You're more important to me than the army is,
that's why I'm staying.
You're absolutely sure?
No nagging doubts?
No, it's time.
Call me.
Why don't you give me a call sometime?
I'm so calling you back.
When's the big day?
I asked him not to say anything.
Congratulations.
Ripped By mstoll
- OK, if you just let me explain. - Doesn't matter.
Glen, it's important to me that you understand the reasons why...
Understand what?
Really? What?
Glen.
You and Tom have a nice life.
Glen!
Shit.
Glen Boyle. Calling.
Come on. Come on.
Hello, this is Glen Boyle,
I can't take your call.
Glen Boyle. Calling.
Glen, the last thing I wanted was to hurt you.
You needed help,
and I came running.
But you knew exactly what would happen, and you just didn't give a shit.
- Did ya? - I called you in a moment of weakness,
because I needed you.
I convinced myself almost certainly you wouldn't come.
I'm sorry, I can't hear you, you broke up.
I said, but I did.
Yes, you did,
two years too late.
- Oh, come on. - I lost our baby, Glen.
I was on my knees,
that's when I needed you.
- You wanted me to go... - I didn't!
- I... - You ran,
just like you're running now.
Where are you even going?
I don't actually know.
Turn around.
Let's talk.
No, you made your choice.
The hell is there to talk about?
Call ended.
I'm sorry, Fi.
I am.
Tom asked me out of the blue.
Because... He...
Shit.
- Call ended. - Shit.
Come on.
Glen?
- Can you hear me? - Yes.
- What about Tom? - He loves me.
I love you.
You know, I came back for you.
Put myself on the line.
For you.
And now you're leaving again.
Yup.
You've made your choice, so...
I don't want you to leave.
I don't want you to leave again.
- Glen. - What do you want, Fiona?
Tell me right now
what do you want?
I don't know.
Hello? Shit.
Glen?
Glen Boyle.
Calling.
Hello?
- Hello? - Hello, Glen?
Glen?
Glen.
Glen, can you hear me?
Talk to me.
I'm fine.
- Ambulance services. - My name is Fiona Lomas,
I'm a trauma fellow at CGH,
first on scene at an OTC.
- Two vehicles involved. - What is your location?
- Sorry? - Your location, madam.
Of course, bear with me.
- We're on the V9144... - Yes.
...at the crossroads of the A 782.
Standby for further information on the casualties.
- Standing by. - Glen.
- Tell me how you're feeling. - I don't know, I...
I'll be OK, you go and check on the other car.
Go, check on the other car. I'll be...
First casualty, GCS 15, no apparent trauma.
Two further casualties.
Sir, can you hear me?
Can you tell me your name?
Apparent major trauma, P1 -slash-P2.
I can't give you any further information now, I'm sorry.
I need to attend to the patients.
Sir, my name is Fiona Lomas,
I'm a trauma doctor at City General Hospital.
Can you hear me?
Can you tell me your name?
Sir, can you hear me? Can you open your eyes for me, sir?
- Glen? - Yes, what have we got?
- Weak pulse, crushed chest. - OK, tubes.
- Yes. - Here.
Don't turn your head, and try not to move.
My name is Glen, I'm a trauma surgeon.
Can you tell me your name, please?
- Rory... - OK, Rory, I'm gonna examine you.
OK? I'm just gonna get this door open.
Shit!
It's jammed.
Chest.
OK.
Rory, I just need to feel your abdomen.
OK?
Shit. His legs are crushed.
Pull up here, there's a tension in the thorax.
OK.
Output's gone.
We're losing this one.
Releasing tension, pneumothorax.
Pulse?
Nothing.
OK, let's get him out.
- Help him. - Are you OK to lift him?
I'm OK.
- Forward, you got it? - Yeah.
A little more.
- Got him. - OK.
Take his feet.
OK, you have to take his head.
OK, got it. Got it.
OK.
We'll start with bilateral thoracotomies.
Cut his top off, please.
Light, please.
Scissors, please.
Thank you.
Any hemothorax?
Nothing, just do on the other side.
What's going on?
Help is on the way, Rory.
You just try and stay calm.
Anything?
Nothing this side either.
OK, I'll go open him up. Here.
Not exactly sterile.
Welcome to operating in the field.
There's timing.
Left anterolateral thoracotomy nearly done.
- OK, I need your help here. - OK.
Assembling the heart.
Tamponade.
Gotta open the pericardium.
Over here.
Yes, ma'am.
What can I do for you?
We're trauma surgeons from CGH.
I need you to hold up this light high,
- so we can see inside his chest. - Oh, my God!
He's got pressure around his heart that's stopping it from pumping.
What's going on?
Your friend's got fluid squeezing his heart,
and we need to release it so we can get his heart going again.
It's gonna be all right, Rory.
I'm getting some contractions.
OK, that's his heart beating again. What output are we getting?
Carotid pulse, and there's not enough to give a radio pulse.
BVM in my bag.
Evacuating the clot.
This guy needs to be in theatre. Now!
I'm managing his airway,
- I need you to get him some oxygen. - Yeah.
There's a passenger still trapped inside the vehicle.
We'll work around you, let's keep talking.
Thank you.
- We need to RSI. - What do you need?
OK, can you continue bagging?
Thio, sux, and a size eight tube,
- in the blue bag just there. - Right, yeah.
I'm gonna work on getting you outta there, mate.
- All right, what's your name, please? - Rory.
All right, Rory, I need you to hold still for me, OK?
OK, Rory...
- Let's get a view. - Yeah.
All right, Rory, just keep breathing deep,
and I'll be back in a few secs, OK?
Just keep that on.
OK, cricoid on.
Two 250 milligrams thio going in now.
Intubating now.
Tube in.
OK.
Cuff up.
- OK. - Yeah.
Breath?
Choppy now.
Breath?
OK, it's inflating now.
Cricoid off.
OK, cardiac output?
OK, it's 120, but it's weak.
OK, he's about as stable as he's gonna get.
I agree. Casevac?
We've got some scoops and gloves.
Let's get it done, please.
Anything we can do?
Is David all right?
Someone take over the transfer from me, please.
OK, I need you to hold his head.
- Yeah. - Yeah, I've got it.
Rory, he's in a bad way,
but we're doing the very best we can for him.
OK, he needs to be in an operating theatre ASAP.
Call that in, please.
- Do you know David's surname? - Hansen.
And by any chance would you know his date of birth?
The 6th of April, 1981.
It's OK.
- Are we ready to go? - Yeah.
I wanna say goodbye to him.
Look, your mate needs to be in a hospital, Rory.
He's not my mate, he's my boyfriend.
OK.
Let's get the trolley around to the other side please, now.
Understood.
- Quick as we can. - OK.
He's on his way.
OK, can I touch his hand?
I love you.
It's OK.
Sorry, we need to get him to the hospital now.
Let's go.
Thank you.
You should go with him.
- Glen? - He needs a surgeon with him.
I'll see you when you bring that one in.
Yes?
This is Fiona Lomas, I'm one of the surgical registrars.
Please can you connect me to the alert phone?
Nicola, it's Fiona.
Glen and I are first on scene at an OTC,
we've two patients coming your way.
First, male, 30s, driver, lung-chest trauma.
Yes.
His name is David Hansen, date of birth 6th of...
OK, guys, on three. One, two, three, and lift.
Glass management is done.
Vehicle's made safe, if you want to go in.
Thank you very much.
- Can you get control of the seats? - Sure.
Let's get him flat, please.
Go down gently, slowly.
- Perfect. - Thank you.
All right, Rory, just gonna check your blood pressure
and your oxygen levels, all right?
Let's put this on your finger.
Here we go.
Abdomen is tense and full.
BP, 60 over 35.
Christ.
You all right, Billy?
Uh, was just passing.
You've been listening in on the police channels, haven't ya?
- No. - Either way, I'm glad you're here.
- Uh, Mr Boyle. - Yeah?
I might be of some help here.
You might have some ketamine in your grab bag.
I couldn't possibly have it.
I'm just an ODP.
Billy, could you possibly see
if you can find some ketamine in my grab bag, please?
I'll have a look, Mr Boyle.
- There's your ketamine, Mr Boyle. - OK.
I'm just giving you something to make you comfortable, OK?
Can you tell me what your surname is, and your date of birth, please?
Billy, can you get this down?
- Yeah. - Roberts,
19th of January, 1983.
Thank you.
20 milligrams ketamine in.
OK, guys, let's make some space,
and get his legs free.
- Should be all right. - Yeah.
Stop, let me get in.
You're fine. You're doing really well.
You're OK?
That's it.
We're just gonna get your leg out, that's all.
There you go.
Doing really well, Rory.
- Thank you. - Really well.
Billy, come release the tourniquet, nice and slowly, please.
Yeah.
Thank you.
Yeah, OK, this is doing the job.
Let's go again, let's get this other leg out, please.
Hurry up.
Let me see, please.
No, you need to keep going.
We can't get any more clearance,
the leg is stuck.
- OK. - You're doing really well, mate.
Let's have another BP, please.
Yeah.
Listen, Rory, I'm just gonna have to feel your belly again.
Ah, it's 50 over unreadable.
He's dropping.
It's looking like there's only one way to get him out over there in time.
Unless you've got something you can come up with in the next five minutes
that will release that leg.
Not in five minutes.
I'm sorry.
Hey, Rory,
can you hear me?
Rory?
Listen, your right leg's trapped,
and I'm very concerned that you might have a massive bleed in your belly.
I'm gonna be honest with you,
if I don't get you get you to a hospital within the next hour, you're gonna die.
Do you understand me?
I'm sorry, but that's why I have to amputate your leg.
Now you listen to me,
I've done this before,
so I know that I can save your knee joint,
and that means with a simple prosthetic
you will be able to walk again and you'll even be able to run.
OK?
We're gonna pump you full of some painkillers.
You got any more of that ketamine left?
Yes, you do.
OK.
Make it up to a total of 120.
- Coming up. - OK.
I'm gonna need gloves and antiseptic from your truck.
Um, I've got glass dressings,
but I need you to get me a couple of blankets
and some bandages please.
Yeah.
- Here you go. - Thank you.
Listen, you wouldn't happen to have sux and a tube, would you?
We've used mine.
Uh, I've got roc in your bag.
OK, and are you up to tubing him?
Under my supervision, obviously.
Uh, yeah.
- Good man. - All right.
Let's get that headrest off, please.
Come down here.
- You got him? - Yeah.
There's your roc.
Thank you.
Sorry.
There's the tube.
Thomas.
All right.
Cricoid on, please.
Lift the mask.
Cricoid on.
80 milligrams roc going in now.
Here we go.
Just bring him this way a little bit.
Here we go.
Tube.
- Cuff up. - OK, I'll do it.
Bag.
Ta.
Here we go.
Breath.
Both lungs ventilated.
Cricoid off, please.
- Well done, Billy. - Ta.
Let's get that brace on here.
Brace.
I don't have enough room here for a saw.
Do you have bolt cutters?
Bolt croppers.
OK, listen,
this is gonna need to be fast.
Billy, I need you to move this tourniquet down
to just above his knee,
and then pull it tight, please, and I mean tight as a drum.
- Yes? - Yeah.
I'm sorry.
- Tell me when. - Yeah.
Got it.
- There's a fresh blade in there, please. - Yeah.
There you go.
- We're good? - Yeah.
Cutting.
Coming around.
- Hit him with that antiseptic, Billy. - Yeah.
- Throw it on there. - Yeah.
- And here. - Yeah.
OK.
I'm gonna snap the tibia.
Still with me, Billy?
Put it this way, I won't be having barbecue ribs for a while.
Now, the fibula.
Here.
Give me the blade.
I'm not gonna spend any time prettifying it
until we get him in hospital.
I am just gonna wrap the stump.
- Billy, antiseptic. - Yeah.
And the blast dressing.
Yeah.
Go ahead.
Thank you.
- Billy. - Yeah?
Call CGH, tell them that we're gonna be on our way.
Yeah.
Hello.
Mrs Hicklin.
Yeah, it's Billy Finlay at the scene with Glen.
- What? - Don't ask.
We've extracted the second casualty via a BK amputation.
Rory Roberts, date of birth, 19th of the first, 1983.
Suspected severe intra-abdominal haemorrhage.
Thanks. Uh, Nicola says she'll have a theatre ready for it.
OK, this is a scoop and run,
he needs to be opened up in theatre.
- Can we go, please? - Yeah.
Can we get a trolley, please?
Tell me when we're ready, please.
Slide it in there.
On three. One, two, three.
That's it.
Yeah.
This time, all the way to the trolley.
- We ready? - Yeah.
Then, on three. One, two, three.
OK, let's get him clocked in.
Thank you, the other side.
Quick as we can, please.
OK, that's us. Thank you.
- That's good work. - Cheers.
Thanks a lot, guys, let's go.
In.
I'll take hold of it.
- Thank you. - Ta.
Need to give another 30 bolus of ket.
- There you go. - Thank you.
- It's done. - Ta.
You, uh...
You've written off your motor, then?
I have, yeah.
Wanna buy a Fiesta?
Yeah.
- What? - Give me the keys.
Amazing... Is a grand all right?
You send me the log book, I'll send you the cash.
Can you hold that door, please?
You did really well tonight, Billy.
It's been great working with ya.
Thanks.
I'll see you back at CGH?
Go.
Glen?
Miss Lomas. Miss Lomas.
Thank you.
Cheeky bastard.
Fiona Lomas, trauma fellow.
Debbie Wong, scrub nurse.
Sarah Molloy, consultant anaesthetist.
Adrian Sands, anaesthetic ODP.
Bruce Colby, rapid infuser operator.
Alice Mukherjee, consultant cardio thoracic surgeon.
Patient is David Hansen, date of birth 6th of the fourth, 1981.
Patient was a driver in an OTC,
and has sustained blunt chest trauma.
I've signed a consent form four,
for exploration of thoracic cavity plus proceed.
Swabs, please.
Scalpel.
First, we'll explore the chest cavity for any ruptures or bleeds
and then we'll get on with repairing the damage to the heart.
Ready when you are, sir.
Finochietto retractor.
Thank you.
Packs, please.
Where's Glen?
Probably already broken down and on to the AA.
Trauma theatre's occupied at the minute. We're just waiting on one.
Theatre six.
Great. Theatre six. Thanks, Giles.
Two units. All pause.
- Yeah. - OK.
OK, quick handover to Dr Bennett-Edwardes.
That's me.
Rory Roberts, 32 year old, front seat passenger
involved in a multi-vehicle RTC at approximately 22:30.
Crush injuries, both legs, prolonged extrication
requiring right side below knee amputation. Suspected...
This is Mrs Hicklin. Theatres, please.
Pulse, 160. BP, 60 over 30.
RSI with 120 milligrams of ketamine.
Rocuronium, 80 milligrams
plus bolus for transfer of another 30 ket.
Great, thanks.
Ah, ready.
Great, let's do it.
I need to know who's on for gen surg.
Thank you, who'll be operating?
Yes, I'll hold.
Oh, guys, please, can you do the necessary paperwork
with Giles down in the front desk?
- Yeah, thanks. - Thank you.
Cheers, guys.
Well, we're on route to theatre six now.
Who's there for the patient?
Fine.
Um, Dr Jones is just covering the transfer,
but Ramakrishna Chandramohan will be your anaesthetist in theatre.
- Who's the surgeon? - I'll get you one.
Three blood, two FFPs straight in, filling them up.
OK.
How's it going?
No active bleeding at present.
No pelvic fractures,
fast scan shows there's no free fluid in the abdomen.
Patient is stable.
Great. Um, Alice, I need Fiona urgently.
I'm good here. Thanks, Fiona.
- Thanks. - All done?
- Thank you. - OK.
The other trauma from the RTC, he's on his way to theatre.
OK.
- Is Glen with the patient? - No.
Glen informed me this week
that he's not taking up the extension of his contract.
He's resigned, I'm sorry.
OK, theatre six, Rory Roberts, laparotomy.
Billy! Hey.
I didn't wanna say it in front of the others,
but you were brilliant.
Call me.
It'll be fine.
Blade?
- OK to cut? - OK.
Cutting.
Swabs to Harry.
Forceps.
Scissors.
I'm going to open the peritoneum.
Suction.
Everybody ready?
OK, ready.
Just follow my lead, Harry. You'll be fine.
Here we go.
Packs.
Packing.
Just whack it in.
Five packs in the abdomen.
Five in.
Packs.
Five more in.
Ten in.
Morris.
Hold it here.
Morris.
Shit!
OK, BP's dropped back to 60 over 30.
No point in us putting blood in him, he's gonna leak out...
Haemorrhaging from the left upper quadrant.
- Spleen? - Yes.
- Management? - Splenectomy.
Yup. Roberts.
Swapsies.
Keep at it, Harry.
In with suction, I need you to keep the field clear.
Mmm-hmm.
OK, I'm struggling.
I need you to hold the bowel clear.
Oh, gosh.
OK.
Got it. Roberts?
Splenic vessels clamped.
- MAC in dose. - OK, fill 'em up.
Yup.
I've divided the splenic ligaments.
Splenic vessels divided. Roberts.
Short gastric vessels clamped.
MAC in dose.
Short gastric vessels divided.
Stop suction.
The bleed's under control.
Good.
Ramakrishna?
BP coming up.
Coming up.
BP holding.
Systolic 80. That's good work.
We'll keep filling him up.
So, blood, FFP platelets, three to two to one.
Got that.
OK, what?
Good work, everyone.
OK.
I'm going to remove the spleen
to make room for tying off the vessels.
MAC in dose.
Fiona.
Have you found someone to replace me yet?
Yes. I'll phone her in the morning and tell her to stand down.
- Thank you. - You're welcome.
All right, Billy?
Mr Boyle.
Do you want to scrub in?
No, I think you should finish.
Dish.
Removing the spleen.
See, you don't need me at all.
I wouldn't say that.
Ripped By mstoll