03x04 - Episode 4

Episode transcripts for season 2 of the 2014 TV mini-series "An Hour to Save Your Life".
"An Hour to Save Your Life" is a medical science series exploring the life or death decisions facing doctors in the first critical hour of emergency care.
Post Reply

03x04 - Episode 4

Post by bunniefuu »

Hello, ambulance service.

There's a guy just got hit by a bus.

He was on a bike. He's
been really badly injured.

From the moment an emergency call
is made, a clock starts ticking.

Female lying on the road,
struggling to breathe.

The golden hour is the opportunity
that we have to save the patient.

Deep breaths, George.

'The longer the clock ticks,'

the increased likelihood
there is of death.

In the fight for survival,
time is the enemy.

I'm ventilating fast on purpose.

Yeah. I'm hoping that heart
rate will pick up any second.

Now, new techniques and technology

are bringing emergency
medicine to the roadside...

We can use the Infrascanner to
give us a slightly clearer picture

of what's going on underneath the skull.

.. breaking new ground and treating
patients faster than ever before.

We can now provide emergency
surgery, blood transfusions,

anaesthesia at the scene of the accident.

- Yeah, through the cords.
Tube, please. - Tube on.

We follow three patients through
the crucial first hour of care.

In central London, a man collapses at work

with a suspected cardiac arrest.

We are going to anaesthetise him here.

In Newcastle, a mother of three

fights for her life after being s*ab.

How big was the knife?

And a cyclist in Durham suffers
horrific crush injuries,

after being hit by a bus.

Let's get the blood in.

minutes that will
change their lives for ever.

You will constantly be surprised

just what you can bring
back from the jaws of death.

Emergency ambulance, tell
me exactly what's happened.

He's out cold.

- Is he awake?
- He wasn't.

- Is he breathing?
- I don't know,

I think he might be choking.

In central London, an emergency call

has just been received about a man

who has collapsed from

a suspected cardiac arrest at work.

It's near Charterhouse
Street. OK, fine, keep going.

On duty in London's Air
Ambulance's emergency medical car

are consultant Anne Weaver
and paramedic Bill Leaning.

They are only minutes from the scene.

'Cardiac arrest is a
time-critical incident.

'It's essential that the patient gets'

immediate care, that can be from
a bystander or a professional.

It doesn't really matter,

as long as someone takes
action as quickly as possible.

Do you want to just carry
the bag for us? Cheers.

Come and hold that for me.
Cheers, thank you very much.

-year-old Michael
collapsed in a corridor

and his heart stopped beating.

A London Ambulance Service
paramedic is already on the scene.

Michael is now breathing
again, but deeply unconscious.

- All right sweetheart, hello.
- You all right, mate?

OK. Someone grab a Guedel, thanks.

- Yeah, of course.
- And some oxygen.

I can see he's got a facial injury,
he's got blood coming from his nose,

but the most worrying thing is
his breathing is not normal.

He's got a lot of blood in his airway.

We don't know what his facial damage is,

but any damage to the airway

instantly compromises you as a person,

because you've got to breathe.

If you're not breathing,
you're in trouble.

Matt, you grab that.

Anne suspects Michael's body
is being starved of oxygen,

and needs to act fast

before organs like his brain
begin to suffer and die.

- OK.
- Grab one more.

What I need you to do is put a
finger behind each jaw, each side,

- and just lift it up.
- Yeah.

We're trying to stop that snoring noise.

I'm going to insert a plastic
airway into his nose,

to make sure there is wide-open channels

for the oxygen to be
delivered down to his lungs.

Knowing that Michael
is deeply unconscious,

Anne urgently needs to find out
what happened when he collapsed.

You're all right, mate.

Who was here first, or saw him collapse?

He was following me up the stairs,

I was walking upstairs from the
ground floor to the third floor,

and he was sort of running behind me.

- He just groaned and fell forward.
- Onto his face? Yeah. OK.

For someone to say he just went
forward, that's quite worrying.

'It sounds as though he's completely lost

'the blood supply to the part of
his brain that keeps you awake,'

and he's literally just gone down
very, very hard, immediately.

Where's that blood coming
from? It that from his nose?

Have we got a bit of gauze to stop it?

One of the first people to help Michael

was co-worker Emily, a
trained first-aider.

I very much felt that this person
in front of me was about to die.

He started to go slightly darker purple,

perhaps a slightly blue colour.

Did you have to do CPR?

- I had to.
- Did you have to breathe for him?

We tried that, but the man at the
on the phone said don't do it.

OK, all right.

We took the decision to go
through the resuscitation routine,

which includes CPR and the defibrillator.

Well done, yeah, you've
done a good job helping him.

The prompt actions of Michael's
co-workers restarted his heart,

but the cause of his
arrest is still unclear.

'It's wide open at that point in
time, as to what is the cause.

'There's a possibility
that Michael's had a bleed'

inside his head, that could be

what we call an intracranial
or intracerebral bleed,

or it could be that
he's had a cardiac event,

he's had an arrhythmia, or
he's had a heart att*ck.

OK, so we've got a heart
rate of , sats of .

His pupils are equal, he's breathing,

but he's fallen onto his face.



OK, probably GCS .

- Yeah. - Can we get a
-lead ECG, please?

Connecting Michael to an
electrocardiogram, or ECG,

will allow Anne to look for
any changes in heart rhythm

or electrical patterns

that could point to the
cause of his cardiac arrest.

Anne, there's your ECG.

OK guys, his ECG isn't entirely
normal from a cardiac point of view.

He's got some ST depression,
inferiorly and laterally.

But I'm slightly worried it could
be a cerebral event as well.

His ECG shows some abnormalities,

but the changes are not diagnostic
of an acute heart att*ck,

but they're not entirely normal.

Those changes could be attributed
to a bleed on the brain.

Anne is concerned that Michael
may have had a brain haemorrhage

that is affecting the area
controlling his lungs and heart.

A further bleed could be
life-thr*at to him.

Time is critical,

whether or not it's Michael's
heart or whether it's his brain,

either way, we need to get a
diagnosis as quickly as possible.

minutes ago in Northumberland,

emergency services received a call

from a suburban street

on the outskirts of Newcastle.

Ambulance service, can you
tell me what the problem is?

Yeah, they put a knife in my wife.

She's been s*ab? Please,
I need an ambulance, please!

Sir, you need to tell me what's happened.

Is she breathing?

Yes... Please...

Listen, don't worry, an emergency
ambulance has been arranged, OK?


North East Ambulance Service
senior paramedic Gary Shaw

is in one of three ambulances
dispatched to the scene.

'Anyone on the air, got a
detail in North Shields.

'A patient, multiple s*ab.'

Yeah, roger, just send it on, thanks.

Multiple s*ab.

I was given information from our
control room that we had a female,

possibly s*ab in the neck.

You have major vessels within
the neck. If they are damaged,

you bleed really heavily and
quickly from those wounds.

s*ab in the neck and the chest.

Wounds to the chest are
obviously very dangerous ones,

you've got your heart within
your chest, your lungs,

all of your vital organs.

If that's not dealt with really quickly,

you're then looking at the
potential for a fatality at scene.

The s*ab victim is Gidia,
a young mother of three.

Paramedic Phil Blance is rapidly assessing

where the knife has penetrated.

- Say again?
- Chest wound?

Chest wound, deep,
possibly full thickness.

In the sternum?

- Yes. - Sternum.
Both sides of the neck.

She'd been s*ab in
the centre of her chest,

and she had some lacerations
to her neck, as well.

OK, / .

Sats are .

'It doesn't have to be
long or particularly wide,'

anything that penetrates that
area, because of the major vessels,

is potentially fatal for the patient.

Right, we're good. Excuse me, honey,

we're going to be going on
blue lights and sirens, OK?

- We've got access.
- Yes.

'Pre-hospitally, I can't see, internally,'

if there's any damage, you've
just got to suspect the worst.

Phil is rushing Gidia to the
nearest major trauma centre

at Newcastle's Royal Victoria Infirmary.

How big was the knife?

Ten inches?

A big one? A kitchen knife?

'I was quite surprised when the
lady said it was a ten-inch knife,'

which does have a different
impact on your treatment.

'The size does matter.

'We've got to assume it
has gone in ten inches,'

that's the main concern for us.

And your date of birth?

- ... - Yeah? - 'Where she was
s*ab in the centre of her chest,

'the knife could have punctured
the lung. If the lung collapses'

due to the s*ab, you
have a build-up of air

in what they call the pleural cavity.

If air is allowed to
build up in her chest,

Gidia will struggle to breathe.

'We will place a Russell Chest Seal,

'which acts as a valve
that lets the air out

'but doesn't let the air in.'

, I wonder if you could
pre-alert the RVI, please?

Are you ready for the details? Over.

Yes, we have a -year-old
female who has three s*ab wounds.

The first s*ab wound

is in the centre of her
chest, in the sternum.

There's a Russell Chest Seal in situ.

Phil phones ahead to
Newcastle's RVI Hospital

to alert the major trauma team
to prepare for Gidia's arrival.

The second s*ab wound is to
the left side of her neck,

she has a small laceration
to the right side of her head.

Gidia's life will be in the hands

of emergency medicine
consultant Sohom Maitra.

The sternum and twice in the neck.

GCS , blood pressure OK.

I think it'll probably
be a question of how deep,

the usual sort of thing.

My current concern is
that she has an injury

in two areas of the body,
the neck and the chest,

where there are vital
organs and vital vessels,

and I am very concerned that
she could have active bleeding

in and around her heart,
or in and around her lungs,

and also in and around the
main vessels of her neck.

Sats are up at .

'You are constantly
reassessing all the time.'

Reassessing her airway,

looking at the monitor to see
if her heart rate is increasing.

Although Gidia appears s*ab,

her body could be masking
a life-thr*at injury.

Phil knows she could
deteriorate at any time.

Pulse, and regular.

BM is . .

You are always aware that things

can change quite dramatically
en route to hospital.

In central London,

-year-old office worker Michael

is still unconscious after suffering

a suspected cardiac arrest at work.

It may not be his heart,
so it's a possibility...

- It could be his head.
- Better off doing... - Yeah.

Anne urgently needs to
get Michael to a hospital

to diagnose whether the arrest

was caused by a brain
haemorrhage or a heart problem.

If he has had an intracerebral bleed,

there may be something that a
neurosurgeon can do about it.

'Equally, if he has had
a cardiac event, again,

'he may need a time-critical

But before she can move him, she
needs to address his breathing.

Michael currently isn't breathing
normally. He is breathing,

but it is not regular and it is
not a normal depth or pattern.

How much O have we got left?

Have we got only one O bottle up here?

- Oh, right.
- Have we only got that cylinder?

That cylinder at the
moment and one on the truck.

Michael's abnormal breathing risks
starving his vital organs of oxygen

and could cause brain damage or
trigger another cardiac arrest.

You're just going to do a little roll,

just enough for me to get
this side of the scoop in.

One, two, three.

Anne decides to anaesthetise
Michael and take over his breathing.

Right, if we've got the oxygen,
let's pop that between his legs.

We are going to anaesthetise
him here, so I need total quiet.

It's really important

that everything is kept
strictly cordoned off now.

I have taken a lot of thought
about whether Michael needs this.

I have given him some
time to see if he recovers

but he is still deeply unconscious.

This procedure will mean
that his airway is protected

and, to some extent, we can
also control the level of oxygen

to make sure, if he
does have a brain injury,

we minimise any further
insult to his brain.

- OK, straight on to the trolley.
- Pull that closed. - So, people,

we're going to give him some
drugs to put him to sleep, OK?

Can I get you to just hold his arm
straight for me, please? Thanks.

Michael is given a combination
of strong sedative drugs

to relax his airway and
paralyse his chest muscles.

Sats are , pulse rate is .

In simple terms, we are
stopping the patient breathing.

Michael is breathing.

We are now going to stop him breathing.

The responsibility that
comes with that is massive.

OK, I'm going to get you
to stay there for a minute

and I'm just going to get you

to hold his neck while
we intubate him, OK?

Can you just hold his head?

- Right, there's a lot of blood.
- Suction?

Now the drugs have taken effect,

Anne has seconds to
insert a breathing tube

through Michael's vocal
cords and down his windpipe.

Just pop your hand where
my finger is, just there.

- OK, bougie, please.
- Bougie in your hand.

'It is a very tense moment.'

Just support the top of it,
Phil, the top of the bougie.

'If I can't get that
tube through the cords,'

Michael isn't going to breathe.

Someone has to do that for him

and I need a way of getting
oxygen down into his lungs.

- Yeah, through the cords. Tube, please.
- Tube on the bougie.

If I fail completely,

I may have to make a hole
in the front of his neck,

so I'm hoping I can get
the tube down first time.

Tube is through.

- OK, bougie out, please.
- Watch your eyes.

- Bougie out.
- OK, let go of the tube, thanks.

With the tube in place,

Anne must now manually
control Michael's breathing.

OK, give me a bag.

And again.

'It's a huge relief when we know
that we can ventilate Michael.'

We know we can deliver oxygen effectively.

It's a bit quieter on that side.

'He is in that place now where
he needs definitive treatment'

and that can only be delivered
by a specialist centre.

- What are our sats?
- Sats are now.

OK, good, let's just
get this out of the way.

But without a clear cause for
Michael's cardiac arrest,

Anne now faces a difficult decision --

whether to take Michael to a cardiac
centre to investigate his heart,

or to a major trauma
centre to look at his brain.

I have to decide what I
think the top diagnosis is,

which hospital I am going to take him to.

If I take him to the cardiac centre,

they investigate him and
treat him for his heart,

that may involve him having
anticoagulation drugs,

which will thin his blood.

If he has a brain injury,
that could make it worse.

If they anticoagulated him and
he had a bleed inside his head,

a further bleed could be
life-thr*at to him,

so it's important that we rule
that out by doing a CT scan.

Guys, just so everyone is clear,

we're going to go to the
London and get his head scanned.

So, could we have a lift
available, fellas, to go? Thank you.

Anne is taking Michael to
the Royal London Hospital

where specialist neurosurgeons
will be able to find out

if he has suffered a
severe brain haemorrhage.

Excuse us, mate.

Thank you.

There is a big risk,
if you go to the London

and there's nothing wrong with his head,

now we are, again, into
minutes of his heart dying.

We're going to go to the London.
I will put the blue call in.

I've got a feeling it's going
to be the wrong hospital

but I think we have to get
his head scanned first.

Guys, we're going to do
a U-turn and go down...

Right, so, I've got a male.

He has collapsed at work in the City

but has fallen forwards and
has got facial injuries.

It's a possible cardiac event,

but I'm coming to you cos I
think we need to scan his head

and put him through as a trauma call.

We'll be with you in eight minutes.

- All right?
- Yeah, we're good.

In Newcastle, it's been minutes

since an ambulance was called

to Gidia, a young mother of three,

s*ab multiple times with a knife.

Suspecting internal
bleeding, the medical team

are rushing her to the major
trauma centre at Newcastle 's RVI.

OK, ladies and gentlemen,

this is a -year-old lady who,
at around o'clock today,

has suffered multiple s*ab
wounds to the chest and neck.

Injuries sustained.

She has a right central
s*ab wound to the chest,

a deep laceration to the
left side of her neck,

blood pressure / ,

respiratory and sats are .

'It's very difficult to work out,

'just from looking from the
outside, what is underneath.'

A s*ab wound could have gone anywhere,

gone to any depth and involved anything.

Sohom's urgent priority is to decide
if any of Gidia's major organs

have been struck by the knife.

OK, we're just having a little
look at these wounds, all right?

I know it's quite sore.

We're going to give you
something for your pain.

I'm very much worried about
the heart and the lungs,

I'm also worried about
the vessels in her neck,

which supply oxygen and
blood to the brain.

Can I ask you to stick your tongue out?

That is quite a deep wound.

Just to the right of the
upper part of the sternum.

Is that sore if I press
on your voice box there?

Yeah, OK.

'She was a little tender over
the top of her voice box,

'which does create a concern in
my mind that there may be damage.

'It can swell up and block the airway

'and stop oxygen going to the brain.

'I am really worried as to
how much is she covering

'for what may be going on underneath.'

Does it hurt when you move your tongue?

Although Gidia looks s*ab,

Sohom is aware that
things can change rapidly.

She is a young person and young
people, particularly, in trauma

can compensate and hold
on to their blood pressure

and heart rate and oxygen levels
for an extremely long time,

right up until moments or seconds

before they actually go
into cardiac arrest or die.

Do you want to have a little look,

if there's any lung points on ultrasound?

Fearing that Gidia could
deteriorate at any minute,

Sohom saves critical time
using a portable ultrasound

to check her vital organs.

Ultrasound is fantastic in
the resuscitation effort

and it provides answers very
timely at the bedside for...

"Is the lung affected?" Yes/no.

"Is the heart affected
in a major way?" Yes/no.

That's fine. And on the right.

I think you have got enough
of a view to say it looks OK.

OK, Gidia, we are just
finishing the ultrasound scan,

we have looked at the
lung and it looks OK so far

which is good news, and we're just
having a look at your tummy as well.

Whilst Gidia's lungs appear
unharmed on the ultrasound,

Sohom is concerned it
can't tell the whole story.

We want to know more
than just a yes/no answer

as to whether something is affected,

we want detail, we want major detail.

Craig, are you all right giving...?

Would you mind giving them a ring in CT?

The CT scan will reveal whether
Gidia is bleeding internally.

After this, we will need to do
some scans, called CT scans,

to make sure that there is
no injury to anything else.

Is there something underneath
that is slowly building,

whether it is a small drip-drip effect

or whether it's something
more severe than that,

whereby, actually, we are about to
run into problems very, very quickly

but we don't know it yet?

minutes ago, at North East
Ambulance Service control,

operators received a call
about a man in Durham

in critical condition after
a serious road accident.

Hello, ambulance service. Can
you tell me what the problem is?

We will get somebody there
as quickly as we can.

Code red trauma, minutes.

An air ambulance team are already at
the scene and issue a code red alert

to Newcastle's Royal Victoria Hospital

to prepare them to receive a patient
suffering from severe blood loss.

He has got pre-hospital
blood coming... going

and he's got bilateral thoracotomies.

I think the main thing is to move quickly.

Emergency medicine consultant Bas Sen

is heading up a specialist team

that will be treating -year-old Ben.

If you have any blood ready,

he has a cannula in his
right antecubital fossa.

- He probably needs that attaching
as soon as you can. - OK.

-year-old male, injured
in Durham about an hour ago.

He is a cyclist, underneath a
bus and had to be extricated.

Ben has severe injuries to his chest,

which is deformed, and
possible pelvic injury as well,

he has had two units
of red cells en route.

His last blood pressure was systolic.

Heart rate is still in the s.

So evidence of severe
chest injury and bleeding.

OK, thanks, Phil.

The weight of the bus
has crushed Ben's chest,

causing major internal bleeding.

The concealed haemorrhage is
when you bleed into a body cavity

so you can't see it but it is as
serious as external haemorrhage.

To save Ben's life and
get him to hospital,

the air ambulance team

have given him two units of
blood and anaesthetised him.

But Ben is still bleeding heavily
and his levels are dangerously low.

Haemorrhagic shock is a condition where

the patient is losing blood actively

and there isn't enough blood
to go around the system.

The major organs start to shut down,
like your brain and your heart,

this does mean that Ben is dying
if there is no intervention.

But before the team can start
to treat Ben's injuries,

Bas must address his
massive internal bleeding.

OK, chaps, can we get the
blood in and started, please?

That is our priority.

Let's get the blood in. Can
I have the blood, please?

In response to the code red call,

blood products such as red blood
cells, plasma and platelets,

have been ordered and are
ready and waiting for Ben.

Is that blood going?

He will need a combination of all
three just to keep him alive.

I knew we had to move
very quickly into CT scan

to find out where he was bleeding from.

- Airway, are you happy?
- OK.

But Ben is dangerously unstable

and too ill to be moved to the scanner.

He has got a pretty bad
crush to his chest.

'The decision I had to
make was whether to wait'

and s*ab his chest further
or whether to go straight for CT.

He has bilateral chest movement.

So, at the moment, we are
happy from a B point of view.

So, Alan, circulation. Has
he got a peripheral pulse?

He does, he has... a very faint radial.

He's got a faint radial? OK.

'We had satisfactory breathing'

but his circulation was worrying me.

Can't really feel his femoral,
in fact. Not very good.

- Is the blood going,
chaps? - Yes. - All right.

'Ben was losing a
significant amount of blood'

and we couldn't get a
satisfactory radial pulse.

A weak pulse in Ben's wrist

means there is not
enough blood in his system

and he is losing it faster
than they can replace it.

If Bas can't increase Ben's blood levels,

it could trigger a cardiac arrest.

Miriam, is the peripheral
line not working?

It is not brilliant, we are
not getting more than...

OK, go for it. Go for it.

I knew that what I needed to do
here was to save his circulation.

I decided to make sure

that we replaced sufficient
blood in his system

for him to have time
to go through a CT scan.

- Have you got a decent pulse there?
- No, it's very, very...

That is what I need to know from you guys.

Are you happy with the
stroke volume or not,

or do you want to transfuse him with more?

We could do with about five
minutes of transfusion.

OK, that is fine.

If that is all right.

Bas must now wait for the
transfusion to take effect.

Only once Ben has a s*ab pulse
and blood pressure can he go to CT.

Five minutes.


In the last minutes,

emergency clinicians have battled

to deliver medical interventions

to three critically ill patients.

Having survived the cardiac arrest,

Michael has been anaesthetised
and his treatment now rests

on doctors determining the exact cause.

Cyclist Ben is being transfused with blood

and doctors now need to locate the
source of his internal bleeding.

And after a knife att*ck

has left mother-of-three Gidia
with multiple s*ab wounds,

the team are using the latest equipment

to look for any injury that
could thr*at her life.

It has been minutes
since cyclist Ben arrived

at Newcastle's major trauma centre
after being crushed by a bus.

Blood pressure is / .

Continuous blood transfusions
have so far kept Ben alive.

Bas now needs to scan him

to find the source of his internal
bleeding as soon as possible.

- Marie? - No, we don't. - OK.

'The longer you leave it,'

the more you are risking

the patient suffering
from multi-organ failure.

I have seen patients die within minutes.

Bas is finally able to see

the severity of the
injuries Ben has sustained.

What's the state of his
lungs? Can you see them?

The bus crushed his chest,

so this is almost like
your chest becomes flat

and when that happens,
all your ribs break.

Ben's ribs have been
severed from his breastbone

and his shattered ribcage
has punctured both lungs.

- OK. - We have got gas
under there. - Mm-hm.

'Ben's chest showed significant
injuries to both his lungs

'and his lungs had collapsed about %.'

He had almost every
abnormality we could find.

OK, as long as he is not
bleeding into his chest.

But despite a life-thr*at
injury to Ben's chest,

the source of his internal
bleeding remains unclear.

As the scan moves down Ben's body,

Bas must look at one organ at a time.

As we went into Ben's abdomen,

it showed that he was bleeding
significantly from his spleen

and I could see by looking at the scans

that his spleen was in two bits.

Ben's spleen has been torn into
pieces by his shattered ribcage,

causing catastrophic bleeding.

He is bleeding into a cavity
called the peritoneal cavity,

which is in the abdomen.

This artery that feeds into the spleen

has to be clamped off and
tied because you can lose

your whole blood volume into
a cavity like the peritoneum.

I think the priority
is to get the drains in.

OK, I will make sure that Steve
is primed and ready to go.

It's... We can put the
arterial line in any...

That's not a therapeutic intervention.

I am just a bit concerned about
his abdominal haemorrhage.

Ben requires immediate
surgery on his spleen

to stop his internal bleeding,

but the scans show that Ben's
lungs are still collapsed

and air is building in his chest cavity.

When he took a deep breath in,
air leaked out of his lungs

and the air was trapped in his body.

If we left the situation as it
is, the air would crush his lungs.

Unless Bas can relieve the
pressure on Ben's lungs,

he won't survive the operation
to stop his bleeding.

OK, chaps, we are going to
take him out, take him back,

put his drains in and
then he goes to theatre

and it will have to be
done fairly quickly.

Bas gains access to Ben's chest cavity

through holes made in his side by
the air ambulance team at the scene.

Put your finger in and make sure
you are in the pleural cavity, yeah?

- Yeah. - Can you feel the lung? - I can
feel the lung, yeah. - OK, good. Alright.

Tubes are inserted into the
holes to keep them open

and allow any build-up of pressure

caused by air or fluids to be released.

OK, done?

With Ben's breathing now under control,

Bas can send him to get the
surgery he so desperately needs.

At the Royal London Hospital,

office worker Michael is
returning to the ambulance

after undergoing a CT scan of his head.

Michael's head scan looks normal,

we can't see any bleeding in
the brain or around the brain,

which is reassuring.

- Good to go?
- Yeah.

How long will it take us
to get to Barts from here?

Having ruled out a brain haemorrhage,

Anne now suspects Michael's cardiac arrest

to be the result of a heart problem.

She now urgently needs to get Michael

to Barts Heart Centre for
further investigation.

Hello, it is Anne Weaver,

I just rang about a patient
we are bringing in,

we will be with you in about four minutes.

If he has got a blocked
coronary artery, for example,

or partially blocked,
that is still a risk,

we haven't fixed that and
we still need to consider

that he could have another
cardiac arrest at any time.

Anne is passing over Michael's care
to a specialist team, headed up

by consultant interventional
cardiologist John Hogan.

-year-old man, we anaesthetised
him at the scene in Holborn,

it could either be cerebral or cardiac.

It has improved, but he has got...

John must think carefully
about treating Michael's heart

as any intervention he makes from here

requires the use of drugs
that thin the blood.

He could be bleeding
slowly within the skull

and that may not be
apparent on the first scan

or there may only be a small bleed

but if we were to give him our drugs
which interfere with blood clotting,

it may aggravate any tendency to bleed

and if he was to have a
brisk bleed into his skull

that would be very thr*at.

At the moment, he has got facial fractures

with some blood in his maxillary sinuses.

Having spent the last hour
thinking hard about this,

I am more and more convinced
that his heart is the problem

so I'm trying to hand
that over to my colleagues.

All right.

I think we look, just to look,

cos we have come this far,

and just to turn our
backs would not be right.

I think he is a collapse, he needed CPR,

we don't know if he had...

- so it really is a bit of a fishing
expedition, so we do it, OK? - Yeah.

John decides to do the angiogram

to try to find the cause
of Michael's collapse.

Ready, steady, slide.

Using detailed X-rays,

John looks for blockages in the
arteries supplying Michael's heart.

You inject dye into the heart arteries

and that demonstrates whether they
have any narrowing or blockages

that you may need to do something
to safeguard their future.

In Michael's case, we do see all
three coronary arteries are present,

but we also see hardenings
or narrowings within them.

Michael does have what we
call triple vessel disease,

so he does have some heart disease

and there is a possibility that
he has had a cardiac event today.

Michael was moving up the
stairs fairly rapidly

and perhaps the coronary arteries

weren't able to allow the
flow of blood and oxygen

that his heart muscle
demanded at that time,

so it may have exacerbated an event.

Although the team have found
evidence of narrowed arteries,

they are not immediately life-thr*at.

None of those narrowings
appear to be complete,

so the vessel is not entirely obstructed,

and the blood flow through the
narrowings seems to be reasonable.

The decision was to
leave things as they were

so that we could reassess the head injury

to make sure that that was
not going to be progressive,

and because his cardiac
circumstances were s*ab,

that would allow us to do that.

Michael may need a procedure

to widen the narrowings in his arteries,

but John and his team decide to
allow his brain and other injuries

time to recover before
any further treatment.

Thank you very much for
helping us, that is great.

In Newcastle, Gidia, a
young mother-of-three,

has been s*ab multiple
times with a knife.

Although her condition has
so far remained s*ab,

Sohom can't be sure Gidia
won't suddenly deteriorate.

He needs to get Gidia to
CT for an urgent scan.

The journey to CT is one
that is very fraught,

the time clock is still ticking,

and we are still not sure
what is going on with Gidia,

are there any major injuries that
we are not seeing at the moment?

OK, Gidia, we are just
doing the CT scan now

and we will look at the neck and chest

and see if there is any injury
underneath those wounds.

It will be a bit sore going across.

- OK, honey?
- Ready, steady, slide.

Having a s*ab wound to the neck

always raises the possibility in my mind

of whether or not there
could be major bleeding

that can thr*at the windpipe
and thr*at the airway.

Ten-inch non-serrated knife.

The chances for her having major bleeding,

particularly in the
left-hand side of her neck,

is still extremely high.

Gidia has been s*ab in the area
occupied by major blood vessels,

including the jugular vein.

Sohom can see from the scans exactly
where the knife has penetrated.

The s*ab wounds were
millimetres from her heart,

her great vessels around the heart
and the vessels in her neck,

by that, the carotid
artery and the jugular vein.

To the amazement of the doctors,

Gidia has narrowly avoided
suffering a severe internal bleed.

The knife has missed vital
organs like her heart.

Gidia is extremely lucky at the moment.

She has come, really, within millimetres

of the s*ab wound affecting
major vessels and organs

and, really, for her to be clear of this

is an excellent position for her to be in.

But Gidia's wounds are deep
and she will need to have

exploratory surgery to assess the damage.

We are looking at about... five inches.

That will need to be explored, won't it?

Give us two seconds.

I can see that it has gone through
the top few layers of muscle,

it has gone through the skin,

and it is a good few
centimetres deep into her neck,

and I will need a formal look
inside, in an operating theatre,

to know exactly what has been damaged

and how deep things have gone.

The main issue I am ringing
you for is for a wound

which is over the border
of the left sternomastoid.

Sohom pre-alerts the specialist
maxillofacial surgeons

who will operate on Gidia.

It is not impossible by any means

that the operating surgeons
can find an injury pattern

or bits of bleeding that
the scans did not show.

No scan ever reaches % accuracy.

Two-and-a-half hours after
being crushed by a bus,

cyclist Ben is being
rushed to emergency theatre

where consultant general
surgeon Peter Coyne

will attempt to tackle the most
urgent thr*at to Ben's survival --

the heavy internal
bleeding from his spleen.

How much has he had? He had
some on the road, didn't he?

- Five and two of platelets.
- Five of...? Blood, two platelets, OK.

The type of surgery that Ben needs
is a damage-control approach,

damage-control surgery,

and essentially, that
means opening his abdomen

and dealing with the things
that are going to k*ll him

in the next half an hour to an hour.

The anaesthetist ventilating
him is fairly happy

that his chest side of things,
at the moment, is s*ab

and the thing that will k*ll him quickest

is his spleen that is actively bleeding.

We will get control and then
get a proper look at everything.

- OK to start?
- Correct to start.

Are you? OK, starting.

To gain access to Ben's spleen,
Peter must cut open his abdomen.

Time is critical,

not only to stop the bleed,

but for every minute
Ben's abdomen is open,

he is losing heat rapidly.

What you don't want

is to have a patient on the
table for a number of hours.

By that point, he has probably got cold,

his acid levels are high

and his blood clotting
factors will be low,

and that cascade, which
we call a deathly triad,

usually means that his blood doesn't clot

and he starts oozing from everywhere,
and that is usually fatal.

The key thing is to fix what
needs to be fixed quickly

and then get him back to
ITU and get him better.

Peter uses sterile swabs to
pack the space in Ben's belly

to absorb the blood that has accumulated.

And the pack, thanks.

And again.

By putting pressure on the vessels
and organs in Ben's abdomen,

Peter stems the bleeding temporarily.

This buys him time to search for
the fragments of Ben's torn spleen.

The spleen had essentially been squashed.

It is well protected normally by the
ribcage, and it sits under the back,

underneath the ribs, and
they usually protect,

but as they have been fractured,
they have clearly punctured into it.

The spleen is a mop, it is a sponge,
and essentially, its main function

is to sponge up all the d*ad blood cells,

so because of that, the turnover of
blood going through it is very high.

He had a spleen that was
in multiple fragments

and all of those were actively bleeding.

Half a spleen.

First half.

Ben's spleen is so badly damaged,

Peter has no choice but
to remove it completely.

Second half.

'If you don't have a spleen, you
are more susceptible to infection.

'It is preferable, if you can,
to have it, but in Ben's case,'

that is simply not possible.

Thank you, could you
take Lorna's right hand?

That would be great. Could
you put a hand over there?


Peter now has control
of the bleeding artery

that supplies Ben's ruptured spleen.

I've just sutured off,
hopefully, the blood supply to it,

and then... That is great, thanks.

Have a look here again.

That is OK, don't go digging
down there. That side is fine.

But just as Peter finishes,

he is alerted to a problem
with Ben's chest drains.

The increased bubbling of the chest drains

means Ben's punctured lungs are
leaking air at an alarming rate.

At that stage, the question

is whether we need to explore his chest.

Peter immediately makes a phone call
to a specialist thoracic surgeon.

During the procedure, his left chest drain

has been bubbling quite extensively.

Ben's chest remains badly
damaged. He needs a procedure

to look for any injuries to his
airway or bleeding in his chest.

But Peter knows another
operation could k*ll him.

We suspect it is a parenchymal
lung injury on the left side,

from bony segments. We didn't know whether

you'd want to do anything about
that while he is on the table.

If he had complex rib injuries
and we were to fix those,

that would take four or five hours.


The chest guys are happy,
they think it might stop,

so they will leave him at the moment
rather than doing the operation.

Leave him for the moment, see
how he goes in ITU overnight.

The human body is a magnificent thing,

but at some point, it reaches
a point of no return.

At this stage, they thought

that going in to explore his
chest, inflate his lungs,

would be too big an insult
for Ben to get through

given what he had already been through

from his abdomen and blood loss.

The surgeons have no
option but to wait to see

if the air leaking out of
Ben's punctured lungs reduces.

Ben will now be moved to Intensive
Care where, over the coming days,

doctors and nurses will
keep a watchful eye on him.

Only if and when he recovers

can they attempt to fix
his shattered ribs.

In the operating theatre
of Newcastle's RVI,

s*ab victim Gidia is about
to undergo emergency surgery.

Consultant maxillofacial
surgeon Matthew Kennedy

needs to explore the wounds by eye

for any injuries that the
scans have failed to pick up.

Can we get a couple of skin hooks, please?

'You can only rule out damage to vessels

'once you have seen the
full extent of the wound.'

I need to be able to see into the wound

as far as that blade has travelled.

OK, that has obviously just
come in here and straight out.

One of these is just an
entry and an exit wound.

It has come down very superficially.

If you leave a bit unexplored,

there could be a small artery
that has had the end severed

and that could start
bleeding again at any moment.

Let's have a look at this one.

Matthew concentrates on the
wound to Gidia's chest.

This one is a different kettle of fish.

I'll tell you what. I'll extend it a
little bit, just to get more of...

He cuts the skin to open the wound wider

to see and feel how far
the knife has penetrated

and what it hit on the way.

I feel there is a little chip of bone

come off the clavicle in there as well.

The blade has skirted straight
over the top of the clavicle.

The knife had essentially skimmed
over the top of her collarbone.

A centimetre lower and it could have
skirted underneath the collarbone,

and then lung, major vessels,
would certainly have been injured

and it could have been a
very different picture.

Take a little bit of bone off the top.

Matthew removes a fragment
of Gidia's collarbone,

chipped off by the knife's blade.

We have to be careful, prodding
around right at the back here.

That is ten centimetres deep.

Only when he is satisfied
there is no bleeding

does Matthew stitch the wound.

Finally, he tackles the
remaining and largest wound,

on the left side of Gidia's neck.

Some more lignocaine... % with
adrenaline, , going in.

The one on the left side of
her neck, towards the back,

is quite obviously deep.

It is the bigger of the wounds,
and you can clearly see

that it has gone through the muscle there.

Matthew inserts a drain to
siphon any excess blood and fluids

away from the injured area, and
stitches the wounds closed.

Can I have a damp swab, as well, please?

Gidia's risk of internal
bleeding is now low,

but she will need to return
to surgery at a later date

to repair the damage to her muscles.

It has been nine days
since office worker Michael

collapsed in cardiac arrest
after running up the stairs.

After further tests and heart scans,

doctors have now confirmed
that Michael's cardiac arrest

was caused by the
narrowings in his arteries.

Sharp scratch in the wrist,
it is the anaesthetic.

Now an interventional cardiology team,

led by consultant Roshan Weerackody,

is attempting to widen
Michael's arteries with stents

to restore their normal blood flow.

If you have got a tube that is narrowed

and it is interrupting the
flow of blood through the tube

when the heart demands
more oxygen or nutrients,

it can't deliver that demand

and those narrowings can
cause a heart att*ck.

Roshan wants to tackle
the most severe narrowing,

in the main artery at
the front of the heart.

In Michael's case, the length
of disease is quite long,

over millimetres.

Bit of pushing at your arm, that
will be me pushing the tube in.

It might be a bit uncomfortable.

Roshan uses continuous X-rays
to help run a tiny guide wire

from Michael's wrist to the
blockage in his artery.

Just take a deep breath in, sir.

We have got the tube in the main artery

and we will start taking some pictures.

Before we put the stent in,

we inflate a balloon
to expand the narrowing,

which allows us more space
for the stent to come in,

because it is slightly bulkier.

The narrowed areas contain fatty
deposits that have calcified,

causing them to become rigid.

I can see the calcium's ridge, so
bring the fine cross back a bit.

And that's very hard material,
and simple ballooning techniques

that we have normally doesn't work.

OK, so you are going to hear a noise now.

It is just my drill, don't worry.

Come off now, please, so that
we can see the distal wire.

Roshan needs to unblock
the artery with a drill.

The diamond encrusted head of
the drill destroys that calcium

into smaller material, that
gets washed away down the artery.

The section where I have to use the
drill is probably the most critical

and most dangerous part of the procedure.

The drill head will only follow
the path of the guide wire

that is placed inside the artery,
and it will only take away

the artery wall where it
is hardened with calcium.

So, we are through the lesion.

We're through the narrowing in the
artery with the drill, so we will

stretch the artery open with the balloon

and then put a couple of stents in, OK?

So, the stent is like a mesh
cylinder made out of cobalt chromium,

a metal scaffold which is left behind,
and it'll keep the artery open.

You might get a bit of
tightness in the chest, sir.

It's just the balloon going
up inside your artery.

Can I have a - non-compliant, please?

The stent is mounted on a tiny
balloon, which Roshan must direct

down the guide wire and position
precisely within the artery.

And as you inflate the balloon,
the stent gets expanded

and gets deposited within the
artery and it doesn't move,

it stays there for ever.

So we've put one stent in.

We're going to put another one in

and, hopefully, that will
be it for this artery.

Same artery, yes.

Michael's stent contains a
drug which will help the artery

heal correctly and stop
it from re-narrowing.

The drug that is embedded in the stent

will disappear after two to three months,

and what is left behind will be
covered in the lining of the artery.

The artery, after it's treated,
it looks bigger and fatter,

and there is brisker blood
flow down the artery.

I'm just going to clean your arm.

So, this is what we started off with.

This was your main artery
in front of the heart.

We can see, in several places here,
it is severely narrowed, and now...

- That is with the stents put in.
It's much fatter, the artery. - Wow!

- You've got the stent...
- Thanks, guys.

- .. running from here to here, and
that's keeping... - All that way?

- Yes. - Blooming heck,
I didn't realise that.

Although Roshan has fixed one of
Michael's arteries, he will need

a similar procedure for any other
narrowed vessels at a later date.

- Thanks so much.
- Good stuff. OK, sir?

All right?

Gidia was literally
millimetres from death.

The scan confirms that the
s*ab wound was millimetres

from her heart, her great vessels
around the heart and her neck.

Gidia's injury pattern and
her surviving this injury

is only by millimetres.

I think she's doing very well.
I'm very hopeful for the future.

With an att*ck like this, there
are physical and emotional scars.

Physical wounds tend to heal
quicker than emotional ones,

but everyone's different.

At the moment, she is troubled with
stiffness, and I think that is due

to scarring in the muscles, but with time,

I would hope that that would
settle and she'll be able to,

before too long, put all this behind her.

Michael has gone on to have intervention,

which, hopefully, will reduce his
risk of having any further events,

and I'm glad that he got
to the hospital in the end

and that they were able to help him.

I tend to walk fast, very
fast, and going up the stairs,

I was walking very fast, and I was
just about to go round a corner

and I felt dizzy, and that's all
I know, that's all I remember.

I was taking a deep breath and
that was it, the lights went out.

Michael was very lucky that he had
colleagues at work who were near him

when he collapsed, who
immediately jumped into action.

The fact that the ambulance service
cycle paramedic was very close,

was there within a couple of minutes,

and then we were literally
only about a minute away,

which may have been the difference

between him having a good
neurological outcome as he did,

or perhaps he could have
been left in a worse state.

The people in work, oh, yes, brilliant,

absolutely fantastic what they did.

I talked to them all afterwards
and that was just fantastic,

getting to know what happened
and to know that they did that.

We have fixed the mechanical problem,

but the interim weeks and months to come,

that same process that caused
the narrowing in the artery

in the first place is not going to
go away, so we need to address that

with tablets, lifestyle changes and so on.

I think I had let myself down before
because I wasn't going to the gym

and I wasn't probably exercising enough.

I just wanted to live life to the full.

I realise living life to
the full can be done better.

A lot of patients we
see with that mechanism,

so a heavy weight crushing them,

have injuries that simply cannot be fixed.

Everything was pretty numb.

I remember sort of vaguely realising
I was under the bus and thinking,

"This doesn't hurt too much,
maybe things aren't so bad."

I remember being told it was
very important to not die,

so I did try very hard not to die,

and everybody else tried
very hard not to let me die.

Statistically, Ben really
should not have survived.

However, I think because everything
worked really well that day,

Ben did survive and he is one
of our unexpected survivors,

and that is what the team is proud of.

I've got to take antibiotics
for the rest of my life

because of the lack of spleen.

That's just a couple of pills each day.

I should make an almost
entirely full recovery.

You do realise that things
could have been very different.

So, yeah, you step back and think,

"I could very easily have not been here."

It's strange sometimes, you almost
feel a little bit like a ghost.
Post Reply