1 00:00:05,000 --> 00:00:06,479 You're destroying my career? 2 00:00:06,800 --> 00:00:07,869 Clive will pay for this. 3 00:00:08,960 --> 00:00:11,076 Take his side, you'll pay for it, too. 4 00:00:12,920 --> 00:00:14,672 Harry. The brain doc. 5 00:00:15,840 --> 00:00:16,829 Is it over then? 6 00:00:17,440 --> 00:00:19,158 - Could be professional... - So, she's single now. 7 00:00:21,880 --> 00:00:23,279 Clive, you're relieved. 8 00:00:23,480 --> 00:00:26,597 The chief executive has made me acting clinical lead. 9 00:00:28,800 --> 00:00:30,074 I am grateful you're here. 10 00:00:31,400 --> 00:00:32,674 I'm grateful you came running 11 00:00:33,120 --> 00:00:34,269 when I called. 12 00:00:42,320 --> 00:00:44,788 The lower ambulance bay is a restricted area. 13 00:00:44,920 --> 00:00:46,239 Essential personnel only. 14 00:00:47,600 --> 00:00:49,397 The lower ambulance bay is a restricted area. 15 00:00:50,560 --> 00:00:52,073 Essential personnel only. 16 00:00:52,280 --> 00:00:53,269 This way. Quick. 17 00:00:53,360 --> 00:00:54,588 - What have we got? - Dog attack. 18 00:00:54,720 --> 00:00:56,551 And one of the dogs, he won't let go. 19 00:00:57,040 --> 00:00:58,029 Dog? 20 00:00:58,120 --> 00:01:00,156 We've been in transit for 15 minutes. 21 00:01:00,320 --> 00:01:01,389 Are the... Is the dog still alive? 22 00:01:01,840 --> 00:01:03,353 Yeah. Bob? 23 00:01:04,000 --> 00:01:05,479 - You okay? - Just about. 24 00:01:05,680 --> 00:01:07,352 The dog. Where is it exactly? 25 00:01:07,440 --> 00:01:08,429 Pinned to the floor. 26 00:01:09,000 --> 00:01:11,116 - You need to hurry, though. - Yeah, okay. 27 00:01:11,680 --> 00:01:12,795 Listen, we're gonna open the door now. 28 00:01:17,400 --> 00:01:20,278 - Oh. Oh, my God. - Ouch. Oh, God. 29 00:01:21,160 --> 00:01:22,149 Thanks. 30 00:01:25,200 --> 00:01:27,634 All we had was diazepam. If this bastard thing wakes up... 31 00:01:27,720 --> 00:01:30,553 Okay. Give me the ketamine, please. 32 00:01:32,280 --> 00:01:34,840 Justin, ketamine, now, please. 33 00:01:39,720 --> 00:01:40,709 Thank you. 34 00:01:46,960 --> 00:01:47,949 Easy, boy. 35 00:01:48,880 --> 00:01:49,995 Why doesn't someone just kill it? 36 00:01:50,320 --> 00:01:51,833 What, shoot it when it's this close to the guy? 37 00:01:52,200 --> 00:01:53,428 Oh, no. You don't have to shoot it. You just... 38 00:01:54,680 --> 00:01:55,669 - Whoa. - Shit. 39 00:01:55,760 --> 00:01:56,795 Be careful, please. 40 00:01:56,880 --> 00:01:58,472 - Sorry. Sorry. - Just be careful. 41 00:01:59,640 --> 00:02:02,108 - Any sign of the vet? - Yeah, he's called. He's on his way. 42 00:02:02,480 --> 00:02:05,517 Let's call him back. Tell him we need access to a vein. 43 00:02:05,600 --> 00:02:07,591 Hind leg, if that's at all possible, yes? 44 00:02:08,160 --> 00:02:10,116 We'll need an ETA. I wouldn't. 45 00:02:10,600 --> 00:02:12,909 Oh, I was just... Switching it off. 46 00:02:13,360 --> 00:02:14,349 Good. 47 00:02:14,480 --> 00:02:16,994 The ketamine, by itself is gonna make it hold on tighter. 48 00:02:17,080 --> 00:02:19,753 You've got to give it some diazepam to counter the muscle rigidity. 49 00:02:19,840 --> 00:02:20,875 No, don't give any more diazepam. 50 00:02:21,360 --> 00:02:23,794 If it relaxes and let's go then, mate, he's gonna bleed like stink. 51 00:02:24,160 --> 00:02:25,513 His brachial artery has been torn up. 52 00:02:26,880 --> 00:02:28,757 That's why we didn't kill it. His jaw's like a clamp. 53 00:02:29,000 --> 00:02:30,592 Soon as it releases... Poof! 54 00:02:31,160 --> 00:02:33,754 We're gonna stick to 50 milligrams of ketamine for now. 55 00:02:33,840 --> 00:02:35,239 That should make him nice and happy. 56 00:02:35,320 --> 00:02:36,309 Yeah, I'd double it. 57 00:02:36,760 --> 00:02:40,435 Okay, he says, the best vein is on the lateral aspect of the hock. 58 00:02:40,520 --> 00:02:42,556 Hock? What the bloody hell's the hock? 59 00:02:43,040 --> 00:02:44,029 Well, don't ask me. 60 00:02:44,120 --> 00:02:45,473 Well, I'm not asking you, am I, Giles? 61 00:02:45,760 --> 00:02:48,320 Oh, yeah, well, what's the... Er, he can hear. 62 00:02:48,480 --> 00:02:51,597 Er, it's half way up the back of the leg. It's the bit that sticks out. 63 00:02:51,680 --> 00:02:52,669 Shh. 64 00:02:54,120 --> 00:02:55,189 Yeah, it's what she said. 65 00:02:56,040 --> 00:02:58,838 Fiona, butterfly cannula, please. 66 00:02:58,960 --> 00:02:59,949 Yeah. 67 00:03:00,040 --> 00:03:01,871 - Sure you've got it? - Got it. 68 00:03:02,000 --> 00:03:05,151 Yeah, now, if someone constricts the stifle... No, what? 69 00:03:06,040 --> 00:03:07,871 Oh, it's the... It's the next joint up its knee. 70 00:03:08,000 --> 00:03:09,513 Then the vein can be palpated. 71 00:03:09,600 --> 00:03:10,589 Thank you. 72 00:03:20,160 --> 00:03:21,354 Okay? 73 00:03:22,160 --> 00:03:23,149 I think, yeah. 74 00:03:27,080 --> 00:03:28,115 Okay, there, I've got it. 75 00:03:33,280 --> 00:03:34,269 - Okay. - Easy. 76 00:03:34,360 --> 00:03:35,349 - Careful there, guys. - Oh, it's okay. 77 00:03:36,600 --> 00:03:37,589 It's okay, boy. 78 00:03:39,920 --> 00:03:43,708 Okay, 50 milligrams ketamine going in, now. 79 00:03:44,200 --> 00:03:46,236 Okay, he says his ETA is five, six minutes. 80 00:03:46,320 --> 00:03:48,515 - Thank you. - We'll need a resus trolley. 81 00:03:49,760 --> 00:03:51,273 The patient, any pain relief? 82 00:03:51,360 --> 00:03:54,318 Ten milligrams IM morphine. We couldn't get a line in. 83 00:03:54,440 --> 00:03:55,429 Okay. 84 00:03:55,520 --> 00:03:56,919 He's called Charlie Walton and he's blind. 85 00:03:57,280 --> 00:03:59,396 Apparently it was his guide dog they went for 86 00:03:59,480 --> 00:04:00,515 and he was trying to save it. 87 00:04:00,800 --> 00:04:02,119 - They? - Three of them. 88 00:04:03,720 --> 00:04:05,233 Dog is now sedated. 89 00:04:05,520 --> 00:04:06,873 Are we ready to transfer? 90 00:04:07,000 --> 00:04:08,433 - Yeah. - No, they're not coming inside. 91 00:04:08,920 --> 00:04:10,512 - Er, what? - A live dog? 92 00:04:10,600 --> 00:04:11,919 Patients and staff all about? No. 93 00:04:12,000 --> 00:04:13,194 Management has spoken. 94 00:04:13,840 --> 00:04:15,796 If you can hear me, Charlie, my name's Glen. 95 00:04:16,080 --> 00:04:17,638 I'm the trauma consultant. 96 00:04:17,800 --> 00:04:20,758 And we need to stabilise you, before we can sort out the dog. 97 00:04:20,840 --> 00:04:21,829 Okay? 98 00:04:21,920 --> 00:04:23,035 Did you manage to get a GCS? 99 00:04:23,240 --> 00:04:24,639 Er, best we could tell, five or six. 100 00:04:25,520 --> 00:04:27,476 GCS five or six. 101 00:04:29,400 --> 00:04:30,958 Okay, we've got to secure the airway. 102 00:04:31,040 --> 00:04:32,996 Yes, we do. Round the side, please. 103 00:04:38,480 --> 00:04:40,311 Radial and brachial pulse absent. 104 00:04:41,080 --> 00:04:42,069 Thank you. 105 00:04:42,400 --> 00:04:43,719 I'm gonna put a cuff around the leg. 106 00:04:44,480 --> 00:04:46,038 Harry, can you help me? 107 00:04:46,120 --> 00:04:47,758 Yeah, er... Okay to come up? 108 00:04:48,520 --> 00:04:49,999 I'm not making any promises. 109 00:04:51,320 --> 00:04:53,834 Great, so, I'll just stay here and let it chew the F out of me, shall I? 110 00:04:55,800 --> 00:04:57,995 Calm down, boy. Calm down. 111 00:05:02,800 --> 00:05:10,800 Ripped By mstoll 112 00:05:14,920 --> 00:05:15,909 Okay. 113 00:05:19,160 --> 00:05:21,037 We need to tube him sooner rather than later. 114 00:05:21,200 --> 00:05:22,758 Er, uh... 115 00:05:22,840 --> 00:05:24,558 Okay, oxygen sat's at 90%. 116 00:05:25,080 --> 00:05:26,399 - Thank you. - BP? 117 00:05:28,120 --> 00:05:29,553 It's cycling. I'm not getting a read. 118 00:05:29,920 --> 00:05:31,672 Okay, we'll need to give him volume before we tube him, 119 00:05:31,760 --> 00:05:33,239 otherwise, he might arrest on induction. 120 00:05:33,760 --> 00:05:34,749 We need access. 121 00:05:35,000 --> 00:05:36,069 Well, good luck with that. 122 00:05:36,600 --> 00:05:37,715 No chance for a subclavia. 123 00:05:39,000 --> 00:05:41,389 Justin, can you get me an IO kit, 124 00:05:41,880 --> 00:05:44,997 some O pos and I need scissors, please. 125 00:05:45,080 --> 00:05:46,069 Yeah. 126 00:05:55,360 --> 00:05:56,349 Thank you. 127 00:06:00,360 --> 00:06:02,794 Can someone prime two three-ways for me please? 128 00:06:02,880 --> 00:06:03,869 Got it. 129 00:06:05,440 --> 00:06:06,555 Hey, Charlie. 130 00:06:06,680 --> 00:06:08,238 - Ugh! - Listen, you hang in there. 131 00:06:08,760 --> 00:06:09,988 We're doing the best that we can. 132 00:06:15,560 --> 00:06:16,549 Oh, God... 133 00:06:16,720 --> 00:06:19,553 In case it can, I'm gonna let the dog hear the sound of the drill. 134 00:06:20,640 --> 00:06:21,629 It's a good idea. 135 00:06:24,120 --> 00:06:25,792 - Steady. - No, leave it. Don't wake it up. 136 00:06:27,280 --> 00:06:28,508 Harry, swab. 137 00:06:28,800 --> 00:06:30,677 Look, forget about the vet, just sucks, 138 00:06:30,840 --> 00:06:31,909 I'll paralyse the shit out of it, 139 00:06:32,360 --> 00:06:34,078 and then you can send it on its merry way, once you've... 140 00:06:34,160 --> 00:06:37,470 If we have to, yes, with a massive dose of thio so it doesn't suffer. 141 00:06:37,960 --> 00:06:39,109 Suffer, after what it's done? 142 00:06:39,680 --> 00:06:40,795 There's no need to be cruel. 143 00:06:41,080 --> 00:06:42,559 Yeah, Ramakrishna. 144 00:06:42,640 --> 00:06:43,993 Okay, Charlie. 145 00:06:45,240 --> 00:06:46,832 My name is Fiona Lomas. 146 00:06:47,320 --> 00:06:48,594 We're gonna take care of you. 147 00:06:49,680 --> 00:06:51,272 I am afraid this is gonna hurt a little. 148 00:06:52,120 --> 00:06:54,031 Listen, Charlie, you've lost a lot of blood, 149 00:06:54,120 --> 00:06:57,476 so we need to get some fluids into you, before we send you off to sleep. 150 00:06:57,560 --> 00:06:58,549 Okay? 151 00:06:58,880 --> 00:07:02,190 Unfortunately, we have to do that through your shin and your shoulder. 152 00:07:03,080 --> 00:07:04,069 Okay? 153 00:07:05,120 --> 00:07:06,109 Yeah. 154 00:07:08,960 --> 00:07:10,154 It's all right, Charlie. 155 00:07:10,240 --> 00:07:11,389 It's okay. 156 00:07:11,600 --> 00:07:12,919 Sorry, Charlie. I'm sorry. 157 00:07:13,360 --> 00:07:14,349 You all right, mate? 158 00:07:17,200 --> 00:07:18,189 It's all right. 159 00:07:19,080 --> 00:07:21,116 - Doing really well, mate. - We're still here with you, mate. 160 00:07:21,200 --> 00:07:24,078 You're okay. We're not going anywhere, mate. Come on, you're okay. 161 00:07:25,400 --> 00:07:26,389 Done here. 162 00:07:31,200 --> 00:07:32,189 Okay, Charlie. 163 00:07:33,040 --> 00:07:34,951 I need to do the same again to your shoulder. 164 00:07:35,640 --> 00:07:36,629 Okay? 165 00:07:43,160 --> 00:07:44,752 We're almost there, buddy. 166 00:07:44,840 --> 00:07:46,717 - You're okay. - It's okay. 167 00:07:47,200 --> 00:07:49,111 It's okay, Charlie, it's done now. That's it. 168 00:07:49,800 --> 00:07:51,472 Okay. Cheers. 169 00:07:59,760 --> 00:08:03,992 - CO2 sats? - Er, 75 and dropping. 170 00:08:04,320 --> 00:08:05,469 We can't wait. We've got to intubate. 171 00:08:05,560 --> 00:08:06,549 Do it. 172 00:08:09,240 --> 00:08:11,310 Er, Billy, this port's looking a bit ropey. 173 00:08:11,400 --> 00:08:13,436 Can you administer the RSI drugs into the tibia? 174 00:08:14,240 --> 00:08:15,309 - Yeah. - Thanks. 175 00:08:16,240 --> 00:08:18,754 The lower ambulance bay is a restricted area. 176 00:08:19,080 --> 00:08:20,479 Essential personnel only. 177 00:08:21,360 --> 00:08:23,954 The lower ambulance bay is a restricted area. 178 00:08:24,200 --> 00:08:25,792 Essential personnel only. 179 00:08:25,880 --> 00:08:28,599 Thank you for, you know, sticking up for the dog. 180 00:08:29,040 --> 00:08:30,029 Yeah. 181 00:08:33,200 --> 00:08:35,430 - Cricoid? - Er, yeah, thanks. 182 00:08:37,640 --> 00:08:38,709 Listen, Charlie, 183 00:08:38,920 --> 00:08:42,196 you're gonna feel me pushing gently down on your throat, okay. 184 00:08:42,280 --> 00:08:43,679 But, it's nothing to worry about. 185 00:08:43,760 --> 00:08:46,194 I have Pantone, 250 milligrams. 186 00:08:50,440 --> 00:08:52,590 Okay, just sending you off to sleep, mate. 187 00:08:53,040 --> 00:08:55,429 Suxamethonium, 100 milligrams. 188 00:09:02,360 --> 00:09:03,349 Whoa! 189 00:09:03,680 --> 00:09:05,033 - It's waking up. - Turn it off. 190 00:09:06,400 --> 00:09:07,753 - Easy there, boy. - Okay. 191 00:09:08,360 --> 00:09:10,032 - All right, boy. Shh... - It's okay. Easy. 192 00:09:10,120 --> 00:09:11,838 - Sorry. - It's fine. Gonna be fine. 193 00:09:12,160 --> 00:09:13,309 - Just keep going. - Easy. 194 00:09:13,480 --> 00:09:16,153 Oh, that's a good dog. That's okay. Good boy. 195 00:09:16,600 --> 00:09:17,589 I said give it double. 196 00:09:18,760 --> 00:09:19,749 And I did. 197 00:09:20,280 --> 00:09:23,397 Er, okay sat's down to 55. 198 00:09:28,280 --> 00:09:29,315 Okay. 199 00:09:43,080 --> 00:09:44,115 Breath. 200 00:09:44,200 --> 00:09:45,235 Okay. 201 00:09:45,880 --> 00:09:46,869 Okay. 202 00:09:57,160 --> 00:09:59,116 - Oh, shit. - I need your hands there, guys. 203 00:09:59,400 --> 00:10:00,389 Just keep banging. 204 00:10:01,520 --> 00:10:03,988 Hey, oxygen sats rising to 65. 205 00:10:04,480 --> 00:10:06,072 Billy, sux, please. 206 00:10:07,720 --> 00:10:08,789 Pass that over. 207 00:10:09,360 --> 00:10:10,349 Okay. 208 00:10:10,440 --> 00:10:13,796 I need you to hold onto him bloody tight and don't let go until I say so, yes? 209 00:10:14,240 --> 00:10:15,229 Yes. 210 00:10:15,320 --> 00:10:16,309 Okay, boy, 211 00:10:17,320 --> 00:10:19,072 I'm really sorry I have to do this. 212 00:10:19,640 --> 00:10:20,959 Er, I, I really love dogs, me. 213 00:10:23,000 --> 00:10:24,399 What are you doing? You're not killing it? 214 00:10:24,920 --> 00:10:27,434 - Too right. - No... No, the vet'll be here any minute 215 00:10:27,520 --> 00:10:30,478 Giles. Giles, erm, we need to get this dog off him, now. 216 00:10:30,560 --> 00:10:32,630 No, no, no, no, dangerous drugs cannot be given to a dog 217 00:10:32,880 --> 00:10:34,916 on a hospital premises, without a vet's prescription. 218 00:10:35,120 --> 00:10:36,997 - For Christ's sake... - No, we don't have the authority... 219 00:10:37,160 --> 00:10:38,229 It's on mine... 220 00:10:39,040 --> 00:10:41,031 As acting clinical lead, okay? 221 00:10:47,120 --> 00:10:48,758 Management has spoken. 222 00:10:48,960 --> 00:10:51,918 Right, we've lost far too much time, so we dispatch this dog 223 00:10:52,000 --> 00:10:53,149 and get this man upstairs quickly. 224 00:10:53,640 --> 00:10:54,629 Thiopentone. 225 00:10:55,080 --> 00:10:56,069 Pass that. 226 00:10:57,000 --> 00:10:57,989 Thank you. 227 00:11:00,040 --> 00:11:02,156 Let's get field dressing ready, please, and hit me again. 228 00:11:03,080 --> 00:11:04,718 - Ta. - Thank you. 229 00:11:08,400 --> 00:11:09,389 It's going in. 230 00:11:13,920 --> 00:11:14,909 Here. 231 00:11:15,400 --> 00:11:16,389 Good dog. 232 00:11:24,920 --> 00:11:25,909 It's dead. 233 00:11:31,560 --> 00:11:32,549 Never mind. 234 00:11:34,400 --> 00:11:36,277 Oxygen sats back up to 90. 235 00:11:36,360 --> 00:11:37,793 Okay, let's get him out of here, please. 236 00:11:38,280 --> 00:11:39,998 - O2 bottle please, Billy. - Yeah. 237 00:11:43,800 --> 00:11:46,553 Okay, I need to get major control of this artery. 238 00:11:46,640 --> 00:11:47,709 - Where are your tourniquets? - Fiona. 239 00:11:48,360 --> 00:11:50,316 I know we've had our difficulties, 240 00:11:50,400 --> 00:11:51,753 but I'm hoping things are going to be better, now. 241 00:11:52,240 --> 00:11:54,515 - Oh, oh, oh... - Whoa, whoa, whoa, whoa... 242 00:11:56,120 --> 00:11:57,109 Really gonna... 243 00:11:58,440 --> 00:11:59,953 - Stand back here... - Hold the doors, please! 244 00:12:00,760 --> 00:12:02,432 We've still got haemorrhage control. 245 00:12:03,680 --> 00:12:05,033 Move, please. Move! 246 00:12:08,640 --> 00:12:10,835 No, don't stop. We have to keep going. Keep going! 247 00:12:11,720 --> 00:12:13,073 I've got... I've got it. 248 00:12:13,200 --> 00:12:14,428 Any news on the agency nurse? 249 00:12:14,520 --> 00:12:16,112 - Er, no. - Then get on it. 250 00:12:16,320 --> 00:12:17,309 Yeah, I have. 251 00:12:18,720 --> 00:12:20,199 Sorry, we're still a nurse down. 252 00:12:20,280 --> 00:12:23,192 Fast bleep the theatre staff, say we'll have him there in five minutes, please. 253 00:12:23,280 --> 00:12:24,269 Yeah. 254 00:12:26,960 --> 00:12:27,949 Hold there. 255 00:12:29,200 --> 00:12:30,599 This is Mrs Nicola Hicklin. 256 00:12:30,680 --> 00:12:32,432 - Er, acting clinical lead. - Okay, on the ventilator now. 257 00:12:32,760 --> 00:12:35,035 - Transfer Mrs Cooper in your account? - Can you fast bleep... 258 00:12:35,120 --> 00:12:37,190 ...the trauma theatre staff and general surgeon. 259 00:12:37,280 --> 00:12:38,395 Right on three. Everyone ready? 260 00:12:38,480 --> 00:12:40,311 Yeah, it's all read, Charlie Walton. 261 00:12:40,400 --> 00:12:42,391 - One, two, three. - Major trauma, Mike Pappa. 262 00:12:42,480 --> 00:12:43,674 On three. One, two, three. 263 00:12:44,160 --> 00:12:46,993 And brace left on three. One, two, three. 264 00:12:48,160 --> 00:12:49,149 Just check the back. 265 00:12:49,360 --> 00:12:51,715 No, that's not good enough. We need to get him there in about five. 266 00:12:51,920 --> 00:12:53,876 - Over half an hour since the attack. - Back on three. One, two, three. 267 00:12:53,960 --> 00:12:54,949 Well done. 268 00:12:55,280 --> 00:12:57,077 Harry, you take over from Bob, please. 269 00:12:57,600 --> 00:12:59,591 All right, they're getting someone off the table now. 270 00:12:59,840 --> 00:13:00,989 So it's just going to be about 10-15 minutes. 271 00:13:01,080 --> 00:13:02,069 Come on. 272 00:13:02,160 --> 00:13:03,149 That's the best I can do. 273 00:13:08,160 --> 00:13:09,388 Setting elapsed time. 274 00:13:10,080 --> 00:13:12,594 Hi, I'm Ania Wasenka, the agency nurse. 275 00:13:12,680 --> 00:13:13,669 Nice of you to come. 276 00:13:13,880 --> 00:13:15,518 Sorry, I was sent to the wrong hospital. 277 00:13:16,920 --> 00:13:18,478 This tourniquet is doing nothing. 278 00:13:18,960 --> 00:13:20,154 Injury is too high. 279 00:13:21,400 --> 00:13:22,719 Can someone get me some shears? 280 00:13:23,800 --> 00:13:24,789 Thank you. 281 00:13:25,680 --> 00:13:27,636 - Scrape, please. - Me? 282 00:13:28,400 --> 00:13:30,914 - Okay. - Er, you need to sign in first. 283 00:13:31,040 --> 00:13:32,109 Keep the pressure on the neck. 284 00:13:32,480 --> 00:13:33,469 Temporary staff 285 00:13:33,840 --> 00:13:35,114 and just run that over to there. 286 00:13:35,520 --> 00:13:36,509 Thanks. 287 00:13:37,160 --> 00:13:38,149 Thank you. 288 00:13:41,760 --> 00:13:42,749 Have another look at what's going on... 289 00:13:42,840 --> 00:13:43,829 Hey. 290 00:13:44,280 --> 00:13:45,474 - We're in luck. - Yeah? 291 00:13:45,560 --> 00:13:47,357 Yeah. He's on my shift. 292 00:13:47,520 --> 00:13:49,556 - Custody duty. - Oh. Great. 293 00:13:49,720 --> 00:13:50,709 Yeah. 294 00:13:52,000 --> 00:13:53,797 Formal handover now, please... 295 00:13:53,880 --> 00:13:57,998 Okay, this is Charlie Walton, 29. He was attacked at, er... 296 00:13:58,320 --> 00:13:59,548 Approx 10:40. 297 00:14:00,200 --> 00:14:02,156 Er, by three dogs. 298 00:14:02,560 --> 00:14:06,758 Considerable blood loss at scene, no BP, no vital stats. 299 00:14:06,840 --> 00:14:09,070 Er, GCS was approximately five to six 300 00:14:09,160 --> 00:14:10,149 - Apron. - Now, we put him on 301 00:14:10,240 --> 00:14:14,995 high flow oxygen and gave him 10 milligrams of IM Morphine. 302 00:14:15,400 --> 00:14:16,913 Got him here as fast as we could, basically. 303 00:14:17,000 --> 00:14:21,152 Now, he was brought in with one of the dogs, er, still alive and attached. 304 00:14:21,400 --> 00:14:24,472 Further defence wounds to both forearms, er, tear... 305 00:14:24,560 --> 00:14:26,073 - Got this for you. - To the right side of the neck 306 00:14:26,160 --> 00:14:28,958 and large wound lower left side of his abdomen. 307 00:14:29,040 --> 00:14:31,634 Er, the presence of the dog hampered any further effective 308 00:14:31,720 --> 00:14:33,233 treatment of the patient. 309 00:14:33,320 --> 00:14:35,231 Delivery from blood bank for Mike Pappa. 310 00:14:35,920 --> 00:14:36,909 Lovely fit, there. 311 00:14:37,960 --> 00:14:38,949 Did he touch your arse? 312 00:14:40,280 --> 00:14:41,269 Thank you. 313 00:14:44,960 --> 00:14:47,155 Whoa! He's been torn right open. 314 00:14:49,280 --> 00:14:50,679 Patient needs to get to theatre. 315 00:14:50,800 --> 00:14:53,678 If I'm not back in 10 minutes, just bring him in. 316 00:14:53,920 --> 00:14:55,478 So, let's not waste any more time. 317 00:14:55,680 --> 00:14:58,069 Anyone got questions for Tessa or Bob? 318 00:14:58,600 --> 00:15:01,239 No? Thank you. You can sign off. 319 00:15:02,840 --> 00:15:04,193 Rapid infuser operators' here. 320 00:15:04,800 --> 00:15:08,554 Hello. Prime the Belmont six units of blood, six of FFP, please. 321 00:15:08,720 --> 00:15:11,314 He's also gonna need one gram of TXA Bolus 322 00:15:11,400 --> 00:15:13,516 and then one gram infusion to follow. 323 00:15:13,800 --> 00:15:15,597 Augmentin 1.2 grams, 324 00:15:15,680 --> 00:15:17,671 and a tetanus booster please, Billy. 325 00:15:17,960 --> 00:15:19,791 Good air entry, bilaterally. 326 00:15:22,720 --> 00:15:24,517 There's no surgical emphysema. 327 00:15:25,160 --> 00:15:26,559 I'm leaving the abdomen for now. 328 00:15:26,840 --> 00:15:28,796 Okay, as I'm here, I might as well do the left arm. 329 00:15:29,440 --> 00:15:31,749 Oh, that one's gonna be nasty. 330 00:15:32,760 --> 00:15:34,478 Anything with teeth, you can't trust. 331 00:15:35,280 --> 00:15:36,952 I won't let my Amy have a hamster. 332 00:15:37,480 --> 00:15:40,472 Obviously no peripheral or even brachial pulse. 333 00:15:40,560 --> 00:15:42,039 Sorry, do I know you? 334 00:15:42,120 --> 00:15:43,712 No. I am Ania. 335 00:15:43,840 --> 00:15:44,829 All right. 336 00:15:46,200 --> 00:15:47,189 Okay? 337 00:15:53,920 --> 00:15:56,388 Ragged wound to the right-hand side of the neck. 338 00:15:57,800 --> 00:16:00,189 Active bleeding from superficial vessel. 339 00:16:01,600 --> 00:16:02,589 Shit. 340 00:16:02,680 --> 00:16:03,795 It must've been a spasm. 341 00:16:03,960 --> 00:16:05,518 We're gonna need to ligate this in theatre. 342 00:16:05,600 --> 00:16:07,431 No, we ligate it here. 343 00:16:07,760 --> 00:16:09,159 - Okay. - Got it. 344 00:16:10,920 --> 00:16:12,353 Harry, continue with the primary. 345 00:16:13,400 --> 00:16:14,389 - Justin? - Yeah. 346 00:16:14,480 --> 00:16:16,391 - IO's too slow. I'll do a femoral line? - Do it. 347 00:16:16,480 --> 00:16:17,469 - Justin. - Yeah. 348 00:16:17,560 --> 00:16:19,596 Harry, let's hear it, please. 349 00:16:19,880 --> 00:16:21,711 Er, multiple bite wounds, 350 00:16:22,280 --> 00:16:24,555 superficial shredding to the forearm, 351 00:16:24,680 --> 00:16:29,549 Er, heavily soiled, more defensive wounds to the hand and wrist. 352 00:16:30,000 --> 00:16:32,150 Extensive tendons exposed. 353 00:16:32,280 --> 00:16:33,474 He must have fought like hell. 354 00:16:33,800 --> 00:16:35,119 And imagine you can't see a thing. 355 00:16:35,280 --> 00:16:36,918 I'm a cat person from now on, me. 356 00:16:37,080 --> 00:16:38,399 I love dogs, me. 357 00:16:38,640 --> 00:16:43,077 Steady radial pulse with small, ring and middle fingers missing. 358 00:16:43,160 --> 00:16:44,673 - Oh, any sign of them? - No. 359 00:16:45,000 --> 00:16:47,195 Okay, I still need an imaging of what's left. 360 00:16:47,280 --> 00:16:48,395 Won't be able to get it here. 361 00:16:48,800 --> 00:16:50,313 - So, is that me out, then? - Yeah. 362 00:16:51,000 --> 00:16:53,434 - Yeah, but she... - No. We're gonna wait till theatre. 363 00:16:54,200 --> 00:16:56,236 But, if you can interest the plastic surgeon, please. 364 00:16:56,400 --> 00:16:57,515 - Okay. - Thank you. 365 00:16:59,960 --> 00:17:01,837 Justin, I'll call you later. 366 00:17:02,240 --> 00:17:03,229 Okay. Yeah. 367 00:17:04,080 --> 00:17:06,469 Hello, this is Mrs Hicklin speaking, 368 00:17:06,640 --> 00:17:08,437 I need a plastic surgeon, please. 369 00:17:08,800 --> 00:17:09,789 Okay... 370 00:17:11,320 --> 00:17:12,309 Whoa, bollocks. 371 00:17:12,520 --> 00:17:14,590 I think he meant to say that in the singular. 372 00:17:14,680 --> 00:17:15,715 Yep, he's a man down. 373 00:17:15,800 --> 00:17:17,836 Okay, let's just swab and dress it for now, please. 374 00:17:17,920 --> 00:17:18,909 Yeah. 375 00:17:19,000 --> 00:17:21,560 We also need blood FBC, UNE, 376 00:17:22,080 --> 00:17:25,038 VBGs, cross-match and coag, please. 377 00:17:25,640 --> 00:17:26,629 Yup. 378 00:17:29,960 --> 00:17:30,949 Yeah. 379 00:17:35,360 --> 00:17:36,349 It's clamped. 380 00:17:36,440 --> 00:17:37,429 Blood coming up. 381 00:17:46,720 --> 00:17:48,153 Justin, scissors, please. 382 00:17:53,760 --> 00:17:54,749 Thank you. 383 00:17:55,000 --> 00:17:56,592 Let's have a Foley as well, please. 384 00:17:58,240 --> 00:17:59,229 Say what you see, Harry. 385 00:17:59,800 --> 00:18:01,233 Oh, shit and shit. 386 00:18:01,560 --> 00:18:02,879 Oh, I mean, sorry. 387 00:18:03,000 --> 00:18:03,989 That doesn't look good. 388 00:18:04,080 --> 00:18:05,877 Ugh, the abdomen is filling up with blood. It's everywhere. 389 00:18:06,040 --> 00:18:08,235 Okay, pack it for now. We'll be in theatre soon. 390 00:18:08,320 --> 00:18:10,515 Packs! Oh, they're over there. 391 00:18:11,760 --> 00:18:13,318 - Foley. - Can you open it, please? 392 00:18:15,160 --> 00:18:16,149 Thank you. 393 00:18:18,520 --> 00:18:21,592 Hopefully, this will inflate enough to stem the bleeding from the arm 394 00:18:21,680 --> 00:18:22,874 until we're in theatre. 395 00:18:25,320 --> 00:18:27,390 Justin, I need you on the syringe, please. 396 00:18:27,480 --> 00:18:28,469 Yeah. 397 00:18:28,880 --> 00:18:29,869 - Ugh. - Now, please. 398 00:18:29,960 --> 00:18:30,949 - Okay. - God. 399 00:18:34,320 --> 00:18:36,072 Okay, just squeeze gently. 400 00:18:39,960 --> 00:18:40,949 Good. 401 00:18:42,000 --> 00:18:42,989 And it's good. 402 00:18:45,040 --> 00:18:46,029 Thank you. 403 00:18:47,520 --> 00:18:48,839 Okay, let's see if this holds. 404 00:18:50,560 --> 00:18:53,028 That should do until we get to theatre. Good. 405 00:18:53,320 --> 00:18:54,355 I'm sure he needs blood, 406 00:18:54,480 --> 00:18:57,233 so as soon as the femoral line is up, whack it in, please. 407 00:18:57,840 --> 00:18:59,398 - Ugh! - Oh, come on. 408 00:18:59,680 --> 00:19:01,557 Reapply pressure. Swabs. 409 00:19:01,640 --> 00:19:03,551 - Sorry. Sorry. - We need to get to theatre now. 410 00:19:04,920 --> 00:19:05,909 Shit. 411 00:19:06,440 --> 00:19:07,429 Pack. Hit me. 412 00:19:09,080 --> 00:19:10,069 Hit me. 413 00:19:11,880 --> 00:19:12,869 Yes. 414 00:19:14,080 --> 00:19:15,593 - Clear for theatre. - Okay. 415 00:19:16,000 --> 00:19:17,274 Let's get him ready to move, please. 416 00:19:17,360 --> 00:19:18,998 Okay, not yet. I'm still suturing. 417 00:19:19,080 --> 00:19:20,638 - Sorry. Can't wait. - Yep. 418 00:19:21,960 --> 00:19:23,234 - Done. - Okay, let's go. 419 00:19:23,880 --> 00:19:25,108 - Justin. - Move, please. 420 00:19:37,760 --> 00:19:39,273 - Oh! Oh! - Whoa! Whoa! 421 00:19:40,920 --> 00:19:42,956 - You got it? - Yeah, yeah, I think so. 422 00:19:43,040 --> 00:19:44,029 Good job, Harry. 423 00:19:44,120 --> 00:19:46,953 Let's keep going, please. Forget the Foley, keep the pressure on it. 424 00:19:47,160 --> 00:19:48,149 Well done. 425 00:19:50,400 --> 00:19:52,595 Daisy, we're gonna need hats on these guys. 426 00:19:52,680 --> 00:19:54,113 Grey and green, please. 427 00:19:54,560 --> 00:19:55,549 Yup. 428 00:20:00,600 --> 00:20:01,589 Side down. 429 00:20:01,880 --> 00:20:04,440 Right, we need to get him across, very carefully, 430 00:20:05,000 --> 00:20:06,592 so that Harry can maintain... 431 00:20:08,000 --> 00:20:08,989 Maintain what? 432 00:20:09,320 --> 00:20:10,309 Pressure. 433 00:20:10,440 --> 00:20:11,555 Very carefully, please. 434 00:20:11,800 --> 00:20:13,279 Everyone ready? Harry, you happy? 435 00:20:13,720 --> 00:20:14,709 - Happy. - Okay. 436 00:20:14,960 --> 00:20:16,757 On three. One, two, three. 437 00:20:23,720 --> 00:20:25,278 Are you okay to stay here, while we scrub in? 438 00:20:25,360 --> 00:20:27,237 - Mmm-hmm. - You two, go on and sort this. 439 00:20:27,520 --> 00:20:29,078 - Thank you. - Where shall we prep him? 440 00:20:29,160 --> 00:20:30,434 Neck to knee, please. 441 00:20:30,720 --> 00:20:32,995 - We'll need arm boards. - And we need a cell saver. 442 00:20:33,480 --> 00:20:35,152 Brian, arm boards, please. 443 00:20:36,560 --> 00:20:38,073 Guys, let's do an instrument check. 444 00:20:45,480 --> 00:20:48,313 Glen, it's Jane Bryant. Call me when you get a chance. 445 00:20:48,520 --> 00:20:51,990 Did you know that was invented by a doctor in the Victorian times? 446 00:20:53,040 --> 00:20:54,519 No. I'm serious. 447 00:20:54,840 --> 00:20:56,796 Because he was embarrassed about putting his 448 00:20:57,200 --> 00:20:58,918 ear near to your... 449 00:21:02,840 --> 00:21:04,114 Spoils the fun, though, eh? 450 00:21:04,280 --> 00:21:05,998 Not if you warm up your bell-end first. 451 00:21:07,480 --> 00:21:09,232 Could you get me a wipe, please? 452 00:21:09,800 --> 00:21:10,789 Yep. 453 00:21:13,360 --> 00:21:14,918 You have got to tell him. 454 00:21:19,440 --> 00:21:20,759 I had to get back. 455 00:21:22,560 --> 00:21:23,629 I just had to. 456 00:21:24,720 --> 00:21:25,948 Tom was waiting. 457 00:21:27,000 --> 00:21:28,399 Did he say anything? 458 00:21:29,760 --> 00:21:30,829 No. 459 00:21:31,720 --> 00:21:33,597 You understand why I couldn't? 460 00:21:34,800 --> 00:21:36,472 We couldn't have gone back to yours. 461 00:21:39,800 --> 00:21:41,279 It wasn't that I didn't want to. 462 00:21:43,280 --> 00:21:44,349 Didn't? 463 00:21:45,480 --> 00:21:46,595 What about now? 464 00:21:57,440 --> 00:22:00,000 Oh, look. Souvenir. 465 00:22:00,440 --> 00:22:01,589 It's another for the black museum? 466 00:22:01,680 --> 00:22:03,557 No. No. I thought it might look nice if it was on a chain. 467 00:22:04,640 --> 00:22:05,709 The police will need it. 468 00:22:06,040 --> 00:22:08,918 Oh, well, in that case, you better, erm... 469 00:22:09,120 --> 00:22:10,599 Mmm-hmm. Thank you. 470 00:22:10,960 --> 00:22:13,155 I'll find out where the steno surgeon is. 471 00:22:16,520 --> 00:22:17,555 Thank you. 472 00:22:22,920 --> 00:22:24,114 Fiona. 473 00:22:28,560 --> 00:22:29,629 It's not that simple. 474 00:22:35,400 --> 00:22:36,515 It is for me. 475 00:22:45,560 --> 00:22:46,834 Okay, let's do the who. 476 00:22:47,120 --> 00:22:49,156 I'm Glen Boyle. I'm the trauma consultant. 477 00:22:49,240 --> 00:22:50,798 Fiona Lomas, trauma fellow. 478 00:22:50,880 --> 00:22:52,199 Khaali Osman, support nurse. 479 00:22:52,280 --> 00:22:54,396 Ramakrishna Chandramohan, anaesthetics reg. 480 00:22:54,480 --> 00:22:56,436 Billy Finlay, anaesthetical DP. 481 00:22:56,520 --> 00:22:57,839 Harry, get me on, please. 482 00:22:57,920 --> 00:22:59,273 Brian Austin, support nurse. 483 00:22:59,440 --> 00:23:00,839 Sandra Bansels, support nurse. 484 00:23:00,920 --> 00:23:02,478 Daisy McDonald, documentation nurse. 485 00:23:02,560 --> 00:23:04,039 Scott Bassy, rapid infuser operator. 486 00:23:04,120 --> 00:23:05,269 Come on this side. 487 00:23:08,400 --> 00:23:09,674 Do you need any extra help? 488 00:23:09,760 --> 00:23:11,193 - Is your shift finished? - Mmm-hmm. 489 00:23:11,480 --> 00:23:13,072 - Glen? - Suits me. 490 00:23:13,400 --> 00:23:16,472 Great, thanks. Er, Harry Bennett-Edwardes EMSHO. 491 00:23:18,200 --> 00:23:20,077 Can we identify the patient, please? 492 00:23:20,440 --> 00:23:22,635 Er, yeah. Patient is major trauma, Mike Pappa. 493 00:23:22,720 --> 00:23:25,280 Date of birth, 18/10/1985. 494 00:23:25,360 --> 00:23:28,318 The right external jugular has been ligated, 495 00:23:28,400 --> 00:23:30,914 there's a defect in the abdominal wall. 496 00:23:31,000 --> 00:23:33,958 Eviscerated omentum and bowel. 497 00:23:34,040 --> 00:23:35,996 There's significant blood loss 498 00:23:36,120 --> 00:23:39,715 through left brachial artery injury which Fiona has her finger on. 499 00:23:40,120 --> 00:23:42,634 It's the only way we've been able to control it, so far. 500 00:23:42,720 --> 00:23:45,280 Consent form four signed for 501 00:23:45,360 --> 00:23:46,873 damage control laparotomy, 502 00:23:46,960 --> 00:23:49,872 haemorrhage and contamination control with laparostomy 503 00:23:49,960 --> 00:23:51,791 and limb re-vascularisation. 504 00:23:51,880 --> 00:23:53,791 - Okay to start? - All set. 505 00:23:54,240 --> 00:23:57,915 Number ten blade and I need the cell saver suction around here, please. 506 00:23:58,000 --> 00:23:59,194 I'll take the suction. 507 00:24:09,240 --> 00:24:10,468 Arterial clamp. 508 00:24:20,520 --> 00:24:21,589 Good. 509 00:24:21,680 --> 00:24:22,999 Clamp's holding for now. 510 00:24:23,640 --> 00:24:27,918 Okay, I need to access the auxiliary artery below the clavicle. 511 00:24:28,000 --> 00:24:30,798 Okay, we'll open him up and see what we can do. 512 00:24:31,960 --> 00:24:33,109 Twenty-two blade, please. 513 00:24:33,200 --> 00:24:34,758 Ten blade, please. 514 00:24:36,360 --> 00:24:37,475 Thank you. 515 00:24:38,760 --> 00:24:39,875 Am I okay to cut? 516 00:24:39,960 --> 00:24:40,949 Yeah, okay. 517 00:24:41,440 --> 00:24:42,714 Cutting. 518 00:24:44,360 --> 00:24:45,554 Cutting. 519 00:24:51,000 --> 00:24:52,115 Can I have a temperature? 520 00:24:52,200 --> 00:24:53,633 Yes, 35.0. 521 00:24:54,320 --> 00:24:55,389 Heart rate? 522 00:24:55,760 --> 00:24:58,877 140. BP holding at 75 over 45. 523 00:24:59,720 --> 00:25:01,790 Topping off as fast as we can. 524 00:25:01,880 --> 00:25:03,199 Mayo, please. 525 00:25:08,680 --> 00:25:11,592 More FFP cryo platelets. Thanks. 526 00:25:18,840 --> 00:25:20,432 Take the ring, please. 527 00:25:21,800 --> 00:25:24,189 Hi. Yeah, this is Billy Finlay ODP, in trauma theatre... 528 00:25:24,320 --> 00:25:25,309 Thank you. 529 00:25:26,000 --> 00:25:28,958 Yeah, can we order more FFP platelets and cryo 530 00:25:29,040 --> 00:25:30,792 for patient Mike Pappa, please? 531 00:25:31,640 --> 00:25:32,629 Yes. 532 00:25:38,120 --> 00:25:39,758 We're gonna need warm saline. 533 00:25:40,200 --> 00:25:41,349 Jugs of it, please. 534 00:25:41,440 --> 00:25:42,919 Warm saline, please. 535 00:25:44,160 --> 00:25:45,513 Packs, please. 536 00:25:47,000 --> 00:25:48,069 One. 537 00:25:51,440 --> 00:25:52,634 - Hit me. - Two. 538 00:25:54,600 --> 00:25:55,953 - Hit me. - Three. 539 00:25:56,240 --> 00:25:57,673 - Three in. - Three in. 540 00:26:01,240 --> 00:26:03,390 Er, look mate, about Harry, 541 00:26:05,000 --> 00:26:06,991 she and I are... 542 00:26:08,560 --> 00:26:09,595 It's back on. 543 00:26:11,600 --> 00:26:13,192 I'm sorry. 544 00:26:13,440 --> 00:26:14,429 It's... 545 00:26:15,320 --> 00:26:18,596 This one's early days. You know, trying to keep under the radar. 546 00:26:20,000 --> 00:26:21,115 No worries. 547 00:26:21,800 --> 00:26:22,835 Thanks for the heads-up. 548 00:26:24,240 --> 00:26:26,276 It's good to know before I make a right tit of myself. 549 00:26:26,920 --> 00:26:27,909 Oh, no... 550 00:26:32,080 --> 00:26:33,672 - Lf you could assist. - Of course. 551 00:26:34,760 --> 00:26:36,113 Retractor, please. 552 00:26:41,280 --> 00:26:43,077 Scissors and forceps, please. 553 00:26:43,640 --> 00:26:45,756 I thought it was only the brachial that was torn. 554 00:26:46,640 --> 00:26:48,915 We need proximal control first, 555 00:26:49,360 --> 00:26:50,873 and then to explore the injury. 556 00:26:51,600 --> 00:26:55,195 As it's so high up, it's easier to cut the auxiliary. 557 00:26:56,000 --> 00:26:59,788 As well as the clamp, I'm also going to put a vascular sling around the artery. 558 00:26:59,960 --> 00:27:02,599 It's easier to control later on if we run into any problems. 559 00:27:04,720 --> 00:27:06,073 Clamp, please. 560 00:27:06,160 --> 00:27:07,639 Hit me. 561 00:27:08,640 --> 00:27:09,629 One. 562 00:27:11,400 --> 00:27:12,628 - Hit me. - Two. 563 00:27:12,920 --> 00:27:15,559 - Two more in. - Sling binding the abdomen. 564 00:27:17,440 --> 00:27:20,750 Voila, succes. Middle and ring fingers recovered from the same. 565 00:27:22,040 --> 00:27:23,075 Where's the plastic surgeon? 566 00:27:23,400 --> 00:27:24,719 Be waiting for the drum roll. 567 00:27:25,720 --> 00:27:27,836 Reckon it's salvageable, well, 568 00:27:28,200 --> 00:27:29,269 one, maybe. 569 00:27:29,360 --> 00:27:30,952 Take a picture, send it to Nicola. 570 00:27:31,040 --> 00:27:33,759 Tell her we need Plastics down here, now, please. 571 00:27:34,160 --> 00:27:35,639 In fact, you should use my phone. 572 00:27:35,880 --> 00:27:38,553 That way, she'll think it's coming from me. It's over here in my pocket. 573 00:27:38,640 --> 00:27:39,629 Yeah. 574 00:27:43,520 --> 00:27:44,714 Over on this side. 575 00:27:47,640 --> 00:27:49,039 No, sorry. You're gonna have to go up from under. 576 00:27:49,120 --> 00:27:50,519 Okay, erm... All right, sorry. 577 00:27:51,160 --> 00:27:52,149 Mmm... 578 00:27:55,040 --> 00:27:56,155 Got it? 579 00:27:56,480 --> 00:27:57,993 Yup. Cheers. 580 00:28:02,600 --> 00:28:05,160 Okay. So, now we unpack 581 00:28:05,240 --> 00:28:07,595 and, er, clean out each section at a time. 582 00:28:07,920 --> 00:28:10,354 If it was me, and you could repair one thing, 583 00:28:10,880 --> 00:28:12,598 I'd rather have a scrotum than a finger. 584 00:28:13,480 --> 00:28:15,596 I don't think most of us in here would necessarily agree. 585 00:28:18,640 --> 00:28:20,631 Oh, I'm gonna need more, much more. 586 00:28:20,800 --> 00:28:22,313 More saline, please. 587 00:28:24,320 --> 00:28:25,753 Do you have a Javid shunt? 588 00:28:26,040 --> 00:28:27,792 Sorry, I... There wasn't time. 589 00:28:28,280 --> 00:28:30,430 Mr Simpson had his carotid list this morning. 590 00:28:30,520 --> 00:28:31,953 We haven't any left on the shelf. 591 00:28:33,000 --> 00:28:35,036 Okay, erm... 592 00:28:36,120 --> 00:28:37,348 A giving set. 593 00:28:37,520 --> 00:28:39,909 I need... I need about a foot of it, please. 594 00:28:40,080 --> 00:28:42,992 - Nurse, er, giving set, please. - Yep. 595 00:28:44,280 --> 00:28:46,191 - And I'll need a sterile field. - Sure. 596 00:28:46,760 --> 00:28:48,193 Blade, please. 597 00:28:51,680 --> 00:28:52,795 Hit. 598 00:28:53,360 --> 00:28:54,349 Hit me. 599 00:28:54,600 --> 00:28:56,875 Blood's going in but BP's still falling. 600 00:28:57,560 --> 00:29:01,712 Yup. His bowel's a mess, it's severed in multiple places. 601 00:29:05,480 --> 00:29:06,708 Come on. 602 00:29:06,960 --> 00:29:08,075 Easy, friend. 603 00:29:08,200 --> 00:29:09,474 Okay, I need, erm... 604 00:29:09,960 --> 00:29:11,632 Get me a TLC stapler 605 00:29:11,760 --> 00:29:14,149 and more gauze, please. Hit me. 606 00:29:16,360 --> 00:29:17,429 One more in. 607 00:29:17,520 --> 00:29:20,080 - Hole in the abdomen. - Retractor, please. 608 00:29:25,440 --> 00:29:26,509 Not those, darling. 609 00:29:29,520 --> 00:29:31,112 BP is still dropping. 610 00:29:40,560 --> 00:29:41,788 Main shunt. 611 00:29:44,560 --> 00:29:47,358 Khaali, I need heavy vital ties of silk. 612 00:29:47,440 --> 00:29:49,192 - Two of them, please. - Sure. 613 00:29:50,240 --> 00:29:52,800 I've got one end and I cannot find the other. 614 00:29:52,880 --> 00:29:56,555 His bowel is a bloody mess and we're running out of time. 615 00:29:57,280 --> 00:29:58,759 Clamp, please. 616 00:30:02,360 --> 00:30:03,588 And I'll take the stapler. 617 00:30:04,600 --> 00:30:06,158 I've still got an odd number of ends, 618 00:30:06,240 --> 00:30:08,196 for now, I'm just gonna have to staple them. 619 00:30:08,960 --> 00:30:09,995 Thank you. 620 00:30:12,920 --> 00:30:14,273 BP is still dropping. 621 00:30:24,840 --> 00:30:26,114 Reload. 622 00:30:29,360 --> 00:30:32,432 And I'll take saline and suction, please. 623 00:30:34,960 --> 00:30:36,109 Thank you. 624 00:30:37,880 --> 00:30:39,029 Cut, thank you. 625 00:30:39,440 --> 00:30:40,509 Thank you. 626 00:30:40,600 --> 00:30:44,195 Photo sent and Plastics called. Er, is that me done? 627 00:30:44,360 --> 00:30:45,429 - Yes. - Okay. 628 00:30:45,520 --> 00:30:48,990 Erm, do you want to put your phone back in your... No, erm... 629 00:30:49,080 --> 00:30:50,832 - Thank you. - Good, thank you. 630 00:30:55,040 --> 00:30:57,759 Shunt's in, let's see how it holds. 631 00:31:01,240 --> 00:31:02,673 You check his pulse? 632 00:31:04,120 --> 00:31:05,439 Thready. 633 00:31:05,640 --> 00:31:08,359 - It will spasm a bit... - But the PONI return's much better. 634 00:31:09,240 --> 00:31:11,037 Right, I have control. 635 00:31:11,160 --> 00:31:13,469 Glad someone does, I have now got three bloody ends. 636 00:31:16,840 --> 00:31:19,559 BP dropping 60 over 40. Billy, whack it in. 637 00:31:19,640 --> 00:31:22,279 It could be a revascularisation bleed. 638 00:31:23,920 --> 00:31:25,319 Auxiliary NAD. 639 00:31:25,800 --> 00:31:27,677 - Brachial NAD. - Show me the jugular. 640 00:31:30,120 --> 00:31:31,553 There is nothing here. 641 00:31:31,880 --> 00:31:34,269 Jugular NAD. Shit! 642 00:31:34,440 --> 00:31:37,876 Whole section's been torn away from the mesentery. Dish. 643 00:31:38,040 --> 00:31:39,473 - Glen? - Yes. 644 00:31:40,320 --> 00:31:41,833 Oh, Christ! 645 00:31:43,200 --> 00:31:44,519 Keep filling him up. 646 00:31:44,640 --> 00:31:47,074 I am, but as fast as I'm topping him up, he keeps pissing out of it. 647 00:31:47,720 --> 00:31:49,438 If this goes on much longer, we're looking at DIC 648 00:31:49,600 --> 00:31:50,828 and then he's buggered. 649 00:31:51,520 --> 00:31:52,635 Tie. 650 00:31:56,760 --> 00:31:58,034 Thank you. 651 00:32:03,080 --> 00:32:05,116 And release, please. 652 00:32:07,160 --> 00:32:08,229 Thank you. 653 00:32:14,480 --> 00:32:15,629 Cut. 654 00:32:21,040 --> 00:32:23,031 He's still bleeding like a sieve. 655 00:32:23,200 --> 00:32:26,510 I'm gonna have to start at the upper abdomen and work my way down, 656 00:32:26,920 --> 00:32:28,751 haemorrhage control as we go. 657 00:32:28,840 --> 00:32:30,273 Maurice retractor. 658 00:32:35,040 --> 00:32:36,359 Liver. 659 00:32:38,000 --> 00:32:41,072 Liver's okay. Let's go to the spleen, please. 660 00:32:42,760 --> 00:32:44,876 BP is continuing to fall. 661 00:32:45,960 --> 00:32:47,313 Spleen. 662 00:32:47,800 --> 00:32:48,994 It's also good. 663 00:32:51,520 --> 00:32:53,988 Stomach is okay. 664 00:32:55,560 --> 00:32:58,438 Jejunum is well perfused. 665 00:32:58,720 --> 00:33:00,278 It'd be easier to take the rest of it out. 666 00:33:00,720 --> 00:33:04,269 Yes, okay. We're gonna need more warm saline and more gauze. 667 00:33:04,360 --> 00:33:08,148 Both wet and dry. Lay them out here and here, please. 668 00:33:16,680 --> 00:33:17,669 Thank you. 669 00:33:19,040 --> 00:33:20,598 - BP is still dropping. - More saline, please. 670 00:33:26,360 --> 00:33:27,588 Hit. 671 00:33:27,720 --> 00:33:28,755 One. 672 00:33:30,440 --> 00:33:31,793 - Hit. - Two. 673 00:33:32,400 --> 00:33:33,435 Here. 674 00:33:33,680 --> 00:33:35,318 We have one left. 675 00:33:35,400 --> 00:33:37,516 Okay, he needs metaraminol. I've got to get his pressure up. 676 00:33:37,600 --> 00:33:38,953 - He's full of holes. - I've got no choice. 677 00:33:39,040 --> 00:33:40,473 - He'll just pump out more blood. - Lf I don't give him 678 00:33:40,560 --> 00:33:42,630 some perfusion, there's gonna be nothing to salvage. 679 00:33:42,880 --> 00:33:43,949 Glen. 680 00:33:47,000 --> 00:33:49,195 Let's just run the bowel, please. 681 00:33:57,440 --> 00:33:58,634 Billy, metaraminol. 682 00:34:04,200 --> 00:34:06,156 - Shit, we haven't got any. - Billy! 683 00:34:07,400 --> 00:34:08,674 Okay, retract. 684 00:34:10,560 --> 00:34:12,152 Need you to flush. 685 00:34:13,080 --> 00:34:14,354 And suction. 686 00:34:17,600 --> 00:34:19,477 Where the hell is this bleed? 687 00:34:23,080 --> 00:34:24,399 Here, please. 688 00:34:30,960 --> 00:34:34,111 Okay, a number of mesenteric vessels are severed. 689 00:34:36,640 --> 00:34:37,789 Give me a clamp. 690 00:34:42,400 --> 00:34:43,594 And again. 691 00:34:47,400 --> 00:34:48,549 Tie. 692 00:34:58,800 --> 00:34:59,994 And release. 693 00:35:01,960 --> 00:35:03,279 Thank you. Just cut it. 694 00:35:05,080 --> 00:35:06,479 - All right. - Sorry. 695 00:35:06,640 --> 00:35:07,789 Here we go. 696 00:35:07,880 --> 00:35:09,199 Okay, thanks. 697 00:35:12,040 --> 00:35:13,155 Thank you. 698 00:35:18,120 --> 00:35:19,189 And release. 699 00:35:21,000 --> 00:35:22,035 Thank you. 700 00:35:23,560 --> 00:35:24,549 Cut. 701 00:35:26,600 --> 00:35:27,919 Metaraminol going in. 702 00:35:31,240 --> 00:35:33,071 That should push up his BP. 703 00:35:42,120 --> 00:35:43,235 Okay, we're winning up here. 704 00:35:43,400 --> 00:35:44,628 But, we're losing in here. 705 00:35:44,720 --> 00:35:47,188 Blood is increasing and we need to pack. Hit me. 706 00:35:50,840 --> 00:35:53,115 General surgeon, Mr Street's here. 707 00:35:53,200 --> 00:35:55,509 - Another two in, Daisy? - Back to three. 708 00:35:56,360 --> 00:35:58,828 Dogs have played tear and share with his small intestine 709 00:35:59,400 --> 00:36:01,470 and his mesentery's been ripped to shreds. 710 00:36:02,040 --> 00:36:04,713 Okay, I'll be right with you. 711 00:36:07,440 --> 00:36:08,475 Plastics is on his way. 712 00:36:08,560 --> 00:36:09,993 All right, I need to isolate the bleeding. 713 00:36:10,080 --> 00:36:12,150 - You want me to cancel? - No. No. 714 00:36:12,640 --> 00:36:13,834 We live in hope. 715 00:36:15,080 --> 00:36:16,911 Well, it shouldn't be a problem in the future, 716 00:36:17,000 --> 00:36:18,479 co-ordinating the specialties. 717 00:36:19,800 --> 00:36:20,915 Thanks. 718 00:36:21,440 --> 00:36:22,475 Okay. 719 00:36:22,560 --> 00:36:24,152 Fine, let's keep going. 720 00:36:24,240 --> 00:36:25,639 One section at a time. 721 00:36:28,600 --> 00:36:29,919 Yeah. 722 00:36:31,120 --> 00:36:32,235 Can you retract, please? 723 00:36:32,760 --> 00:36:33,875 One out. 724 00:36:35,400 --> 00:36:36,435 Okay. 725 00:36:36,800 --> 00:36:39,519 Yeah. His spleen is bleeding from the wound with the mesentery. 726 00:36:39,720 --> 00:36:41,039 Roberts, please. 727 00:36:44,880 --> 00:36:46,996 And I'm gonna need a transfixion stitch. 728 00:36:47,720 --> 00:36:51,156 If this is the main source of the bleed, he might stand a chance. 729 00:36:52,280 --> 00:36:53,508 Scissors, please. 730 00:36:55,960 --> 00:36:56,949 Forceps. 731 00:36:58,720 --> 00:36:59,709 Thank you. 732 00:37:25,360 --> 00:37:26,475 Okay, let's cut. 733 00:37:26,560 --> 00:37:28,118 Mr Doubting, Plastic's here. 734 00:37:28,200 --> 00:37:29,713 Think we're there. 735 00:37:31,280 --> 00:37:33,077 Not exactly key-hole surgery. 736 00:37:35,440 --> 00:37:37,908 We thought you'd like to see a proper operation for once, Henry. 737 00:37:38,720 --> 00:37:39,709 Hit me. 738 00:37:41,920 --> 00:37:43,399 And again, please. 739 00:37:44,920 --> 00:37:46,399 - Yeah. - Two more in. 740 00:37:46,560 --> 00:37:47,834 Back to five? 741 00:37:47,920 --> 00:37:49,069 So, how long ago did this happen? 742 00:37:49,160 --> 00:37:51,720 Just over an hour ago, fingers are over there. 743 00:37:53,920 --> 00:37:57,674 Er, eight and a half gloves and, er, can you open the bag for me, please? 744 00:37:59,160 --> 00:38:00,195 Thank you. 745 00:38:02,120 --> 00:38:04,634 Okay, it's good. 746 00:38:12,320 --> 00:38:13,833 Think you can save them? 747 00:38:13,960 --> 00:38:17,555 Yeah, the fingers are in pretty decent shape, actually, but 748 00:38:17,640 --> 00:38:19,392 that's only half the story. 749 00:38:19,840 --> 00:38:21,558 Need to assess the hand. 750 00:38:23,000 --> 00:38:24,115 Thank you. 751 00:38:27,280 --> 00:38:28,429 How's Tom? 752 00:38:29,600 --> 00:38:30,919 Yeah. He's fine. 753 00:38:33,160 --> 00:38:36,038 Okay, the arm looks pretty decent, 754 00:38:36,160 --> 00:38:39,152 but I'll need to scrub before I make a definitive assessment. 755 00:38:39,240 --> 00:38:41,310 Okay, can you call up a microscope? 756 00:38:41,400 --> 00:38:44,233 And I'll need an arm board, drapes and a stool, please. 757 00:38:44,640 --> 00:38:45,834 Brian, help the Plastic, please. 758 00:38:52,440 --> 00:38:54,396 - Oh, sorry. - Oh! 759 00:38:56,920 --> 00:38:59,798 We need the microscope in the trauma theatre for Mr Doubting, please. 760 00:39:00,520 --> 00:39:02,033 Thank you. 761 00:39:03,960 --> 00:39:05,678 - What's up? - One sec. 762 00:39:07,000 --> 00:39:08,592 The case of the small intestine, 763 00:39:08,760 --> 00:39:10,716 no wonder it doesn't all match up and the 764 00:39:10,800 --> 00:39:12,358 mesentery is so badly torn. 765 00:39:12,680 --> 00:39:13,954 There are huge sections missing. 766 00:39:14,240 --> 00:39:15,355 Missing? 767 00:39:15,480 --> 00:39:17,311 And not all accounted for, I would say, 768 00:39:17,960 --> 00:39:19,598 we're about a metre and a half down. 769 00:39:19,760 --> 00:39:21,830 Somebody won't need to feed his dog, tonight. 770 00:39:22,000 --> 00:39:24,230 - Can he survive it? - Yes, he's got enough. 771 00:39:24,320 --> 00:39:26,788 And at least, he won't end up on home TPN. 772 00:39:26,880 --> 00:39:28,916 - But you found and stapled all the ends? - Yes. 773 00:39:29,000 --> 00:39:30,069 Haemorrhage control? 774 00:39:30,160 --> 00:39:33,391 All bleeding mesenteric vessels have been ligated. 775 00:39:33,680 --> 00:39:34,908 Where are we? 776 00:39:35,120 --> 00:39:38,669 Yeah, he's responding to filling, BP is 100 over 60. 777 00:39:39,400 --> 00:39:40,515 So, he'll make it then? 778 00:39:40,640 --> 00:39:41,675 Oh, yes. 779 00:39:41,800 --> 00:39:44,314 Look, there's just a few serosal tears I need to deal with. 780 00:39:44,400 --> 00:39:45,913 - I think I can manage, mate. - It won't take me that... 781 00:39:46,000 --> 00:39:48,560 Glen, go. Give the poor general surgeon a chance. 782 00:39:49,360 --> 00:39:51,430 He'll be fine. Go. 783 00:39:56,440 --> 00:39:57,634 Oh, Harry, can you assist? 784 00:39:58,320 --> 00:40:00,470 - Yes, Mr Street. - Just till my registrar, turns up. 785 00:40:01,400 --> 00:40:02,913 We need to get more blood in there and warm him up 786 00:40:03,000 --> 00:40:04,752 before Mr Doubting performs his magic. 787 00:40:05,800 --> 00:40:09,395 Okay, I'll need the microvascular in handsets, please. 788 00:40:09,600 --> 00:40:11,875 Actually, why don't you just call up to theatre five 789 00:40:11,960 --> 00:40:13,871 and get them to send my whole trolley down? 790 00:40:15,320 --> 00:40:16,912 I'll need an assistant, too. 791 00:40:18,120 --> 00:40:20,759 I'm all right to carry on for now, just need a knife and fork, please. 792 00:40:20,840 --> 00:40:22,876 Need someone to push your stool in for you, Mr Doubting? 793 00:40:22,960 --> 00:40:24,154 No. 794 00:40:25,680 --> 00:40:28,194 Hi, Glen, thanks for calling back. Good news. 795 00:40:28,280 --> 00:40:30,510 That's, erm... Yeah. 796 00:40:30,720 --> 00:40:34,349 Re our last session, I passed on my recommendation and it's been approved. 797 00:40:35,240 --> 00:40:37,595 It's official. You can return to active service. 798 00:40:37,920 --> 00:40:40,150 That's great, but, erm... 799 00:40:41,120 --> 00:40:42,473 - Well done. - Thanks. 800 00:40:43,600 --> 00:40:44,669 Thanks for everything, Jane. 801 00:40:44,760 --> 00:40:47,479 Deployment papers should come through in about ten days, okay? 802 00:40:47,560 --> 00:40:48,913 Yeah. Yeah, bye. 803 00:40:49,000 --> 00:40:50,069 Cheers, bye. 804 00:40:53,200 --> 00:41:01,200 Ripped By mstoll