Teen Girl Fights For Breath... And Her Life | 999 Critical Condition Full Episode S5 E6

[00:00:00]Nice and still, very gentle. [music] Nice and still, don't hold your breath.

[00:00:05]Worst case scenario, he can't walk, can't work, and would be in a wheelchair.

[00:00:11]>> [cough] >> He's critical. If we don't do something, they might die.

[00:00:23]>> So, when you pee, is it bright red?

[00:00:25]>> Yeah.

[00:00:31]>> Anyone who has significant trauma who then turns up passing blood, you've got to worry that they've got an internal injury, which could ultimately be life-threatening.

[00:00:45]>> Hello, Royal Stoke.

[00:00:47]Okay, an overdose for what reason?

[00:00:50]Yeah.

[00:00:51]Are you flying?

[00:00:56]RTC at speed, pulled out the window.

[00:00:59]Good start.

[00:01:03]I've got three patients [music] that need urgent surgical opinion.

[00:01:08]>> No pulse, back on the chest.

[00:01:09]>> They're all critically ill.

[00:01:16]Hello, Royal Stoke resource.

[00:01:19]Yeah.

[00:01:21]Hang on a second. Die?

[00:01:23]You want to listen to this? [music] >> Yeah.

[00:01:25]>> Go on, what have you got?

[00:01:27]>> It's fallen three way roof.

[00:01:30]>> Okay, it's not good, is it? Yeah, okay.

[00:01:32]>> It's like two short leads by the bay.

[00:01:36]>> Okay, [music] so we're going to have to make some space again.

[00:01:40]We have a gentleman coming in who's fallen a quite a significant height, around 15 ft. He's fallen, landed on both feet, and then fallen backwards, and he's complaining [music] of quite a bit of pain in his back.

[00:01:50]>> And can we warm up fluids?

[00:01:51]>> I am on it.

[00:01:52]>> We do worry [music] that if you fall from sort of more than a human height, that you've got an increased risk of [music] life-threatening injuries.

[00:02:01]Never know with any of them how bad they're going to be. He certainly could have done himself some significant damage.

[00:02:07]Just get a trolley in there. Yeah, okay.

[00:02:13]Let's go then. Okay.

[00:02:19]Hello. Right.

[00:02:23]What's his name?

[00:02:24]>> Thomas.

[00:02:25]>> Thomas, okay. Right then, so let's get him across.

[00:02:33]So could we just have quiet for the handover, please?

[00:02:35]>> This is Thomas. He's 47.

[00:02:38]Um at approximately 8:00 this evening, he's been working on a building. He's fallen approximately 5 m unwitnessed through a hole in the roof.

[00:02:47]>> Oh, bless him. Okay.

[00:02:49]>> Friend who was working on the building outside has heard shouts, found him on the floor. We believe he had tried to get up after he had landed on his feet.

[00:02:58]>> Yeah.

[00:02:59]>> Um but then was unable to stand, so he was loaded back onto the floor where we found him when we arrived.

[00:03:04]>> Okay.

[00:03:05]>> Um he's complaining of pain to >> [music] >> mid-thoracic all the way down to lower lumbar.

[00:03:11]No apparent head injury, no apparent chest injury. So as far as we're aware, normally fit and well, no medical conditions.

[00:03:16]>> Any allergies or anything like that?

[00:03:17]>> Penicillin.

[00:03:18]>> Penicillin, okay.

[00:03:20]>> And that's about it.

[00:03:21]>> Lovely. Do you want to book him in?

[00:03:22]>> Yeah, thanks a million. Thanks very much.

[00:03:24]>> Thomas.

[00:03:25]>> My name's Diane.

[00:03:27]>> Where is he hurting at the moment?

[00:03:29]>> In his back and his shoulder.

[00:03:31]>> All All the back basically from his from this part to the now.

[00:03:33]>> Okay. So, you tell him what we're going to do is we're going to get him off this scoop. Okay, cuz that that's not helping. We just need him to stay super still. Okay, one two three. Nice and still, very gentle.

[00:03:46]Very gentle.

[00:03:49]Okay, let's get rid of that.

[00:03:50]All right, okay. Do the same on the other side, please?

[00:03:54]Okay, it's all right.

[00:03:56]All right then.

[00:03:57]Just put your hands here. Just tell him we're just going to have a little look at him, all right?

[00:04:05]Sore here?

[00:04:06]>> No, on on the back.

[00:04:07]>> On the back, yeah.

[00:04:10]Sore down here or not?

[00:04:12]So sore on the coccyx.

[00:04:14]Just going to have a feel of his tummy.

[00:04:21]You can feel on his back.

[00:04:23]Does it feel sore inside his tummy?

[00:04:28]Okay, relax your tummy.

[00:04:31]Let's get him in a gown, please.

[00:04:34]We're going to have to roll him to get the trousers off, so I may as well have a Yeah, I'll have a feel down his back at the same time.

[00:04:40]Very, very gently, please.

[00:04:43]It's a nerve-racking moment to move a patient like Thomas.

[00:04:47]>> Ready, steady, roll.

[00:04:48]>> Nice and still. Don't hold your breath.

[00:04:51]The slightest wrong move could lead to him having a more [music] serious injury. Can I have a feel? Okay, nice and gentle.

[00:04:58]There.

[00:05:00]It's really frightening to have hurt yourself, and if you add into that the fact that you don't understand what people are saying to you, it's really scary.

[00:05:09]All of it?

[00:05:12]It's really important that we make people feel safe. Having an interpreter makes things so much better for the patient and for us.

[00:05:20]Flat down.

[00:05:21]>> On roll, ready, steady, roll.

[00:05:26]>> Does he smoke at all?

[00:05:27]>> Oh, yes, he smokes, yes.

[00:05:30]>> Thomas, your chest and everything feels fine.

[00:05:33]Your your tummy feels fine, but it's quite tight. Okay, that might be because you've got an injury in your back.

[00:05:42]You're sore down on your on your heels as well from your feet.

[00:05:47]Okay, so what we need to do is we're going to take you around for a CT scan to have a look at your back.

[00:05:53]Do you Does he need some more pain relief? Looks like he does to me.

[00:05:56]>> Yes.

[00:05:57]>> Yeah. So, let's go another five of morphine. Get him sorted ready for scan.

[00:06:02]>> Okay.

[00:06:03]>> I'm worried that he's fractured his spine cuz he's fallen down onto his heels from a height and then the the force of that can go up through the spine and cause fractures.

[00:06:12]Guys that work on building sites are normally pretty tough, so for him to come to me says that there's something majorly wrong.

[00:06:20]>> We're going to scan.

[00:06:23]>> He'll be going around for a scan now just to quantify what injury is there. We do a code red scan and it enables to us to find anything that's life-threatening.

[00:06:36]>> How much oxygen do you want us to >> Basically 10.

[00:06:39]>> Ready, steady, slide.

[00:06:48]Hello.

[00:06:50]>> Breathe in and hold your breath.

[00:06:56]>> Main worry is T [music] spine and a voluntary guarding throughout the whole of the abdomen.

[00:07:09]>> Breathe normal.

[00:07:12]>> Is there any pneumothorax?

[00:07:22]In terms of [music] acute finding, I can't see anything in the abdomen.

[00:07:31]Um it looks okay.

[00:07:42]There is a spinal fracture just there.

[00:07:48]So, that is kind of T10 Yes, so exactly that. Probably one more there. One more there. So, at least three vertebral body fractures.

[00:08:04]See the posterior limits.

[00:08:06]Yes, that was one.

[00:08:09]Two.

[00:08:10]Three. Yeah, those are the ones I can see at the moment. They're all thoracic.

[00:08:14]There's quite a few rib fractures as well.

[00:08:18]>> So, there's at least um three vertebral body fractures. It's a serious serious [music] injury to his injured spine.

[00:08:27]>> [music] >> And then, obviously, he's he's been a heavy smoker for a long time. And he's got multiple rib fractures, so that [music] puts him in a sort of tiger territory of developing a nasty pneumonia.

[00:08:38]That could ultimately lead to him losing his life.

[00:08:47]Hello.

[00:08:49]So, I've had your scan results back.

[00:08:54]Okay. And they've shown that you've got some fractures in the spine.

[00:09:01]So, the most important thing now is just keeping him super still and flat.

[00:09:06]We've asked the spinal surgeons to come down and have a look at him and examine him >> [music] >> so that they can make a decision then about whether he would need surgery or not. All right?

[00:09:16]Okay. All right, darling.

[00:09:19]There's a few little bits of bone that are pushing into the area where the spinal cord sits.

[00:09:26]He's got no neurology at the moment, so no changes to the nerves down in his legs.

[00:09:31]However, doesn't mean that he's not going to develop any, so we need to keep a really close eye on him.

[00:09:36]Worst case scenario, he can't walk, can't work, and would be in a wheelchair.

[00:09:50]>> Yes, in medical trauma.

[00:09:56]No helmet.

[00:09:57]>> Quad bike.

[00:09:59]The least stable form of transport known to mankind this side of a unicycle.

[00:10:04]Well, we've got to punch him.

[00:10:06]>> Uh I don't even know what bandage he's got for his >> What happened?

[00:10:09]Excuse me.

[00:10:11]Ah, I've had best starts to shift.

[00:10:17]>> Have they got straight laces?

[00:10:21]Female.

[00:10:22]How much oxygen is she on?

[00:10:26]Okay, how long ago?

[00:10:30]Bye-bye.

[00:10:32]Oh.

[00:10:33]It's a type [music] two. Brittle asthmatic, 19. She's had two adrenaline with the crew.

[00:10:39]Couple of nebs, breast minute [snorts] 40, shown 8 liters. Blood pressure's on the lower side.

[00:10:44]>> How long have you had her in?

[00:10:45]>> 7 minutes.

[00:10:49]>> What have we got set up here?

[00:10:50]>> We're going to have to use six.

[00:11:01]>> I'm expecting a brittle asthmatic and so that's a very severe form of asthma.

[00:11:11]We might be expecting ITU to come down if they are not getting better.

[00:11:16]At the moment, we need to give medications that quickly open up the airway. Unfortunately, they could deteriorate quite quickly as a very severe form of asthma.

[00:11:27]>> Okay, BP's 88 on 45.

[00:11:30]>> If we don't do something, they might die.

[00:11:33]>> What about in there?

[00:11:34]>> What's her name, please?

[00:11:44]How old is she?

[00:11:45]>> 19, okay.

[00:11:52]>> What's her name?

[00:11:53]>> Anya.

[00:11:54]>> Hello, Anya. My name is Sunday. I'm going to take a hand over from the crew very quickly. I'm the doctor on the We're looking after you.

[00:12:01]>> Okay.

[00:12:02]>> Um This is Anya. She's 19. She's doing bits last night, you She's got 2-day history of acute shortness of breath. She's actually got through two of her Ventolin inhalers in the last 2 days to no effect. She's recovering from a viral infection last week.

[00:12:16]>> Yeah.

[00:12:17]>> Um not known to be COVID.

[00:12:19]With ourselves, she's had [music] three salbutamol nebulizers now.

[00:12:23]>> Okay.

[00:12:24]>> One ipratropium and two lots of IM adrenaline to [music] very little effect, to be honest.

[00:12:29]>> Thank you.

[00:12:31]Anya, do you present like this before, quite bad?

[00:12:36]Cuz you're quite poorly from the sound of things.

[00:12:39]>> My niece is 26.

[00:12:42]>> I'm going to have a listen to your chest, okay?

[00:12:47]And lean forward for me, please, Anya.

[00:12:49]Thank you.

[00:12:55]Okay.

[00:12:59]So, being that you've had some salbutamol and adrenaline, that's not really helped.

[00:13:06]>> [music] >> So, what the paramedics have given her hasn't worked. So, it's vital to get her blood test done quickly because it helps [music] us to know the state of her breathing problem. It's time critical. I'm standing between the [music] patient and death.

[00:13:26]>> Yeah.

[00:13:27]>> I need to take some blood from here.

[00:13:33]Have you had that done before?

[00:13:34]>> No, I hate it.

[00:13:37]I have a phobia of needles.

[00:13:43]Lean back if you want.

[00:13:45]>> Okay, so we're going to put in some medication.

[00:13:48]>> What is it? It's magnesium. [music] >> It's supposed to help you breathe better.

[00:13:59]>> [music] >> 36.1 >> That's high.

[00:14:09]That's not good. So, I need to do an ABG right away.

[00:14:21]The bloods we've just done shows that your oxygen level is quite low and your CO2, so carbon mono carbon dioxide is quite high. You're not breathing it out effectively.

[00:14:35]>> I can't breathe this anymore.

[00:14:37]>> I'm sorry, I'm sorry.

[00:14:40]I'm sorry. You need to keep this on.

[00:14:42]Sorry. Sorry, Mom. I'm sorry.

[00:14:45]Sorry.

[00:14:47]Sorry. You just keep this with you.

[00:14:51]Do you mind holding this? Yeah.

[00:14:54]I just speak to her.

[00:14:55]My biggest concern is still her breathing. She's She's not taking in enough oxygen and not breathing out enough CO2.

[00:15:04]>> Right, keep that on.

[00:15:06]>> If you don't breathe out enough carbon dioxide, it will push you into a coma.

[00:15:10]If Anya's condition were to be left untreated, [music] she could die. This is quite critical.

[00:15:15]This is quite critical.

[00:15:19]>> [cough] >> Hello Raymond resource.

[00:15:33]Just tell me the ETA first.

[00:15:36]>> We're going to have to make some more space. [music] I've got another two at least and two on the card.

[00:15:41]>> All at once?

[00:15:42]>> Yeah.

[00:15:42]>> Game on.

[00:15:55]>> Hopefully I'll uh see you tomorrow.

[00:15:58]>> Yeah.

[00:16:07]I hope I can [music] ring you later. I want to come out.

[00:16:09]>> We don't stray you boys.

[00:16:16]>> I found a lump in my neck about a year ago. It basically just didn't go away.

[00:16:21]>> [clears throat] >> So, I got it checked out [music] and yeah, they did a biopsy on it and they found that that it was thyroid cancer.

[00:16:27]It was a bit of a shock really cuz I I thought oh it'll be a cyst or something like that.

[00:16:32]>> So, all we're going to do is listening to baby, okay?

[00:16:35]>> Yeah.

[00:16:50]>> Baby girl, nice and strong.

[00:16:53]Oh, you'll get up girl.

[00:16:54]>> Yeah.

[00:16:54]>> Yeah, little girl.

[00:16:57]>> I think I'm a priority being pregnant because they have to time the timings right to have the surgery. [music] They can't do it when you're in the first trimester of pregnancy because um at the baby's obviously organ main organs are forming um and they can't do it in the third trimester cuz the baby's too [music] big and it puts a lot of pressure on your spine and things like that cuz the baby's bigger. So, they have to do it in the second [music] trimester.

[00:17:18]They have to get it done now.

[00:17:21]Baby sounds good.

[00:17:23]Thank you very much.

[00:17:24]>> Okay, hon.

[00:17:27]>> I'm hoping to get rid of the cancer completely and have a healthy baby.

[00:17:33]>> [music] >> So, Melissa's got a papillary thyroid cancer. It was found by a lump in the neck. You can [music] see on this side how that's lighting up.

[00:17:43]First, the tumor has to come out.

[00:17:45][music] And you can just make out here there's a lesion sat in the thyroid gland as well on the [music] right side.

[00:17:52]So, the thyroid will have to come out as been spread to that and the lymph nodes will have to come out, too.

[00:17:59]The main concerns that we're going to have are preserving the key structures in the neck, so especially the recurrent laryngeal nerves. These are the nerves that uh power the voice box.

[00:18:12]So, if we injure both nerves to the voice box, Melissa may lose the ability to breathe, which means that she may need a breathing tube in the neck called a tracheostomy. It's an emergency procedure.

[00:18:27]And also, bleeding's always a concern when we do any head and neck [music] surgery.

[00:18:32]So, it it's very delicate surgery that we're doing.

[00:18:45]>> [music] >> It's quite a big thing to go through.

[00:18:52]With her being a nurse herself, she's [music] a great person. She literally thinks about everybody else but herself.

[00:18:59]Loves her family.

[00:19:01]So, yeah, she's a diamond.

[00:19:04]I just can't wait to sort of hear off her, really. Just make sure everything's gone well and um fingers crossed.

[00:19:17]>> Room or medical?

[00:19:19]>> Yeah.

[00:19:42]>> Are you numb?

[00:19:43]>> Yes.

[00:19:58]>> You're you're you're more more wheezy now.

[00:20:05]We're going to get you some steroids, okay? Hydrocortisone.

[00:20:09]>> Well, okay. Well, so >> put the hydrocortisone through now, and I'll go and mix the magnesium and then I can attach that with the saline.

[00:20:16]>> Okay.

[00:20:17]You're going to need to be on oxygen now.

[00:20:21]>> Yeah.

[00:20:24]I'm [music] too tight.

[00:20:26]>> Can I have this on your finger, love?

[00:20:28]>> Oh.

[00:20:28]>> Sorry. Sorry.

[00:20:32]>> I know, sweetheart.

[00:20:40]>> Patients with brittle asthma, they can go up and down.

[00:20:44]She's requiring all these medications to breathe. We've tried everything, but it it's not quite where we want it to be.

[00:20:53]She might get so bad that she can't breathe for herself. Oxygen we're giving is not helping. She's going to need intensive care to sedate her, intubate her, and uh ventilate until her lungs improve.

[00:21:11]>> Who's that, Mum?

[00:21:12]>> Yeah, that's Nan.

[00:21:13]>> Nan, okay.

[00:21:15]I'll have a chat with her because we've not had an in-depth chat with her yet, tonight. Sneak in and put her in that position as to where we're at.

[00:21:28]Anya.

[00:21:30]Anya, and you and you's Nan.

[00:21:32]My name's Paul.

[00:21:34]I'm one of the main consultants. So, I've been in the background of your care.

[00:21:38]So, I know all about you. Obviously, we're giving you the right treatments now.

[00:21:44]But, unless you were to turn a corner and start improving, potentially, you could deteriorate.

[00:21:51]And if you were to deteriorate, the best course of action would be intubating you.

[00:22:04]Have you Have you ever been intubated before?

[00:22:07]No. If it's a fear about the tube itself, you're in the right place. You've got very senior doctors surrounding you.

[00:22:22]>> Can we just you know, just take a step back and just go from neb to neb and see how we go from there.

[00:22:30]>> Well, the thing is that, Mum, we've we've tried that.

[00:22:33]Uh unfortunately, uh the numbers don't look well.

[00:22:40]Anya, we're doing the best for you.

[00:22:43]Okay.

[00:22:48]It's something we need to consider and we need to discuss early because potentially it may be something that comes up today if if you don't respond to the treatment in the way we'd want you to.

[00:23:00]But, at the moment, Anya's improving.

[00:23:02]she's settling, but we need to monitor her thoroughly.

[00:23:07]We might need to intubate her and ventilate her and take over control of her breathing that way.

[00:23:14]Patients such as Anya can change quite quickly, so we really need to be kept on our toes.

[00:23:30]Hello.

[00:23:32]Any questions?

[00:23:33]>> No.

[00:23:34]Let's get it done.

[00:23:35]>> Right. We're all good. We'll take good care of you, all right?

[00:23:38]>> Yeah.

[00:23:38]>> Okay.

[00:23:39]>> Thank you very much.

[00:23:39]>> See you later. With any patient who's pregnant, our main concern is that [music] we don't induce a miscarriage.

[00:23:46]Right, should we go and look at the scans?

[00:23:49]>> There's a massive responsibility [music] that comes with looking after not just a patient themselves, but someone who's also carrying a baby.

[00:23:59]>> Okay. So, that you might feel that a little bit cold just going up your arm.

[00:24:04]The only job you've got for this whole thing [music] is to think about something nice to dream about, okay?

[00:24:14]>> [music] >> Perfect. Well, and before you know it, you'll be waking up and all this will be all over and done with.

[00:24:29]Okay, so let's just park there a second.

[00:24:34]>> We're always concerned about the health of the baby.

[00:24:38]The timing of it is important because we have to find a window of opportunity to give mum and and the baby the the best chance.

[00:24:46]I think if we left this till after the pregnancy, my [music] worry is it's already gone to a lymph node, it's of a significant size, it's near some key [music] structures. I really don't want that advancing anymore.

[00:25:01]Right. Nice. Thanks.

[00:25:09]First, I'll start by cutting down into the neck and locate the tumor so I can dissect it out.

[00:25:14]And then nice incision.

[00:25:17]Taking out any lymph nodes that I see on the way.

[00:25:25]That's good.

[00:25:27]So, it's just unwrapping everything. Staying away from these veins.

[00:25:36]So.

[00:25:42]And there's a key structure in this area called the accessory nerve.

[00:25:46]And that's the nerve to help you turn left or right.

[00:25:51]Now, you've got the Ligasure there.

[00:25:52]Thanks.

[00:25:55]What we have to do is try and identify that nerve and then keep all the tissue off it.

[00:26:01]Which side?

[00:26:04]So, this is the accessory nerve, isn't it?

[00:26:06]>> Yeah.

[00:26:09]>> So, the only difference is that this one will definitely cause a twitch.

[00:26:15]There you go. Just down there.

[00:26:18]That's deeper.

[00:26:26]And that feels like that's the back of the lump. You see the cancer has a very dark appearance to it.

[00:26:34]And just try and get as much of this free.

[00:26:39]Tooth forceps, thanks, Paul.

[00:26:42]>> Oh, yeah. There's timing there.

[00:26:43]>> Something there, wasn't there?

[00:26:50]Just got to skin this last bit of uh little bit off here.

[00:27:18]Perfect.

[00:27:23]Everything's dissected out. The swab in the neck is out for a bit.

[00:27:31]So, here we've got the neck dissection that we've removed.

[00:27:36]And you can clearly see the tumors, this abnormal dark nasty-looking lymph nodes.

[00:27:43]All of this we're happy is out.

[00:27:47]We'll have a load of saline, please.

[00:27:49]We still have the most dangerous [music] part of the operation to do, which is to take out the thyroid gland, which is very near the windpipe, and also [music] the nerves that control the voice box.

[00:27:58]So, damage to either of these could be catastrophic.

[00:28:13]>> So, we need resource.

[00:28:15]Did she get any neuro respiratory yesterday?

[00:28:20]>> One's going to be tubed. Three is in CT, [music] and four is for thrombectomy, and hopefully we'll go to IR soon.

[00:28:26]There's one on the way.

[00:28:34]>> Do we have a backup before falling?

[00:28:36]>> Hello, it's Dr. Mackey here, intensive care.

[00:28:38]>> Yeah, is that on our way or too late?

[00:28:41]Okay, thank you.

[00:28:42]Bye.

[00:28:46]Call Richard for a seat.

[00:28:54]>> We've just had a standby call from the ambulance service for a gentleman who's reportedly fallen top to bottom of the stairs. Their main concerns are he seems to be reporting he's peeing blood.

[00:29:04]Because of the way he tumbled down the stairs, a lot of the time they'll come in with the head injuries, significant chest, abdominal, pelvic injuries, or limb injuries. Causes significant mortality and morbidity. [music] So resus one's empty if you need it.

[00:29:20]They should be here any minute.

[00:29:23]So anyone who has significant trauma who then zones up passing blood, you got to worry that they've got an internal injury which could ultimately be life threatening.

[00:29:34]Now there is this uh fall downstairs?

[00:29:38]All right then, so what's going on?

[00:29:41]>> I think it's Timothy, 59.

[00:29:44]I don't know. So he's he's been upstairs since Sunday night. He thinks he's well, he [music] knows he's blacked out at the top of the stairs. He's gone top to tail, uncarpeted to the bottom.

[00:29:53]>> Okay. What time was this?

[00:29:55]>> Uh what time was it about?

[00:29:57]>> 10:00.

[00:29:57]>> About 10:00-ish.

[00:29:58]>> 10:00 10:00 in the >> This morning.

[00:30:00]>> Uh no, Sunday.

[00:30:01]>> Oh, Sunday. Okay.

[00:30:02]>> Um he's managed to get himself into bed.

[00:30:06]He's been immobilized for the last two days and since yesterday he's had episodes of hematuria in his urine.

[00:30:12]>> So when you pee, is it bright red?

[00:30:15]>> Yeah.

[00:30:16]>> And it clots or anything?

[00:30:18]>> Not that I noticed.

[00:30:19]>> Tim, when you fell down the stairs, were you able to get back up again and walk upstairs and stuff?

[00:30:25]>> No, I crawled upstairs.

[00:30:26]>> So he was crawling and then be >> I don't know how long I was out for.

[00:30:30]>> Okay.

[00:30:30]>> I don't know how long I was lying at the bottom of the stairs for, to be honest.

[00:30:33]>> Okay. As Have you blacked out before ever? Okay. And when you woke up at the bottom of the stairs, did anything feel funny, tingling, like did everything work okay?

[00:30:44]>> No, it just So, yeah. Pain.

[00:30:46]>> Okay, whereabouts?

[00:30:47]>> All over.

[00:30:48]>> Then what we're going to do is we need to do some tests for you, okay? Just cuz obviously we're a bit worried since you fell down the stairs, that you might have done some internal damage, all right? So, we'll do some scans.

[00:30:58]>> [music] >> But then, assuming that nothing's broken, we need to work out why you're passing out as well, okay? So, two different things going on here, all right?

[00:31:11]>> Just going to have a feel of your tummy, Tim, okay?

[00:31:13]Just let me know if there's any pain anywhere in your tummy, okay?

[00:31:18]A bit tender there?

[00:31:21]What about there?

[00:31:23]So, right hip tenderness.

[00:31:25]>> No bruising or anything?

[00:31:26]>> Um yes, he's got bruising all around.

[00:31:29]Yes, he's probably got a >> Almost like it's quite extensive now.

[00:31:34]He's probably got a right kidney injury, I would have thought.

[00:31:37]Right, so we're going to have to do a scan.

[00:31:40]And look at your kidneys, okay? Is that sore there as well?

[00:31:47]What we're worried about is potentially a right kidney injury cuz he's really tender there.

[00:31:52]Your liver injury, and also the worrying sign that he's peeing blood.

[00:31:56]>> And again.

[00:31:57]>> So, you got to be suspicious that he's got some internal bleeding going on that we need to get on top of.

[00:32:05]>> Testicular and electric throughout.

[00:32:08]>> Uh right, let's just do just do trauma bloods.

[00:32:12]Just need to make sure he's not ruptured his kidney or something like that.

[00:32:19]Right, Tim. Going to get you round to that scan now, okay? Hopefully that'll give us a better idea of if there's anything we need to be too worried about, or whether all this is just a bit of bruising, okay? But this scan will give us much better idea, especially with your kidney and stuff like that.

[00:32:37]He's got a lot of worrying features at the moment.

[00:32:39]>> Uh especially depending on what's going on with that kidney. His symptoms are definitely getting worse by the fact he's now peeing blood.

[00:32:48]>> Uh he's potentially got some life-changing injuries.

[00:33:02]>> So, we're starting the second part of this operation, which is the thyroid.

[00:33:20]The thyroid >> It's a very vascular gland.

[00:33:24]Even though none of these vessels look particularly large, if they get cut, they really do bleed quite significantly.

[00:33:31]>> Dry swab, thanks.

[00:33:35]>> It's critical here because um bleeding in this compartment it puts a lot of pressure on the airway.

[00:33:41]Um and that becomes an emergency very quickly.

[00:33:50]So, somewhere deep underneath here will be the nerves that move the voice box.

[00:33:56]>> If we damage one of the nerves, the patient gets a hoarse voice, which does impact their quality of life.

[00:34:02]We damage both nerves to the voice box, it effectively stops you breathing.

[00:34:10]>> So, we have to be careful of the amount of tension we're putting on the nerves.

[00:34:17]Bipolar.

[00:34:25]Very nice.

[00:34:29]>> We've now identified both of the nerves to the [music] uh voice box, so we're now finishing up the lymph nodes.

[00:34:39]You've got to get all these out.

[00:34:45]These look a bit suspicious. I've got to be honest. You know, they've got that dark appearance to them.

[00:34:51]So, we need [music] to make sure that we do a good job.

[00:34:56]There's nothing else I can see.

[00:35:02]Um so, we're we're really not too far away from getting the thyroid out.

[00:35:08]There we go. Released.

[00:35:11]Suddenly it goes, eh?

[00:35:13]Okay.

[00:35:14]Thyroid's done.

[00:35:17]Okay.

[00:35:19]There we go. So, you can see that how small it is, the right side of the thyroid.

[00:35:25]That's the nodule there. This is our level six dissection that we've done.

[00:35:30]Just have a quick check now. So, we've got nerve and nerve.

[00:35:39]Looks good. Nerves are working.

[00:35:41]We're happy we've cleared everything for her.

[00:35:44]>> [music] >> So, now we're just going to clean up with a bit of saline.

[00:35:49]Do the hemostasis check. Make sure there's no bleeding.

[00:35:52]And then we'll close.

[00:35:58]Everything that we wanted to remove has been removed, and all the key structures have been left intact. Really pleased that the nerves to the voice box are preserved, so that's great on both sides. So, um she should wake up without any problems at all with regards to the voice.

[00:36:16]One, two, three.

[00:36:20]The maternity team are going to just check on the baby tonight.

[00:36:24]Make sure everything's okay, but from what I hear from John, anesthetics [music] has gone pretty well.

[00:36:29]>> Mel, operation's all done. You're just waking up.

[00:36:32]>> Melissa's case, you know, runs quite close to your heart. She's, you know, >> [music] >> one of our members of staff.

[00:36:38]We treat everyone with the highest level of respect and care.

[00:36:42]But it it does make it a little bit more personal when you've got one of your own team here in the operating theater.

[00:36:55]>> Got that there. Yep.

[00:36:57]Everyone got that?

[00:36:58]Yep.

[00:37:11]He was at the top. He's blacked out.

[00:37:13]He's woken up at the bottom of the stairs. [music] Just complaining of pain everywhere.

[00:37:18]>> Breathe in and hold your breath.

[00:37:21]>> Apparently the paramedics said he's cuz he couldn't he's not moved. He's >> [music] >> peed into like a jug or something. He said it's bright red.

[00:37:33]So me I mean literally as soon as I went to just gently blow up the kidney, I mean he was in agony. So >> Breathe in and hold your breath.

[00:37:49]>> And the kidneys, there is effusion.

[00:37:52]Small effusion on the right.

[00:37:54]>> Breathe >> Can we look at the spine?

[00:38:04]Right, there are cracks there.

[00:38:07]Hopefully.

[00:38:09]Yeah, firm's come off.

[00:38:10]Brilliant. Thank you.

[00:38:12]So one of the great things about CT is it will reveal injuries that we're potentially not thinking about. And that's because we get distracted with, you know, really obvious things like bits of bone sticking out or parts of the body that the patient's really complaining about and might be distracted from those more subtle injuries. And the great thing about the CT, it doesn't care about any of that.

[00:38:32]It just gives you a black and white image of exactly what's wrong with the patient.

[00:38:40]Sam.

[00:38:41]Right. Finally got the report, okay?

[00:38:44]Your kidneys and, [music] you know, your waterworks kind of look okay. So, the thing we were worried about most when you came in [music] cuz you're peeing blood, actually at the moment everything there looks to be working [music] all right on the CT scan.

[00:38:57]The other thing you've got some cracks in your spine, like the bones at the bottom of your back. [music] So, you there it shows that you've broken some of those bones, okay? Now, what we need to do for you to get more information is get an MRI [music] scan for you. So, don't go anywhere. All right?

[00:39:15]>> Thanks a lot for your help.

[00:39:15]>> No worries.

[00:39:17]Yes.

[00:39:19]He's got several vertebral fractures, so fractures of the bone in his spine, uh sort of further down his spine, so at the at the lumbar level. Um so, more kind of like small of your back.

[00:39:31]And that's what we're really worried about cuz that could cause some lifelong problems for him such as >> [music] >> reduced his ability to walk or it you know, worst case scenario affecting like his ability to go to the toilet or even kind of ever stand again. [music] So, that's kind of our priority at the moment. Um we are going to need to get the spinal team surgeons, uh various other people involved in his care now.

[00:40:01]Um this guy's going to be here in 5 minutes. So, this guy this guy can step down.

[00:40:11]>> [music] [music] >> I'm just glad it's the surgery's done, to be honest. And I'm glad that they've got rid of all the cancer. [music] And they've been checking the baby's heartbeat, and they did an ultrasound scan yesterday [music] morning, and everything's okay. She's fine. She's kicking away, and she's happy in there.

[00:40:38]So, she's oblivious to everything what's going on.

[00:40:53]>> It was 2015 when the somebody was bring Thomas to me.

[00:40:58]He's been basically homeless.

[00:40:59]He's live on a riverside in the Nottingham.

[00:41:02]And basically, when I took him, I was getting him straight to accommodation.

[00:41:06]He comes to me. He asked me if he can work [music] with me together.

[00:41:11]That is how how start as the friends relations.

[00:41:14]That's why That's why we are almost like the family at the moment.

[00:41:22]The best The best friend.

[00:41:25]The best friend ever.

[00:41:32]He say he's never He's never had someone someone like me.

[00:41:36]In the all his life.

[00:41:40]>> [music] [music] >> So, I'll probably say she might be here for another 1 to hours.

[00:41:59]>> I wouldn't think how lovely she looks when she's asleep.

[00:42:17]>> Working here [music] and dealing with patients in such a life-threatening condition puts me under a lot of pressure.

[00:42:24]But when I'm able to [music] help them get better, it gives me a lot of satisfaction.

[00:42:30]It is the reason I do my job.