One Wrong Move Could Be Catastrophic As Doctors Suspect Injury To Major Artery | Emergency S4 E5

[00:00:01][music] Good morning, Royal Melbourne. I've got a 70-year-old male in a bike versus car.

[00:00:07]He does have a penetrating injury on the left side of his uh trachea.

[00:00:12]>> Penetrating injury to his neck.

[00:00:14]>> What?

[00:00:15]>> Looks like a piece of glass. We're not sure how deep it might be. We're not going to touch it, >> but it's anything.

[00:00:22]>> We're hearing that uh a push bike rider has uh collided with a car and he's hit the windscreen. He's got um some glass sticking in his neck. That makes us worried straight away cuz there's a lot of blood vessels in the neck that can get cut.

[00:00:38]>> Do you guys know where they put a former alert, please?

[00:00:41]>> The patient is 75year-old Hugh, who was riding his push bike when a van reversed from a parking space and hit him.

[00:00:51]>> Oh, well, I reckon it's more more than what we thought. Hugh, who regularly cycles over a 100 kilometers a week, hit the back window of the van, shattering the glass.

[00:01:01]>> Are you worried about his uh bleeding neck?

[00:01:03]>> We've got to be very careful and very attentive to this piece of glass that he happens to have stuck in his neck and properly work out what structures have been damaged. Just go nice and slow cuz he does have a shard of glass stuck in his neck.

[00:01:18]>> Rolling on three. 1 2 3.

[00:01:22]Back to three. [music] Okay, just relax and we'll do it all for you. Okay, on three. 1 2 3.

[00:01:29]>> Assisting Dr. Jonathan is emergency doctor Emanuel Kathus who starts delicately assessing Hugh's injuries.

[00:01:36]>> This is Hugh. He's a 75year-old male. Uh lives at home with his wife.

[00:01:41]>> Nice and steal.

[00:01:42]>> Was riding his bike when a car reversed into him, hitting his head on the glass.

[00:01:48]my hands.

[00:01:49]>> Traveling at 20 km an hour cycling.

[00:01:53]>> Okay. Yes. So, it's a sort of a low impact, but something cut his neck.

[00:01:57]>> Yeah.

[00:01:57]>> Yeah. I don't think we're going to get a collar on him because of the neck wound.

[00:02:01]>> All the things I'm worried about live in the neck. If he cuts his corroed artery, he could bleed very quickly. Um, can be in a lot of trouble very quickly.

[00:02:09]>> My name's Ebony. I'm one of the nurses.

[00:02:12]How's your pain going? Hugh's facing a very scary moment because I don't think he even knows how dangerous and serious this is.

[00:02:20]>> How did you go, Manny? What did you find?

[00:02:22]>> So, what we've got?

[00:02:23]>> They quickly [music] assess if he has any other injuries.

[00:02:26]>> We've got a intact airway. He's breathing spontaneous. He's on his own at the moment. He has a shot of glass on the left side of the neck.

[00:02:33]>> The fact that he's awake [music] and talking to us um without making any obvious gurgling airway sounds means that his airway is okay. Hugh's wife, Nolene, was at home when she heard her husband of 44 years was in an ambulance heading to the ED.

[00:02:49]>> The police rang and they said, "Hugh's been in an accident." My heart stopped and I just I couldn't believe it. It's just dread. You hope to goodness that everything's going [music] to be okay.

[00:03:02]>> I haven't taken that bandage now, I guess. Do you want to do it now?

[00:03:04]>> Yeah, let's do it. This is the first time they see if Hugh's injury could kill him, >> I think.

[00:03:13]>> Oh, that's I see. That's what I thought I saw. Yeah.

[00:03:15]>> Yeah. How much do you want me to >> Well, why don't we go everything apart from >> Don't move your head.

[00:03:21]>> We'll keep it in the spot. We'll take everything else off around it.

[00:03:25]>> Yeah. I'm not actually expecting a huge shard of glass sticking into his neck like, you know, someone stabbed him with a shard. That's It actually looks like that. So, he's got that little thing there. Yeah.

[00:03:36]>> And he's got this guy.

[00:03:37]>> Oh, he's got a bit of swelling up there, too.

[00:03:39]>> All right.

[00:03:40]>> Is that clavicle or is that swelling?

[00:03:43]>> Yeah, it's swollen, doesn't it? Yeah.

[00:03:45]Oh, he's got a big He's got a big hematoma.

[00:03:47]>> That swelling may represent active bleeding. That's a sign to us that there's probably an artery involved and we need to be dealing with this absolutely urgently.

[00:03:57]>> It could have hit the vein for sure.

[00:03:59]>> I'm touching it anymore. No, >> they know if they make a wrong move, the consequences could be catastrophic.

[00:04:07]>> Where's that piece of glass? What's it sitting on? What's it next to? It's critical situation.

[00:04:13]>> How are you feeling there, mate?

[00:04:15]>> I feel fine.

[00:04:17]>> You've got this little thing sticking in your neck and it might have hit the vein. Um, so we're going to get a a scan and see exactly where that is before we pull it out. If the piece of glass comes out and it's actually sitting in the artery and plugging the artery and it falls out, um, he will just bleed like stink out of his neck. Um, and he could be dead within minutes. So, we're going to leave it in and scan it and then pull it out after that.

[00:04:42]>> Try not to move that head of yours. All right.

[00:04:44]>> I'm constantly reminding him just to stay nice and still. Try not to talk too much because every time he talks, this piece of glass is moving as well.

[00:04:53]>> Wow.

[00:04:55]That was worth getting worried about.

[00:04:57]>> Does it hurt in your swallow?

[00:05:00]>> Just careful. Careful.

[00:05:03]>> When Q is reaching across. That is certainly quite a hearttoppping moment.

[00:05:10]>> Case numbers are starting to build.

[00:05:13]Paramedics arrive with mother of two Cindy who's unconscious after a series of lifethreatening seizures.

[00:05:20]>> What's the patient in recess six?

[00:05:22]>> Emergency Dr. Michelle Thornnehill acts fast. The 37year-old's life is in danger.

[00:05:28]>> I was just thinking, well, there's just the coloring here cuz it almost looks a little bluish. When I lift the mask off, I think her lips do actually look a bit blue. It's actually a pretty ominous sign cuz it can mean that they're very low on oxygen.

[00:05:41]>> Open your eyes for me.

[00:05:43]>> Open your eyes.

[00:05:45]>> The team know it could be fatal if they don't get enough oxygen into her immediately.

[00:05:50]>> This is Cindy. She's 37 years of age, works at Melbourne airport, lives at home with her partner. She's at approximately five reoccurring chronic seizures with no return to consciousness between them.

[00:06:04]>> So, you go ahead. I'm just going to come up here.

[00:06:07]>> Cindy's partner is at home with their two young children, so can't be with her now.

[00:06:12]>> All right, there. Give us some deep breaths.

[00:06:15]>> Cindy's status is life-threatening [music] at the moment. If she doesn't get the critical oxygen that she needs and she keeps seizing, then she can have lifelong brain damage.

[00:06:29]>> She's localizing.

[00:06:32]>> The young mother's seizures haven't stopped. She's deteriorating fast.

[00:06:37]>> As soon as I identify the critical nature of Cindy's illness, I realize that I need more hands on deck.

[00:06:45]>> Martin, it's Michelle. I need help in recess 6. Thanks. Bye.

[00:06:51]When your colleague says that they need a hand, you drop everything and go.

[00:06:55]>> Can you [music] just take that phone and hang it up for me?

[00:06:59]>> All right. And then I need someone to back. Yep.

[00:07:02]>> If they can't get enough oxygen into her, Cindy's life is at risk.

[00:07:08]>> What's Martin on here?

[00:07:10]>> Hi. So this lady 30s something seizure history had basically status epilepto about four or five recurrent seizures didn't recover.

[00:07:20]>> We've got a seizure.

[00:07:21]>> Yeah. So we're definitely going to proceed to intubation. Guys, just to be clear, >> it's immediately apparent to me that this is a life-threatening situation.

[00:07:33]>> Did Could we plug in the nasal prongs, please? We need to put her in an induced coma and put her on a breathing machine, which would both stop any ongoing seizures and deliver the oxygen that she vitally needs to her organs.

[00:07:48]>> So, let's try to optimize this oxygenation while we can. We think she's had no seizures for 2 years.

[00:07:55]>> Every second counts.

[00:07:59]>> All right, I'm just going to give her some to settle her down.

[00:08:02]>> Try to relax for me.

[00:08:06]Dr. Martin start sedation.

[00:08:12]>> Okay, dear.

[00:08:15]>> Try to relax for me.

[00:08:20]>> All right, I'm just going to give her another 40 of propol.

[00:08:23]>> Cindy has to be stable before they can put her on life support. Yeah, >> work quite nicely.

[00:08:29]>> There we go. Look at >> that. Woo!

[00:08:32]>> Oxygen's coming back off now. Look at that for a blood pressure.

[00:08:36]>> Brilliant. Thank you very much.

[00:08:39]>> Finally, they've stopped [music] Cindy's seizures. Dr. Michelle can now start to insert the breathing tube.

[00:08:46]>> I'm happy to proceed. Martin, this is critical. She could die from this.

[00:08:51]>> All right, everybody. Ready?

[00:08:59]>> Does it hurt when you swallow?

[00:09:02]>> Just careful.

[00:09:04]a little stone just on the left side.

[00:09:06]>> 75year-old Hugh has nearly touched the shard of glass that's embedded in his neck after a serious cycling accident.

[00:09:13][music] >> So Hugh, thanks for trying to help out.

[00:09:16]Just so you know, there's a shard of something sticking out of your neck. So don't go peeling around there. Just >> When Q is reaching across, my mind immediately is thinking there is a potential here that it may be accidentally knocked and dislodged.

[00:09:29][music] If it moves, he could bleed to death.

[00:09:33]>> Can you order me a scan and get me an angio?

[00:09:36]>> Um, so man, do you want to do the ultrasound of his chest and do the tummy?

[00:09:40]>> Dr. Jonathan needs [music] to make sure that Hugh doesn't have any hidden injuries before moving him to the CT scanner.

[00:09:47]>> I'm just going to have a look with the ultrasound probe. Okay.

[00:09:50]>> People who've got a a stab wound to the neck can sometimes puncture the lung or hurt some of the structures in the chest. So, we have to make sure he hasn't done that as well. And I'm trying to rule out any other injuries while we're there.

[00:10:01]>> I think he's hit the uh the jug of the vein.

[00:10:05]>> Hi, it's Jonathan. Can I get a mobile chest and pelvis in trauma one, please?

[00:10:09]Thanks, mate.

[00:10:12]>> Anything on [music] ultrasound, Manny?

[00:10:14]So, the left lung up, >> Manny or not?

[00:10:17]>> Yeah, lungs are up. Sorry.

[00:10:18]>> Lungs are up.

[00:10:18]>> Yeah.

[00:10:19]>> Hugh's lungs are working normally.

[00:10:22][snorts] >> What I think we should do is put a bit of tape on the actual gauze that's holding the glass. so it stays still.

[00:10:30]We're either going to have to hang on to the piece of glass or hold it in place.

[00:10:35]Um, so I elect to try and tape it or at least stabilize it so it won't move because any movement is going to make it worse.

[00:10:47]>> While Jonathan's taping this piece of glass up, I'm holding my breath.

[00:10:54]>> Um, did you want to put something?

[00:10:55]>> No, I'm just going to do this.

[00:10:57]Oh, I bumped the piece of glass and it moves. That's not good. Have to be very careful here that I don't actually dislodge it myself. The idea being that that shouldn't move too much. All right.

[00:11:08]You okay?

[00:11:08]>> Yeah, I'm fine. Thank you.

[00:11:10]>> All right.

[00:11:10]>> Getting the required scans of Hugh's neck without touching the glass is extremely nerve-wracking.

[00:11:18]>> Go right up to it, but don't touch it.

[00:11:22]>> Is it sitting in the vein?

[00:11:24]It's important to look as closely as we can with the ultrasound probe.

[00:11:28]Potentially it gives us an indication [music] of the depth of the injury. I'm very very mindful of not inadvertently knocking on that shard, dislodging it and causing any greater damage.

[00:11:40]>> Looks like it's moving.

[00:11:44]>> I'm trying to be really cool.

[00:11:45]>> That's all right. I just want to have a look.

[00:11:48]>> That's a foreign body there. See that?

[00:11:50]There are things that can happen when glass or foreign bodies enter [music] blood vessels. A piece of glass can actually get into the blood vessel, float upstream, and you could have a stroke.

[00:12:00]>> Oh, what's that?

[00:12:01]>> Yeah.

[00:12:02]>> What the hell's going on there?

[00:12:10]>> Airport worker Cindy's had a series of life-threatening seizures.

[00:12:14]>> We're definitely going to proceed to intubation, guys.

[00:12:17]>> Dr. Michelle's about to put her on life support to take over her breathing.

[00:12:22]>> Everybody ready? I'm going to have a look. Yeah, >> perfect. Epigotus and I can see cords.

[00:12:35]>> Now, Dr. Michelle inserts the [music] breathing tube into the lungs.

[00:12:39]>> Feed the tube over, please.

[00:12:44]You have the bougie.

[00:12:46]>> Good. Can you give me a bit of backwards? Yeah, a little bit more backwards if you can.

[00:12:56]If it's in the wrong hole, we might be pushing air into his stomach instead of her lungs. So, it's a really critical point in that procedure where time [music] seems to stand still. Excellent.

[00:13:09]That's over. Bougie out.

[00:13:12]Good. And let's get >> cup up. Perfect. And go ahead.

[00:13:17]>> It's critical the tube is in exactly the right position.

[00:13:22]>> So I am 22 at the lips. Have a CO2 trace. We have direct visualization.

[00:13:28]Would you mind just having a quick listen? I get Martin to listen to both sides of her chest to check to see that air is flowing equally into both sides.

[00:13:39]>> That sound all right.

[00:13:41]>> You're in the right hole. There's more entry on the right side than than the left.

[00:13:46]>> All right. Okay. Ready? So, tube clamped.

[00:13:52]>> They remove the manual pump. The machine takes over Cindy's breathing.

[00:13:57]>> We just took off that entitle from there and it's going through over here.

[00:14:02]>> The oxygen levels are coming up, but we need to check the state of the lungs and the easiest way to do that is to get a chest X-ray.

[00:14:11]Martin, did you get a hold of X-ray?

[00:14:13]>> Uh, they promised me they're coming immediately.

[00:14:15]>> Excellent. [music] Thank you.

[00:14:19]>> All right. Well, it's maintaining. This is not going down.

[00:14:24]>> Excellent. Hi.

[00:14:27][music] >> X-ray.

[00:14:36]>> Stay on the Yeah, we're in the rock place.

[00:14:39]>> Great. The tube is fine. And it's like, yeah, well above the karina, so it's not down the right way.

[00:14:43]>> Cindy is stabilized, but until they know why she's having seizures, her life is still at risk.

[00:14:49]>> Yeah, X-ray looks great. I'm going to book her a CT brain.

[00:14:53]The next step is to get a CT scan to see if we can see any changes on her brain that may have caused this to happen.

[00:15:01]>> All right, so we go all the way slowly on three. 1 2 3.

[00:15:07]Absolutely. We're having a look at her brain. We're making sure there are no bleeds on the brain or anything to suggest a tumor or a mass there.

[00:15:23]Just looking to see if there was a big bleed or anything.

[00:15:27]31 still at the moment.

[00:15:31]>> All done. Done. Thank you.

[00:15:34]Luckily for Cindy, there don't seem to be any abnormalities at first look. So, for now, it looks okay, and we just need to go the next steps further to figure out what's caused Cindy to have all these seizures today.

[00:15:52]Well, she's definitely not out of the woods [music] yet. Cindy's still critically unwell. She needs to be admitted to the intensive care unit where they can keep a close eye on her.

[00:16:03]It's up to the neurology doctors and the intensive care specialists to further manage and figure out what's caused Cindy to have all these seizures today and what can be done to prevent them in the future.

[00:16:25]So, this lady's in her bed now. We should just go have a look at her.

[00:16:28]>> Emergency Dr. Scott Taylor is about to meet his next patient.

[00:16:32]>> We're expecting a lady in her 90s uh who sounds like she's probably broken her hip uh or something around her hip. And we know that these sort of injuries um are pretty good predictors of of people dying within the next 48 hours.

[00:16:48]>> Hello there, >> Phyllis. I'm Scott, one of the doctors.

[00:16:51]>> 94year-old Phyllis has fallen badly while getting [music] out of the shower.

[00:16:56]What do you remember happening?

[00:16:58]>> I just fell.

[00:16:59]>> Mhm.

[00:17:01]>> I went down so quick. Well, the older you are and the taller you are, the quicker you go down.

[00:17:08]>> Phyllis has lived alone since her husband died 13 years ago.

[00:17:12]>> Just have a look at your pelvis here.

[00:17:14]So, this is the sore side, is it?

[00:17:16]>> It's sore in here.

[00:17:18]>> Yeah, there.

[00:17:19]>> Sore in there. Okay.

[00:17:20]>> Dr. Scott suspects she has a broken hip and a possible head injury. Did you hit your head at all?

[00:17:28]>> Don't think like that.

[00:17:29]>> Okay. You're conscious the whole time?

[00:17:31]>> Yeah.

[00:17:33]>> You saw anywhere other than your hip?

[00:17:35]>> Just that whole leg?

[00:17:36]>> The whole leg. Okay. It's quite obvious after the initial assessment that she's either broken the neck of her feur um or or potentially the upper part of her feur um below the hip joint. How long did it take you to get to the phone? Oh god, I don't know.

[00:17:54]There he was. I was scaring around his back. [music] >> Okay.

[00:17:58]>> I only got the phone down on himself.

[00:17:59]I'm laying on the back on the floor. I rang his brother. [music] >> Phyllis's brother Eric lives a 30inut drive away. Oh, the shock of her life because she rang me saying she had a fall [music] and uh to see her laying there and it uh makes you think >> Phyllis was trapped for 2 hours before Eric [music] could let the paramedics in.

[00:18:24]>> It's also possible that she's had some complications as a result of being on the floor for so long. Their muscles break down a [music] little bit which can cause some issues with their kidneys and uh their electrolytes and make them potentially really really sick. You got a bit of fluid in your knee as well.

[00:18:38]>> No, the very knee.

[00:18:40]>> Okay. Can you bend that knee at all?

[00:18:44]>> No, that's okay. That's okay. Is it because it hurts in your hip?

[00:18:50]>> Okay. We know these injuries can be can be catastrophic. They've got a high risk of having a a complication like a pneumonia while they're in the hospital.

[00:18:57]Maybe that fluid in your knee um is always there. I don't know.

[00:19:02]>> Yeah. But we'll get an X-ray of your your thigh bone, your feur, and an X-ray of your knee. I think you're probably going to have a broken hip. And if it's not your hip, it's probably going to be the top part of your your feur.

[00:19:14]Um, if that's the case, either of those things are the case, you you'll need an operation.

[00:19:22]>> Oh dear.

[00:19:31]That's a foreign body there. Oh, what's that?

[00:19:34]>> What the hell's going on there?

[00:19:35]>> Dr. Jonathan and Dr. Manny are performing an ultrasound on 75year-old cyclist Hugh.

[00:19:42]>> That's the common karate.

[00:19:43]>> A shard of glass sticking out of his neck after crashing into a van's back window.

[00:19:50]>> The common karate's got some >> weird stuff.

[00:19:52]>> The actual foreign body.

[00:19:54]>> Okay.

[00:19:55]worried pieces of glass have broken off the main shard and have entered the corroted artery in the neck.

[00:20:02]>> You okay there?

[00:20:03]>> Me? Yeah.

[00:20:04]>> Yeah, you're doing fine.

[00:20:05]>> If a projectile or a piece of glass gets into a blood vessel, it can actually be taken along um for a ride in the flow of the blood vessel. It's called an embolism.

[00:20:15]>> Those reflections we were seeing, I think, are reflections.

[00:20:19]>> That little dot looks like when you put a central line wire through a vein.

[00:20:24]And that but that's that's what we were seeing in the art.

[00:20:26]>> There may be shards of glass within the actual vessels themselves. And that's most alarming because if there are small pieces of foreign body material, they can act like a clot that causes stroke and travel up to the brain.

[00:20:41]>> You ready for X-ray?

[00:20:42]>> Yeah.

[00:20:42]>> Y >> X-ray.

[00:20:47]>> Before moving Hugh to CT, Dr. Jonathan wants to make sure he has no other significant injuries.

[00:20:54]>> You're saying that's the aorta?

[00:20:56]>> Yeah.

[00:20:57]So, there's no need to thus the X-ray looks okay.

[00:21:01]>> We're going to do a scan um which will show us whether the glass is in the vein or not. If it's not in the vein and everything's all right, we'll be able to pull it out. But we'll still need to do a little operation to have a look and see what what damage has done. All right. Are you feeling all right otherwise?

[00:21:16]>> Yeah.

[00:21:16]>> Yeah.

[00:21:17]>> Yeah. We want that uh bit of glass out pretty quick. We want to be in the operating theater when it comes out. We need to get more information for the surgeons first. So, we're going to go to the CT scan to work that out.

[00:21:30]>> All right. No movement with your neck.

[00:21:32]Okay. Ready? Okay. On three. 1 2 3.

[00:21:37]>> Emergency nurse Ebony Butterworth has taken Hugh for a CT scan. He has a shard of glass embedded in his neck after a serious cycling accident.

[00:21:47]>> [music] >> The team are worried the shard is in his corroted artery and that tiny fragments of glass have broken off and could cause Hugh to have a stroke at any moment.

[00:22:04]>> He is very precarious right now. He's coming across as okay. Um but very obvious that things aren't normal. We can see a funny reflection going on in the blood vessel. Does that mean there's glass actually in the blood vessel?

[00:22:20]We're not sure.

[00:22:25]>> I mean, the question is, what would you do if it happened to you?

[00:22:28]>> Would you pull it out?

[00:22:29]>> You would have an initial instinct to pull it out, wouldn't you?

[00:22:32]>> Yeah. I reckon I'd pull it out.

[00:22:34]>> The CT scan reveals the glass has miraculously not severed his corroted artery.

[00:22:40]>> Not in the back.

[00:22:42]>> Not in the vessel. No, the cored's here.

[00:22:44]>> Good.

[00:22:45]>> It is anterior >> about a cime in.

[00:22:48]>> Yeah, maybe one of the close.

[00:22:51]>> It looks like it's right over the corroted sheath, which is a uh plane of tissue that holds the corroted artery and the corroted vein. And that's what I don't want it to be penetrating. That's the bit with tape sticking out. Goes in.

[00:23:06]But there's more. There's other bits.

[00:23:10]>> Yeah, that's the broken off bits. seems to go. And >> that's the broken off bits. Then >> I think these bits here, they shouldn't be there.

[00:23:18]>> This glass has gone in round that corroted sheath and he's and fractured and is still okay. Pretty amazing stuff. That's That's the glass.

[00:23:28]>> Yeah. So So that shouldn't be there.

[00:23:30]>> It's actually >> It's like around the sheath.

[00:23:33]>> It's almost like >> it's gone around the corroted sheath.

[00:23:38]>> Oh my god. There's fragments way deeper um beyond that. So, we were right to be worried because the glass is right over that corroted sheath.

[00:23:50]>> There's a concern that some of those pieces of glass may be sitting around a major vessel in your head.

[00:23:55]>> Hugh's remarkable. He maintains an absolutely calm and measured approach throughout. I can't even begin to imagine what must be going through his head. No doubt there's a level of fear and anxiety. I think we're heading in the direction of needing to explore this in theater. Yeah. So that it's all done really safely.

[00:24:13]>> He's going to need a pretty extensive significant operation to explore and dig all the pieces of glass out.

[00:24:21]>> You're fine. Yeah.

[00:24:22]>> On three. 1 [music] 2 3.

[00:24:25]Back two three.

[00:24:27]>> Hugh is immediately taken to surgery.

[00:24:30]>> He's unlucky that he's had the accident.

[00:24:32]Um, but he's lucky he's still with us cuz if it was 1 cm further in, um, he might not be with us.

[00:24:47]Taking a quick [music] break, emergency Dr. Maya Cubet is doing two things at once as usual. Grabbing a bite to eat and trying to become an Australian.

[00:24:58]I'm trying to while I'm sitting here, I'm trying to organize my citizenship ceremony, which has been a nightmare.

[00:25:09]I've had our um citizenship approval, but I'm waiting for the ceremony [music] so that it's official, but it's taken so far 7 months. I have to swear allegiance, and until I do that, I'm not [music] Australian.

[00:25:22]So, I I remain New Zealander just for a little bit longer.

[00:25:27]As Dr. Maya heads back down to the ED floor, her next case is on the way.

[00:25:34]>> Royal Melbourne receiving.

[00:25:37]>> Good evening, Royal Melbourne. We're coming to you as a 24 year old female um one week post tonslectomy. Um currently with active bleeding. Her birth name is Georgia.

[00:25:52]So, we've just had a call about a young woman who's coming in having had her tonsils removed, uh, who's bleeding from the area at the back of her throat where the surgery happened.

[00:26:04]It's called a post tonslectomy bleed. It often happens at, you know, sort of 5 to 7 days after surgery, but it can be a life-threatening situation. You all right? Can get in. 24year-old student Georgia was at home when she started bleeding heavily from her throat.

[00:26:21]>> Who did your surgery? Which day?

[00:26:23]>> It was last Tuesday.

[00:26:24]>> Last Tuesday. Okay.

[00:26:28]Um, why don't we just leave him there?

[00:26:30]>> We had a whole other bucket at home as well. And then we had about 50 m of just straight blood coming from her nose and her mouth.

[00:26:37]>> Yeah.

[00:26:38]>> The young psychology student is hemorrhaging.

[00:26:41]>> You know what? I'm also going to give you this in your hand. You stick that sucker in your mouth and suck out some stuff out of there.

[00:26:52]Good one. One of the problems for Georgia is there's blood coming out. And if it doesn't come out the front, it'll go down potentially into her stomach or potentially into her airway, causing her trouble, feeling like you're drowning.

[00:27:04]>> If Georgia keeps losing blood, she'll go into shock. Dr. Maya prepares [music] for the worst.

[00:27:12]What is going on?

[00:27:13]>> I just need to give you another needle on this side so that if we need to, we can give you a bit of blood in the hurry. Okay.

[00:27:20]>> Georgia was at home alone when the bleeding started. She called her mom who then called triple0.

[00:27:27]>> She frighten daylights out of her saying she goes, "Oh, there's a lot of bleeding." I was panicking because she's so far away. Like getting to her quickly is just Yeah. tricky. So that's why I called the ambulance and thank goodness I did. She was actually quite hysterical on the phone to me. Very panicked.

[00:27:48]>> Good one.

[00:27:49]>> I'll hold the bag. You won't get mine.

[00:27:50]>> Yeah, that's the way you do it cuz then you can guide where it needs [music] to be.

[00:27:53]>> The paramedics have done a fabulous job of gaining her trust, of keeping her settled and putting her in a good position where the bleeding's coming forward and she's able to manage that.

[00:28:08]How you doing?

[00:28:10]>> You're the most chipper person that I've seen this.

[00:28:13]>> I don't really laugh.

[00:28:15]>> People smiling at me with blood dripping out of their mouth. It's like being on Halloween.

[00:28:21]We can definitely help with a costume.

[00:28:23]At this point, >> Dr. Maya urgently needs to see where the blood is coming from and if she can stop it.

[00:28:30]>> Let me just have a look. A bit sliding.

[00:28:33]>> Yeah, I know. Lovely.

[00:28:36]big ah >> realizing she can't stop the bleeding herself, Dr. Maya calls for the help of the emergency ear, nose, and throat specialist.

[00:28:51]>> Oh, hey, it's Maya here. There is quite a lot of ongoing blood loss. You got any other tricks up your sleeve while we're waiting?

[00:28:59]There's an enormous [music] amount of blood that has come from her tonsil area. She's got bags of it [music] with the paramedics. It's not a small problem. This is a big problem.

[00:29:10]>> You all right?

[00:29:11]>> Yeah.

[00:29:12]>> Feel like it's going to get all right.

[00:29:13]>> Emergency ear nose and throat specialist Dr. Cisco MacArthur [music] has been called to help.

[00:29:19]>> So things are a little bit less voluminous.

[00:29:22]>> So this is a very dangerous situation.

[00:29:24]We're dealing with a bleeding airway.

[00:29:27]Georgia may actually be unable to breathe uh and suffocate on on blood.

[00:29:33]>> Take a little bit of the blood clot away.

[00:29:38]>> Right.

[00:29:40]>> Gross, huh?

[00:29:41]>> Yeah.

[00:29:42]>> Pretty horrible stuff. Yeah.

[00:29:43]>> Imagine having his job used to look at snot all day.

[00:29:47]>> Oh, yeah. That's uh Yeah, the head holes are pretty gross.

[00:29:51]>> Sorry.

[00:29:54]>> If Dr. [music] Cisco can't stop the bleeding. She'll need urgent surgery.

[00:30:00]>> Sorry if this makes you cry.

[00:30:02]>> Yeah, >> there you go.

[00:30:03]>> Cisco has had a look and he's using um cery uh so essentially like a matchick, but the end is applied to the wet surface of the area, the back of George's throat that's bleeding, and it will corderize or burn the area and create a clot where there wasn't one sitting there to try and plug the hole.

[00:30:25]You done really, really well there.

[00:30:29]>> You okay?

[00:30:30]>> Yeah, just my lips are really wet.

[00:30:34]>> It's honestly the best Halloween [music] costume at the moment. The bleeding seems to have settled and stopped with uh the cordery that Cisco's applied. What we need to do now is wait and see whether that clot holds. Hopefully, it won't bleed again.

[00:30:51]>> Hello.

[00:30:52]>> Hey, sweetie.

[00:30:54]At last, George's parents can be with her.

[00:30:57]>> It was just very overwhelming cuz it just like would not stop. [music] I was just worried I was going to bleed out.

[00:31:04]>> Oh, Leanne, it's Maya. I'm um consultant for [music] the patient in recess 3 tonight.

[00:31:10]>> Dr. Maya, make sure Georgia will be closely watched overnight in case the bleeding starts [music] again.

[00:31:17]>> They've got a seven southeast bed that they've been holding on to for her. So, sorted. They're all over it. The risk, of course, is that the bleeding starts again. So, if this is to happen again, Georgia is at risk of having another really big bleed, and we really need to keep her safe, [music] make sure that we're prepared for the worst while hoping for the best. At the moment, we're all under control. She's safe.

[00:31:39]She's in the right place. [music] And if things don't stay settled down, we have a plan, but at the moment, we don't need to use it.

[00:31:47]>> And fingers crossed, we won't need to use it. I've >> got anchor, please.

[00:31:56]94year-old Phyllis lay helpless on her bathroom floor after a shocking fall in the shower.

[00:32:02]>> Let's have a look at your pelvis here.

[00:32:04]So, this is the sore side, is it?

[00:32:07]>> It's sore in here.

[00:32:09]>> Sore in there. Okay.

[00:32:10]>> Dr. Scott suspects a bad break near her hip, which could be catastrophic for someone her age.

[00:32:17]>> Can you lift that leg up towards the ceiling?

[00:32:20]>> Oh, >> no. That's okay.

[00:32:24]Can you bend your knee and straight?

[00:32:27]>> We've noticed some fluid around her knee, uh, which has me concerned that there may be a second injury there. Uh, and it tells me that that she's fallen pretty hard and probably sustained some pretty significant damage to have injuries of of this nature to two different places. I'm 94 and I've got all this time I do for myself doing shopping and washing house cleaning.

[00:32:54]>> At 94, Phyllis manages to live happily on her own. [music] This accident could change that forever. Her worst fear is losing her independence.

[00:33:06]Any elderly patient that's fallen over, no matter how good they might have been before the injury, a lot of them actually die within the first 2 years after sustaining an injury like this.

[00:33:18]What we can do to help your pain uh in the short term is we can you can give you an injection of some [music] anesthetic. Um and that targets the the nerves around the hip. I'm going to go and organize a few things for you. Um, so those the rest of those X-rays, I'll come back with some equipment to do that injection. Um, and then we'll we'll use the ultrasound to to find a good vein.

[00:33:40]Okay.

[00:33:42]>> All right. We'll take good care of you.

[00:33:44]I promise. I'll be back in a couple of minutes. Okay.

[00:33:48]>> Dr. Scott needs to do blood tests to make sure Phyllis is okay if they need to operate on her leg.

[00:33:56]>> We often use our ultrasound machine to help find veins in patients.

[00:34:00]>> [music] >> um who may be difficult to put a drip in for whatever reason.

[00:34:05]>> It's a bit of an awkward position cuz it's right where it crosses the elbow.

[00:34:09]So, I'm right over the top of it.

[00:34:11]>> Y sharp sting.

[00:34:15]>> These veins can be quite mobile. Um so, you really need to pin them down. Uh the veins that is not the patient. Um but, um yeah, the veins tend to roll around a little bit.

[00:34:27]>> Are you getting any?

[00:34:28]>> Yeah. Yeah. Yeah. Getting plenty >> blood.

[00:34:32]>> Cool. All right. So, we got all the blood we need.

[00:34:35]We'll get you off for your scans very shortly.

[00:34:39]>> If Phyllis needs an operation, the risks are high. She [music] may not survive.

[00:34:45]>> All right. We'll be back in once your X-rays are done.

[00:34:47]>> Just tilt chin up a [snorts] little bit.

[00:34:50]That's perfect. Thank you. So injuries of this magnitude, we worry about people having low bone density and that that's certainly not unusual. Uh in elderly females, we know that their bones break much more easily.

[00:35:03]>> Hold there.

[00:35:05]Breathe normally, Phyllis.

[00:35:14]>> Oh yeah.

[00:35:17]>> Now Dr. Scott can finally see how badly damaged Phyllis's leg is.

[00:35:24]>> Unfortunately, Phyllis has got pretty nasty fracture um of her feur, so her thigh bone. Um so, it's broken up the top around the hip joint. It's also broken just below that at the the top part of the the feur. I'm really worried about the bad news that I'm going to have to deliver to Phyllis. She's got two pretty nasty fractures. even just one of those fractures on their own is something that's lifealtering for a lot of people. It may be that she doesn't quite get back to her level of independence that she was before the accident. Um it's also quite possible that um she may run into some complications while she's in the hospital or recovering [music] um which certainly may be lifealtering or lifeending unfortunately.

[00:36:09]All right, Phyllis. Hey, you've got a pretty nasty break in your hip. So, it it's through the top part of the hip [music] and then it's to the top of your thigh bone as well. So, there's a couple of separate breaks there. And it looks like there's a break down near your knee as well.

[00:36:27]An operation's [music] definitely in order. It's just how much metal it's going to need and where that metal's [music] actually going to go.

[00:36:40]do your best.

[00:36:41]>> I'm really sorry.

[00:36:43]>> Phyllis is going to need some pretty extensive input from here uh in the form of surgery and physiootherapy and uh occupational therapy, [music] nursing care, which is has the potential to to take a toll on her uh both from a physical point of view, but also from an emotional point of view. And somebody who's been very independent, very active up until this point of their life, that can be very confronting. Oh, I knew I broke something. So that fell. I didn't [music] have to be told.

[00:37:15]>> She's going to have a long [music] recovery ahead of her. Um, assuming that everything goes to plan from here and that she doesn't run into any problems.

[00:37:23]>> I know there's people worse off and I'm feeling sorry for myself at the moment.

[00:37:39]Martin, it's Michelle. I need help in recess six.

[00:37:42]>> Busy mother of two, Cindy was losing oxygen after she collapsed at home while having seizures.

[00:37:48]>> We're definitely going to proceed to intubation, guys.

[00:37:50]>> Dr. Michelle needed to put her on a breathing machine and scan her brain, looking for the cause.

[00:37:56]>> We're just looking to see if there was a big bleed or anything.

[00:37:59]>> Well, she's definitely not out of the woods yet. Cindy went to intensive care to be monitored before going home. 2 months later, she's still seeing specialists [music] to find the cause of her illness and very grateful for the care she received at the Royal Melbourne.

[00:38:16]A day before she was to begin university, psychology student Georgia was rushed to emergency, hemorrhaging after having her tonsils removed.

[00:38:26]>> People smiling at me with blood dripping out of their mouth. It's like being on Halloween. Doctors managed to stop the bleeding and helped Georgia through a terrifying episode.

[00:38:37]>> Just made me feel really nice and [music] like just comfortable.

[00:38:40]>> After a night in hospital, Georgia went home. 2 weeks later, the bleeding started again and she needed surgery.

[00:38:47]She's now back at uni, fully recovered.

[00:38:52]75year-old cyclist Hugh collided with a van and [snorts] came into emergency with a shard of glass embedded in his neck. You've got this little thing sticking in your neck and it might have hit the vein.

[00:39:03]>> If the piece of glass comes out and it's actually sitting in the artery and plugging the artery and it falls out, he will just bleed like stink out of his neck. Um, and he could be dead within minutes.

[00:39:16]>> A CT scan confirmed Hugh needed immediate surgery.

[00:39:22]>> That's That's the glass.

[00:39:23]>> Yeah. So So that shouldn't be there.

[00:39:25]>> Oh my god. surgeons removed the glass and Hugh went home 5 days later.

[00:39:35]>> I had just the one operation where they um removed all the bits of [music] glass and there were about 35 36 stitches down the left side of my neck and it's actually healed up brilliantly though.

[00:39:49]The surgeons uh were remarkable.

[00:39:52]>> Just in time for a cuppper.

[00:39:54]>> Well timed.

[00:39:55]>> Well timed. Hugh is grateful for the help of strangers. When the accident happened, a tradey pulled up and rang the police and the ambulance and uh helped me to sit on the curb and then a couple of other trades uh pulled up as well and I have no idea who they were so I haven't been able to thank [music] them or whatever but they they were really um very caring and first rate people. The accident hasn't stopped him doing what he loves.

[00:40:30]>> I've been back on the bike for about four weeks. Had a couple of 70 km rides recently.

[00:40:36]I couldn't fault the treatment and care I received.

[00:40:43]>> 94year-old Phyllis arrived in emergency after falling in her shower and fracturing her hip.

[00:40:50]>> An operation's definitely in order. It's just how much metal it's going to need and where that metal's actually going to go.

[00:40:57]>> Do your best.

[00:40:58]>> I'm really sorry.

[00:40:59]>> Dr. Scott feared for Phyllis's future.

[00:41:03]>> She's got two pretty nasty fractures, which certainly may be lifealtering or life- ending. Unfortunately, >> after a major hip operation and 5 weeks in rehab, [music] Phyllis is back on her feet and living with her brother Eric. I spent a lot of time in bed for quite a while. I got stronger, but when I came home, Eric had to do a lot of things for me. I'm pretty good now. And I can walk. Phyllis is determined to keep improving.

[00:41:35]>> I can make a cup of tea. [music] I do have to be cooking. And the afternoons, I do watch the television. A B A Come on. Yeah.

[00:41:45]>> Come on, tell her. That's it. You've got to drive, Harry.

[00:41:48]Each day I'm getting more independent, which [music] is good. Just make the best of what I've got left. That's all I can do.

[00:42:00][music]