01x09 - Episode 9

[bunniefuu]

You'll be charged with serious professional misconduct.

You'll destroy my career?

Changing room fire, someone trapped. Member of staff.

It's definitely Lorraine.

She d*ed en route.

She didn't even get there. You bastard!

There's something I need you to see.

The guy doing the sh**ting is meant to be one of ours.

We sh*t him three times. He was your friend?

He was. I thought I knew him.

You couldn't save him.

I wasn't trying to save him. It was completely the opposite.

Male, 30s, drowner, two minutes. Yep, got it. Thanks.

OK, male, 30s, got into difficulty while swimming in the river. Probably some pisshead.

Ground escort via TAS. That's all we've got so far.

12 cans of Super - ten quid.

Helicopter and a week on ITU - 10,000 quid.

PA: 'Major Trauma, ETA one minute.'

Justin.

Yeah, run it off, mate.

What's up with Justin?

Orthopaedics night out.

Is there a date for Lorraine's funeral?

I haven't heard from the family.

I'd like to be able to pay my respects.

I'll make sure you get the information. Thank you.

(Siren)

Oh, God. Uh. Follow me!

The call was for a 30-year-old.

13.

Oh, right. This way!

We know, mate.

Nice and controlled.

This way.

Wild guess he's pulseless.

They really ought to stop pumping on his chest.

Oh, God.

Oh, sh*t. Paeds trolley! I thought he was meant to be 30.

Well he's not. I'll fast-bleep paeds.

Starting the clock.

Can you fast-bleep the on-call Paediatrician to resus, please. Thank you.

How old is this patient?

Year eight, he's about 13.

I suggest on my count you stop CPR, we transfer on the scoop, and we then resume CPR.

OK.

Justin, are you OK for chest compressions?

Yeah.

Great.

Ready to transfer.

Yeah I've got the head.

Off the chest.

Transfer on three. One, two, three.

This marks the first cycle of CPR.

We're 28 seconds in.

Help yourselves to some new blocks, boys. Cheers.

Scoop out. Yep, top.

Justin, off the chest.

Brace to the patient's left on three. One, two, three.

Brace right on three, everyone ready? One, two, three.

Justin, back on the chest.

We're bagging on 100% O2 at 15 litres a minute.

Struggling to auscultate chest cos of compressions.

Justin, on my order, pause compressions.

No not now! I said on my order.

Sorry.

Well, you've stopped now so you might as well stop.

Sorry.

Thanks, man.

Restart compressions, please.

(Sings quietly)

♪ Well, you can tell ♪

♪ By the way I use my walk ♪

♪ I'm a woman's man... ♪

Decent enough ventilation on both sides.

Monitor's showing asystole.

Let's get the bear hugger on and get him cabled up.

Already done it.

Thank you.

Have we got any of his next of kin yet? He needs his parents with him.

We'll get to that.

Could you hold that there, please?

Yeah.

Patient size, 157cm.

Calculating approximate weight.

1.57 squared is about 2.5. BMI looks lower level of normal, say 18.

18 multiplied by 2.5 gives us 45 kilos.

Yeah. Well done, Harry.

Let's make sure we've got some warmed liquids, please?

Yes, Mr Boyle.

Thank you, sister.

Oh, sh*t.

Justin! You bloody idiot!

Nerys. I'm really sorry.

OK, just take it easy.

Mouths: I'm really, really sorry.

Sorry. I shouldn't have shouted.

Can I borrow a light, please?

Yeah.

Pupils very sluggish.

Coming up to three minutes.

Amiodarone and adrenaline?

Adrenaline only.

There's no point doing anything if the core temperature's below 30.

Let's get a temperature.

Who's going to do that?

I can do that. Thank you.

Starting primary survey?

Please. Paeds.

Perfect timing.

Sorry to keep you guys waiting.

Everybody, nice and quiet and give our full attention to TAS, please.

Thank you. Patient is Ryan Curtis,

13 years of age.

At just after 1400, a couple of younger lads got into some difficulty swimming in the river.

We understand that Ryan swam against strong currents to get them to the bank, where they were helped by bystanders, but Ryan got pulled under, and was in the water for close to ten minutes.

Bystanders administered CPR.

Helicopter on scene at 1425.

Patient showed no signs of trauma.

Patient was not breathing spontaneously, had absent carotid and femoral pulses, and was cold and blue.

The portable monitoring showed asystole.

Patient was intubated at the scene and bagged with 100% oxygen.

Chest compressions given continuously.

Bilateral thoracostomies.

IV cannulation of left ACF.

0.4mg of adrenaline given at 1430. Bubble wrapped.

Due to the ongoing CPR, we made the decision to escort him here via ground ambulance.

Thank you. Any questions for TAS?

Any alcohol ingestion?

Denied by everyone at scene, and no evidence of alcohol at scene.

Come and sign, please.

OK, let's get these blocks off.

Primary survey completed. Surgical scar on the right lower quadrant.

No clinical evidence of trauma.

Thank you.

To me, Dr Bennett-Edwardes.

We should borrow an IVC probe from ITU.

Happy to get that for us, Dr Bennett-Edwardes?

It'd be my pleasure, Dr Chandramohan.

Billy, do you mind?

Yes, Miss Bennett-Edwardes OK, boss, that should give us a more accurate core temperature.

Fluids are warming. Thank you.

Temperature is below 30.

No dr*gs to be given.

I believe you've got a Lucas.

We do.

I'm fine. I love this bit.

Let's get it, please.

Coming right up, Mr Boyle.

Thank you, Sister.

Anything more for TAS?

No. It's good to meet you.

Thanks, guys.

I'll call later. My Boyle - fingers crossed with this one.

We're going to start warming this patient up.

I want a femoral line.

I want an NG Tube.

I want pleural irrigation.

I want a urinary catheter.

Now, please.

Femoral line.

Pleural irrigation. Pleural Fluids should be warm by now.

NG Tube.

You OK to do the catheter?

Sure. Thank you.

Want to vent this kid, boss. Do it.

You know, I've got this if you need to get a coffee.

I'm fine.

I'm here.

I'm on this.

OK.

Beep, beep, beep, beep, beep.

You OK, Justin?

Yeah.

Breathe in, boys.

Acidic gastric contents.

NG Tube is in position.

(She seems to be taking it all right. Harry. The break-up.)

(Is it over, then?)

(Got to be professional.

(Thing is, at my level, you can't be seen to mess about with...)

(So she's single now?)

Left thoracostomy patent.

Warm saline running into the pleural cavity. Good.

Warm saline filling bladder.

Right thoracostomy patent.

Warm saline running in. Got it.

Justin, off the chest, help me lift him.

Don't fire that up till I get there. OK.

Yep.

Warm saline now running in via the femoral line.

I won't re-connect to the ventilator straight away in case there's still some water in the lungs. OK.

How we doing?

Ready to go.

OK. Justin, off the chest.

Better out than in.

Hi, boss. It's Jenny.

The trauma call is a 13-year-old drowner, asystolic at a core temperature sub-30.

How's it going?

We've just started warming him up.

The optimal rate for rewarming a quick hypothermic is one degree every five minutes.

Yes, that's very helpful, thank you.

No trauma. No significant PMH.

No dr*gs. No interventions below 30.

The way you treated Lorraine was disgusting.

God only knows how you can live with yourself.

What Lorraine did to herself was a shock to us all.

Did to herself? You drove her to it!

Lorraine's death is a tragedy that affects us all, but we must remain professional.

Now, this situation seems to be under control.

You're needed back in the ED, Sister Campbell.

Fine.

Clive?

Mm-hmm?

Sorry about that.

Not your fault. Only to be expected.

OK.

ITU's miles.

Great. Dr Bennett-Edwardes, can you assist me, please?

Certainly, Dr Chandramohan.

ITU used to be called Intensive Care...

Till they realised nobody did.

Connect up, please.

Connected. OK.

Temperature 28.5.

Yeah, it's got to come up faster.

We're going to move to bypass.

Someone fast-bleep the trauma theatre, please.

I'll fast-bleep the perfusionist.

Someone fast-bleep the theatre trauma staff.

I'll do it. Thank you.

Fiona Lomas, trauma fellow.

Can you fast-bleep the perfusionist to trauma theatre, please?

Hello, this is trauma resus.

Can we fast-bleep the theatre staff to trauma theatre, please?

Thank you.

Dead eyes.

He's not dead until I pronounce him dead.

Sorry.

Right. If you're going to theatre, I'll leave you to it.

My consultant said she's happy with your management and to contact us if anything changes.

OK.

And thank you.

Is this a bad time?

I've got a relly in.

It's the dad.

Harry, can you print out a consent form two and bring it to the relatives' room?

Thank you.

We'll be a good five minutes here.

See you in theatre. Yeah.

Is there something you want to say to me?

A combat surgeon overcome by the stress of the moment? No?

Oh, OK.

So you don't want to hear from me.

You just want to judge me.

You showed me something shocking.

The man I saw in that film isn't the man I know.

It's the man standing in front of you now.

Well, that scares me.

Yeah, and it scares me too.

I want to understand.

He was bleeding internally and I went to him to save his life.

And then...

And it was in that moment, with my fist wrapped around his heart.

I just... I just squeezed.

Till I was squeezing the life out of him.

I hope that's understandable enough for you.

This is Mr Curtis, Ryan's father.

Glen Boyle, I'm the consultant.

Fiona Lomas, I'm the registrar.

Please.

Mr Curtis, what I'm about to say will be difficult to hear but I have to be straight with you.

You should understand that I think Ryan still stands a chance.

We haven't given up on him, and we are still doing our very best for him, but so far we've been able unable to get his heart pumping again.

Ryan's hypothermic, which means his body can survive longer without a heartbeat.

When will you know?

We're taking him to an operating theatre now, to try and accelerate the rewarming process.

We're going to put him on a bypass machine that will warm up his blood.

It's only when his temperature's nearer normal that we'll know for sure whether or not we're going to be able to get his heart pumping again.

Do you have kids?

No.

You?

No.

It's OK, it's OK.

It's OK, Mr Curtis.

I'm sorry he asked about kids.

It's OK.

I don't fall apart every time someone shows me a baby photo.

No. Still, I'm sorry.

I've told you why I think you came here.

One way or another, you thought it would fix things.

I don't know.

Including between you and me.

Like I said, I don't...

I don't know.

Constance?

The bastard.

No. Go to theatre.

Go.

You people. God, you make me sick.

You're emotional, which is why you're failing to consider your own professional security.

I think it would be in your best interests if I were to disregard your remark.

Clive will pay for this.

Take his side, you'll pay for it too.

It didn't happen just because I was off my face.

You're a sweetie, Justin.

But let's be sensible, yeah?

Oh.

Right.

Cheers, Billy. No worries.

See you in a bit.

(Text message chimes)

Sister Campbell's been suspended.

Right. You take that.

Mrs Hicklin. You know this reshuffle in orthopaedics?

Yeah, I heard something about...

They offered me a band seven post and I'm going to take it.

This'll be my last trauma call.

Before you ask, yes, it does have something to do with the way that this department is run.

Nerys...

Save your breath, love.

I won't be here next week, and that's that.

I should lead.

Vascular procedure.

Of course.

Patient remains asystolic on Lucas.

Been undergoing CPR for nearly half an hour in hospital.

And, including pre-hospital care, patient has shown no signs of life for 45 minutes.

Baseline ACT...

This patient is not dead until he is warm and dead, do you understand?

Erm, yeah. That's fine.

The baseline ACT's normal.

Blade.

Give a bolus of heparin.

Swab. Diathermy.

Thank you.

Forceps, please.

Sorry.

Yes, Harry?

I got your form signed, no problem - but the dad's asking all sorts about the bypass?

We're inserting tubes into the femoral artery and vein at the top of the thigh, so we can divert circulation through the bypass machine.

So when it flows back into the patient, it increases the temperature throughout the entire body.

Thanks.

Harry?

I'm also going to put in a perfusion cannula to stop the leg becoming ischaemic.

Got it.

I'll get the form.

Erm, I can take the consent form, if you like.

Oh, it's OK.

Better safe than sorry.

How's the operation going?

All right.

Yeah. It's...

It's all right.

We look alike.

What?

I mean, you're, like, a much prettier version. And a girl.

Obviously.

OK.

They say that, don't they, they say that people fancy people who look like them.

I'm not sure they do say that.

It's like brother and sister, separated at birth, meeting up, like, 20-odd years later and getting off with each other.

Not that you're like my sister.

I wouldn't want to go out with my sister.

See you later.

See ya.

Travis.

Forceps and Lahey, please.

Sling.

Haemostat.

Thank you.

Sling.

Haemostat.

11 blade, please.

Cannula.

Clamp, please.

Artery cannulated.

Moving on to the vein.

That's good.

Did you get a bite yet?

Erm, what do you mean?

Any takers for the Fiesta?

Oh.

Oh, no, just tyre kickers.

It's a good runner though.

Why, are you interested?

Me? No.

My motor's not in the same league as your motor, is that what you're saying?

I'm happy with the one that I've got, that's what I'm saying.

Cannula, please.

Hey, want to buy a car?

(Person on phone laughs)

Sorry.

Vein cannulated.

Perfusion cannula.

Clamps and tubing shears, please.

20mls.

Clamp off.

Thank you.

Clamps off.

OK to go onto bypass?

OK - heparin IVI is going, ACT is good.

Go for it.

Onto bypass, please.

Going on bypass.

Happy for the Lucas to go off?

Yeah, happy.

Lucas off.

Vent on standby.

Patient's circulation is now on the bypass pump.

28.5.

29.2.

29.7.

Threshold.

As of now, we shock any shockable rhythm. Yeah.

Temperature coming up steadily.

OK.

Tannoy: 'Trauma call, ETA 15 minutes. Trauma call, ETA 15 minutes.'

There's timing.

Someone go and find out what that is, please.

Ventricular complexes.

And again.

Come on.

Another.

Come on.

Picking up a rhythm.

Temperature rising steadily.

Motorcyclist, bullseyed a windscreen.

Injuries?

Critical.

Well, this guy's under, so can you see if Dr Busby can cover me, please?

I'll see what I can do, Dr Chandramohan.

(Flatline tone)

Lost rhythm. Yeah.

Back to asystole.

So, adrenaline straight away. Yeah.

I've got this.

You should see to the motorcyclist.

No.

This one's mine.

If you need me, I'll be right here.

OK.

Still nothing.

Let's keep the temperature going up, please.

34 degrees.

Let's hold the temperature there, to protect the brain.

Boss. Yeah?

OVER INTERCOM: 'Sorry, Glen.

He's been down a long time.'

His temperature's just passed 34 degrees, so...

It's Fiona. I need information on the incoming motorcyclist, please.

Bloods?

There is nothing in the blood profile to support a treatable cause of cardiorespiratory arrest.

Here we go again.

(Flatline tone)

They're saying the motorcyclist is very bad.

I see nothing but agonal rhythms.

This is my case.

And we're going to keep going.

OK, Glen and I need to talk.

Please do.

Glen?

I'm not giving up on this one.

Don't make the mistake of thinking it helps, if for every one you lose, you save one.

I need to be here, I need to be doing my job right.

We'll assess the motorcyclist when he arrives, but I don't even know if there's an available theatre upstairs yet.

Fine. There's a possible incoming.

If so we go to recovery or we go back to resus.

I'd rather you didn't.

He stays here.

If you can't get a pulse, you pronounce him.

You've got five minutes.

Coming up to 46 minutes, the patient is still down, no signs of life.

Yes. We'll keep you informed, yes.

What's the incoming?

Motorcyclist. Major trauma.

What's going on with the hypothermia?

I asked you a civil question.

Still down. We wanted to move him but Clive said no.

That's not right. We'll need theatre for the motorcyclist.

Exactly.

Clive, hi. Yep.

I'm puzzled.

What about?

We need to clear theatre.

We will do, once the hypothermia's been pronounced dead.

Maybe I'm being thick...

You know, we used to be the best performing unit in the region.

Now we have the highest mortality rate. You want to know why?

Because we take all the critically injured patients.

Now, the worse your injuries, the greater the likelihood you'll succumb to them.

Try broaching that statistical no-brainer with the DoH.

That patient cannot be an ED death.

He has to be a trauma death.

He has to be pronounced in theatre.

And the motorcyclist, should he succumb to his injuries, should also do so, not in resus, but in theatre.

Tick-tock.

(Door slams)

Incoming Major Trauma, ETA now nine minutes.

Mrs Hicklin, I just had a call through from the chief exec's office.

What was the message?

There's no message, but she wants you to call her back ASAP.

Thank you.

That's 48 minutes.

Give adrenaline.

No.

It's time to call this off.

Get out of my theatre.

Point of information, it's not your theatre.

Stop resuscitation and pronounce him.

He's not dead until he's...

He's dead.

Warm and dead.

Well, I haven't pronounced him and no-one is going to pronounce him until we have exhausted all of our options.

They are exhausted. That's my point.

Adrenaline, 0.4mg IV, given.

Clive.

Oh, good. You can talk some sense into these two.

Clive, you're relieved.

The chief executive has made me acting clinical lead.

You?

How?

She asked me and I said yes.

No way.

Check your e-mails.

Someone from HR will take you through your exit protocol.

Manage this case as you see fit.

I've secured space in theatre upstairs for the incoming major trauma.

Thank you.

You're welcome.

Get in there if you want.

Really?

You've been champing at the bit for weeks.

Ventricular complexes.

Come on.

Harry.

No output.

Pulseless VT.

Harry, defib.

Yes!

150?

Yes.

Defib unit: '150 Joules selected. Charging. Warning. Stand clear.'

Everyone OK to clear?

Shocking in three, two, one...

Shocking.

No output.

51 minutes.

Let's defib and try again in two minutes.

Can we have 0.4mg of adrenaline and 200mg of amiodarone ready to go in for the next cycle, please?

Coming right up.

On it, Debs.

Rhythm's becoming less organised.

Don't do this. Don't do this.

Come on!

SVT.

Strong output. Good output.

Sync shock, 50.

Defib: 'Synchronised 50 Joules selected. Charging. Charged. Prepare to cardiovert. Warning. Stand clear. Warning. Stand clear.'

Shocking.

Refractory SVT. Output fading.

Losing output.

Hit him with 100. Quickly, please.

Synchronised 100 Joules selected.

Charging. Just do it!

Shocking.

Output dropping.

150, hit him, fast as you can.

Shocking.

Sinus!

OK. OK, what've we got with that?

Good output. Sinus holding.

Got a good blood pressure.

We've got Rosc. I want to see if his heart can hold its own.

Pump to three-quarter flow, please, now.

Three-quarter flow.

Back on vent.

Three-quarter flow.

Sinus holding. BP...

..dropping.

Holding.

Half flow.

Half flow.

Half flow. Sinus holding.

BP... holding.

Yep. Quarter flow.

Quarter flow.

Quarter flow.

Sinus holding.

BP...

..holding.

Clamp and fully off.

Do it.

OK. Bypass off.

BP dropping.

Dropping.

Holding.

BP holding.

Patient in normal sinus rhythm.

Tannoy: 'Major trauma patient ETA now one minute.'

Pupils contracting.

Sluggish, but contracting.

Well, we should get this kid an ITU bed.

(Glen laughs)

If, when the cannulae are out, that's job done here?

It's a job done.

Our trauma team have managed to restart Ryan's heart.

It's b*ating strongly.

Hi, I'm after a Picu bed for a post-arrest hypothermic recovered to sinus after 59 minutes' CPR.

Let's have the other Dardik, then a 4-0 Prolene, round-bodied, please.

Yeah, it's Ryan Curtis,

06-3-02. OK, thanks.

I'm grateful you're here.

I'm grateful you came running, when I called.

Cannula out.