,480 --> 00:08:37,152
It's not going in the trachea.
165
00:08:38,440 --> 00:08:41,512
No, it's not going in the trachea.
166
00:08:42,000 --> 00:08:43,479
- Course of action?
- Bagging.
167
00:08:44,400 --> 00:08:45,753
Tell me how the chest drains are.
168
00:08:46,080 --> 00:08:47,479
Swinging and bubbling.
169
00:08:48,560 --> 00:08:49,913
Sats are below 60%.
170
00:08:51,320 --> 00:08:52,833
- Let's try two person.
- Yeah.
171
00:08:55,960 --> 00:08:57,678
- Anything?
- No, it's not going in.
172
00:08:57,840 --> 00:08:59,831
Well, no. Okay, let's try
and get that out of the way, please.
173
00:09:06,920 --> 00:09:08,114
Come on!
174
00:09:08,720 --> 00:09:10,312
Can I have a gown, please?
175
00:09:11,400 --> 00:09:12,435
Okay. Done. Done.
176
00:09:13,080 --> 00:09:14,149
Sats below 50%.
177
00:09:14,640 --> 00:09:15,755
Come on!
178
00:09:17,560 --> 00:09:19,198
- It's also not happening.
- Okay.
179
00:09:28,800 --> 00:09:31,234
- I don't think you're moving any air.
- Can't intubate, can't ventilate.
180
00:09:31,320 --> 00:09:32,594
- He needs a crike.
- Yeah.
181
00:09:32,720 --> 00:09:34,199
I'll need a crike kit now, please.
182
00:09:34,480 --> 00:09:35,469
Yes!
183
00:09:35,840 --> 00:09:37,671
Harry, ties, please.
184
00:09:40,360 --> 00:09:41,395
Thank you.
185
00:09:42,840 --> 00:09:44,558
There's lots of swelling and bruising.
186
00:09:44,640 --> 00:09:45,675
It's okay.
187
00:09:46,080 --> 00:09:47,069
Got it.
188
00:09:48,000 --> 00:09:49,035
Can I please the blade?
189
00:10:05,760 --> 00:10:06,795
A set of forceps.
190
00:10:13,480 --> 00:10:14,515
There we go.
191
00:10:15,960 --> 00:10:16,995
Let's have the bougie.
192
00:10:17,560 --> 00:10:18,549
Thank you.
193
00:10:25,280 --> 00:10:26,599
Trach.
194
00:10:36,520 --> 00:10:38,112
- Okay, bougie out.
- Okay, got it?
195
00:10:40,240 --> 00:10:41,309
Okay, hold to be secure?
196
00:10:41,880 --> 00:10:42,869
Safe hands.
197
00:10:43,120 --> 00:10:44,189
- Good form.
- Thanks.
198
00:10:49,240 --> 00:10:50,798
- Cup.
- Yup.
199
00:10:54,480 --> 00:10:56,198
Breath.
200
00:10:57,240 --> 00:10:58,719
Breath.
201
00:11:00,320 --> 00:11:02,709
- Patient's ventilated.
- Sats are rising.
202
00:11:02,920 --> 00:11:03,909
Good.
203
00:11:05,400 --> 00:11:06,515
I'll do a subclavian line.
204
00:11:06,600 --> 00:11:07,589
- Yup.
- Thank you.
205
00:11:07,840 --> 00:11:08,909
Suture, please.
206
00:11:11,000 --> 00:11:12,479
- Could you?
- Yup.
207
00:11:14,880 --> 00:11:16,108
He's warmed up.
208
00:11:16,640 --> 00:11:17,675
That was fast.
209
00:11:17,880 --> 00:11:18,915
Let's get the Bair Hugger off him,
210
00:11:19,000 --> 00:11:21,673
and then we'll give him
a 250 mil bolus of saline, please.
211
00:11:21,920 --> 00:11:22,955
Yeah.
212
00:11:23,160 --> 00:11:26,357
And when the subclavian line is ready,
let's do the usual bloods.
213
00:11:26,760 --> 00:11:31,675
So that's, FBC, U&E, ETOH,
cross-match TEG,
214
00:11:31,800 --> 00:11:33,597
LFTs and BBGs.
215
00:11:35,720 --> 00:11:37,517
Lots of blood on that blanket.
216
00:11:40,120 --> 00:11:42,236
Let's clean up
these lacerations and compress.
217
00:11:42,920 --> 00:11:45,480
Pulse 113. BP 88 over 58, falling.
218
00:11:45,720 --> 00:11:47,631
Okay, we need to get blood in.
219
00:11:47,960 --> 00:11:50,758
We will transfuse through
the subclavian line when it's clear.
220
00:11:51,040 --> 00:11:55,397
So that's platelets, FFPs,
and let's get in one gram of TXA.
221
00:11:55,640 --> 00:11:57,790
And please, let's move on this.
222
00:11:58,480 --> 00:12:00,198
BBG's and samples ready to go.
223
00:12:00,760 --> 00:12:02,557
- Nerys.
- I'll sort it.
224
00:12:02,640 --> 00:12:04,198
Harry, will you put
the blood on for me, please?
225
00:12:04,280 --> 00:12:05,508
Uh, yeah, these are flushed.
226
00:12:06,120 --> 00:12:07,917
TXA going in through the Venflon.
227
00:12:10,480 --> 00:12:12,869
Tachycardic. BP 80 over 50.
228
00:12:13,680 --> 00:12:14,795
It's too low.
229
00:12:16,240 --> 00:12:17,355
And he's clammy.
230
00:12:18,080 --> 00:12:20,196
Tell me his temperature, please.
231
00:12:25,120 --> 00:12:27,475
39.7.
232
00:12:28,920 --> 00:12:30,592
- He's cooking.
- Yeah, bollocks.
233
00:12:32,040 --> 00:12:33,109
Looks like he's septic.
234
00:12:41,280 --> 00:12:42,395
What's your instinct?
235
00:12:42,480 --> 00:12:44,232
Is he septic or
is it internal haemorrhaging?
236
00:12:44,320 --> 00:12:45,309
Probably both.
237
00:12:46,160 --> 00:12:47,957
But that would be me being pessimistic.
238
00:12:48,360 --> 00:12:49,554
Not like you then.
239
00:12:52,800 --> 00:12:54,791
So, uh, how did you get her back then?
240
00:12:55,400 --> 00:12:56,549
Trade secrets, Billy.
241
00:12:57,320 --> 00:12:58,309
Right.
242
00:13:11,360 --> 00:13:12,634
Thank you.
243
00:13:17,120 --> 00:13:18,553
Sliding up on three.
244
00:13:18,880 --> 00:13:19,949
One, two, three.
245
00:13:20,560 --> 00:13:21,754
Thanks very much.
246
00:13:23,640 --> 00:13:25,119
And please be careful with the drips.
247
00:13:25,880 --> 00:13:27,359
Non-essential people may leave us.
248
00:13:28,240 --> 00:13:32,518
Hmm. That's me, you and you.
249
00:13:33,800 --> 00:13:34,994
That's harsh.
250
00:13:44,240 --> 00:13:45,878
Control scan.
251
00:13:48,480 --> 00:13:49,754
Oh...
252
00:13:51,040 --> 00:13:53,429
What is it?
Yes, I have loads of Wotsits.
253
00:14:00,000 --> 00:14:01,479
Control scan complete.
254
00:14:02,160 --> 00:14:03,639
Scanning head.
255
00:14:04,160 --> 00:14:05,912
I don't care how much make-up he's got,
256
00:14:06,000 --> 00:14:08,389
he can get changed
in the downstairs toilet.
257
00:14:09,480 --> 00:14:10,515
He's a clown.
258
00:14:12,240 --> 00:14:15,232
- Head scan complete.
- Sorry.
259
00:14:16,800 --> 00:14:19,030
There's no obvious
intracranial haemorrhage.
260
00:14:21,560 --> 00:14:22,993
Nobody touch any buttons.
261
00:14:24,280 --> 00:14:25,474
Sorry.
262
00:14:31,200 --> 00:14:32,918
Does Clive know anything
about the other consultants
263
00:14:33,000 --> 00:14:34,319
down for the trauma call?
264
00:14:34,400 --> 00:14:35,594
He's fine with it.
265
00:14:36,680 --> 00:14:37,669
Clive's all right.
266
00:14:38,040 --> 00:14:39,234
Is he?
267
00:14:40,400 --> 00:14:41,389
Ask Lorraine.
268
00:14:41,920 --> 00:14:43,035
I don't know her.
269
00:14:43,480 --> 00:14:44,833
I do know him.
270
00:14:44,920 --> 00:14:46,990
Be careful.
You don't know what he's like.
271
00:14:47,160 --> 00:14:48,639
Oh, come on.
272
00:14:49,080 --> 00:14:51,275
You said you wanted this
to be just about work.
273
00:14:52,040 --> 00:14:56,352
So can we focus on the patient
in front of us, please?
274
00:14:57,880 --> 00:14:59,233
Okay.
275
00:15:00,240 --> 00:15:01,389
Excuse me.
276
00:15:06,480 --> 00:15:07,595
I've got the VBG results.
277
00:15:08,160 --> 00:15:09,388
How did he get in here?
278
00:15:09,520 --> 00:15:10,873
- Who's him?
- Uh, stopping scan.
279
00:15:11,120 --> 00:15:12,997
- He followed me in.
- Get him out of there!
280
00:15:13,280 --> 00:15:14,759
I'm not lying in a bed...
281
00:15:15,280 --> 00:15:16,759
Security to CT Scan room.
282
00:15:17,600 --> 00:15:18,589
...Not that bucket.
283
00:15:18,840 --> 00:15:20,558
Mr Devlin, you've got to stay
off this fracture.
284
00:15:21,040 --> 00:15:22,189
Haematology results will be ready,
285
00:15:22,280 --> 00:15:24,475
but I'm looking at it now
and there's nothing.
286
00:15:25,200 --> 00:15:26,315
Oh, yeah, I see it. Thanks.
287
00:15:26,480 --> 00:15:28,118
Conscious patients
are a pain in the arse.
288
00:15:28,360 --> 00:15:31,352
Unpleasant! Unprofessional!
Uh, just a moment, please.
289
00:15:31,440 --> 00:15:33,670
- VBG results and scan from Haematology.
- Thank you.
290
00:15:34,280 --> 00:15:36,555
INR four,
and he's also thrombocytopenic.
291
00:15:36,760 --> 00:15:38,398
And there's a leucocytosis.
292
00:15:39,040 --> 00:15:40,598
Let's try again, shall we?
293
00:15:44,040 --> 00:15:45,758
So, apparently, this is where
all the action is.
294
00:15:47,320 --> 00:15:49,197
Starting contrast run.
295
00:15:56,360 --> 00:16:00,194
The abdomen is clear.
Well, that's me off the hook.
296
00:16:00,920 --> 00:16:02,399
- Bleep me if anything changes.
- Thank you.
297
00:16:02,840 --> 00:16:04,159
- We'll be in touch.
- Just a minute.
298
00:16:05,400 --> 00:16:06,435
There it is.
299
00:16:07,400 --> 00:16:09,311
That's an open book
pelvic fracture confirmed.
300
00:16:10,080 --> 00:16:14,119
It's a pelvic haematoma
but there's no active extravasation.
301
00:16:14,800 --> 00:16:16,279
Thank you.
302
00:16:16,400 --> 00:16:17,389
So, how are we doing?
303
00:16:17,680 --> 00:16:20,069
Well, we have fractured pelvis
so we're going to theatre.
304
00:16:20,160 --> 00:16:21,388
- Mmm-hmm.
- I'll go prep.
305
00:16:21,560 --> 00:16:23,710
Nurse medic trauma, nurse practitioner
could you fast bleep trauma theatre.
306
00:16:23,840 --> 00:16:25,751
No abdominal complications?
307
00:16:26,200 --> 00:16:28,316
No. I'm a precautionary measure.
308
00:16:28,840 --> 00:16:31,513
But happy to attend.
Glen will do a first-class job.
309
00:16:31,800 --> 00:16:33,472
- Hmm.
- I better push off.
310
00:16:35,400 --> 00:16:37,231
Could we get ready for theatre, please?
311
00:16:37,520 --> 00:16:38,509
Can I get 30 seconds?
312
00:16:39,520 --> 00:16:40,555
Absolutely.
313
00:16:53,600 --> 00:16:56,876
Mrs Mukherjee from Cardiothoracics
has been complaining to her line manager
314
00:16:56,960 --> 00:16:58,359
about the new policy.
315
00:16:58,600 --> 00:16:59,589
Now, he's phoned me
316
00:16:59,680 --> 00:17:01,796
and I've told him,
"There is no new policy."
317
00:17:02,080 --> 00:17:04,355
I just asked for
a gen surgeon, cardiothoracics,
318
00:17:04,440 --> 00:17:06,351
to routinely attend
all major trauma calls.
319
00:17:06,640 --> 00:17:08,119
Yeah, so I see.
320
00:17:08,360 --> 00:17:09,588
You didn't run it past me.
321
00:17:10,880 --> 00:17:13,633
We can wait months for a rubber stamp
322
00:17:13,720 --> 00:17:16,280
or we implement it
and we start saving lives now.
323
00:17:16,600 --> 00:17:17,953
I know where you're coming from,
324
00:17:18,040 --> 00:17:20,713
but this is the stuff of
nightmarish hospital politics.
325
00:17:20,840 --> 00:17:21,955
It's best left to me.
326
00:17:22,040 --> 00:17:23,189
It just seems obvious.
327
00:17:23,960 --> 00:17:24,949
Doesn't it?
328
00:17:27,080 --> 00:17:30,072
Look, I'll handle it this time but, uh,
329
00:17:30,160 --> 00:17:31,639
next time talk to me.
330
00:17:32,520 --> 00:17:33,999
You know where I am.
331
00:17:39,480 --> 00:17:40,674
Mr Boyle, before you go
332
00:17:40,760 --> 00:17:44,036
I have an admin query for our files,
about your CV.
333
00:17:44,120 --> 00:17:47,556
We're having difficulty verifying your
dates of deployment in Camp Bastion.
334
00:17:47,840 --> 00:17:48,829
Oh, I really don't have time for this.
335
00:17:49,160 --> 00:17:51,390
Did you come straight to us
from active service?
336
00:17:51,640 --> 00:17:53,278
Glen, we need you in here.
337
00:17:53,720 --> 00:17:56,951
Whatever it says on the form.
Sorry, dying man waiting for me.
338
00:17:59,360 --> 00:18:00,839
He's sweating buckets!
339
00:18:01,360 --> 00:18:03,874
- Check his temperature again, please.
- Yeah.
340
00:18:08,560 --> 00:18:10,596
- Up to 40.
- He looks flushed.
341
00:18:10,920 --> 00:18:11,989
Face and neck.
342
00:18:12,320 --> 00:18:15,756
- Pulse 114. BP 86 over 56.
- It's still low.
343
00:18:15,880 --> 00:18:16,915
I've ordered more pack "B" bloods,
344
00:18:17,000 --> 00:18:19,275
but I'm not sure he's responding
to bloods or fluids.
345
00:18:19,400 --> 00:18:20,879
High temp, low BP.
346
00:18:21,000 --> 00:18:23,639
We need to get him open
and deal with the haematoma ASAP.
347
00:18:23,880 --> 00:18:25,154
It may not be the cause of his problems.
348
00:18:25,440 --> 00:18:27,556
- Okay.
- I think we need further investigations.
349
00:18:27,760 --> 00:18:28,954
- I agree.
- Police update.
350
00:18:29,200 --> 00:18:31,031
- What have you got for us?
- I've passed on the information
351
00:18:31,120 --> 00:18:33,270
about the unusual branding marks
on the patient's arms.
352
00:18:33,360 --> 00:18:34,395
And what did they say?
353
00:18:34,600 --> 00:18:38,036
Well, it can be characteristic
of trafficking from East Africa.
354
00:18:38,720 --> 00:18:40,199
- Mark of ownership.
- Okay.
355
00:18:40,360 --> 00:18:41,873
People get brought over
for slave labour,
356
00:18:41,960 --> 00:18:43,075
often in agriculture.
357
00:18:44,440 --> 00:18:46,476
So, someone's exploited this guy
and then they tried to kill him.
358
00:18:49,320 --> 00:18:50,912
We don't know how long
he's been in the country.
359
00:18:51,160 --> 00:18:52,513
The police are anxious for any news.
360
00:18:52,600 --> 00:18:53,749
Tell them they're in the loop.
361
00:18:54,280 --> 00:18:55,838
And if anything comes up about his ID?
362
00:18:55,920 --> 00:18:57,239
- You'll be the first to know.
- Thank you.
363
00:18:57,320 --> 00:18:59,151
We shouldn't rule out
and important, existing condition.
364
00:18:59,240 --> 00:19:00,912
I think we need to get him
back into resus.
365
00:19:01,040 --> 00:19:02,189
The fracture is the priority.
366
00:19:02,360 --> 00:19:04,112
This patient needs to go
to the theatre now.
367
00:19:04,680 --> 00:19:07,877
We'll put an ex fix over his pelvis,
and see how he responds.
368
00:19:07,960 --> 00:19:10,190
If he's unstable,
then we'll need to pack the pelvis.
369
00:19:10,280 --> 00:19:11,349
Okay, then. Let's go.
370
00:19:19,160 --> 00:19:20,752
Oh, nursing my same doubt.
371
00:19:21,480 --> 00:19:22,515
You minges!
372
00:19:22,640 --> 00:19:25,313
- Mr Devlin, I thought we'd sorted this.
- Please, step aside, please.
373
00:19:25,400 --> 00:19:26,469
If that's what you want.
374
00:19:27,640 --> 00:19:28,675
- That's enough now.
- Come on.
375
00:19:28,760 --> 00:19:29,749
You have to watch that fracture.
376
00:19:30,120 --> 00:19:31,951
Mr Devlin, this isn't helping anyone.
377
00:19:32,240 --> 00:19:33,468
Up yours.
378
00:19:36,680 --> 00:19:38,796
Your problem, Harry.
Let's move around him.
379
00:19:39,600 --> 00:19:40,874
Would you stay still, Mr Devlin?
380
00:19:41,880 --> 00:19:43,074
It's all right.
381
00:19:43,760 --> 00:19:44,909
Cheers, Nerys.
382
00:19:46,240 --> 00:19:47,275
What was all that?
383
00:19:47,480 --> 00:19:48,515
Gin-breath man.
384
00:19:49,440 --> 00:19:50,998
Twat. Right, let's take him through.
385
00:19:51,640 --> 00:19:52,675
It's changing.
386
00:19:57,680 --> 00:19:59,432
Lesions are becoming confluent.
387
00:20:01,200 --> 00:20:03,395
The rash in his arm is looking purpuric.
388
00:20:05,400 --> 00:20:07,960
Pulse 114. BP 86 over 56.
389
00:20:08,720 --> 00:20:10,039
Can we lift him up to look at his back?
390
00:20:10,320 --> 00:20:11,878
- No more than 20 degrees.
- Okay.
391
00:20:18,080 --> 00:20:21,038
We're rolling on three.
One, two, three.
392
00:20:27,080 --> 00:20:28,069
Thank you.
393
00:20:28,200 --> 00:20:29,519
Back on three. One, two, three.
394
00:20:31,800 --> 00:20:32,949
It's spreading very fast.
395
00:20:33,880 --> 00:20:35,359
Right, they're ready to
get him on the table.
396
00:20:35,840 --> 00:20:37,751
No. Could we just wait a moment?
397
00:20:44,280 --> 00:20:45,759
Everybody take a step back.
398
00:20:49,920 --> 00:20:50,989
Check his eyes.
399
00:20:59,640 --> 00:21:00,914
He's bleeding in the sclera.
400
00:21:02,240 --> 00:21:03,389
So, if he's recently arrived...
401
00:21:04,240 --> 00:21:05,992
I've got a house full of kids
this afternoon.
402
00:21:06,200 --> 00:21:07,838
We need to call a microbiologist.
403
00:21:08,280 --> 00:21:09,759
We need them here right away.
404
00:21:10,080 --> 00:21:11,479
You think it's a haemorrhagic virus?
405
00:21:11,920 --> 00:21:13,069
What's the procedure?
406
00:21:15,360 --> 00:21:19,717
This is Mrs Hicklin,
we need full barrier precautions.
407
00:21:19,800 --> 00:21:21,711
With immediate effect
we are locked down.
408
00:21:28,680 --> 00:21:32,229
The on-call microbiologist,
put me through, please.
409
00:21:34,920 --> 00:21:37,559
I need to know where we stand
on the possible haemorrhagic virus.
410
00:21:38,760 --> 00:21:40,239
What our risk of infection is.
411
00:21:41,040 --> 00:21:42,553
And the expert will tell us.
412
00:21:43,120 --> 00:21:45,076
But right now,
you need to operate on his pelvis.
413
00:21:45,640 --> 00:21:47,551
- Okay?
- Trauma theatre.
414
00:21:47,760 --> 00:21:48,988
This is urgent!
415
00:21:49,840 --> 00:21:51,831
Dr Howe? Where is he?
416
00:21:52,960 --> 00:21:54,916
Yes, I do! Immediately, please.
417
00:21:57,680 --> 00:21:59,830
The microbiologist serves
three different centres.
418
00:21:59,920 --> 00:22:01,114
He's at a different hospital.
419
00:22:01,480 --> 00:22:03,710
- That could be 60 minutes plus.
- Well, we're not waiting.
420
00:22:04,160 --> 00:22:05,639
Dr Howe is Wes Howe, isn't he?
421
00:22:06,000 --> 00:22:07,228
That's what the technician called him.
422
00:22:07,800 --> 00:22:09,597
Uh, Justin's friendly with Wes.
423
00:22:10,640 --> 00:22:11,675
Okay.
424
00:22:12,200 --> 00:22:13,189
I'll find Justin.
425
00:22:16,040 --> 00:22:19,077
You have
entered an infection control area.
426
00:22:19,160 --> 00:22:21,515
Strictly authorised personnel only.
427
00:22:25,520 --> 00:22:27,272
- Have you seen Justin?
- No.
428
00:22:39,800 --> 00:22:41,791
So in the light of
a possible haemorrhagic virus,
429
00:22:41,880 --> 00:22:44,394
surgery is a clear
health and safety issue.
430
00:22:46,480 --> 00:22:47,708
I'm not willing to participate.
431
00:22:48,160 --> 00:22:50,628
Yeah, you've got two hours
left on your shift so...
432
00:22:50,720 --> 00:22:52,517
I'll catch up with some admin off site.
433
00:22:52,600 --> 00:22:54,079
Rebecca, where are you going?
434
00:22:54,160 --> 00:22:58,392
Look, Giles will inform my department
superior, he will get you a substitute.
435
00:22:58,560 --> 00:23:01,074
We're just about to start the operation.
436
00:23:01,160 --> 00:23:02,434
I can't take the risk.
437
00:23:03,080 --> 00:23:04,229
- Not with kids.
- Look,
438
00:23:05,000 --> 00:23:06,479
I understand where
you're coming from...
439
00:23:06,560 --> 00:23:08,630
No offence, but you don't.
440
00:23:09,400 --> 00:23:10,879
- I'm sorry.
- Mrs Osgood...
441
00:23:14,840 --> 00:23:17,274
- Call upstairs.
- Have you seen Justin?
442
00:23:24,360 --> 00:23:26,157
Strictly authorised personnel...
443
00:23:26,240 --> 00:23:28,276
Justin, do you know Wes Howe?
444
00:23:28,640 --> 00:23:32,633
What?
Look, we're just into the same music.
445
00:23:32,720 --> 00:23:35,188
- Wes is...
- It doesn't matter. We need a favour.
446
00:23:35,640 --> 00:23:38,757
We urgently need a clinical picture
for the trauma patient.
447
00:23:38,840 --> 00:23:40,910
Can you call Wes, please?
448
00:23:41,000 --> 00:23:42,752
- Yeah, okay.
- Thank you.
449
00:23:47,360 --> 00:23:48,839
We're an orthopod short.
450
00:23:49,280 --> 00:23:50,474
Tell me you're joking.
451
00:23:50,760 --> 00:23:52,637
Part-timer just became a no-timer.
452
00:23:52,960 --> 00:23:55,554
Oh, great.
So how long for a replacement?
453
00:23:55,800 --> 00:23:58,234
Calls have been made. Can you postpone?
454
00:23:59,040 --> 00:24:02,589
No time. No choice.
He needs his ex fix immediately.
455
00:24:03,040 --> 00:24:04,519
This is life-saving.
456
00:24:08,600 --> 00:24:10,431
He needs us to start now.
Where's Rebecca?
457
00:24:10,800 --> 00:24:12,677
We will be proceeding without her.
458
00:24:13,280 --> 00:24:14,429
Yummy mummies who you can't sack.
459
00:24:16,000 --> 00:24:19,675
I need a pelvic external fixator set
and a major O tray, please.
460
00:24:20,520 --> 00:24:22,954
Let's do the who. I'm Glen Boyle,
I'm the trauma consultant.
461
00:24:23,320 --> 00:24:24,878
Fiona Lomas, trauma fellow.
462
00:24:25,120 --> 00:24:27,270
Ramakrishna Chandramohan,
anaesthetics registrar.
463
00:24:27,560 --> 00:24:29,312
Billy Finlay, anaesthetic ODB.
464
00:24:29,480 --> 00:24:31,277
Debbie Wong, theatre scrub nurse.
465
00:24:31,520 --> 00:24:32,839
Heather Dooley, staff nurse.
466
00:24:33,080 --> 00:24:34,513
Jason Marshall, staff nurse.
467
00:24:34,720 --> 00:24:36,392
Shelley Imms, radiographer.
468
00:24:36,640 --> 00:24:38,596
Bruce Colby, rapid infuser operator.
469
00:24:38,760 --> 00:24:42,719
Patient's name is Mike Oscar,
date of birth 1-1-1900.
470
00:24:43,120 --> 00:24:44,838
The patient has
an unknown infection
471
00:24:44,920 --> 00:24:46,831
that may or may not be
a haemorrhagic virus.
472
00:24:47,400 --> 00:24:48,879
We have all been exposed.
473
00:24:49,120 --> 00:24:50,109
But if there's anyone else here
474
00:24:50,200 --> 00:24:54,591
who feels they can't take part in
this operation and they need to leave,
475
00:24:54,680 --> 00:24:55,999
you should do so now.
476
00:25:01,440 --> 00:25:02,555
Thank you.
477
00:25:03,320 --> 00:25:04,355
Drapes, please.
478
00:25:04,720 --> 00:25:08,952
This operation is to perform
a external fixation of the pelvis,
479
00:25:09,040 --> 00:25:11,315
for which I have signed
a Consent Form Four.
480
00:25:11,840 --> 00:25:15,753
Patient has been given one gram
of tranexamic acid in resus.
481
00:25:16,240 --> 00:25:19,915
The critical step in the operation
will be placing of the ex fix.
482
00:25:20,200 --> 00:25:21,519
There should be minimal blood loss,
483
00:25:22,120 --> 00:25:24,998
but if the patient is still unstable
he'll need packing.
484
00:25:25,080 --> 00:25:27,469
He's got no urine output,
so I'm gonna put in the vas cath,
485
00:25:27,560 --> 00:25:29,278
which I can use as
a volume line afterwards.
486
00:25:29,440 --> 00:25:31,635
He's being transfused
blood and blood products,
487
00:25:31,720 --> 00:25:33,472
and we're expecting cross-match
from blood bank.
488
00:25:34,080 --> 00:25:35,149
I've got
Dr Howe on Skype.
489
00:25:36,280 --> 00:25:38,236
Thank you.
Put on a hat and come through.
490
00:25:39,200 --> 00:25:40,235
Can we try and patch him up
491
00:25:40,320 --> 00:25:41,878
- to one of the monitors, please?
- Yeah.
492
00:25:51,200 --> 00:25:54,556
My name is Fiona Lomas.
Do you know where we're at, Dr Howe?
493
00:25:54,640 --> 00:25:57,234
Uh, "Wes".
Mrs Hicklin has given me the basics.
494
00:25:57,320 --> 00:25:59,436
Apologies for the virtual presence,
I am off site.
495
00:25:59,680 --> 00:26:01,398
It'd be really great to get your take.
496
00:26:02,680 --> 00:26:03,715
Let me have a look at the rash.
497
00:26:08,800 --> 00:26:10,074
It's evolving quickly.
498
00:26:10,800 --> 00:26:11,835
Closer, please.
499
00:26:15,840 --> 00:26:17,319
Okay. Yeah.
500
00:26:18,040 --> 00:26:21,919
Patient is shocked,
has leucocytosis and thrombocytopenia.
501
00:26:22,160 --> 00:26:23,195
Okay, can I see the TEG?
502
00:26:23,400 --> 00:26:24,389
Yeah, it should be up now.
503
00:26:26,920 --> 00:26:28,273
Yeah.
504
00:26:29,320 --> 00:26:30,958
- Okay. And, Fiona?
- Yes.
505
00:26:31,240 --> 00:26:32,719
- Are you taking barrier precautions?
- Yes.
506
00:26:33,080 --> 00:26:35,071
Good. Worst-case scenario
is a haemorrhagic virus.
507
00:26:35,160 --> 00:26:36,912
It could be a staph sepsis
or a pneumococcus.
508
00:26:37,520 --> 00:26:38,794
I can short-cut with a sample.
509
00:26:39,080 --> 00:26:40,069
Okay, what do you need?
510
00:26:40,160 --> 00:26:43,789
I need you to scrape the skin lesion
with the point of a sterile needle
511
00:26:43,880 --> 00:26:44,995
until blood starts to appear.
512
00:26:45,120 --> 00:26:48,317
Then, blot the blood onto
a microscopic slide and allow it to dry.
513
00:26:48,760 --> 00:26:50,159
Sterile needle and slide, please.
514
00:26:50,360 --> 00:26:51,839
- We've got slides.
- Thank you.
515
00:26:51,920 --> 00:26:52,955
Get it straight out to the lab
516
00:26:53,040 --> 00:26:54,712
and I'll process it
as soon as I get there.
517
00:26:55,040 --> 00:26:56,075
What else should we be doing?
518
00:26:56,240 --> 00:26:57,309
Usual supportive measures,
519
00:26:57,400 --> 00:27:01,234
give him ceftriaxone
and, um, two grams IVstat.
520
00:27:01,320 --> 00:27:02,435
And I can't be sure what it is yet,
521
00:27:02,520 --> 00:27:04,272
so give him a slug
of vancomycin as well.
522
00:27:04,360 --> 00:27:06,635
Let's get two grams of ceftriaxone,
523
00:27:06,720 --> 00:27:10,554
IV stat and one gram
of vancomycin IV, please.
524
00:27:10,640 --> 00:27:11,675
How about fluids?
525
00:27:11,760 --> 00:27:14,115
Fluids as usual. Keep 'em
coming same with blood products,
526
00:27:14,200 --> 00:27:16,839
but we will need to start inotropes
if the fluids don't pick things up.
527
00:27:18,280 --> 00:27:19,508
Let that dry.
528
00:27:21,480 --> 00:27:24,631
Which personnel should we list
for prophylactic antibiotics?
529
00:27:25,080 --> 00:27:26,195
Sorry, I didn't catch that.
530
00:27:26,360 --> 00:27:28,078
Who else needs prophylactic antibiotics?
531
00:27:28,400 --> 00:27:31,392
Anyone exposed to
bodily fluids or aerosols directly,
532
00:27:31,480 --> 00:27:33,596
who wasn't wearing
personal protective equipment.
533
00:27:33,680 --> 00:27:36,478
Give them Ciprofloxacin 500 milligram,
one dose.
534
00:27:36,800 --> 00:27:38,552
Not perfect, but it helps.
535
00:27:38,960 --> 00:27:40,075
I've called the paramedics in.
536
00:27:40,480 --> 00:27:44,155
The cardiothoracic and general surgeons
were exposed to aerosols and resus.
537
00:27:44,240 --> 00:27:45,229
And Rebecca.
538
00:27:45,800 --> 00:27:48,189
I'll contact them.
Nerys will distribute the Cipro.
539
00:27:48,520 --> 00:27:50,476
Okay, well, it sounds good,
let's see the next stage.
540
00:27:50,560 --> 00:27:52,278
And I'll report this to
the Health Protection Unit, okay?
541
00:27:52,520 --> 00:27:55,956
- Thank you.
- Pulse 120. BP 80 over 60.
542
00:27:56,320 --> 00:27:58,515
He's pyrexial, over 40.
543
00:27:58,600 --> 00:28:01,512
Justin. Hi, Wes, I'm Glen Boyle.
544
00:28:01,600 --> 00:28:04,637
The patient has a pelvic fracture
with contained haemorrhage
545
00:28:04,720 --> 00:28:07,678
requiring urgent surgery,
and we were just about to get started.
546
00:28:08,040 --> 00:28:10,679
Coagulopathy means that any bleed
could lead to exsanguination.
547
00:28:11,000 --> 00:28:12,592
- Yeah.
- Let me see what bugs I can find
548
00:28:12,680 --> 00:28:14,830
- and get back to you, okay?
- Okay. I appreciate it.
549
00:28:16,040 --> 00:28:17,598
The minute you hear
anything back from him
550
00:28:17,680 --> 00:28:19,591
- you bring the news straight in here.
- Sure.
551
00:28:20,760 --> 00:28:23,035
He's burning up.
Nothing is improving it.
552
00:28:24,800 --> 00:28:26,552
Okay, let's get the C-arm in, please.
553
00:28:27,880 --> 00:28:30,917
- What do you think?
- It's the ex fix or we lose him.
554
00:28:34,200 --> 00:28:35,315
Can we arc it, please?
555
00:28:36,960 --> 00:28:38,154
That's good.
556
00:28:40,400 --> 00:28:41,628
- Okay to raise?
- Yeah.
557
00:28:43,400 --> 00:28:44,515
Raise.
558
00:28:46,880 --> 00:28:47,869
Raise off.
559
00:28:48,680 --> 00:28:50,875
Thank you. Play it, please.
560
00:28:54,200 --> 00:28:56,555
Glen, you got a sec?
561
00:28:56,960 --> 00:28:58,029
No.
562
00:28:58,680 --> 00:28:59,908
It's not Ebola, is it?
563
00:29:00,160 --> 00:29:02,037
Might be. Might not be.
564
00:29:02,120 --> 00:29:03,599
Well, I can fight most infections but...
565
00:29:03,680 --> 00:29:05,910
Talk to Nerys
about prophylactic antibiotics.
566
00:29:06,240 --> 00:29:07,275
Now piss off, Bob.
567
00:29:08,480 --> 00:29:09,629
And focus.
568
00:29:20,920 --> 00:29:22,399
A Spencer Wells, please.
569
00:29:25,520 --> 00:29:26,635
Thank you.
570
00:29:32,520 --> 00:29:33,555
Okay.
571
00:29:33,760 --> 00:29:37,309
I'm gonna need a drill with a 150 pin
and a drill sleeve, please.
572
00:29:37,400 --> 00:29:38,515
Give me your hand.
573
00:29:39,800 --> 00:29:41,074
Just there.
574
00:29:41,920 --> 00:29:43,194
Thank you.
575
00:29:48,680 --> 00:29:50,159
Let's take a shot, please.
576
00:29:50,520 --> 00:29:51,555
Raise.
577
00:29:52,240 --> 00:29:53,559
Raise off.
578
00:29:54,520 --> 00:29:55,794
Okay. Thank you.
579
00:30:07,120 --> 00:30:08,189
Let's get the T-handle, please.
580
00:30:13,720 --> 00:30:14,709
Thank you.
581
00:30:20,800 --> 00:30:21,835
Let's have another shot.
582
00:30:22,440 --> 00:30:23,714
Okay. Raise.
583
00:30:25,560 --> 00:30:26,629
Raise off.
584
00:30:26,960 --> 00:30:28,598
Good. I'm gonna need another pin.
585
00:30:41,080 --> 00:30:42,274
Okay, need you again.
586
00:30:42,920 --> 00:30:44,672
Open. Just there.
587
00:30:45,880 --> 00:30:47,359
Thank you.
588
00:30:49,800 --> 00:30:51,756
- Let's have another shot.
- Raise.
589
00:30:52,280 --> 00:30:54,077
Raise off.
590
00:30:55,480 --> 00:30:56,629
Thank you.
591
00:31:06,760 --> 00:31:07,909
Let's have the T-handle, please.
592
00:31:08,840 --> 00:31:09,875
Pulse is rising.
593
00:31:11,760 --> 00:31:12,795
BP dropping.
594
00:31:16,320 --> 00:31:17,548
- Another shot.
- Raise.
595
00:31:17,960 --> 00:31:19,029
Push the Belmont, please.
596
00:31:19,240 --> 00:31:20,559
Yup.
597
00:31:25,440 --> 00:31:27,237
Okay, he's crashing.
598
00:31:28,080 --> 00:31:29,877
- Is it blood loss?
- Yes, we're losing a lot of blood, fast.
599
00:31:29,960 --> 00:31:31,791
Can you see where these
cross-match bloods have got to, please?
600
00:31:31,880 --> 00:31:32,949
Hey, let's repeat the TEG.
601
00:31:33,360 --> 00:31:34,395
We need to open him up.
602
00:31:36,320 --> 00:31:37,355
Blood bank?
603
00:31:37,920 --> 00:31:39,273
- This is the ODP in trauma theatre.
- Come on.
604
00:31:39,800 --> 00:31:41,552
We need pack C ASAP.
605
00:31:46,480 --> 00:31:47,549
Still crashing.
606
00:31:47,960 --> 00:31:50,997
Let's prep for
a full laparotomy for PPP.
607
00:31:53,040 --> 00:31:54,029
Come on!
608
00:31:54,680 --> 00:31:56,398
BP still very low. His numbers are crap.
609
00:31:56,600 --> 00:31:57,794
Blade.
610
00:31:59,360 --> 00:32:00,839
Cutting.
611
00:32:25,800 --> 00:32:26,835
Mayo.
612
00:32:42,720 --> 00:32:43,994
Balfour, please.
613
00:32:45,000 --> 00:32:46,035
Thank you.
614
00:32:49,680 --> 00:32:51,193
Morris retractors, please.
615
00:32:55,960 --> 00:32:58,554
Suction, please.
616
00:32:59,480 --> 00:33:00,469
It's no better.
617
00:33:01,720 --> 00:33:03,676
Okay, I can see the pelvic haematoma.
618
00:33:08,160 --> 00:33:09,309
Receptor, please.
619
00:33:10,800 --> 00:33:11,915
Here.
620
00:33:13,720 --> 00:33:14,994
Suction.
621
00:33:15,280 --> 00:33:17,510
I'm gonna need swabs, one at a time.
Hit me.
622
00:33:20,680 --> 00:33:21,874
Hit me.
623
00:33:24,640 --> 00:33:25,629
Hit me.
624
00:33:27,840 --> 00:33:29,319
Hit me. Oh, shit!
625
00:33:32,960 --> 00:33:33,995
Hmm.
626
00:33:35,880 --> 00:33:37,074
Glen, the glove is torn.
627
00:33:37,920 --> 00:33:38,955
It's just a nick.
628
00:33:41,520 --> 00:33:42,509
See to it.
629
00:33:43,880 --> 00:33:45,074
Gloves.
630
00:34:01,920 --> 00:34:03,035
Okay to proceed?
631
00:34:07,000 --> 00:34:08,194
Hit me.
632
00:34:13,000 --> 00:34:14,149
Hit me.
633
00:34:14,240 --> 00:34:15,673
Five packs in.
634
00:34:15,760 --> 00:34:16,795
Any improvement?
635
00:34:16,880 --> 00:34:19,394
No, I've given him a second doze
of tranexamic acid.
636
00:34:19,480 --> 00:34:21,436
And he's still crashing.
637
00:34:22,680 --> 00:34:25,319
Bleeding is continuing
through the packs.
638
00:34:25,400 --> 00:34:29,678
We've got an active arterial bleed
in a branch of the internal iliac.
639
00:34:29,760 --> 00:34:31,034
It didn't show in CT scan.
640
00:34:31,120 --> 00:34:33,076
He must've blown-off a clot,
it's a rupture.
641
00:34:33,880 --> 00:34:35,108
- I'm gonna need some...
- Press the...
642
00:34:35,200 --> 00:34:36,599
Get some suction in here, please.
643
00:34:36,680 --> 00:34:38,989
New take should be on the system.
644
00:34:39,080 --> 00:34:40,513
Let's see it.
645
00:34:40,920 --> 00:34:42,717
It's a previous one and the new one...
646
00:34:42,800 --> 00:34:43,869
- Lazy.
- Old.
647
00:34:44,880 --> 00:34:46,154
New.
648
00:34:46,400 --> 00:34:47,469
Old.
649
00:34:48,520 --> 00:34:50,397
- New.
- Oh, my God.
650
00:34:50,480 --> 00:34:51,993
He's doing really well.
651
00:34:52,080 --> 00:34:53,877
It's much more deranged.
652
00:34:53,960 --> 00:34:55,154
Two are vital, please.
653
00:34:55,240 --> 00:34:56,559
BP's still falling.
654
00:34:56,640 --> 00:34:58,915
We need to reverse
this man's coagulopathy,
655
00:34:59,000 --> 00:35:01,753
otherwise, he's gonna
bleed out very, very quickly.
656
00:35:01,840 --> 00:35:03,956
He needs cryoplate. It's an FFP.
657
00:35:04,040 --> 00:35:05,359
We're in pack C.
658
00:35:06,680 --> 00:35:08,272
- It's not here.
- Oh!
659
00:35:08,360 --> 00:35:09,998
Where the hell is pack C?
660
00:35:16,760 --> 00:35:18,193
Blood bank, please...
661
00:35:19,400 --> 00:35:21,709
Yes, this is the ODP
in trauma theatre again.
662
00:35:21,800 --> 00:35:23,711
We're still waiting for pack C.
663
00:35:25,080 --> 00:35:26,798
Oh, they're refusing to bring it.
664
00:35:26,880 --> 00:35:28,791
They're waiting for advice
from the line manager
665
00:35:28,880 --> 00:35:30,279
whether should go
near an infection area.
666
00:35:30,360 --> 00:35:31,395
Joking.
667
00:35:31,480 --> 00:35:32,708
Tell them you'll meet them
at the infection barrier.
668
00:35:43,400 --> 00:35:46,836
The trauma department
is an infection control area.
669
00:35:46,920 --> 00:35:49,480
Strictly authorised personnel only.
670
00:35:56,040 --> 00:35:59,430
The trauma department is
an infection control area.
671
00:35:59,520 --> 00:36:01,988
Strictly authorised personnel only.
672
00:36:04,040 --> 00:36:05,598
Do you want me to sign for it?
673
00:36:05,680 --> 00:36:07,875
Knob-head.
674
00:36:08,160 --> 00:36:09,798
Suction, please. And packs.
675
00:36:13,080 --> 00:36:14,911
- I got it.
- Well done. Hit me.
676
00:36:18,120 --> 00:36:19,997
I'm your other pod consultant.
677
00:36:20,080 --> 00:36:21,308
Joseph Whitnell.
678
00:36:21,400 --> 00:36:23,960
Substitute for the reluctant Mrs Osgood.
679
00:36:24,040 --> 00:36:26,429
We've abandoned the ex fix
at the moment.
680
00:36:26,520 --> 00:36:29,432
We've got an internal iliac bleed
and some other issues.
681
00:36:29,520 --> 00:36:31,317
- I'll come through.
- Oh, no, listen, Joseph.
682
00:36:31,400 --> 00:36:34,472
We've got a pathogen in here and there's
no point in exposing anyone else to it.
683
00:36:34,560 --> 00:36:37,916
We'll need to fix the fracture.
I'll take full precautions.
684
00:36:39,600 --> 00:36:41,431
Microbiology results.
685
00:36:41,960 --> 00:36:43,439
Come on through.
686
00:36:50,520 --> 00:36:51,589
What can you tell us, Wes?
687
00:36:51,720 --> 00:36:53,278
Okay, so I found the bugs.
688
00:36:53,360 --> 00:36:56,909
Good news. Ruled out Haemorrhagic virus.
It's only meningococcal sepsis.
689
00:36:58,040 --> 00:37:00,395
- Great news.
- But we should treat this seriously.
690
00:37:00,480 --> 00:37:03,074
Continue the cataracts
and two grams BD
691
00:37:03,160 --> 00:37:06,038
and make sure that someone's
getting those prophylaxes sorted.
692
00:37:06,120 --> 00:37:09,157
Once you're done, get him up to ITU and
I'll be there as soon as I can, okay?
693
00:37:09,240 --> 00:37:10,832
- Okay.
- Scissors.
694
00:37:11,680 --> 00:37:13,477
Ligation is completed.
695
00:37:13,560 --> 00:37:15,391
Seems as if the bleeding's
under control.
696
00:37:15,480 --> 00:37:17,835
- Pulse rate, 110.
- Large swabs, please.
697
00:37:17,920 --> 00:37:19,797
- Thank you, Wes.
- Yeah.
698
00:37:19,880 --> 00:37:21,598
- Thanks for doing that.
- No problem.
699
00:37:21,680 --> 00:37:23,033
Give me the Robinson tube.
700
00:37:24,080 --> 00:37:25,354
Numbers are improving slowly.
701
00:37:27,440 --> 00:37:29,158
A Spencer, please?
702
00:37:30,200 --> 00:37:31,394
Systolic up to 100.
703
00:37:31,480 --> 00:37:33,277
Come on!
That's it, my friend.
704
00:37:34,480 --> 00:37:37,517
I think the coagulopathy's been
corrected by the blood products.
705
00:37:37,880 --> 00:37:39,359
Morris out.
706
00:37:44,840 --> 00:37:46,273
He's stabilising.
707
00:37:47,200 --> 00:37:49,714
- Piece of piss, this game.
- That's terrific news.
708
00:37:50,760 --> 00:37:52,193
I'll finish the ex fix for you.
709
00:37:52,280 --> 00:37:54,794
Yeah, I'll just go and organise
a side room in ITU.
710
00:37:54,880 --> 00:37:56,154
Thank you.
711
00:37:57,360 --> 00:37:58,998
Listen, everyone.
712
00:37:59,920 --> 00:38:01,876
I think we got there.
713
00:38:01,960 --> 00:38:03,632
We saved him and...
714
00:38:05,120 --> 00:38:06,872
I just wanted to say thank you.
715
00:38:09,560 --> 00:38:11,312
Hi, it's Ramakrishna calling
from trauma theatre.
716
00:38:11,400 --> 00:38:12,913
Can I have a side room
for Mike Oscar, please?
717
00:38:13,480 --> 00:38:15,357
Bring up
the CT image onscreen, please.
718
00:38:17,200 --> 00:38:18,679
Bring up the CR.
719
00:38:19,680 --> 00:38:21,272
Thank you.
720
00:38:26,400 --> 00:38:28,118
It's blood.
721
00:38:29,520 --> 00:38:31,715
Is it yours or the patient's?
722
00:39:01,400 --> 00:39:02,389
Is it cut?
723
00:39:06,320 --> 00:39:07,309
Not my blood.
724
00:39:11,040 --> 00:39:12,393
Got a result?
725
00:39:13,400 --> 00:39:15,516
Yes. He's come through it.
726
00:39:17,720 --> 00:39:20,075
Pre the diagnosis, we had
to take both the general
727
00:39:20,160 --> 00:39:23,118
and the cardiothoracic consultants
temporarily off duty.
728
00:39:23,600 --> 00:39:25,591
Down to possible exposure.
729
00:39:25,680 --> 00:39:27,557
They both missed their clinics.
730
00:39:27,640 --> 00:39:30,950
That's down to unnecessary trauma
attendance. It's not ideal, is it?
731
00:39:31,920 --> 00:39:33,035
No.
732
00:39:33,120 --> 00:39:34,235
I suppose not being...
733
00:39:34,320 --> 00:39:37,312
You know, you left me right in
the middle of the schedule manager.
734
00:39:41,360 --> 00:39:44,511
But the most important thing is
that the patient didn't die.
735
00:39:46,200 --> 00:39:48,953
That's down to your intervention
and the team's hard work.
736
00:39:49,800 --> 00:39:50,994
Thanks.
737
00:39:53,240 --> 00:39:54,514
Fiona?
738
00:39:57,320 --> 00:39:58,912
Glen's just a locum.
739
00:39:59,560 --> 00:40:01,551
He's here one day, he's gone tomorrow.
740
00:40:02,760 --> 00:40:04,239
You know how we do things here.
741
00:40:04,320 --> 00:40:06,038
But he has a point.
742
00:40:06,280 --> 00:40:07,918
Sorry, excuse me.
743
00:40:11,160 --> 00:40:12,832
It's your career.
744
00:40:23,040 --> 00:40:24,359
So, he's doing well,
745
00:40:24,440 --> 00:40:26,476
and Ramakrishna will take
him to ITU when they're done.
746
00:40:26,560 --> 00:40:29,028
I'll let Dr Harry know. Mr Boyle?
747
00:40:29,120 --> 00:40:31,076
We rechecked the Camp Bastion dates.
748
00:40:31,160 --> 00:40:34,470
There's a three-month gap between
your deployment and your arrival here.
749
00:40:37,120 --> 00:40:38,155
Is there?
750
00:40:38,240 --> 00:40:40,390
For the records,
can you account for the time?
751
00:40:42,680 --> 00:40:44,079
I can. Yes!
752
00:40:47,720 --> 00:40:49,631
We need to write up our notes.
753
00:40:50,360 --> 00:40:51,509
Good.
754
00:40:55,360 --> 00:40:56,873
You all right?
755
00:41:00,040 --> 00:41:04,033
The patient will live to testify
against the people who did that to him.
756
00:41:05,600 --> 00:41:06,953
I'm very all right.
757
00:41:16,440 --> 00:41:19,557
Remember to take the Cipro.
758
00:41:20,160 --> 00:41:21,275
Yes.
759
00:41:22,080 --> 00:41:25,390
- Thanks.
- And I wanted to apologise.
760
00:41:27,680 --> 00:41:28,954
For what?
761
00:41:29,640 --> 00:41:34,475
You've been dealing with
the hospital protocols, all that crap.
762
00:41:36,560 --> 00:41:38,676
And I don't want you
to feel compromised,
763
00:41:38,760 --> 00:41:40,910
I don't want it to be
professionally difficult for you.
764
00:41:43,120 --> 00:41:44,758
But it's working.
765
00:41:46,080 --> 00:41:48,036
You're making the team a unit.
766
00:41:51,920 --> 00:41:53,194
It seems so.
767
00:41:58,920 --> 00:42:00,148
Look...
768
00:42:00,840 --> 00:42:03,912
Maybe I've been a bit defensive,
769
00:42:04,000 --> 00:42:08,118
but there's no reason why we
can't talk to each other more.
770
00:42:11,160 --> 00:42:12,309
Good.
771
00:42:20,320 --> 00:42:22,959
I'm actually heading back to my digs.
772
00:42:23,560 --> 00:42:24,675
Yeah.
773
00:42:26,500 --> 00:42:33,500
Ripped By mstoll