Casualty S43E04
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00:00You have a mass on your ovary
00:02Is it the lane or I don't have any answers yet in terms of like wait time our guidelines say 62 days
00:10Hey, come on. Just so fed up with having to prove myself Danny. I just want to be able to do my job
00:15There's an opening for an advanced nurse practitioner. What do you think?
00:18Yeah
00:20Good all the places. I'm looking at the rent is crazy
00:24You've got a good job, don't they pay you properly I say these shifts are part of my course
00:29So I don't get paid the patient you brought him. She asked me to give this to you. Yeah a woman died
00:36Alone in a corridor patient was your responsibility
00:39Come on, this isn't on me. You're fired. Get out. Have your witch hunt without me. I quit
00:53I
01:21Very much a spectator sport
01:23I
01:43Can't knock down
01:53I
02:06Jesus
02:083-0-0-6 control running call possible major trauma life status questionable
02:23I
02:43Still warm
02:53I
03:10Don't know
03:19Okay, I see something
03:23I
03:40Hope it's coming. Okay, Teddy. Hey, my name's Indy. I'm just gonna go around there
03:53Look at your arm there
04:00Deep breath. Hey, it's gonna really hurt. Sorry
04:11Everybody stay nice and calm for me. I'm Indian. Okay, we're gonna help you say that you want to call it in
04:183-0-0-6 control update on the running call request heavy support and urgent evacuation ASAP
04:25We've got an RTC with two male patients one with a traumatic amputation to the left arm. Oh, yeah
04:33All right truth, where's the pain
04:37We need a line in it's a ready five or more people what's your name fella?
04:43Ellis
04:46Bleeding then we'll get some pain relief as soon as we kind of right
04:53What we've done
04:55Nice and steady mate. Yeah, I mean if I'm a you are the less good you're gonna lose. All right
05:00Okay, good
05:03Don't any more blood over your nice car dear
05:07It's not my car. Yeah, who's is it? He's gonna kill it. Yes. That does. Are you two brothers?
05:14Tell me this is your first driver lesson
05:22Ellis Ellis stay with me Ellis Ellis talk to me, right?
05:29That tree is gonna come down
05:32We need to get finished up again. We need to immobilize him. We ain't got time. Let's go
05:43I
06:13I
06:44Okay, let's go
06:58Ian Indy
07:13Oh
07:32BD
07:34Yeah, of course. Go ahead. Oh
07:38Wow, all right
07:40Yeah, I'm sorry my
07:42business me my plans not working
07:44Thank you. Thank you
07:46Yes, so go ahead. Is it as it has it partially come? No the whole thing's come up as it
07:51Okay, thank you faith. I can you about the trauma team, please. We've got a hems eight minutes out. It's trauma case seven
07:57Then sure, I'll uh, I'll take it. Oh, no. No, it's fine. You've only just arrived
08:01There should be another one in from the same RTC by road so you can take that one house. Okay
08:06I
08:07Didn't you? Okay. Uh, no, not really. Someone smashed my wingmer. I'd said my flat on purpose
08:15Why do you know, you know, anyway, I'm just gonna put it behind me
08:22Look I know it's been a bit of a rough stop
08:26Should be able to get out of here on time. You want me to pick up fish and chips on the way home?
08:30You know, it's money's parents evening
08:33Yep, yeah. Yeah, I'd meant after the parents evening
08:37You're coming to parents evening. Of course. I'm coming to parents evening. I can't wait to meet mrs
08:42Mrs. Breed. Yeah, I thought it was mrs. Beard. I
08:46Know you please don't call it that cuz she is actually quite whiskery
08:51She sounds lovely
08:53She's actually Millie loves her. Well, then I definitely need to meet her. Don't I you know, you don't have to come tonight, right?
09:02It's gonna take some time to get to grips with it. I get it Claire. I want to be there
09:06Okay, I took on this job so I could spend more time with you. Yes, I
09:11Appreciate the honor of you
09:13Do you think I've bitten off more than I could chew this time? Honestly, I
09:18Think you can do whatever you put your mind to
09:21Just try not to go
09:23Dr. Byron
09:26Yeah, you appear to have me at a disadvantage Anna Mills
09:31Counselor for Hobby West. Yes, of course. Yeah
09:38You've forgotten our appointment, I know no not at all good
09:44Shall we
09:47I
09:54Give him another two units of FFP another two units of packed cells as well, please
10:00So and should we get that TXA infusion up any sign of the surgeons because the devil and he shall appear
10:07Good good good. Thank you. Thank you. Okay, so this is Ellis Garrick
10:11He was brought about 12 minutes go by air ambulance and his passenger in an RTC
10:16It was a convertible car his arm outside. They they hit a bridge
10:21So there's a traumatic amputation at the elbow and a catastrophic hemorrhage there the car then left the road and hit a tree
10:27So we've we've done a fast scan. There's nothing to be free fluid in the abdomen. So I think we can assume an intra-abdominal injury
10:33Okay
10:34Now hems intubated at the scene. He's had a hundred milligrams for uranium hundred milligrams ketamine
10:40He's had a gram of TXA we've given him two units FFP four units a neck and there's enough gram of TXA going up now
10:47He's had 1.2. Come on Scott. He's had 500 metronidazole and tetanus immunoglobulin
10:56Chasing BP at the moment with blood products, but how are we doing?
10:59I mean, it's still bleeding through the bandages 20k time about 42 minutes at the moment. That's it. That's all that. Okay
11:06Thank you. Let's get going
11:10Concerned about the album. I like to be we should prioritize the surgery and talk to plastic software's
11:15Yeah, we'll take it up and then they can review. Where is the arm?
11:18Yeah
11:19Hi, come on
11:21No one's going to be able to reattach an arm to a dead body. We have plenty of bandages to stem the bleed on that arm
11:25Yeah, it's on the bed. Sorry. It's on the bed. So it is. Thank you
11:31Keep I'm gonna push it this rapid infusers soon as you're situated inside
11:35I'm a bag. Amazing. Thank you. Yeah. Yes
11:40That's even want to get you started. No, I mean get a boss at me
11:43Oh
12:00Keep that we're gonna need another tourniquet guy. You'll have to hold it
12:05Okay, don't really squeeze
12:09There you go
12:14Anyone get up to the course on Saturday
12:18Yes
12:19That was the 13th don't
12:22double bogey
12:24The Greens are still running fast. Yeah
12:28How's your new driver beautiful
12:31Yeah of the HT 212 yards
12:35Nice
12:36Very nice
12:40Here we go
12:43Okay
12:49If somebody get the arm, please
12:56Okay, someone clean this up
13:02Okay, this is the window for viable reattachment of the arm after that we're looking at tissue death
13:08Plastics won't even think of it until he's hemodynamically stable. So let's get prepped and get going
13:12No, someone okay to scrub in
13:17I'll open up and deal with whatever's going on inside
13:19But I want you Sean to be on the arm get on top of the bleed deep right whatever you can and tidy it up
13:26Through then there should be some clean scrubs and spare thirds cloaks in the changing room
13:42I
13:47I'm sure people are frustrated. Yeah, I'm frustrated
13:50But if you want to speak to somebody you should be speaking to the health secretary. Dr. Byron, I'm a counselor. I'm not an MP
13:56I don't have access to the health secretary. Neither do my what I do
14:01have is an inbox full of heartbreaking stories about patients queuing through the night in ambulances and
14:07undignified treatments being meted out in corridors
14:12Well, believe me none of us want that so so what are you doing about it?
14:19It took a long time for things to get this bad I've been in the post for less than a month
14:24I understand a lady died in one of your corridors
14:28Just a couple of weeks ago
14:30Gloria Scott
14:33You were in post then I'm trying to kill the patients
14:39I'm sorry
14:45Silly joke we have
14:47Siobhan this is Anna Mills local counselors Mills. This is Siobhan Mackenzie clinical nurse manager and
14:55Comedian I'll let you get on. I know you have a lot to do
15:04I really hope we don't have to have this conversation again
15:09I
15:23Apologize for the rather crude initiation
15:26Fine
15:28bodily fluids very much in my job description, sir
15:31It's good attitude
15:33Now look if you have any concerns do come and talk to me
15:38Excuse me
15:44Hey, there she is
15:47You know what you're letting yourself in for
15:49Change your mind about this yet
15:52Not at all
15:54All this system that I'm used to in it
15:59Thank you
16:00I'm just
16:02So excited to see everybody's happily ever after what have you ever after coming right up?
16:08so
16:10This is Drew Gary. He's got a head laceration and vomited at the scene abdomens tender
16:14I need to complain of lower back pain. We had to form a rapid extrication due to safety at the scene
16:19Okay, let's say the baseball please all right BP is 105 over 60
16:23It's tacky at 110 sats are a hundred on high flow and GCS has been 15 throughout
16:27He's had a gram of IV paracetamol 10 milligrams of morphine and four of on dancetron
16:32He's my brother. Okay. He's in theater
16:34It's been looked at seven across on the left, please
16:38brace lift
16:41Don't you give me a permit survey? Yeah, good. It's gonna listen church cats. Thank you. Did you get ahold of our mom?
16:47She's in Edinburgh. It's it's our anniversary. Yeah, we've got the number somebody else also. Okay, don't worry
16:53How we doing? Okay BPS drops in 90 over 60
16:57Okay, right. I think we're looking at intra-abdominal injury. So let's say the morning, but can you call CT and request a pan scan?
17:03Thank you
17:05Do you being chair of the resource committee?
17:07I thought you would have prioritized the ED getting one of the new defeat the cath lab were absolutely desperate
17:13We are desperate
17:14Hours is on its last legs
17:16The patients won't even make it to the cath lab if they're in VF and we can't shock them
17:20Look, I had to balance the books in the procurement budget was all that was left
17:23I've ordered the new equipment until we just have to make do
17:28I'm not telling you how to do your job. Okay, I know it's hard
17:32Been there got the t-shirt, but with respect there is saving money and there's
17:38Compromising patient care. Can I show you something?
17:45Mr. Effing I have a consultant here who would like to take a look at those pressure source
17:53Okay, hi how you doing I'm dr. Byron you mind if I take a look sure
17:59A
18:01Nice custom job you got going on there can't take any credit. I'm afraid my granddaughter's worked
18:07How old is she three and she's told me to be very careful because these are her best stickers
18:13Yeah, I can see she's been very generous with them. Yes. Well, I don't want to blow my own trumpet, but I am her favorite grandpa
18:20Do you remember when this was put on?
18:22Last Wednesday, I think my appointment at the fracture clinic is supposed to be tomorrow
18:29Who put this on? It doesn't matter who was there young man over there, wasn't it?
18:36Okay, would you excuse us for a second, please
18:41Maybe the nursing staff need a refresher on basic competencies and bag slabs
18:45It's cheap plaster. It dries badly. It cracks. This is the result. That is a grade for pressure ulcer
18:52He has a raging infection. It's this close to success
18:57Sure, I'm sorry to dr. Tsum wrote up 40 milligrams of furosemide for this patient, but she's not responding to the medication
19:03I'm a bit concerned. Okay. All right, Bridget love. Take it nice and steady. Yeah. Oh
19:09Excuse me. Excuse me a minute
19:12The cannula is tissueed half of its on the bed. I'm so sorry. I didn't realize no, it's not your fault
19:18Give another 40 milligrams of furosemide and if she doesn't respond to that set up a GTN infusion for God's sake change the cannula
19:27Okay
19:29The cannulas are just as bad as the plastic. They are as flimsy as anything
19:34They won't stay still because the tape that you bought
19:37doesn't stick
19:39See, it's rubbish. Hey false economy. We need to go back to the original supplier
19:45All right, so it's just the coincidence that the two people who have problems were treated by the same nurse
19:52Come on a bad workman blames his tools. Yeah, and a bad leader blames his team
20:02Dr. Merson you care to weigh in on this. I
20:07Thought we were taking responsibility when things went wrong not blaming the nurses, excuse me
20:16I'll get that frozen hide
20:21Oh
20:29Still
20:33Suction don't be scared. They're not going to do any damage
20:41Hey
20:44Hey
20:47Hey
20:51How you doing dr. Redman
21:00Hey, please yes, thank you. Dr. Piper. I do have ears
21:05Vessels a clamp
21:08And the abdomen is packed
21:12Should mitigate the loss of volume
21:16Let's replace his blood volume and correct his coagulopathy
21:21And see if he stabilizes
21:25I'm much longer on the arm. Dr. Odin
21:2974 minutes 74 minutes. What do you think? Can we do it? Yeah, I think so
21:38We have hemorrhage control let's get team anesthetics a chance to catch up and we'll see what we got
21:45I
22:03My hands were shaking
22:06It's not like we knew we were going to it and could prepare for it
22:09Can you do brilliantly?
22:10Really mean it proud of you
22:16I forgot about this
22:18Come told me to put it up last week
22:21Look, it's got a little tear off strips like we're in the 90s
22:26If they got a ring going yeah a little box room. Not sure if I'll have any takers. It's tiny. I don't care about that
22:33You'll learn what's done about his eyes together. It's ridiculous. Yeah, so I'm thinking I should find somewhere else
22:39Right. Well, there you go
22:41It's quite handy, isn't it?
22:44I'll message him. All right, give me a favor though. Keep telling me I found it in the break room
22:48Cuz I forgot to put it on. Yeah. Yeah
23:13You
23:34That's been right up a quadrant so dry it'll in Spain
23:39In fact moving on
23:46Here we go suction
23:52Come on
24:02Music down I
24:05I can't see what I'm doing to more suction
24:25Got it me centeric evulsion. I'll use a clip
24:35Good
24:38To zero suture piece for this
24:43And then we'll do the repair on the serosal injury
24:53Cool plastics tell them we're nearly ready for them to have a look at this arm
25:05Hmm
25:07Temperature's not coming down is it? I think you're gonna have to admit you so we get on top of this infection stay
25:13I'm afraid so. Is there anyone I can call to bring some stuff in for you?
25:17My daughter his daughter's on the system as his next of kin. Okay, I'll give her a call
25:22Come by have a word. Yeah, could you will do that cast while I sort that out?
25:27Well, I think maybe someone else should do it
25:29Like I said before this wasn't your fault. You did nothing wrong
25:34Thank you
25:38All right, mr. Epping, I'll take this I'll be right back. Oh, no, don't throw it away. I
25:47Just need to get this back on you
25:50Hey, I drew and someone's managed to get in touch with your mom and dad stepdad, okay stepdad
25:55Um, they're getting the next train. So they should be here soon. Okay
25:59You think I'm good? No, I don't
26:02How's Alice I imagine he's still in theater
26:06Sorry, it's okay
26:10I'm always messing everything up. I can't do anything right? No, I'm sure that's not sure it is
26:16He was helping me pass my driving test before I started uni
26:20This is how I repay him
26:22You'll say that as well. Just try and stay calm. Okay, but this was a horrible accident. It's nobody's fault
26:32No, no, um, where's the pain drink and just examine you're out
26:42Yeah, okay
26:44Abdomen Dylan, is that CT report back by any chance? Yes, it is. Yes, it is
26:51Yes, it's got some interleaver there and also much ruptured. Okay. Thank you, right?
26:56Yeah, let's get him on IV colmox club and we'll do a stat dose of gentamicin
27:00I'm gonna bring surgery as well. I can do that. No, no, you're grand. If you actually review his analgesics, that'd be great
27:18Please don't tell anyone that I'm using this. Okay, because this is just meant for closing wounds our secret
27:24Okay
27:27Last one that goes there
27:30Now just got to make sure that these are on absolutely perfectly because she will definitely notice
27:40And that's it there we go, what do you think Barry?
27:49Barry
27:51Barry can you hear me?
27:54Mr. Epping
27:56Mr. Epping, can you hear me?
27:59Um, can I get some help, please?
28:05He was drowsy but talking now, it's just not responsive crash trolley
28:09I
28:21Just do a rhythm check
28:30There's a false
28:32Okay, fine get it off. Let's continue. Please can keep up compressions. It's going to release us. Let's go go
28:39Let's go
28:48Yeah, can you put me through please thanks
28:52Yeah, they can't stop a theater without pulling another team from surgery
28:56Okay, well, he's the two you're eating fast. Should we give him another two units of packed red cells in the unit of FFP?
29:02Rita hi. It's a Stevie here. Hi
29:07Yeah, yeah it is and look I'm here with the kid from the RTC this morning the driver
29:13I think you're treating his brother at the minute. And we've got a possible bile injury at the DJ flexure
29:19Can I set him up to you?
29:22We have plastics here
29:25Looking at the arm reattachment. I think that's gonna take a couple of hours
29:28I've got a kid here. It's the 17 year old the new score of six
29:32You know, he's triggering for sepsis. We're looking at possible organ failure. Whatever it is. The other trauma team will have to do it
29:38I'm really tell a Russell if he has something to say him come on the phone to say it because I'm perfectly where the
29:42Other trauma team are working on a ruptured spleen. So you're this kid's only hope. Yeah. Do you know what just hold on?
29:48I'm gonna call you back. I'm gonna call you back. I'm gonna call you back. I'm gonna call you back
29:51I'm gonna call you back. I'm gonna call you back. I'm gonna call you back. I'm gonna call you back
29:55Yeah, um, do you know what just hold on hold
30:00They sound quite worried they always sound worried
30:04It it's his brother. He was driving the car. They were in a bowel injury triggering for sepsis
30:10If we clear the theater for him, then this fellow loses an arm
30:14I'm sure he'd rather that than lose his little brother
30:17Rita
30:22Mr. White law has given his final I'm really sorry guys
30:25it's not up to me and I don't know anything, but
30:29How likely is it that this arm reattachment is gonna work?
30:35Genuine question I
30:37Agree it is a long shot
30:40And there is an outside chance that he might be too unstable for a plastic sock
30:44This could be life or death
30:48I
30:53Apologize gentlemen, it appears that your services are no longer required. Thank you
31:03Send him up great. Thank you. Thanks. She gave us a theater. Yeah, she did I did
31:11All right, let's go
31:14If we open him up and find that it's a fuss over nothing
31:17Then you're going to have to explain why we didn't at least try to save his arm
31:22Let's close and reset the theater, please and will somebody take the arm down to the morgue
31:41I've been down for 10 minutes. He's in BF. Come on shocking. Okay charging to 150
31:47Okay, top middle bottom clear
31:52Chest
31:55Shocking
31:58Wait, wait
32:01I
32:03Got Ross right to start a repeat ECG a blood gas call ITU. I owe you an apology
32:11It's okay, no, it's not let him apologize
32:16I'm sorry. Okay. Nothing that happened today is on you Adam
32:21You're an excellent nurse
32:23And I'm grateful for your hard work
32:27Thank you
32:31I
32:42Was interesting God
32:45Really? Hope this kids on death's door
32:48Sorry, you know I meant
32:52Do you think it was a mistake I
32:55Just can't believe you listen to you
32:58Doesn't isn't anyone then again, I've never seen anyone speak to him the way you do so
33:03Yeah
33:05Everyone keeps saying how he's this big tyrant, but he seems perfectly friendly to me if anything a little too friendly
33:15Well, you got some balls I'll give you that
33:27Oh
33:30Hey guys, okay. Hey Rumi. Hey, can I give you this now? Don't worry we can sort that later
33:35That's not because then I just know it's definite and done and sorted. Okay?
33:40And I'm sorry, it's not as much as you wanted for the deposit. It's all I've got left saved. Okay, silly. That's fine
33:45Um, well, I suppose we should all celebrate later. Yeah, have a drink or something. Yeah, cool
33:49And I guess I'm buying you're gonna have to
33:58Cheers
34:20Suction I
34:23Think we can safely confirm a perforated colon. Okay plan of action. Dr. Piper here at meal saline washout
34:32And then primary anastomosis
34:34Dr. Redmond, I agree with the washouts, but I joined wouldn't heal
34:40I'd give him a Hartman's in reverse in six months or so. I agree with you. Dr. Redmond anastomosis is a ludicrous suggestion
34:47The brother has already sacrificed an arm. Let's not risk anything more
34:51That's a man
34:54This boy may well owe you his life
34:58This is why I brought her up here all patients should be so lucky as to have such an advocate
35:07Let's begin
35:09I
35:20Thought you said you haven't stolen that's all not
35:24Sure, you're not just gonna leave it. No, I'm not cracking up. I'm not saying you're cracking up
35:29But maybe you're overthinking it. There's all sorts of people around here. It's a public place. Okay, but I'd say my mom is a public street
35:37Like why would somebody be talking to you? Who would want to do that?
35:48Yeah, oh
35:52Great more paperwork. It's a
35:56Since it's not more numbers that don't add up you're at that stage, right? Yeah, it's impossible
36:02Okay, good as long as you realize that I mean it is actually impossible
36:06It doesn't matter which way you try and add things up
36:09They don't because there just isn't enough money to go around
36:12Resources are just allocated according to whatever people are most upset about on any given day
36:17Well, no, I think once you realize that you are just moving deck chairs about on the Titanic strange enough
36:23It does become it becomes less frustrating strange. They're just giving up or pragmatism. I think just
36:29Understanding there's only so much the one person can do it's a bigger job than you it's a bigger job even than me
36:35Watch on
36:58Oh
37:11What's this
37:13Wait, it's just a colostomy bag. Hey, hey drew. I'm Rita. I'm your surgical nurse. I want you to know this is temporary
37:20It's just giving your body time to recover and then you can have another operation to reverse it. Where's my brother?
37:26Ellis
37:33Hey
37:39It's okay
37:42Look at me look at me. It's all right
37:48It's not all right
37:50This is all your fault
37:53What
37:55Faster go faster. Now. Look at this drew. Hey, I know this is such a shock, isn't it?
38:03It's so much to take in but I promise you this is temporary. Okay
38:09Yes, screw you
38:12And it won't stop you from doing anything
38:15Nothing that you can't do with a bag that you couldn't do before pushing me
38:21Always pushing me learn to drive go to uni. I didn't even want to go to uni in the first place
38:26I was trying to help you
38:28Selfish I don't need your help
38:32You're not my dad
38:50I
38:59Look in the in this me. It's your dad. Oh
39:04Hi
39:07Oh, yeah
39:09All right, how are you
39:11Yeah
39:19I'm in a bit of trouble. We're supposed to be staying out of trouble after what happened. It wasn't a one-time thing. Was it?
39:30But I need to borrow some money just a few hundred quid I'll pay you back the price
39:37Really help me out
39:40Wouldn't you know
39:55Okay
40:10Look I know it's not my place, but you're both extremely lucky to be alive
40:20And seeing as you still have each other I think you need to talk I
40:26Can't leave because I have to monitor you but I'm gonna just turn around and pretend I can't hear you and you two can just
40:35Yeah
40:39You
40:59Look
41:02When that died
41:05I didn't seem important exams
41:13You can be better than me you can have more
41:21You can't carry on at the factory anymore, what else you gonna do
41:27I
41:33Thought maybe drive an instructor
41:57Oh
42:22Hi
42:27Thought we agreed we wouldn't need to speak again. Yeah, I think you agreed that
42:43Look the way I see it
42:46We are on the same side
42:49So we don't need to treat each other like the enemy we both want the same thing
42:54I
42:56Started this job
43:00To do something positive
43:04And instead I am wasting my time making impossible decisions between safe staffing and safe equipment
43:13We need more money
43:16It's that simple
43:19What I want to know is
43:25What are you gonna do about it
43:43Hey
43:45Good news. Yeah, I'm really sorry to mess you all around. I I don't actually need the room anymore. Oh
43:52Yeah, I went to talk to my landlord's hand in my notice and he said that renovations are gonna be done by the weekend
43:57Oh, that's a shame would've been fun. Yeah
44:01It's just all my stuff's already there. So it's easier. No, of course not that makes complete sense here
44:05I should give you this back. All right. Yeah, of course it is
44:10Sorry
44:14Well, do you guys still want to go to the pub absolutely yeah, yeah
44:18Rita
44:19We'll see you in there. Okay, we're just going for a drink in the car. No, I can't stop
44:24I just wanted a quick word about how amazing I was Nicole. I already know
44:31You okay, yeah, so when I started in surgery
44:36One of the last has told me what I'm gonna tell you
44:39Okay
44:42There's a list
44:45Of
44:47Blocks you want to be careful around
44:50And mr. White law is top of that list
44:54He's serious
44:56Well, he said he's already been a bit too friendly
45:00Yeah, but
45:03Okay
45:05Thank you, thank you for letting me know
45:09He wasn't the only one I was warned about
45:15I
45:17Sean's name is on the list, too
45:22I'm so sorry. I just I just thought you should know
45:35Allen I better sorry Pat
45:44I
46:14I
46:44I
47:14I
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47:44You