Critical (UK) (2015) s01e13 Episode Script
Episode 13
You're more important to me than the army is.
That's why I'm staying.
You're absolutely sure? No nagging doubts? No, it's time.
Call me.
Why don't you give me a call some time? I am SO calling you, babes.
THEY LAUGH When's the big day? I asked him not to say anything.
Congratulations.
OK, if you'll just let me explain.
Doesn't matter.
Glen, it's important to me that you understand the reason why Really.
What? Glen.
You and Tom have a nice life.
Glen? TYRES SCREECH Shit.
COMPUTER: 'Glen Boyle.
'Calling.
' Come on, come on.
PHONE RINGS 'Hello this is Glen Boyle, I can't take your call.
' 'Glen Boyle.
'Calling.
' PHONE RINGS Glen? The last thing I wanted was to hurt you.
You needed help and I came running.
You knew exactly what would happen, and you just didn't give a shit.
Did you? I called you in a moment of weakness because I needed you.
I convinced myself, almost certainly, you wouldn't come.
But I I'm sorry, I can't hear you - you broke up.
I said, but I did.
Yes, you did.
Two years too late.
Oh, come on.
I lost our baby, Glen.
I was on my knees.
That's when I needed you.
You wanted me to go I didn't.
I You ran.
Just like you're running now.
Where are you even going? I don't actually know.
Turn around.
Let's talk.
No, you've made your choice.
What the hell is there to talk about? 'Call ended.
' PHONE RINGS I'm sorry, OK.
I am.
Tom asked me out of the blue.
He's a good he's CALL FAILS Shit.
Shit.
'Call ended.
' Come on.
PHONE RINGS Glen? Can you hear me? Yes.
What about Tom? He loves me.
I love you.
You know, I came back for you.
Put myself on the line.
For you.
And now you're leaving again.
You've made your choice, so I don't want you to leave.
I don't want you to leave again.
Glen? What DO you want, Fiona? Tell me, right now, what do you want? I don't know! Hello? Shit.
Glen? ELECTRONIC VOICE: Glen Boyle.
Calling.
RINGTONE Hello? Hello? Hello, Glen? Glen! Glen! CAR ALARM BLARES Glen! Glen! Glen! Can you hear me? Talk to me.
I'm fine.
'Ambulance Service.
' My name's Fiona Lomas, I'm a trauma fellow at CGH.
First on scene at an RTC, two vehicles involved.
'What is your location?' Sorry? 'Your location, madam.
' Of course, bear with me.
We're on the B9144 at the crossroads of the A782.
Stand by for further information on casualties.
Glen, tell me how you're feeling? I don't know.
I'll be OK.
You go and check on the other car.
Go! Check on the other car, I'll be First casualty, GCS 15, no apparent trauma.
Two further casualties Sir, can you hear me? Can you tell me your name? Apparent major trauma P1/P2.
I can't give you any further information now, I'm sorry.
I need to attend to the patients.
Sir, my name is Fiona Lomas, I'm a trauma doctor at City General Hospital.
Can you hear me? Can you tell me your name? Sir, can you hear me? Can you open your eyes for me, sir? Glen? Yes.
What have we got? Weak pulse, crushed chest.
OK, tubes? Yes.
Don't turn your head and try not to move.
My name is Glen, I'm a trauma surgeon.
Can you tell me your name, please? Rory.
OK, Rory, I'm going to examine you.
OK, I'm just going to get this door open.
Shit! It's jammed.
ChestOK.
Rory, I just need to feel your abdomen, OK? Shit.
His legs are crushed.
Clinically, there's a tension pneumothorax.
OK.
Output's gone! We're losing this one! Releasing tension pneumothorax.
Pulse? Nothing.
OK, let's get him out.
Help him! You OK to lift him? I'm OK.
Forward, you got it? Yep.
A little more.
Got him.
OK.
Take his feet.
OK.
Take his head.
OK.
Got it.
OK.
We'll start with bilateral thoracostomies.
Cut his top off, please.
Light, please.
Scissors, please.
Thank you.
Any haemothorax? Nothing.
It's still on the other side.
What's going on? Help is on the way, Rory, just try and stay calm.
Anything? Nothing this side either.
OK, I've got to open him up.
Not exactly sterile.
Welcome to operating in the field.
SIRENS BLARE IN DISTANCE Nice timing.
Left anterolateral thoracotomy nearly done.
OK, I need your help here.
OK.
Examining the heart.
BOTH: Tamponade.
Got to open the pericardium.
Over here! Yes, ma'am! What can I do for you? We're trauma surgeons from CGH.
I need you to hold up this light high so we can see inside his chest.
Oh, my God.
He's got pressure round his heart that's stopping it from pumping.
What's going on? Your friend's got fluid squeezing his heart and we need to release it so we can get his heart going again.
It's going to be all right, Rory.
I'm getting some contractions.
OK, that's his heart beating again.
What output are we getting? Carotid pulse.
It isn't enough to give a radial pulse.
BVM.
In my bag.
Evacuating the clot.
This guy needs to be in theatre.
Now.
I'm managing his airway.
I need you to get him some oxygen.
Yeah.
There's a passenger still trapped inside the vehicle.
We'll work round you guys - keep talking.
Thank you.
I need to RSI.
What do you need? OK, can you continue bagging? Thio, sux, and a size eight tube.
In the blue bag, just there.
We're going to work on getting you out of there, mate.
All right, what's your name, please? Rory.
All right, Rory, I need you to hold still for me, OK? Can I just get in here? All right, Rory, just keep breathing deeply and I'll be back in a few seconds, OK? Just keep that on.
OK, cricoid on.
250 milligrams thio going in now.
Intubating now.
Tube in.
Cuff up.
OK.
Breath.
Breath.
OK, it's inflating now.
Cricoid off.
Cardiac output? OK, it's 120, but it's weak.
OK, it's about as stable as he's going to get.
I agree.
Cas-evac? We've got scoops and blocks.
Let's get it done, please.
Anything we can do? Is David all right? Someone take over the transfer for me, please.
OK, I need you to hold his head.
Rory, he's in a bad way but we're doing the very best we can for him.
OK, he needs to be in an operating theatre ASAP.
Call that in, please.
Do you know David's surname? Hanson.
And by any chance would you know his date of birth? 6th April, 1981.
OK.
Are we ready to go? I want to say goodbye to him! Your mate needs to be in a hospital, Rory.
He's not my mate.
He's my boyfriend.
OK.
Let's get the trolley round to the other side, please, now.
Quick as we can.
OK.
He's on his way.
Can I touch his hand? I love you.
It's OK.
It's OK.
I'm sorry, we need to get him to the hospital now.
Let's go.
Thank you.
You should go with him.
Glen He needs a surgeon with him.
I'll see you when you bring that one in, yes? This is Fiona Lomas, I'm one of the surgical registrars.
Please can you connect me to the Alert Phone? Nicola, it's Fiona.
Glen and I are first on scene at an RTC.
We've two patients coming your way.
First, male, 30s, driver, blunt chest trauma.
Yes.
His name is David Hanson, date of birth, 6th On three.
One, two, three, and lift.
Vehicle's made safe if you want to go in.
Thank you very much.
Can you get control of the C-spine please? Sure.
Let's get him flat, please.
Gently, slowly.
All right, Rory, we're just going to check your blood pressure and your oxygen levels, all right? Put this on your finger.
Abdomen is tense and full.
BP 60 over 35.
Christ.
All right, Billy? Er, I was just passing.
You've been listening in on a police channel, haven't you? No.
No.
Either way - glad you're here.
Mr Boyle.
Yeah? I might be of some help here.
You might have some ketamine in your grab-bag.
I couldn't possibly have it.
I'm just an ODP.
Billy, could you possibly see if you can find some ketamine in my grab-bag, please? I'll have a look, Mr Boyle.
There's your ketamine, Mr Boyle.
OK.
I'm just giving you something to make you comfortable, OK? Can you tell me what your surname is and your date of birth, please? Billy, can you get this down? Roberts.
19th January 1983.
Thank you.
20mg ketamine in.
OK, guys, let's make some space.
Get his legs free.
ENGINE SPLUTTERS ENGINE WHIRS Bit of noise, you'll be all right.
Yeah METAL GROANS HE SCREAMS All right, it's all right.
STOP! Let me get in.
You're doing really well.
You OK? That's it.
Just going to get your leg out.
HE WHIMPERS You're doing really well, really well.
Thank you.
Billy, can we release the tourniquet nice and slowly, please? Yeah.
Thank you.
Yep, OK, this is doing the job.
Let's go again, let's get this other leg out please.
Carry on! ENGINE SPLUTTERS, METAL CREAKS AND GROANS HE WHIMPERS HYDRAULICS WHIR Cut it! Let me see, please.
No, you need to keep going.
We can't get any more clearance.
The leg is stuck.
OK.
You're doing really well, mate.
Let's have another BP please.
Yeah.
So, Rory, I'm just going to have to feel your belly again.
Nah, it's 50 over unreadable.
It's dropping.
INSTRUMENTS BEEP RAPIDLY It's looking like there's only one way to get him out of there in time.
Unless you've got something you can come up with in the next five minutes that will release that leg? Not in five minutes.
I'm sorry.
Hey, Rory, can you hear me? HE GASPS Rory? Listen, your right leg's trapped.
And I'm very concerned that you might have a massive bleed in your belly.
I'm going to be honest with you.
If I don't get you to a hospital within the next hour, you're going to die.
Do you understand me? I'm sorry, but that's why I have to amputate your leg.
Now, you listen to me.
I've done this before.
So, I know that I can save your knee joint.
And that means that with a simple prosthetic, you will be able to walk again, and you'll even be able to run.
OK? We're going to pump you full of some painkillers.
.
.
Any more of that ketamine left? Yes, you do.
OK.
Make it up to a total of 120.
Coming up.
OK.
I'm going to need gloves and antiseptic from your truck.
I've got blast dressings, but I need you to get me a couple of blankets and some bandages, please.
Yep.
There you go.
Thank you.
Listen, you wouldn't happen to have sux and a tube, would you? We've used mine.
I've got roc.
In your bag.
OK.
And are you up to tubing him, under my supervision, obviously? Er, yeah.
Good man.
All right.
Let's get that head rest off, please.
Come down here.
Have you got him? Yep.
There's your roc.
Thank you.
HE EXHALES There's a tube, Thomas.
Cricoid on, please.
Let me get the mask.
Cricoid on.
80mg roc going in now.
HE EXHALES Here we go.
Bring him this way a little bit.
HE EXHALES Here we go.
Tube.
Cuff up.
OK.
I'll do it.
Bag.
Ta.
Here we go.
Breath.
HISSING Breath.
HISSING Both lungs ventilated! Cricoid off, please.
HE PANTS Well done, Billy.
Ta.
Let's get that brace on here.
Brace.
FABRIC RIPS I don't have enough room here for a saw.
Do you have bolt-cutters? Bolt croppers? OK, listen.
This is going to need to be fast.
Billy, I need you to move this tourniquet down to just above his knee and then pull it tight, please.
And I mean tight as a drum.
Yes? Yeah.
Sorry.
Tell me when.
Yeah, got it.
Fresh blade in there, please.
Yeah.
There you go.
We good? Yeah.
Cutting.
Coming around.
Do you have any more of that antiseptic, Billy? Yeah.
Throw it on there.
Yep.
And here.
Yep.
OK.
I'm going to snap the tibia.
CRACK! Still with me, Billy? Put it this way, I won't be having barbecue ribs for a while GLEN CHUCKLES Now the fibula.
CRACK! Here.
Get me the blade.
I'm not going to spend any time prettifying it until we get him in hospital.
I'm just going to wrap the stump.
Billy - antiseptic.
Yep.
And the blast dressing.
Yep.
Got it.
Thank you.
Billy? Yeah.
Call CGH, tell them that we're going to be on our way.
Yeah.
Ah, Mrs Hicklin, yeah, it's Billy Finlay, at the scene with Glen.
'What?' Don't ask.
We've extracted the second casualty via a BK amputation.
Rory Roberts.
Date of birth, 19th of the first, 1983.
Suspected severe intra-abdominal haemorrhage.
Suspected severe intra-abdominal haemorrhage.
Thanks.
Nicola says she'll have a theatre ready for him.
OK, this is a scoop-and-run.
He needs to be opened up in theatre.
Can we go, please? Can I get a trolley, please? Tell me when we're ready, please.
Get the board ready! WHIRRING On three.
One, two, three.
This time, all the way to the trolley.
We ready? Then on three.
One, two, three.
OK, let's get him in.
Thank you, the other side.
Quick as we can, please.
OK, that's us.
Thank you.
Good work.
Cheers.
Thanks a lot, guys, let's go.
Well done, everyone.
OK, have you got everything? Mind out.
In.
I'll take over, mate.
Thank you.
Ta.
Need to give another 30 bolus for ket.
There you go.
Thank you.
DOOR SLAMS SHU It's done.
Ta.
You, er You written off your motor, then? I have yeah.
Want to buy a Fiesta? Here.
What? Give me the keys.
Amazing! Is a grand all right? Send me the logbook, I'll send you the cash.
Can you hold that door, please? You did really well tonight, Billy.
It's been great working with you.
Thanks.
I'll see you back at CGH? Go.
Glen! DOOR SLAMS ENGINE STARTS SIREN WAILS SIREN FADES Ms Lomas? Ms Lomas! Thank you.
(Cheeky bastard!) Fiona Lomas, Trauma Fellow.
Debbie Wong, Scrub Nurse.
Sarah Molloy, Consultant Anaesthetist.
Adrian Sands, Anaesthetic ODP.
Bruce Corby, Rapid Infuser Operator .
.
Alice Murkherjee, Consultant Cardiothoracic Surgeon.
Patient is David Hanson, date of birth, 6th of the fourth, 1981.
Patient was the driver in an RTC, and has sustained blunt chest trauma.
I've signed a Consent Form 4 for exploration of thoracic cavity plus proceed.
ENGINE STARTS Swabs, please.
Scalpel.
First, we'll explore the chest cavity for any ruptures or bleeds, and then we'll get on with repairing the damage to the heart.
Ready when you are, sir! Finochietto retractor.
Thank you.
Packs, please.
Where's Glen? Probably already broken down and on to the AA.
Trauma Theatre's occupied at the minute, we're just waiting on one.
Theatre 6.
Great! Theatre 6.
Thanks, Giles.
Pack A.
Two units of O pos.
Quick handover to Dr Bennett-Edwardes.
That's me.
Rory Roberts, 32-year-old, front seat passenger involved in a multi vehicle RTC at approximately 2230.
Crush injuries both legs.
Prolonged extrication requiring right-sided below-knee amputation.
Suspected intra-abdominal haemorrhage This is Mrs Hicklin.
Theatres, please.
Pulse 160, BP 60 over 30.
RSI'd with 120mg of ketamine, rocuronium 80 mg, plus bolus for transfer of another 30 ket.
Great, thanks.
Ready.
Great, let's do it.
I need to know who's on for general surg.
Who will be the anaesthetist? Who'll be operating? Yes, I'll hold.
Guys, can you do the necessary paperwork with Giles Dhillon at the front desk? Yep, will do.
Thank you.
Cheers, guys.
Well, we're en route to Theatre 6 now.
Who's there for the patient? Fine.
Dr Jones is just covering the transfer.
Ramakrishna Chandramohan will be your anaesthetist in theatre.
Who's the surgeon? I'll get you one.
Three blood, two FFP, straight in.
Filling him up.
OK.
BEEPING How's it going? No active bleeding at present.
No pelvic fractures.
FAST scan shows there's no free fluid in the abdomen.
Patient is stable.
Great.
Alice, I need Fiona urgently.
I'm good here.
Thanks, Fiona.
Thanks.
All done? Thank you.
OK.
The other trauma from the RTC, he's on his way to theatre.
OK.
Is Glen with the patient? No.
Glen confirmed to me this week that he's not taking up the extension on his contract.
He's resigned.
I'm sorry.
Theatre 6, Rory Roberts, laparotomy.
Billy! BEEPING I didn't want to say in front of the others butyou were brilliant.
Call me.
MONITORS BEEP You'll be fine.
Blade.
OK to cut? OK.
Cutting.
Swabs to Harry.
Forceps.
Scissors.
I'm going to open the peritoneum.
Suction.
Everybody ready? OK, ready.
Just follow my lead, Harry, and you'll be fine.
Here we go.
Packs.
Packing! Just whack it in.
Five packs in the abdomen.
Five in.
Packs! Five more in.
Ten in.
Morris.
Hold it here.
Morris.
ALARMS BEEP Shit.
OK, BP's dropped back to 60 over 30.
There's no point us putting blood in if he's going to leak it out everywhere Haemorrhaging from the left upper quadrant.
Spleen? Yes.
Management? Splenectomy.
Yep.
Roberts.
Swapsies.
Keep at it, Harry.
In with suction, I need you to keep the field clear.
Mm-hm.
OK, I'm struggling.
METAL CLATTERS I need you to hold the bowel clear.
Oh, God OK Got it.
Roberts.
Splenic vessels clamped.
McIndoes.
Fill him up.
Yep.
I've divided the splenic ligaments.
Splenic vessels divided.
Roberts.
Short gastric vessels clamped.
McIndoes.
Short gastric vessels divided.
Stop suction.
The bleed's under control.
MONITORS BEEP Good.
Ramakrishna? BP coming up.
Coming up.
BP holding.
Systolic 80.
That's good work.
We'll keep filling him up.
So, blood, FFP, platelets, 3-to-2-to-1.
Got that.
OK, what?! Good work, everyone.
OK I'm going to remove the spleen to make room for tying off the vessels.
McIndoes.
Fiona Have you found someone to replace me yet? Yes.
I'll phone her in the morning and tell her to stand down.
Thank you.
You're welcome.
All right, Billy.
Mr Boyle.
Do you want to scrub in? No, I think you should finish.
Dish.
Removing the spleen.
DULL THUD See, you don't need me at all.
I wouldn't say that.
accessibility@bskyb.
com
That's why I'm staying.
You're absolutely sure? No nagging doubts? No, it's time.
Call me.
Why don't you give me a call some time? I am SO calling you, babes.
THEY LAUGH When's the big day? I asked him not to say anything.
Congratulations.
OK, if you'll just let me explain.
Doesn't matter.
Glen, it's important to me that you understand the reason why Really.
What? Glen.
You and Tom have a nice life.
Glen? TYRES SCREECH Shit.
COMPUTER: 'Glen Boyle.
'Calling.
' Come on, come on.
PHONE RINGS 'Hello this is Glen Boyle, I can't take your call.
' 'Glen Boyle.
'Calling.
' PHONE RINGS Glen? The last thing I wanted was to hurt you.
You needed help and I came running.
You knew exactly what would happen, and you just didn't give a shit.
Did you? I called you in a moment of weakness because I needed you.
I convinced myself, almost certainly, you wouldn't come.
But I I'm sorry, I can't hear you - you broke up.
I said, but I did.
Yes, you did.
Two years too late.
Oh, come on.
I lost our baby, Glen.
I was on my knees.
That's when I needed you.
You wanted me to go I didn't.
I You ran.
Just like you're running now.
Where are you even going? I don't actually know.
Turn around.
Let's talk.
No, you've made your choice.
What the hell is there to talk about? 'Call ended.
' PHONE RINGS I'm sorry, OK.
I am.
Tom asked me out of the blue.
He's a good he's CALL FAILS Shit.
Shit.
'Call ended.
' Come on.
PHONE RINGS Glen? Can you hear me? Yes.
What about Tom? He loves me.
I love you.
You know, I came back for you.
Put myself on the line.
For you.
And now you're leaving again.
You've made your choice, so I don't want you to leave.
I don't want you to leave again.
Glen? What DO you want, Fiona? Tell me, right now, what do you want? I don't know! Hello? Shit.
Glen? ELECTRONIC VOICE: Glen Boyle.
Calling.
RINGTONE Hello? Hello? Hello, Glen? Glen! Glen! CAR ALARM BLARES Glen! Glen! Glen! Can you hear me? Talk to me.
I'm fine.
'Ambulance Service.
' My name's Fiona Lomas, I'm a trauma fellow at CGH.
First on scene at an RTC, two vehicles involved.
'What is your location?' Sorry? 'Your location, madam.
' Of course, bear with me.
We're on the B9144 at the crossroads of the A782.
Stand by for further information on casualties.
Glen, tell me how you're feeling? I don't know.
I'll be OK.
You go and check on the other car.
Go! Check on the other car, I'll be First casualty, GCS 15, no apparent trauma.
Two further casualties Sir, can you hear me? Can you tell me your name? Apparent major trauma P1/P2.
I can't give you any further information now, I'm sorry.
I need to attend to the patients.
Sir, my name is Fiona Lomas, I'm a trauma doctor at City General Hospital.
Can you hear me? Can you tell me your name? Sir, can you hear me? Can you open your eyes for me, sir? Glen? Yes.
What have we got? Weak pulse, crushed chest.
OK, tubes? Yes.
Don't turn your head and try not to move.
My name is Glen, I'm a trauma surgeon.
Can you tell me your name, please? Rory.
OK, Rory, I'm going to examine you.
OK, I'm just going to get this door open.
Shit! It's jammed.
ChestOK.
Rory, I just need to feel your abdomen, OK? Shit.
His legs are crushed.
Clinically, there's a tension pneumothorax.
OK.
Output's gone! We're losing this one! Releasing tension pneumothorax.
Pulse? Nothing.
OK, let's get him out.
Help him! You OK to lift him? I'm OK.
Forward, you got it? Yep.
A little more.
Got him.
OK.
Take his feet.
OK.
Take his head.
OK.
Got it.
OK.
We'll start with bilateral thoracostomies.
Cut his top off, please.
Light, please.
Scissors, please.
Thank you.
Any haemothorax? Nothing.
It's still on the other side.
What's going on? Help is on the way, Rory, just try and stay calm.
Anything? Nothing this side either.
OK, I've got to open him up.
Not exactly sterile.
Welcome to operating in the field.
SIRENS BLARE IN DISTANCE Nice timing.
Left anterolateral thoracotomy nearly done.
OK, I need your help here.
OK.
Examining the heart.
BOTH: Tamponade.
Got to open the pericardium.
Over here! Yes, ma'am! What can I do for you? We're trauma surgeons from CGH.
I need you to hold up this light high so we can see inside his chest.
Oh, my God.
He's got pressure round his heart that's stopping it from pumping.
What's going on? Your friend's got fluid squeezing his heart and we need to release it so we can get his heart going again.
It's going to be all right, Rory.
I'm getting some contractions.
OK, that's his heart beating again.
What output are we getting? Carotid pulse.
It isn't enough to give a radial pulse.
BVM.
In my bag.
Evacuating the clot.
This guy needs to be in theatre.
Now.
I'm managing his airway.
I need you to get him some oxygen.
Yeah.
There's a passenger still trapped inside the vehicle.
We'll work round you guys - keep talking.
Thank you.
I need to RSI.
What do you need? OK, can you continue bagging? Thio, sux, and a size eight tube.
In the blue bag, just there.
We're going to work on getting you out of there, mate.
All right, what's your name, please? Rory.
All right, Rory, I need you to hold still for me, OK? Can I just get in here? All right, Rory, just keep breathing deeply and I'll be back in a few seconds, OK? Just keep that on.
OK, cricoid on.
250 milligrams thio going in now.
Intubating now.
Tube in.
Cuff up.
OK.
Breath.
Breath.
OK, it's inflating now.
Cricoid off.
Cardiac output? OK, it's 120, but it's weak.
OK, it's about as stable as he's going to get.
I agree.
Cas-evac? We've got scoops and blocks.
Let's get it done, please.
Anything we can do? Is David all right? Someone take over the transfer for me, please.
OK, I need you to hold his head.
Rory, he's in a bad way but we're doing the very best we can for him.
OK, he needs to be in an operating theatre ASAP.
Call that in, please.
Do you know David's surname? Hanson.
And by any chance would you know his date of birth? 6th April, 1981.
OK.
Are we ready to go? I want to say goodbye to him! Your mate needs to be in a hospital, Rory.
He's not my mate.
He's my boyfriend.
OK.
Let's get the trolley round to the other side, please, now.
Quick as we can.
OK.
He's on his way.
Can I touch his hand? I love you.
It's OK.
It's OK.
I'm sorry, we need to get him to the hospital now.
Let's go.
Thank you.
You should go with him.
Glen He needs a surgeon with him.
I'll see you when you bring that one in, yes? This is Fiona Lomas, I'm one of the surgical registrars.
Please can you connect me to the Alert Phone? Nicola, it's Fiona.
Glen and I are first on scene at an RTC.
We've two patients coming your way.
First, male, 30s, driver, blunt chest trauma.
Yes.
His name is David Hanson, date of birth, 6th On three.
One, two, three, and lift.
Vehicle's made safe if you want to go in.
Thank you very much.
Can you get control of the C-spine please? Sure.
Let's get him flat, please.
Gently, slowly.
All right, Rory, we're just going to check your blood pressure and your oxygen levels, all right? Put this on your finger.
Abdomen is tense and full.
BP 60 over 35.
Christ.
All right, Billy? Er, I was just passing.
You've been listening in on a police channel, haven't you? No.
No.
Either way - glad you're here.
Mr Boyle.
Yeah? I might be of some help here.
You might have some ketamine in your grab-bag.
I couldn't possibly have it.
I'm just an ODP.
Billy, could you possibly see if you can find some ketamine in my grab-bag, please? I'll have a look, Mr Boyle.
There's your ketamine, Mr Boyle.
OK.
I'm just giving you something to make you comfortable, OK? Can you tell me what your surname is and your date of birth, please? Billy, can you get this down? Roberts.
19th January 1983.
Thank you.
20mg ketamine in.
OK, guys, let's make some space.
Get his legs free.
ENGINE SPLUTTERS ENGINE WHIRS Bit of noise, you'll be all right.
Yeah METAL GROANS HE SCREAMS All right, it's all right.
STOP! Let me get in.
You're doing really well.
You OK? That's it.
Just going to get your leg out.
HE WHIMPERS You're doing really well, really well.
Thank you.
Billy, can we release the tourniquet nice and slowly, please? Yeah.
Thank you.
Yep, OK, this is doing the job.
Let's go again, let's get this other leg out please.
Carry on! ENGINE SPLUTTERS, METAL CREAKS AND GROANS HE WHIMPERS HYDRAULICS WHIR Cut it! Let me see, please.
No, you need to keep going.
We can't get any more clearance.
The leg is stuck.
OK.
You're doing really well, mate.
Let's have another BP please.
Yeah.
So, Rory, I'm just going to have to feel your belly again.
Nah, it's 50 over unreadable.
It's dropping.
INSTRUMENTS BEEP RAPIDLY It's looking like there's only one way to get him out of there in time.
Unless you've got something you can come up with in the next five minutes that will release that leg? Not in five minutes.
I'm sorry.
Hey, Rory, can you hear me? HE GASPS Rory? Listen, your right leg's trapped.
And I'm very concerned that you might have a massive bleed in your belly.
I'm going to be honest with you.
If I don't get you to a hospital within the next hour, you're going to die.
Do you understand me? I'm sorry, but that's why I have to amputate your leg.
Now, you listen to me.
I've done this before.
So, I know that I can save your knee joint.
And that means that with a simple prosthetic, you will be able to walk again, and you'll even be able to run.
OK? We're going to pump you full of some painkillers.
.
.
Any more of that ketamine left? Yes, you do.
OK.
Make it up to a total of 120.
Coming up.
OK.
I'm going to need gloves and antiseptic from your truck.
I've got blast dressings, but I need you to get me a couple of blankets and some bandages, please.
Yep.
There you go.
Thank you.
Listen, you wouldn't happen to have sux and a tube, would you? We've used mine.
I've got roc.
In your bag.
OK.
And are you up to tubing him, under my supervision, obviously? Er, yeah.
Good man.
All right.
Let's get that head rest off, please.
Come down here.
Have you got him? Yep.
There's your roc.
Thank you.
HE EXHALES There's a tube, Thomas.
Cricoid on, please.
Let me get the mask.
Cricoid on.
80mg roc going in now.
HE EXHALES Here we go.
Bring him this way a little bit.
HE EXHALES Here we go.
Tube.
Cuff up.
OK.
I'll do it.
Bag.
Ta.
Here we go.
Breath.
HISSING Breath.
HISSING Both lungs ventilated! Cricoid off, please.
HE PANTS Well done, Billy.
Ta.
Let's get that brace on here.
Brace.
FABRIC RIPS I don't have enough room here for a saw.
Do you have bolt-cutters? Bolt croppers? OK, listen.
This is going to need to be fast.
Billy, I need you to move this tourniquet down to just above his knee and then pull it tight, please.
And I mean tight as a drum.
Yes? Yeah.
Sorry.
Tell me when.
Yeah, got it.
Fresh blade in there, please.
Yeah.
There you go.
We good? Yeah.
Cutting.
Coming around.
Do you have any more of that antiseptic, Billy? Yeah.
Throw it on there.
Yep.
And here.
Yep.
OK.
I'm going to snap the tibia.
CRACK! Still with me, Billy? Put it this way, I won't be having barbecue ribs for a while GLEN CHUCKLES Now the fibula.
CRACK! Here.
Get me the blade.
I'm not going to spend any time prettifying it until we get him in hospital.
I'm just going to wrap the stump.
Billy - antiseptic.
Yep.
And the blast dressing.
Yep.
Got it.
Thank you.
Billy? Yeah.
Call CGH, tell them that we're going to be on our way.
Yeah.
Ah, Mrs Hicklin, yeah, it's Billy Finlay, at the scene with Glen.
'What?' Don't ask.
We've extracted the second casualty via a BK amputation.
Rory Roberts.
Date of birth, 19th of the first, 1983.
Suspected severe intra-abdominal haemorrhage.
Suspected severe intra-abdominal haemorrhage.
Thanks.
Nicola says she'll have a theatre ready for him.
OK, this is a scoop-and-run.
He needs to be opened up in theatre.
Can we go, please? Can I get a trolley, please? Tell me when we're ready, please.
Get the board ready! WHIRRING On three.
One, two, three.
This time, all the way to the trolley.
We ready? Then on three.
One, two, three.
OK, let's get him in.
Thank you, the other side.
Quick as we can, please.
OK, that's us.
Thank you.
Good work.
Cheers.
Thanks a lot, guys, let's go.
Well done, everyone.
OK, have you got everything? Mind out.
In.
I'll take over, mate.
Thank you.
Ta.
Need to give another 30 bolus for ket.
There you go.
Thank you.
DOOR SLAMS SHU It's done.
Ta.
You, er You written off your motor, then? I have yeah.
Want to buy a Fiesta? Here.
What? Give me the keys.
Amazing! Is a grand all right? Send me the logbook, I'll send you the cash.
Can you hold that door, please? You did really well tonight, Billy.
It's been great working with you.
Thanks.
I'll see you back at CGH? Go.
Glen! DOOR SLAMS ENGINE STARTS SIREN WAILS SIREN FADES Ms Lomas? Ms Lomas! Thank you.
(Cheeky bastard!) Fiona Lomas, Trauma Fellow.
Debbie Wong, Scrub Nurse.
Sarah Molloy, Consultant Anaesthetist.
Adrian Sands, Anaesthetic ODP.
Bruce Corby, Rapid Infuser Operator .
.
Alice Murkherjee, Consultant Cardiothoracic Surgeon.
Patient is David Hanson, date of birth, 6th of the fourth, 1981.
Patient was the driver in an RTC, and has sustained blunt chest trauma.
I've signed a Consent Form 4 for exploration of thoracic cavity plus proceed.
ENGINE STARTS Swabs, please.
Scalpel.
First, we'll explore the chest cavity for any ruptures or bleeds, and then we'll get on with repairing the damage to the heart.
Ready when you are, sir! Finochietto retractor.
Thank you.
Packs, please.
Where's Glen? Probably already broken down and on to the AA.
Trauma Theatre's occupied at the minute, we're just waiting on one.
Theatre 6.
Great! Theatre 6.
Thanks, Giles.
Pack A.
Two units of O pos.
Quick handover to Dr Bennett-Edwardes.
That's me.
Rory Roberts, 32-year-old, front seat passenger involved in a multi vehicle RTC at approximately 2230.
Crush injuries both legs.
Prolonged extrication requiring right-sided below-knee amputation.
Suspected intra-abdominal haemorrhage This is Mrs Hicklin.
Theatres, please.
Pulse 160, BP 60 over 30.
RSI'd with 120mg of ketamine, rocuronium 80 mg, plus bolus for transfer of another 30 ket.
Great, thanks.
Ready.
Great, let's do it.
I need to know who's on for general surg.
Who will be the anaesthetist? Who'll be operating? Yes, I'll hold.
Guys, can you do the necessary paperwork with Giles Dhillon at the front desk? Yep, will do.
Thank you.
Cheers, guys.
Well, we're en route to Theatre 6 now.
Who's there for the patient? Fine.
Dr Jones is just covering the transfer.
Ramakrishna Chandramohan will be your anaesthetist in theatre.
Who's the surgeon? I'll get you one.
Three blood, two FFP, straight in.
Filling him up.
OK.
BEEPING How's it going? No active bleeding at present.
No pelvic fractures.
FAST scan shows there's no free fluid in the abdomen.
Patient is stable.
Great.
Alice, I need Fiona urgently.
I'm good here.
Thanks, Fiona.
Thanks.
All done? Thank you.
OK.
The other trauma from the RTC, he's on his way to theatre.
OK.
Is Glen with the patient? No.
Glen confirmed to me this week that he's not taking up the extension on his contract.
He's resigned.
I'm sorry.
Theatre 6, Rory Roberts, laparotomy.
Billy! BEEPING I didn't want to say in front of the others butyou were brilliant.
Call me.
MONITORS BEEP You'll be fine.
Blade.
OK to cut? OK.
Cutting.
Swabs to Harry.
Forceps.
Scissors.
I'm going to open the peritoneum.
Suction.
Everybody ready? OK, ready.
Just follow my lead, Harry, and you'll be fine.
Here we go.
Packs.
Packing! Just whack it in.
Five packs in the abdomen.
Five in.
Packs! Five more in.
Ten in.
Morris.
Hold it here.
Morris.
ALARMS BEEP Shit.
OK, BP's dropped back to 60 over 30.
There's no point us putting blood in if he's going to leak it out everywhere Haemorrhaging from the left upper quadrant.
Spleen? Yes.
Management? Splenectomy.
Yep.
Roberts.
Swapsies.
Keep at it, Harry.
In with suction, I need you to keep the field clear.
Mm-hm.
OK, I'm struggling.
METAL CLATTERS I need you to hold the bowel clear.
Oh, God OK Got it.
Roberts.
Splenic vessels clamped.
McIndoes.
Fill him up.
Yep.
I've divided the splenic ligaments.
Splenic vessels divided.
Roberts.
Short gastric vessels clamped.
McIndoes.
Short gastric vessels divided.
Stop suction.
The bleed's under control.
MONITORS BEEP Good.
Ramakrishna? BP coming up.
Coming up.
BP holding.
Systolic 80.
That's good work.
We'll keep filling him up.
So, blood, FFP, platelets, 3-to-2-to-1.
Got that.
OK, what?! Good work, everyone.
OK I'm going to remove the spleen to make room for tying off the vessels.
McIndoes.
Fiona Have you found someone to replace me yet? Yes.
I'll phone her in the morning and tell her to stand down.
Thank you.
You're welcome.
All right, Billy.
Mr Boyle.
Do you want to scrub in? No, I think you should finish.
Dish.
Removing the spleen.
DULL THUD See, you don't need me at all.
I wouldn't say that.
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