"Critical: Between Life and Death" Episode #1.2

1 00:00:11,120 --> 00:00:15,120 Okay, guys, we have a young male arriving by helicopter. 2 00:00:16,120 --> 00:00:19,240 A code black was declared 30 minutes ago. 3 00:00:19,320 --> 00:00:22,000 Should be here in two minutes, helicopter's landing. 4 00:00:28,480 --> 00:00:33,760 The timeframe that is required to save the patient's life is very short. 5 00:00:34,400 --> 00:00:37,520 Minutes, indeed seconds, equal brain function. 6 00:00:42,520 --> 00:00:46,000 Like a Formula One pit stop, it's absolutely critical 7 00:00:46,080 --> 00:00:49,240 that every member of the resus team knows their role. 8 00:00:49,320 --> 00:00:51,920 Neurosurgery have now arrived. Anesthesia? 9 00:00:52,000 --> 00:00:53,800 Anesthetic consultant, Arch. 10 00:00:53,880 --> 00:00:55,720 -Surgery? -CC2, arm in. 11 00:00:55,800 --> 00:00:58,280 Radiography, Mehmet. Thank you very much. 12 00:00:58,360 --> 00:00:59,840 Stand by for the handover. 13 00:01:00,640 --> 00:01:01,640 Just go ahead, please. 14 00:01:01,720 --> 00:01:04,320 This is Jack. He's 34. 15 00:01:04,400 --> 00:01:07,640 At 15:20, he's been seen on CCTV 16 00:01:07,720 --> 00:01:09,880 to be assaulted by someone with a metal pole. 17 00:01:09,960 --> 00:01:12,800 Hit around the head at least three times. 18 00:01:12,880 --> 00:01:15,120 There are three wounds to the back of the head. 19 00:01:15,200 --> 00:01:18,280 He's got one large seven-centimeter wound above the right eye, 20 00:01:18,360 --> 00:01:20,880 and his immediate requirement is a CT of his head. 21 00:01:20,960 --> 00:01:25,440 Okay, guys, so in summary, a potentially time-critical head injury. 22 00:01:25,520 --> 00:01:26,920 Blizzard out, scoop off. 23 00:01:27,000 --> 00:01:29,360 Go on, lift. Ready, steady, lift. 24 00:01:29,440 --> 00:01:33,000 There are very few emergencies that are more life-threatening 25 00:01:33,080 --> 00:01:34,600 than a serious head injury. 26 00:01:35,320 --> 00:01:40,040 So, the pupils are left-sided, two, reactive but slow. 27 00:01:40,120 --> 00:01:41,680 Right-sided, four. 28 00:01:41,760 --> 00:01:44,240 CT is ready for us. 29 00:01:44,320 --> 00:01:48,320 In a code black, the brain is under such extreme pressure, 30 00:01:48,400 --> 00:01:49,760 the patient's life is at risk. 31 00:01:51,000 --> 00:01:57,074 32 00:02:03,920 --> 00:02:05,360 Ready, steady, move. 33 00:02:06,920 --> 00:02:11,200 Get them on the CT scanner 'cause that's the key to the diagnosis. 34 00:02:12,800 --> 00:02:14,480 We'll be looking for fractures. 35 00:02:15,080 --> 00:02:17,160 We need to scan the patient's brain 36 00:02:17,240 --> 00:02:21,120 and diagnose the injuries within the fastest possible timeframe. 37 00:02:21,200 --> 00:02:23,400 Every single minute is critical. 38 00:02:25,200 --> 00:02:29,040 There's a fracture there. The eye is completely torn. 39 00:02:30,640 --> 00:02:32,160 -There are some contusions. -Yeah. 40 00:02:32,240 --> 00:02:33,600 Contusional hematomas. 41 00:02:35,040 --> 00:02:38,000 With so many fractures in that orbital wall, 42 00:02:38,600 --> 00:02:39,800 it's a bit of a concern. 43 00:02:41,760 --> 00:02:46,440 The patient has skull fractures, bleeding around the brain. 44 00:02:46,960 --> 00:02:49,080 Okay, let's get him back to resus. 45 00:02:49,160 --> 00:02:50,600 The brain is under pressure, 46 00:02:50,680 --> 00:02:56,120 risking the life-sustaining component of the brain, which is the brain stem. 47 00:03:02,760 --> 00:03:05,840 When you first encounter a major trauma victim… 48 00:03:05,920 --> 00:03:08,000 With a pupil that's unreactive. 49 00:03:08,080 --> 00:03:10,960 …you're building a picture of the injuries. 50 00:03:11,560 --> 00:03:14,040 You prioritize what you're going to do, 51 00:03:14,120 --> 00:03:18,480 and then you begin to think of them as a person 52 00:03:19,320 --> 00:03:20,520 with a life 53 00:03:22,000 --> 00:03:23,560 and a family. 54 00:03:25,000 --> 00:03:29,400 That changes them to a father, mother, or son. 55 00:03:29,920 --> 00:03:34,240 That's, without a doubt, the most difficult aspect of the job. 56 00:03:41,080 --> 00:03:45,120 I found out about Jack's assault when we were on holiday. 57 00:03:47,080 --> 00:03:51,360 We were told that we really needed to get to the hospital as soon as possible. 58 00:03:56,200 --> 00:03:59,840 I remember flying back to the UK, 59 00:03:59,920 --> 00:04:04,360 and looking at all the people around you eating Pringles and having a drink, 60 00:04:04,440 --> 00:04:10,240 and how very, very different the world inside my head was. 61 00:04:12,080 --> 00:04:13,400 This is our child. 62 00:04:14,600 --> 00:04:16,280 So I know how to steer now. 63 00:04:17,440 --> 00:04:21,200 Our only son, and the middle child between two girls. 64 00:04:22,320 --> 00:04:26,560 He's a good brother. He clearly loves his sisters. 65 00:04:27,960 --> 00:04:28,960 Hey, stop there! 66 00:04:30,320 --> 00:04:32,120 And he's also a great uncle. 67 00:04:33,400 --> 00:04:36,720 He's always very much valued his family. 68 00:04:37,880 --> 00:04:42,920 But in an instant, we had to face the fact that we could lose our son. 69 00:04:43,840 --> 00:04:47,680 And the utter sadness, horror, that we couldn't be there. 70 00:04:54,800 --> 00:04:57,280 The scan has so far showed a skull fracture, 71 00:04:58,080 --> 00:05:00,560 multiple fractures of the eye socket. 72 00:05:01,480 --> 00:05:03,080 We have some bruising on the brain. 73 00:05:03,160 --> 00:05:06,800 So, I'm worrying about a blood clot forming, 74 00:05:07,560 --> 00:05:09,440 creating such pressure 75 00:05:09,520 --> 00:05:12,880 that the center of life, the brain stem, is affected. 76 00:05:14,520 --> 00:05:17,320 Hi, Radiology. It's regarding the code black trauma. 77 00:05:17,400 --> 00:05:19,960 Have you had a chance to look at the images? 78 00:05:20,040 --> 00:05:24,120 The priority now is to keep the patient sedated to protect the brain, 79 00:05:24,200 --> 00:05:26,920 and we'll move the patient to the intensive care unit. 80 00:05:31,000 --> 00:05:34,240 When you encounter such cases of extreme violence, 81 00:05:34,320 --> 00:05:36,560 it's actually thoroughly distressing. 82 00:05:37,080 --> 00:05:42,720 What circumstances have led to this is very hard to understand. 83 00:05:43,240 --> 00:05:46,960 And the group of patients that's most affected by violence 84 00:05:47,480 --> 00:05:50,800 and more likely to commit violence, they're unfortunately young men. 85 00:05:53,640 --> 00:05:59,200 Even aside from violence, more men engage in risk-taking activities. 86 00:05:59,920 --> 00:06:02,680 Men are more likely to be riding motorbikes. 87 00:06:02,760 --> 00:06:05,440 Statistically, they're engaged in more traffic collisions, 88 00:06:05,520 --> 00:06:09,600 and that's why, if you're a male under the age of 45, 89 00:06:10,120 --> 00:06:11,640 trauma is the top killer. 90 00:06:15,600 --> 00:06:18,320 Two-five-one-three, it's a male being assaulted. 91 00:06:18,920 --> 00:06:22,000 -Holy moly. -We've got help coming now. 92 00:06:22,760 --> 00:06:25,360 Every second, there's a new job tipping in on the screen. 93 00:06:26,080 --> 00:06:30,240 This gentleman has fallen 15, 20 feet onto part of the embankment. 94 00:06:30,760 --> 00:06:33,960 Alpha 216, hello, mate. It's David on the APP desk. 95 00:06:34,640 --> 00:06:36,480 There's a lot of calls coming to London. 96 00:06:36,560 --> 00:06:38,400 -Medic two. -Medic two, go ahead. 97 00:06:38,480 --> 00:06:41,200 We have a limited number of Advanced Paramedics. 98 00:06:41,280 --> 00:06:44,520 And so we can only really send them to the most critical patients. 99 00:06:46,360 --> 00:06:48,720 New incident details received. 100 00:06:49,400 --> 00:06:53,320 APPs are integral to London's major trauma system, 101 00:06:54,120 --> 00:06:56,400 and they're critical to making interventions 102 00:06:56,480 --> 00:06:57,680 to save people's lives. 103 00:07:00,280 --> 00:07:02,760 When I go into work, I have literally no idea 104 00:07:02,840 --> 00:07:04,400 what I'm going to be dealing with, 105 00:07:05,240 --> 00:07:07,000 especially in a city like London. 106 00:07:07,520 --> 00:07:10,040 We have a pedestrian that's been hit by a bus. 107 00:07:10,120 --> 00:07:12,600 They're unconscious and bleeding from their head. 108 00:07:13,520 --> 00:07:17,200 But if you can look after a traumatically injured patient in London, 109 00:07:17,920 --> 00:07:19,840 I think you can do it pretty much anywhere. 110 00:07:19,920 --> 00:07:22,560 Six-two, mate. I'm mobile. 111 00:07:23,640 --> 00:07:28,120 A few years back, I was an RAF paramedic deployed out to Afghanistan. 112 00:07:28,200 --> 00:07:31,400 And I will, to the day I die, remember the feeling 113 00:07:31,480 --> 00:07:34,160 of getting off the aircraft at Camp Bastion. 114 00:07:34,960 --> 00:07:36,880 The casualties that I was managing was done 115 00:07:36,960 --> 00:07:39,400 in the back of a moving helicopter. 116 00:07:39,920 --> 00:07:42,360 The environment was utterly different. 117 00:07:43,840 --> 00:07:45,400 But the medicine isn't. 118 00:07:47,800 --> 00:07:49,200 Did you witness what happened? 119 00:07:49,280 --> 00:07:50,720 He got hit by a van. 120 00:07:51,360 --> 00:07:53,480 Talk to me about what's happening with his leg. 121 00:07:53,560 --> 00:07:54,960 Does it look deformed? 122 00:07:55,040 --> 00:07:57,400 Yeah, it looks as if it's hanging off. 123 00:07:58,200 --> 00:08:00,560 I think this is almost definitely gonna be for us. 124 00:08:01,240 --> 00:08:03,360 We've got an APP close to the call. 125 00:08:03,440 --> 00:08:06,440 It's only 11 minutes away. 126 00:08:06,520 --> 00:08:08,560 New incident details received. 127 00:08:09,760 --> 00:08:12,480 Six-two, mobile, 5.6 miles. 128 00:08:13,720 --> 00:08:17,600 There's so much crossover between London and Afghanistan. 129 00:08:18,840 --> 00:08:23,040 If a patient isn't properly managed in the first few minutes of their injury, 130 00:08:23,120 --> 00:08:26,560 the damage has already been done before you arrive at the hospital. 131 00:08:27,080 --> 00:08:30,120 You need a response there that can do everything it can 132 00:08:30,200 --> 00:08:33,480 to minimize the effect of that life-changing event. 133 00:08:34,680 --> 00:08:39,040 All of the work I do is seeing people on the very worst day of their lives. 134 00:08:39,760 --> 00:08:42,600 You almost act like a human lightning rod. 135 00:08:42,680 --> 00:08:45,120 You have to absorb a lot of the energy. 136 00:08:47,160 --> 00:08:49,320 Hi, everybody. I'm Pete. 137 00:08:51,000 --> 00:08:55,520 This is Jared. He's a 26-year-old who's been hit off his motorcycle. 138 00:08:55,600 --> 00:08:58,640 He's been flung about ten feet in the air, landed on the floor. 139 00:08:58,720 --> 00:09:00,960 So tib fib, I think we've got some critical skin, 140 00:09:01,040 --> 00:09:03,960 and we haven't assessed circulation or sensation down there yet. 141 00:09:04,040 --> 00:09:07,320 I'm gonna sort your leg out. I know you're in a load of pain. 142 00:09:07,400 --> 00:09:08,720 I'm gonna help you with that. 143 00:09:08,800 --> 00:09:10,360 -Are you family? -Mum. 144 00:09:10,440 --> 00:09:13,080 Hi, Mum. It don't matter how old you are in life, buddy, 145 00:09:13,160 --> 00:09:15,840 when you hurt yourself, everybody wants their mum. 146 00:09:15,920 --> 00:09:16,760 Okay. 147 00:09:16,840 --> 00:09:19,920 -Mum, I'm going to chop his pants off. -Okay. 148 00:09:20,000 --> 00:09:21,720 Look away if it's something 149 00:09:22,280 --> 00:09:25,320 that it's been a few years since you wanna see. 150 00:09:25,400 --> 00:09:28,200 I'll cover him. I don't want to flash him to anyone. 151 00:09:28,280 --> 00:09:29,640 That's it. Well done. 152 00:09:29,720 --> 00:09:31,720 Have we given him anything so far? 153 00:09:31,800 --> 00:09:34,680 Do you mind giving him just two and a half to start with? 154 00:09:35,200 --> 00:09:36,760 And then give him some ketamine. 155 00:09:36,840 --> 00:09:39,400 Get that leg straight and pulled straight. 156 00:09:40,720 --> 00:09:42,400 Looking at Jared's leg, 157 00:09:42,480 --> 00:09:46,240 straightaway, I know this is a limb-threatening injury. 158 00:09:49,200 --> 00:09:50,760 There's multiple breaks. 159 00:09:51,640 --> 00:09:54,440 And if you don't manage a fracture properly 160 00:09:54,520 --> 00:09:56,160 in the pre-hospital phase, 161 00:09:56,240 --> 00:09:59,840 you can start causing lifelong irreversible damage. 162 00:10:02,240 --> 00:10:04,640 I am going to give you a nice, strong painkiller. 163 00:10:04,720 --> 00:10:06,520 It'll make you feel a bit lightheaded. 164 00:10:06,600 --> 00:10:09,920 While you're away with the fairies, I'm gonna sort your leg out, okay? 165 00:10:10,000 --> 00:10:11,560 Is it gonna stop my heart? 166 00:10:11,640 --> 00:10:13,640 I'm definitely not gonna stop your heart. 167 00:10:13,720 --> 00:10:17,080 Of all the things I'm gonna do for you, that ain't one of them, all right? 168 00:10:17,920 --> 00:10:19,720 So, that's the good stuff gone in. 169 00:10:20,320 --> 00:10:23,480 We must realign the leg as quickly as possible 170 00:10:23,560 --> 00:10:27,160 to make sure that the broken bones aren't obstructing the blood flow. 171 00:10:28,160 --> 00:10:30,480 Otherwise, he could lose his leg. 172 00:10:31,680 --> 00:10:33,440 So all we're gonna have now 173 00:10:33,520 --> 00:10:36,400 is Mum's voice only, but we don't want to wake him up. 174 00:10:37,480 --> 00:10:38,760 You're doing good. 175 00:10:39,760 --> 00:10:42,360 Okay, you got it? I want one hand under here. 176 00:10:42,920 --> 00:10:45,040 And we're gently going to lift his leg up. 177 00:10:47,160 --> 00:10:48,600 -You ready, Owen? -Yeah. 178 00:10:53,200 --> 00:10:54,240 Nice. 179 00:10:58,520 --> 00:11:01,400 One of the most important things that's come out of Afghanistan 180 00:11:01,480 --> 00:11:04,800 is the learning around traumatically injured patients. 181 00:11:06,000 --> 00:11:09,360 You're just gonna keep applying that nice, gentle southward pressure 182 00:11:09,440 --> 00:11:10,920 and pop the hand there. 183 00:11:11,920 --> 00:11:14,800 What we want to do is go to a major trauma center. 184 00:11:14,880 --> 00:11:16,200 King's is closest. 185 00:11:16,280 --> 00:11:17,400 Yeah, perfect. 186 00:11:17,480 --> 00:11:20,720 This learning that was captured in the hardest possible environment 187 00:11:20,800 --> 00:11:24,440 is now being used in the major trauma network across London. 188 00:11:25,280 --> 00:11:27,240 Mum, I feel weird. 189 00:11:27,320 --> 00:11:31,400 It will feel weird. You're naked on Peckham High Street. 190 00:11:32,480 --> 00:11:35,440 First time in your life? I'll pick my street, yeah. 191 00:11:36,000 --> 00:11:38,880 Owen, let's extend the scoop to its full length. 192 00:11:38,960 --> 00:11:39,960 He's a tall chap. 193 00:11:40,040 --> 00:11:42,160 I tell the females 5' 11". 194 00:11:44,080 --> 00:11:46,200 Ready, brace, lift. 195 00:11:46,280 --> 00:11:48,760 Down he comes. Couple of seatbelts on him, please. 196 00:11:48,840 --> 00:11:50,280 And then onto your vehicle. 197 00:11:50,360 --> 00:11:52,840 Mum, this is scaring me. 198 00:11:52,920 --> 00:11:53,800 I love you, Mummy. 199 00:11:53,880 --> 00:11:55,080 You've got drugs. 200 00:11:55,160 --> 00:11:56,400 Mummy! 201 00:11:56,480 --> 00:11:57,920 -Meet you at King's. -Okay. 202 00:11:58,000 --> 00:12:01,240 All right? No, calm down. Breathe for me. 203 00:12:01,760 --> 00:12:02,600 In. 204 00:12:03,480 --> 00:12:04,600 Good lad. 205 00:12:04,680 --> 00:12:06,520 I'm not cold but shivering. 206 00:12:06,600 --> 00:12:08,560 Let's get the doors shut, please, guys. 207 00:12:08,640 --> 00:12:10,160 We need to start making a move. 208 00:12:13,880 --> 00:12:16,920 -Your name's Peter? -That's it. Well remembered. 209 00:12:17,000 --> 00:12:20,160 You've done a great job, my friend. Thank you so much. 210 00:12:20,240 --> 00:12:22,120 Can I high-five you with my other hand? 211 00:12:22,200 --> 00:12:24,120 Where's your hand? Can you coordinate that? 212 00:12:24,200 --> 00:12:25,840 There you go. That'll do us for now. 213 00:12:27,080 --> 00:12:29,040 How long you been riding your motorbike for? 214 00:12:29,120 --> 00:12:32,080 For ten, 11 years now. 215 00:12:32,160 --> 00:12:34,160 All right, nice and slow with your breathing. 216 00:12:34,240 --> 00:12:36,880 Don't get yourself distressed. Think nice, slow. That's it. 217 00:12:36,960 --> 00:12:38,320 Nice, slow, deep breaths. 218 00:12:38,400 --> 00:12:41,320 Jared's body will've absorbed a huge amount of energy, 219 00:12:41,400 --> 00:12:45,480 and he's at very high risk of having some really significant injuries. 220 00:12:46,400 --> 00:12:50,040 You can help me, Jared, by just thinking about your breathing. 221 00:12:51,000 --> 00:12:52,880 This is a complicated injury. 222 00:12:54,360 --> 00:12:55,920 And he could lose his leg. 223 00:12:57,200 --> 00:12:58,640 This is not an injury 224 00:12:58,720 --> 00:13:01,800 that every hospital in London is set up to deal with. 225 00:13:05,600 --> 00:13:09,320 Jared needs that multidisciplinary specialist care 226 00:13:09,400 --> 00:13:11,720 that he will get at a major trauma center. 227 00:13:12,880 --> 00:13:16,160 And he needs world-leading orthopedic surgeons. 228 00:13:20,800 --> 00:13:22,680 I'm of Egyptian origin. 229 00:13:22,760 --> 00:13:26,560 And in Egypt, they're known for being master builders. 230 00:13:26,640 --> 00:13:30,440 Dude, am I doing the nailing, yeah? I'm doing the nailing? 231 00:13:30,520 --> 00:13:33,040 So, it's in my blood, yeah. 232 00:13:33,120 --> 00:13:34,680 The plan is to straighten it out. 233 00:13:35,400 --> 00:13:37,800 Orthopedic surgery, it's a craft. 234 00:13:37,880 --> 00:13:41,360 You have to be able to be in tune with your tools. 235 00:13:42,080 --> 00:13:44,520 The drill. That's my favorite. 236 00:13:46,200 --> 00:13:48,920 What we do is we straighten bones. We fix them. 237 00:13:49,440 --> 00:13:52,400 What I love about it is the fact that the patient 238 00:13:52,480 --> 00:13:54,120 who's in pain and discomfort… 239 00:13:54,200 --> 00:13:59,520 The shift between that and getting better, it's an immediate thing. 240 00:14:00,480 --> 00:14:02,920 Nothing in medicine gives you that immediacy. 241 00:14:05,480 --> 00:14:08,280 Good afternoon. This is 26-year-old Jared. 242 00:14:08,360 --> 00:14:10,600 He was the solo rider of a motorcycle 243 00:14:10,680 --> 00:14:13,080 negotiating through traffic on Peckham High Road 244 00:14:13,160 --> 00:14:14,920 when he collided with another vehicle. 245 00:14:15,000 --> 00:14:19,200 Injuries, he has an open, comminuted, distorted fib. 246 00:14:19,280 --> 00:14:20,280 Okay. 247 00:14:20,360 --> 00:14:22,560 Posterior, somewhere next to his sub-Achilles, 248 00:14:22,640 --> 00:14:25,440 is a two-to-three-centimeter puncture wound, 249 00:14:25,520 --> 00:14:28,160 which looks like it's been done by bone coming out. 250 00:14:28,680 --> 00:14:32,560 I think the drugs are finally coming out of my system. 251 00:14:32,640 --> 00:14:33,480 I don't know. 252 00:14:33,560 --> 00:14:35,400 Don't worry. I've got plenty more. 253 00:14:35,480 --> 00:14:37,560 -Can we have the scoop off, please? -Yeah. 254 00:14:39,880 --> 00:14:41,520 Well done. 255 00:14:44,480 --> 00:14:46,280 We'll do a CT scan. 256 00:14:46,360 --> 00:14:49,320 Can we get ortho to check the neurovascular status? 257 00:14:50,000 --> 00:14:52,400 Hi, my name's Remi. I'm one of the orthopedic doctors. 258 00:14:52,480 --> 00:14:54,960 I want to have a brief examination of your foot 259 00:14:55,040 --> 00:14:56,600 before you run off to the scanner. 260 00:14:56,680 --> 00:14:58,200 -All right? -How am I gonna run? 261 00:14:58,280 --> 00:15:01,560 That's it. Can you wiggle both sets of toes for me? 262 00:15:02,280 --> 00:15:03,320 Close your eyes, mate. 263 00:15:03,400 --> 00:15:05,880 -Say yes if you can feel me touching you. -Yeah. 264 00:15:06,400 --> 00:15:08,520 We're doing a full-body trauma scan. 265 00:15:08,600 --> 00:15:12,280 The reason is the mechanism, the way the accident has happened. 266 00:15:12,360 --> 00:15:14,560 Sorry, mate. 267 00:15:14,640 --> 00:15:17,320 We all know that there's a nasty fracture. 268 00:15:17,400 --> 00:15:21,680 We may have to intervene imminently so that we don't lose that leg. 269 00:15:22,880 --> 00:15:24,760 I think we have to take that down now. 270 00:15:25,520 --> 00:15:27,320 Please, no. Don't amputate my leg. 271 00:15:27,920 --> 00:15:28,960 Hopefully not. 272 00:15:29,040 --> 00:15:31,520 Please. I'll die. 273 00:15:35,360 --> 00:15:37,000 I just saw Jared on the floor. 274 00:15:38,120 --> 00:15:40,240 And it was… Oh my gosh. 275 00:15:42,560 --> 00:15:43,920 I was scared. 276 00:15:44,520 --> 00:15:46,240 Ready, steady, slide. 277 00:15:48,840 --> 00:15:50,320 I know he's a man. 278 00:15:51,320 --> 00:15:52,440 But he's my baby. 279 00:15:52,520 --> 00:15:53,760 He's my baby boy. 280 00:15:55,000 --> 00:15:57,200 Jared, breathe normally, okay? 281 00:15:59,000 --> 00:16:01,480 But he just kept on saying, "Sorry, Mummy." 282 00:16:02,520 --> 00:16:05,040 He was really scared. 283 00:16:12,440 --> 00:16:14,120 -You'll be all right. -Yeah. 284 00:16:14,200 --> 00:16:16,760 -Yeah? -Don't cry. It's making me cry, bruv. 285 00:16:18,840 --> 00:16:21,240 I guess I can't take you out then, you know? 286 00:16:21,960 --> 00:16:24,240 I guess not. 287 00:16:26,080 --> 00:16:27,080 But yeah. 288 00:16:27,600 --> 00:16:28,440 Yeah. 289 00:16:29,040 --> 00:16:31,680 We've just had a report from the radiologist. 290 00:16:32,320 --> 00:16:36,280 It's a fracture of both of the bones. It's called your tibia and your fibula. 291 00:16:36,800 --> 00:16:41,680 Overlying that is a laceration or a cut, which is more complicated. 292 00:16:41,760 --> 00:16:43,760 You're gonna need an operation here. 293 00:16:46,120 --> 00:16:49,720 Could you please leave ortho to the major trauma and resus now? 294 00:16:51,640 --> 00:16:53,440 So, this is Jared's scan. 295 00:16:54,080 --> 00:16:55,880 He's got quite a nasty injury. 296 00:16:56,480 --> 00:16:59,000 It looks like his bones exploded. 297 00:17:00,640 --> 00:17:03,840 And not only exploding, but the fragments coming through the leg, 298 00:17:05,040 --> 00:17:09,120 tearing through the muscle of the skin, creating what's called an open fracture. 299 00:17:09,200 --> 00:17:10,640 This is a serious injury. 300 00:17:12,240 --> 00:17:13,920 If the operation doesn't go well, 301 00:17:14,440 --> 00:17:16,760 Jared might not be able to walk properly again. 302 00:17:35,920 --> 00:17:37,960 Jack is a seriously injured patient, 303 00:17:38,040 --> 00:17:40,760 having been struck on the head with a metal bar. 304 00:17:40,840 --> 00:17:43,360 He's been in ICU for two days. 305 00:17:44,400 --> 00:17:47,440 My colleagues are lightening his sedation to wake him up. 306 00:17:50,520 --> 00:17:52,640 This is always a crucial time. 307 00:17:54,480 --> 00:17:56,160 Our job now is to prioritize 308 00:17:56,240 --> 00:17:58,640 his next sequence of operations and procedures 309 00:17:58,720 --> 00:18:03,880 to get him back as close as possible to who he was before this injury occurred. 310 00:18:07,960 --> 00:18:11,680 The tube has come out, so he's no longer on a ventilator. 311 00:18:11,760 --> 00:18:13,160 He's breathing for himself. 312 00:18:14,200 --> 00:18:16,680 But Jack could have life-changing injuries. 313 00:18:18,280 --> 00:18:23,040 As well as being a flight doctor, I'm also a consultant in critical care. 314 00:18:23,120 --> 00:18:27,640 Having, like, a true understanding of the journey that patient's been on 315 00:18:27,720 --> 00:18:29,200 is really beneficial. 316 00:18:31,160 --> 00:18:32,960 Hi, how are you doing? 317 00:18:33,040 --> 00:18:34,640 -Yeah, not too bad. -Good. 318 00:18:35,360 --> 00:18:36,560 And how's your pain? 319 00:18:37,200 --> 00:18:39,000 I mean, yeah, it's not as bad. 320 00:18:40,360 --> 00:18:41,520 Obviously the right eye. 321 00:18:42,120 --> 00:18:43,960 I'm seeing, like, what looks like a… 322 00:18:44,480 --> 00:18:47,160 I can describe it as a spider's leg coming out of this eye. 323 00:18:47,240 --> 00:18:48,280 Okay. 324 00:18:48,960 --> 00:18:51,800 Biggest concern for us right now with Jack is 325 00:18:51,880 --> 00:18:56,360 that he's got multiple facial fractures, mostly around the eye socket. 326 00:18:56,960 --> 00:19:00,600 This could lead to long-term disfigurement to the face, 327 00:19:01,120 --> 00:19:03,600 and Jack may lose the vision in that eye. 328 00:19:05,000 --> 00:19:07,880 He will need urgent surgery to have those fixed. 329 00:19:09,400 --> 00:19:13,160 You're gonna be seen by max fax, the maxillofacial surgeons. 330 00:19:13,240 --> 00:19:15,680 They look after the broken bones in the face. 331 00:19:15,760 --> 00:19:18,000 So they'll be able to look at it properly. Okay? 332 00:19:18,080 --> 00:19:20,000 -All right, you're doing well. -Thank you. 333 00:19:20,080 --> 00:19:22,000 That's okay. My pleasure. 334 00:19:24,800 --> 00:19:28,120 There are jobs that sometimes makes you think of somebody 335 00:19:28,200 --> 00:19:29,560 that you know or you love. 336 00:19:31,000 --> 00:19:34,120 And one of the things you realize working on the intensive care unit 337 00:19:34,200 --> 00:19:36,320 is how these traumatic injuries, 338 00:19:36,400 --> 00:19:39,120 they have ripple effects on the rest of the family, 339 00:19:39,200 --> 00:19:41,640 and how that can really impact everybody. 340 00:19:42,240 --> 00:19:44,200 -Left or right? -Left. 341 00:19:44,280 --> 00:19:46,120 I think they call him John in here. 342 00:19:46,640 --> 00:19:49,400 'Cause he was in that one. That's the higher dependency. 343 00:19:50,360 --> 00:19:52,840 It's the first time I've seen Jack today. 344 00:19:53,600 --> 00:19:54,800 Do you need help? 345 00:19:54,880 --> 00:19:56,720 Yeah, we've just come to see John. 346 00:19:57,400 --> 00:19:59,280 But I'm here with my daughter. 347 00:19:59,920 --> 00:20:01,320 We're a close family. 348 00:20:02,080 --> 00:20:03,480 Second door on your right. 349 00:20:03,560 --> 00:20:04,680 Thank you. 350 00:20:05,480 --> 00:20:06,960 We're just shocked. 351 00:20:08,640 --> 00:20:13,000 I kind of know a bit of what to expect, but I'm still nervous. 352 00:20:15,240 --> 00:20:16,320 Here. 353 00:20:16,840 --> 00:20:17,840 -All right? -Yeah. 354 00:20:17,920 --> 00:20:18,880 -You sure? -Yeah. 355 00:20:24,520 --> 00:20:25,400 Yeah. 356 00:20:25,960 --> 00:20:29,120 Just gonna head to the window and back, and then… 357 00:20:29,640 --> 00:20:30,800 -Hello. -Hello. 358 00:20:30,880 --> 00:20:34,720 Obviously if there's any dizziness, just let me know, okay? Step this way. 359 00:20:34,800 --> 00:20:35,960 -This way? -Yeah. 360 00:20:36,560 --> 00:20:38,760 -Good. You okay? -Yeah. 361 00:20:41,640 --> 00:20:43,040 Breathe a little bit. 362 00:20:45,360 --> 00:20:47,640 And this is obviously quite a significant change 363 00:20:47,720 --> 00:20:49,120 from your normal walking. 364 00:20:49,200 --> 00:20:50,840 Just a little bit, yeah. 365 00:20:53,360 --> 00:20:55,520 -You're doing all right? -Yeah. 366 00:20:56,440 --> 00:20:57,560 As long as you are. 367 00:21:09,480 --> 00:21:12,000 -All right? -Yeah. I'm fine. 368 00:21:22,920 --> 00:21:25,040 -Is that the first time you've walked out? -Yeah. 369 00:21:25,120 --> 00:21:27,160 I didn't realize you were gonna be out there. 370 00:21:27,240 --> 00:21:28,600 It's not the best look. 371 00:21:30,120 --> 00:21:32,960 -We were your first audience. -Yeah, I know. 372 00:21:33,480 --> 00:21:35,400 Sorry to bring you back from holiday. 373 00:21:35,480 --> 00:21:38,320 That's all right. What's Italy compared with… 374 00:21:38,400 --> 00:21:42,800 What's 28 degrees of sunshine compared with London? 375 00:21:44,240 --> 00:21:45,720 How much do you remember? 376 00:21:46,240 --> 00:21:48,240 I only remember getting hit once, 377 00:21:48,320 --> 00:21:50,480 and then I lost all vision, and it went black. 378 00:21:52,240 --> 00:21:54,600 Maybe you don't want to talk about that right now. 379 00:22:02,760 --> 00:22:05,000 Last night, I didn't sleep until 3:00 or 4:00. 380 00:22:06,440 --> 00:22:08,800 That was the first time the penny dropped. 381 00:22:08,880 --> 00:22:09,960 I could have died. 382 00:22:12,760 --> 00:22:13,600 Jack! 383 00:22:15,200 --> 00:22:17,720 I've always been pretty small in height. 384 00:22:19,800 --> 00:22:22,400 I took steps over the years to mitigate that. 385 00:22:25,080 --> 00:22:28,880 By doing jiujitsu training, some boxing. 386 00:22:38,120 --> 00:22:41,080 -Do you want your phone? -I've got it on my lap here. Thank you. 387 00:22:44,680 --> 00:22:46,280 Tuesday afternoon, 388 00:22:46,920 --> 00:22:49,120 went to Tesco's up the road from my house. 389 00:22:50,680 --> 00:22:54,000 And I got into a stupid argument with a man in the store, 390 00:22:54,720 --> 00:22:56,120 which just escalated. 391 00:23:01,320 --> 00:23:02,280 -You okay? -Yeah. 392 00:23:04,200 --> 00:23:08,920 And I've seen the man running at me with a metal pole. 393 00:23:09,760 --> 00:23:11,640 -Can I examine you? -Yeah, sure. 394 00:23:12,560 --> 00:23:13,560 Follow my finger. 395 00:23:15,440 --> 00:23:17,080 And I decided to run. 396 00:23:18,400 --> 00:23:20,560 -Any double? -A little bit now. 397 00:23:21,680 --> 00:23:23,440 That's the last thing I remember. 398 00:23:27,640 --> 00:23:30,280 I've been struggling to sleep 'cause the incident's been… 399 00:23:30,360 --> 00:23:31,800 Replaying over in your mind. 400 00:23:31,880 --> 00:23:35,440 And trying to think, "If I'd done this, or if I'd done that." You know? 401 00:23:35,520 --> 00:23:37,800 -And then it's 4 a.m. and you're like… -Yeah. 402 00:23:37,880 --> 00:23:40,280 But that's just the way it is. I think that's natural. 403 00:23:40,360 --> 00:23:43,520 Yeah, it is, but it's something that we need to deal with. 404 00:23:44,480 --> 00:23:46,800 -Okay, buddy. -Thanks for your help. 405 00:23:48,360 --> 00:23:49,960 It was a pathetic argument. 406 00:23:50,640 --> 00:23:52,760 Shouldn't have got into a fight. 407 00:23:54,280 --> 00:23:58,040 I could have and should have walked away from the situation. 408 00:24:00,160 --> 00:24:02,640 It's almost cost me my life. 409 00:24:11,160 --> 00:24:12,880 Medic One, go ahead. 410 00:24:12,960 --> 00:24:16,320 One-fifty, all received, bilateral open, clear pelvis. 411 00:24:16,400 --> 00:24:19,120 Medic One, thank you. Ground escort to St George's. 412 00:24:26,040 --> 00:24:27,440 Hey, mate. 413 00:24:27,520 --> 00:24:29,240 It's been really busy. 414 00:24:30,200 --> 00:24:33,000 From the moment I wake up, it doesn't stop. 415 00:24:33,080 --> 00:24:34,280 Dude, hiya. 416 00:24:34,360 --> 00:24:35,600 I'm on the phone. 417 00:24:35,680 --> 00:24:37,120 Absolutely. 418 00:24:38,480 --> 00:24:39,760 Speaking to colleagues. 419 00:24:39,840 --> 00:24:42,520 Umar, how are you? Good to see you, dude. 420 00:24:42,600 --> 00:24:46,240 About patients, about operations, about life in general. 421 00:24:46,920 --> 00:24:48,960 So yeah, I'm always running behind time. 422 00:24:49,040 --> 00:24:50,280 Let's go. 423 00:24:50,360 --> 00:24:52,320 I need to master time management. 424 00:24:54,320 --> 00:24:55,760 Okay, shall we… 425 00:24:57,120 --> 00:24:58,880 This is the first time he's on time. 426 00:24:58,960 --> 00:25:01,200 I know. 427 00:25:02,320 --> 00:25:04,040 I think I lose track of time. 428 00:25:04,640 --> 00:25:06,400 But there's always something. 429 00:25:06,480 --> 00:25:09,000 I've had some really weird stuff happen to me, like… 430 00:25:09,080 --> 00:25:13,280 I dropped the only key to my car in the drain outside my house. 431 00:25:13,360 --> 00:25:16,160 It just went, "Plop." And then I was like, "Oh." 432 00:25:16,240 --> 00:25:18,160 But I managed to get it. 433 00:25:18,800 --> 00:25:23,080 The council have this sort of service where they come and suck it up. 434 00:25:23,160 --> 00:25:25,440 Got this big machine. It came quite quickly. 435 00:25:25,520 --> 00:25:27,360 What are the odds of that? 436 00:25:27,440 --> 00:25:29,480 Go on, Remi. Present, please. 437 00:25:29,560 --> 00:25:30,600 Thanks, mate. 438 00:25:32,240 --> 00:25:34,600 When it comes to the way we operate, 439 00:25:34,680 --> 00:25:38,200 it's a collection of some of the best minds in the country 440 00:25:38,280 --> 00:25:43,200 coming together and offering an opinion on what's best for that patient. 441 00:25:43,720 --> 00:25:48,760 So Jared is a 26-year-old gentleman who had a motorcycle versus car. 442 00:25:48,840 --> 00:25:53,640 He suffered an open fracture, comminuted distal tib fib. 443 00:25:53,720 --> 00:25:56,400 Can you show us a picture of the… of the wound there? 444 00:25:57,640 --> 00:25:59,440 So, three medial wounds. 445 00:25:59,520 --> 00:26:03,160 There was what looked like tibia basically protruding through the skin. 446 00:26:04,000 --> 00:26:05,720 Okay, so we'll go down and start. 447 00:26:05,800 --> 00:26:06,680 See you there. 448 00:26:11,160 --> 00:26:14,520 This first operation is so crucial and critical. 449 00:26:15,080 --> 00:26:17,080 It's fraught with a lot of danger. 450 00:26:18,760 --> 00:26:21,120 The most important thing with open fractures 451 00:26:21,200 --> 00:26:23,200 is the decision-making. 452 00:26:23,280 --> 00:26:28,040 It's to decide when to do definitive fixation 453 00:26:28,120 --> 00:26:31,800 versus temporary fixation and come back another day. 454 00:26:31,880 --> 00:26:36,120 We'll be assessing the soft tissue, and we'll be assessing the patient's limb. 455 00:26:36,960 --> 00:26:39,440 We'll make a decision on the table. So at the moment, 456 00:26:39,520 --> 00:26:41,960 it could go either way. It's fifty-fifty. 457 00:26:44,960 --> 00:26:48,720 I was travelling along Peckham Road, and a van collided into me. 458 00:26:49,320 --> 00:26:53,360 I took out my phone, and I called Mum instead of 999. 459 00:26:55,800 --> 00:26:58,520 I said, "Mum, I just had my first accident." 460 00:27:00,200 --> 00:27:03,480 My family, it's just me, my two sisters, 461 00:27:04,240 --> 00:27:05,080 and my mum. 462 00:27:06,760 --> 00:27:08,600 It's a bit of a windy stair. 463 00:27:09,280 --> 00:27:12,600 Mummy is pretty much the most powerful person I've ever met. 464 00:27:13,120 --> 00:27:14,080 You know? 465 00:27:14,160 --> 00:27:16,200 And she empowers me. So… 466 00:27:17,000 --> 00:27:20,560 If I talk about her anymore, it's gonna make me start crying. 467 00:27:23,760 --> 00:27:25,080 His little bedroom. 468 00:27:26,720 --> 00:27:28,400 It worked well, I think. 469 00:27:30,360 --> 00:27:33,320 These are all his clothes that got cut off. 470 00:27:34,880 --> 00:27:36,920 That's his new leathers. 471 00:27:37,680 --> 00:27:39,680 It was an early birthday pressie. 472 00:27:40,880 --> 00:27:42,080 We are close. 473 00:27:42,160 --> 00:27:44,880 We've been through quite a bit together. 474 00:27:45,920 --> 00:27:47,480 We're quite a close unit. 475 00:27:48,200 --> 00:27:50,760 When one of us wobbles a bit, 476 00:27:50,840 --> 00:27:54,040 it's like, no, the rest of them will hold you up for a while. 477 00:27:56,480 --> 00:27:58,040 See, and that's why, 478 00:27:58,560 --> 00:28:02,280 you tell everyone to wear clean undies. 479 00:28:03,040 --> 00:28:05,680 New, clean undies. Just in case. 480 00:28:10,040 --> 00:28:13,080 Jared brings the life in the house. 481 00:28:13,680 --> 00:28:16,280 He's got a beautiful character that shines. 482 00:28:17,720 --> 00:28:19,600 Good luck with the procedure. 483 00:28:20,080 --> 00:28:23,680 The operation, it was really, really scary. 484 00:28:25,160 --> 00:28:26,880 He's my baby boy. 485 00:28:33,560 --> 00:28:37,400 In the operating theater, the moment the lights go on, 486 00:28:38,840 --> 00:28:39,800 it's action time. 487 00:28:41,760 --> 00:28:44,440 You're laser-focused on the task. 488 00:28:45,400 --> 00:28:48,760 So, you'll start falling asleep. Just keep on breathing now. 489 00:28:48,840 --> 00:28:50,120 We'll look after you. 490 00:28:51,000 --> 00:28:52,880 The level of responsibility 491 00:28:52,960 --> 00:28:55,560 on the shoulder of a surgeon is substantial. 492 00:28:56,600 --> 00:28:58,160 Their life is in your hands. 493 00:28:59,240 --> 00:29:00,960 -Okay. -Let's do it. 494 00:29:05,040 --> 00:29:07,080 Scans only show us so much. 495 00:29:07,160 --> 00:29:10,960 The only way to really determine what a patient needs 496 00:29:11,040 --> 00:29:12,680 is once you open them up. 497 00:29:17,120 --> 00:29:18,840 This is a high-energy injury. 498 00:29:18,920 --> 00:29:21,600 So, although the wounds are small to start off with, 499 00:29:21,680 --> 00:29:25,200 when you get in there, you discover that the muscle's all been ripped. 500 00:29:26,040 --> 00:29:28,880 You can see, actually, that the bone is twisted and turned. 501 00:29:28,960 --> 00:29:31,040 That bone is flipped 180. 502 00:29:32,040 --> 00:29:34,200 That's a massive butterfly fragment. 503 00:29:35,680 --> 00:29:37,640 Can I have the bone nibbler? 504 00:29:37,720 --> 00:29:41,800 It's shocking just how much damage that impact has caused. 505 00:29:45,280 --> 00:29:46,440 -There you go. -Wow. 506 00:29:46,520 --> 00:29:49,000 So, we need to remove the necrotic tissue. 507 00:29:49,800 --> 00:29:54,640 Leaving any of that dead skin, muscle, and bone behind 508 00:29:54,720 --> 00:29:56,960 will increase the risk of infection. 509 00:29:57,480 --> 00:29:59,240 There's fragment in the canal. 510 00:30:00,000 --> 00:30:04,320 Because it creates this sort of dead soup for bacteria to thrive off. 511 00:30:05,200 --> 00:30:08,360 There's a chance that some of this skin might die as well. 512 00:30:09,200 --> 00:30:12,200 Jared's extremely vulnerable to infection, 513 00:30:12,280 --> 00:30:15,200 and this could eventually lead to him having an amputation. 514 00:30:16,120 --> 00:30:19,120 Gosh. We've got an unstable ankle as well. 515 00:30:19,640 --> 00:30:22,480 So, he's what we call circumferentially degloved. 516 00:30:23,000 --> 00:30:24,800 He's taken off his ATFL 517 00:30:25,480 --> 00:30:27,320 and stripped off all the ligaments. 518 00:30:28,040 --> 00:30:31,840 The muscle has been ripped off the bone 360 degrees. 519 00:30:31,920 --> 00:30:35,280 So, there's no longer any muscle in contact with the bone. 520 00:30:36,680 --> 00:30:38,720 There's a saying that states, 521 00:30:38,800 --> 00:30:41,280 "A good surgeon knows how to operate, 522 00:30:41,960 --> 00:30:44,640 a better surgeon knows when to operate, 523 00:30:45,840 --> 00:30:48,680 and the best surgeon knows when not to operate." 524 00:30:51,720 --> 00:30:54,960 It's gonna be ex fix, guys. Can we get the Hoffman ready? 525 00:30:57,240 --> 00:30:59,720 Given the complexity of Jared's fracture 526 00:30:59,800 --> 00:31:01,720 and the soft tissue damage, 527 00:31:01,800 --> 00:31:04,280 we can't permanently fix Jared's leg today. 528 00:31:05,640 --> 00:31:07,880 -Can we get a Langenbeck, please? -Yep. 529 00:31:07,960 --> 00:31:09,520 We need nine liters, guys. 530 00:31:10,360 --> 00:31:13,200 So today, I'm doing an external scaffold 531 00:31:13,280 --> 00:31:16,000 to temporarily hold the bones out to length. 532 00:31:16,600 --> 00:31:19,440 We're using pins to drill into the patient's leg. 533 00:31:20,560 --> 00:31:23,480 These pins provide a strong hold in the bone 534 00:31:23,560 --> 00:31:26,120 to allow us to then put rods across 535 00:31:26,200 --> 00:31:28,080 to hold the bones stable 536 00:31:28,680 --> 00:31:31,400 so that it doesn't move and cause the patient any pain. 537 00:31:34,680 --> 00:31:36,000 Shall we start the pins? 538 00:31:36,080 --> 00:31:37,280 Yeah, ready. I'm ready. 539 00:31:38,680 --> 00:31:42,600 Let's look at the angle, straight up and down, pop onto the bone. 540 00:31:43,120 --> 00:31:44,240 That's it. Go for it. 541 00:31:47,080 --> 00:31:48,360 We're a teaching hospital, 542 00:31:48,440 --> 00:31:51,760 so we get a lot of trainees coming through our doors, 543 00:31:51,840 --> 00:31:54,880 and these are the future surgeons. They will look after me one day. 544 00:31:55,480 --> 00:31:56,880 Maybe one more turn. 545 00:31:58,080 --> 00:31:59,400 That's perfect. 546 00:31:59,480 --> 00:32:00,920 So you have to ensure 547 00:32:01,000 --> 00:32:03,440 that you pass on your knowledge, your skill set. 548 00:32:03,520 --> 00:32:04,640 Go on, drive it in. 549 00:32:04,720 --> 00:32:05,840 It's a duty. 550 00:32:05,920 --> 00:32:06,840 Just go there. 551 00:32:08,000 --> 00:32:10,920 You keep the finger on the trigger. You don't let go. 552 00:32:11,000 --> 00:32:12,080 You're gonna hear "nyeh!" 553 00:32:12,160 --> 00:32:15,120 As it goes through the first cortex, you're gonna feel the torque 554 00:32:15,200 --> 00:32:17,160 on your wrist. The pitch is gonna change. 555 00:32:17,240 --> 00:32:19,920 You're gonna hit the next cortex, and then you let go. 556 00:32:20,000 --> 00:32:22,920 Once the pitch… You understand what I'm talking about? 557 00:32:23,560 --> 00:32:24,720 Go for it. 558 00:32:26,920 --> 00:32:29,040 -Stop. That's it. Did you hear that? -Yeah. 559 00:32:29,120 --> 00:32:31,520 "Nyeh!" Yeah, that's it. Wicked. 560 00:32:32,280 --> 00:32:35,080 I find a deep sense of pleasure 561 00:32:35,160 --> 00:32:40,120 when a person who I've shown something, they can actually then do it. 562 00:32:40,200 --> 00:32:42,040 It's like a success story. 563 00:32:43,080 --> 00:32:45,520 Shot there. See where we are. Boom! 564 00:32:46,360 --> 00:32:48,080 Well done, yeah? That's very good. 565 00:32:50,560 --> 00:32:54,360 Today, we've debrided, and we've put a scaffold on. 566 00:32:54,440 --> 00:32:56,680 This is a journey, you know, 567 00:32:56,760 --> 00:32:59,520 but I think the first step is to make the right decision, 568 00:32:59,600 --> 00:33:03,000 which is what we've done today, which is, we're gonna hold our nerve, 569 00:33:03,080 --> 00:33:05,240 we're gonna wait, we're gonna come back. 570 00:33:05,320 --> 00:33:07,360 And the next stage is the bigger stage. 571 00:33:08,400 --> 00:33:11,720 It's the stage which is sort of, I'd say, highest risk. 572 00:33:11,800 --> 00:33:13,880 You know, he could still lose his leg. 573 00:33:14,640 --> 00:33:18,560 Jared, stay nice and still for us. You're just waking up from your operation. 574 00:33:21,920 --> 00:33:23,480 See you later, dude. 575 00:33:25,560 --> 00:33:28,560 From the moment a patient is picked up from the roadside 576 00:33:29,080 --> 00:33:30,960 to the moment they're discharged, 577 00:33:31,480 --> 00:33:35,000 several hundred hands have been involved in the care of that patient, 578 00:33:36,360 --> 00:33:37,800 and everyone leaves their mark. 579 00:33:37,880 --> 00:33:43,000 And that's where the trauma system works perfectly. 580 00:33:46,240 --> 00:33:49,760 Hands down, we outbid the world when it comes to that. 581 00:34:03,600 --> 00:34:07,000 …airborne on the hour. We'll be there in two minutes. 582 00:34:15,400 --> 00:34:17,120 How was your night? 583 00:34:17,200 --> 00:34:19,800 Yeah. I was a bit tired this morning, but it's all right. 584 00:34:20,440 --> 00:34:22,640 -Tired, but not sleeping. Yeah. -Yeah. 585 00:34:23,640 --> 00:34:26,520 I've started having very vivid dreams each night. 586 00:34:27,480 --> 00:34:30,000 Dreams where I was sort of being attacked. 587 00:34:31,640 --> 00:34:33,920 You are in the best possible place. 588 00:34:34,000 --> 00:34:34,840 Yeah. 589 00:34:35,360 --> 00:34:40,240 I think the next major step forward is the appointment that we're going to. 590 00:34:44,400 --> 00:34:46,040 -Good morning, Prof. -Hi. 591 00:34:46,800 --> 00:34:48,720 My job is to fix facial bones. 592 00:34:49,560 --> 00:34:53,440 Historically, we've been known as tooth fairies, but that's derogatory. 593 00:34:53,520 --> 00:34:57,760 But these days, just "max fax" is kinda the label that we adhere to. 594 00:35:01,560 --> 00:35:05,680 The thing about facial trauma is that often it's initiated by violence. 595 00:35:06,400 --> 00:35:09,000 Knife wounds, fisticuffs, and baseball bats. 596 00:35:10,080 --> 00:35:12,040 I've treated all sorts, good and bad. 597 00:35:13,600 --> 00:35:15,000 I've had a patient saying, 598 00:35:15,080 --> 00:35:18,120 "If you need anyone beaten up, let me know. It would be a pleasure." 599 00:35:18,200 --> 00:35:19,440 "Here's my card." 600 00:35:19,520 --> 00:35:21,240 Which I declined, by the way. 601 00:35:24,600 --> 00:35:28,240 Most people, if they've had an accident, would regret getting on the e-scooter. 602 00:35:28,320 --> 00:35:32,920 Would regret getting on the bike. Would regret getting involved in fights. 603 00:35:33,800 --> 00:35:35,480 But there is an element of fate. 604 00:35:36,000 --> 00:35:38,920 It's important to understand that you're not always in charge 605 00:35:39,000 --> 00:35:40,160 of your own destiny. 606 00:35:41,280 --> 00:35:43,400 My mission is to see people come back to life, 607 00:35:43,480 --> 00:35:44,800 and come back to health. 608 00:35:45,320 --> 00:35:47,400 Come back to who they used to be. 609 00:35:51,000 --> 00:35:54,360 Jack has bits of broken face that are all over the place. 610 00:35:54,880 --> 00:35:57,960 He has demolished the roof of the eye socket, 611 00:35:58,040 --> 00:35:59,840 and his cheekbone is broken. 612 00:36:00,520 --> 00:36:03,720 So there's a definite risk that his face can collapse. 613 00:36:04,760 --> 00:36:08,800 He has a problem with his eye movements because there's damaged muscle and bone, 614 00:36:08,880 --> 00:36:11,760 which could cause significant damage to his vision. 615 00:36:12,480 --> 00:36:14,240 But probably most important is, 616 00:36:14,320 --> 00:36:16,880 because of the immense force that he experienced, 617 00:36:16,960 --> 00:36:20,000 there is a hole between his brain and his nose. 618 00:36:20,880 --> 00:36:24,360 So, there's a definite risk of complications from brain infections 619 00:36:24,440 --> 00:36:25,960 if this is left alone. 620 00:36:27,320 --> 00:36:29,800 We need to make sure that we seal the hole 621 00:36:29,880 --> 00:36:32,040 between his brain and his nose 622 00:36:32,120 --> 00:36:35,080 with his soft tissue, and we have to rebuild his eye socket 623 00:36:35,160 --> 00:36:38,800 using bone fragments and titanium mesh. 624 00:36:41,880 --> 00:36:43,840 So, you'll be seeing Professor Holmes today. 625 00:36:43,920 --> 00:36:45,280 -How are you doing? -Hello. 626 00:36:45,360 --> 00:36:47,160 If you want to come in and take a seat. 627 00:36:47,240 --> 00:36:50,000 So, first of all, I'm sorry for what's happened to you. 628 00:36:50,080 --> 00:36:51,080 -Thank you. -Okay. 629 00:36:51,160 --> 00:36:56,600 And I'm very aware of just how awful it's been for you. 630 00:36:56,680 --> 00:36:58,360 Do you remember it happening to you? 631 00:36:58,440 --> 00:37:00,760 I can remember the first blow, and then… 632 00:37:00,840 --> 00:37:02,640 -That was it? Okay. -That was it. 633 00:37:03,360 --> 00:37:07,120 All right. Rest your head back. So, I'll just have a little look at you 634 00:37:07,200 --> 00:37:08,240 to start with. 635 00:37:08,320 --> 00:37:11,440 Your eyebrow's distorted because the bone is out of the way. 636 00:37:11,520 --> 00:37:13,520 Open your mouth for me. Bite hard. 637 00:37:14,520 --> 00:37:16,160 Back teeth. Okay. 638 00:37:16,880 --> 00:37:19,640 And you've got an issue here, haven't you? 639 00:37:20,680 --> 00:37:23,640 You can see there's missing bone just at the front, 640 00:37:23,720 --> 00:37:25,640 and there's a break at the back. 641 00:37:25,720 --> 00:37:27,440 So you were hit really hard. 642 00:37:29,880 --> 00:37:32,000 Your cheekbone has been pushed back. 643 00:37:33,160 --> 00:37:35,280 That's a marker of how bad that was. 644 00:37:36,440 --> 00:37:39,360 -Is it possible to get a glass of water? -Of course it is. 645 00:37:39,440 --> 00:37:41,840 Starting to feel myself start sweating all over again. 646 00:37:41,920 --> 00:37:42,760 Okay. 647 00:37:49,080 --> 00:37:51,040 -Want me to lie you back? -Yes, please. 648 00:37:51,120 --> 00:37:54,240 What I'm gonna do is just lift your legs up for you, okay? 649 00:37:58,440 --> 00:38:02,080 The psychological impact of trauma cannot be underestimated. 650 00:38:04,960 --> 00:38:10,040 What can happen in a split second can have ramifications that go on forever. 651 00:38:10,920 --> 00:38:12,600 -Feel better? -A bit. Yeah. 652 00:38:13,360 --> 00:38:14,400 Okay. 653 00:38:15,200 --> 00:38:16,400 Are you reliving it? 654 00:38:18,280 --> 00:38:20,760 -This is crap. I'm sorry. -Yeah, it's okay. 655 00:38:22,520 --> 00:38:24,320 It's such a lot to take in. 656 00:38:25,600 --> 00:38:27,680 -We'll get you back. -Yeah, thank you. 657 00:38:31,880 --> 00:38:34,880 Jack has a complex operation ahead of him. 658 00:38:36,000 --> 00:38:38,920 I want to put him back together physically, 659 00:38:39,000 --> 00:38:42,040 but also I want to build him psychologically up as well. 660 00:38:42,560 --> 00:38:43,800 -Appreciate it. -Sure. 661 00:38:44,720 --> 00:38:46,360 Trauma can happen to everyone. 662 00:38:48,080 --> 00:38:51,160 And I have my own experience with trauma. 663 00:38:53,400 --> 00:38:57,560 Dad was a dentist in Leicester and a very kind man. 664 00:39:00,120 --> 00:39:03,680 He married the love of his life, and they had an amazing marriage 665 00:39:04,240 --> 00:39:05,840 until they had a car accident. 666 00:39:10,560 --> 00:39:14,200 It was terrible coming to terms with two amazing people 667 00:39:14,280 --> 00:39:17,240 who were suddenly torn from you, potentially both of them. 668 00:39:19,040 --> 00:39:21,880 Dad didn't make it. Mum was badly injured. 669 00:39:26,720 --> 00:39:29,640 They preserved her life, but she had a damaged eye 670 00:39:29,720 --> 00:39:31,680 and had terrible facial scarring. 671 00:39:34,120 --> 00:39:35,720 Which she has 672 00:39:36,960 --> 00:39:38,080 always remarked about. 673 00:39:39,280 --> 00:39:42,360 Mum's injuries very much cemented the thought in my mind, 674 00:39:42,440 --> 00:39:44,000 "I must make this better." 675 00:39:49,520 --> 00:39:53,360 I want to give the patients the chance that she never had. 676 00:39:57,360 --> 00:39:58,840 I'm in the best place. 677 00:39:59,760 --> 00:40:03,200 I'll be asleep. Fingers crossed, I don't wake up halfway through. 678 00:40:10,000 --> 00:40:12,840 The sort of surgery that I perform takes a long time. 679 00:40:13,600 --> 00:40:15,440 And attention to detail is key. 680 00:40:17,240 --> 00:40:20,440 So, my presurgery drill is a cup of coffee. 681 00:40:20,960 --> 00:40:25,320 And then another cup of coffee. Usually Italian and usually very strong. 682 00:40:30,960 --> 00:40:34,320 What we're gonna do is we're gonna expose his hole in his skull, 683 00:40:34,400 --> 00:40:40,120 and then my neurosurgeon will come in and seal the brain from the nose. 684 00:40:42,040 --> 00:40:43,400 If we don't treat it, 685 00:40:43,480 --> 00:40:46,640 there's a definite risk of a serious life-threatening infection. 686 00:40:47,960 --> 00:40:50,880 Then we'll remove all the bits of damaged bone 687 00:40:50,960 --> 00:40:54,360 and build him a new eye socket out of metal and bone. 688 00:40:58,600 --> 00:41:00,680 Well, I hope you've had your breakfast. 689 00:41:01,400 --> 00:41:02,920 This could take quite a while. 690 00:41:06,440 --> 00:41:07,400 Okay. 691 00:41:08,000 --> 00:41:10,800 We start by separating the face from the muscles underneath 692 00:41:10,880 --> 00:41:12,760 so we can get access to the fracture. 693 00:41:14,160 --> 00:41:16,040 You have to have a steady hand. 694 00:41:17,160 --> 00:41:20,120 We have to be very careful that we make the depth of cuts 695 00:41:20,200 --> 00:41:22,080 at the right point at the right time. 696 00:41:23,680 --> 00:41:26,200 If you get it right, it's like peeling an orange. 697 00:41:27,080 --> 00:41:29,520 You hear the rasp as the skin pulls away. 698 00:41:31,240 --> 00:41:32,960 I'm lifting the scalp off it. 699 00:41:37,000 --> 00:41:39,080 Until I see inside Jack's face, 700 00:41:39,760 --> 00:41:42,360 I don't really know what I'm gonna find. 701 00:41:43,640 --> 00:41:44,560 That's it. 702 00:41:45,600 --> 00:41:48,760 Okay, now, peel his face off. 703 00:41:54,400 --> 00:41:57,120 So we start to see the fracture for the first time. 704 00:42:02,280 --> 00:42:04,760 It's so smashed. 705 00:42:08,840 --> 00:42:11,480 This is where we're all gonna have to work as a team. 706 00:42:14,120 --> 00:42:17,000 Before I can do my job to rebuild his eye socket, 707 00:42:17,720 --> 00:42:22,480 I need a neurosurgeon to join us to seal the fracture. 708 00:42:24,120 --> 00:42:27,360 The frontal air sinus, 709 00:42:27,440 --> 00:42:30,360 which is around here, has been fractured. 710 00:42:30,440 --> 00:42:34,000 Which means there is a very high chance 711 00:42:34,080 --> 00:42:38,800 the lining of the sinus will start producing snot, 712 00:42:39,400 --> 00:42:43,640 which will press on his brain and potentially be life-threatening. 713 00:42:46,800 --> 00:42:49,440 Can I turn his head a tiny bit towards me? 714 00:42:50,200 --> 00:42:51,400 That's great. 715 00:42:53,760 --> 00:42:57,840 He's now gonna take away through the hole all of the frontal sinus. 716 00:43:00,240 --> 00:43:04,560 Okay. So, we're starting to see the lining of the brain. 717 00:43:05,960 --> 00:43:09,200 Could I have bayonet forceps, please? 718 00:43:10,000 --> 00:43:13,600 This tissue here is the lining of his skull, 719 00:43:13,680 --> 00:43:15,680 and that's going to be pushed in the hole 720 00:43:15,760 --> 00:43:20,440 to seal the link between the brain and the face. 721 00:43:22,040 --> 00:43:24,200 Just watch your hand because we can see light 722 00:43:24,280 --> 00:43:26,160 through the translucent skull. 723 00:43:27,520 --> 00:43:28,840 This is his eyeball. 724 00:43:31,360 --> 00:43:32,840 One of the major concerns 725 00:43:32,920 --> 00:43:35,960 about operating close to a patient's eye sockets, 726 00:43:36,480 --> 00:43:40,200 we're right on the optic nerve, the nerve that makes the eye see. 727 00:43:42,480 --> 00:43:43,800 If you get this wrong, 728 00:43:45,080 --> 00:43:47,520 then you could jeopardize the person's vision, 729 00:43:47,600 --> 00:43:49,240 and they can go blind. 730 00:44:00,360 --> 00:44:01,440 It's really good. 731 00:44:02,080 --> 00:44:04,080 We've taken the lining of the head 732 00:44:04,760 --> 00:44:09,520 and put it over the top of the nose and the frontal sinuses. 733 00:44:11,160 --> 00:44:12,880 -Okay, perfect. Good. -Thanks, Chris. 734 00:44:12,960 --> 00:44:14,640 That all looks good. 735 00:44:14,720 --> 00:44:15,960 -That's my part done. -Yeah. 736 00:44:17,000 --> 00:44:18,600 Right, let's change place. 737 00:44:20,800 --> 00:44:23,240 Right, Zeeshan. We'll need two plates. 738 00:44:25,280 --> 00:44:28,320 What we have to do is reconstruct Jack's forehead. 739 00:44:28,400 --> 00:44:29,800 Seven-hole, please, Captain. 740 00:44:31,600 --> 00:44:32,960 The fracture's difficult to repair 741 00:44:33,040 --> 00:44:36,360 because the bone fragment's been shattered into microscopic pieces. 742 00:44:37,880 --> 00:44:41,920 There is no bone between the middle and the side of his eye socket 743 00:44:42,000 --> 00:44:43,400 to hang anything on. 744 00:44:44,720 --> 00:44:48,200 So, we need to graft a new three-dimensional shape. 745 00:44:51,640 --> 00:44:54,440 This is where it starts to get a bit difficult. 746 00:44:57,640 --> 00:45:01,240 One of the things we're taught is, "Treat the patient, not the X-ray." 747 00:45:01,320 --> 00:45:04,400 Now, with Jack, never is there a more true thing. 748 00:45:04,480 --> 00:45:06,600 Screw, please. 749 00:45:08,760 --> 00:45:11,880 One must never assume everything's gonna run smoothly. 750 00:45:12,720 --> 00:45:14,200 Don't go in there. Go in there. 751 00:45:14,280 --> 00:45:15,720 Zip, zip. Yeah. 752 00:45:17,760 --> 00:45:19,800 Any mistakes that we make here 753 00:45:19,880 --> 00:45:22,720 would have life-threatening and serious complications. 754 00:45:25,240 --> 00:45:27,680 -Ready? -Ready to go. 754 00:45:28,305 --> 00:46:28,556 Do you want subtitles for any video? -=[ ai.OpenSubtitles.com ]=-