Big Burps! Operation Ouch! Hospital Takeover

-He's Dr Chris.

-He's Dr Xand.

-And we're... BOTH:

-Identical twins.

Well, we were until you grew your beard.

In this series, we're taking over one of the biggest

children's hospitals in Europe, the amazing Alder Hey in Liverpool.

We'll go head-to-head as we take on some of our hospital's

most important jobs.

This isn't going well.

Ouch & About hits the wards for more medical mysteries.

-That is a hole going inside your stomach.

-Yeah.

WHISTLE BLOWS

And we'll be catching up with our extraordinary Ouch patients

who come in for regular treatment.

Hello!

We've hidden our lab in a top-secret location...

'And our experiments just...'

ARGH!

-'..got...'

-Ugh!

'..BIGGER!'

-Ooh!

-You guys are cray-zy.

So get ready to join us, it's going to be out of this world!

As... HE SPLUTTERS

What are you doing?!

Coming up today on...

..Operation Ouch!

We take a driving test with a difference.

Are you all right?

What's wrong with this little fella?

Meow, meow.

And it gets explosive in the lab.

-BOTH:

-Arghhh!

But first...

What started out as a normal day for our next patient

has ended with a trip to the emergency department.

-Luckily, they've come to the right place.

-BOTH:

-Phew!

Phee-uw! Pheeeee... Agh!

In the waiting room, seven-year-old Sophie

has come in with Mum and Dad and a cut hand.

-Who's that, Chris?

-That's Tab.

Oh, hi, Tab. So, how did Sophie hurt her hand?

On a sharp knife.

A sharp knife? Ouch!

-Sophie was in her bedroom doing some arts and crafts.

-Cool!

Was she making paper aeroplanes?

-I dunno, Xand.

-Well, was she making a selfie portrait, then?

It doesn't matter what she was making, Xand,

the point is she decided she needed something sharp.

Sharp? Sounds dangerous.

So, off she went to fetch a knife WITHOUT asking Mum or Dad.

-Oh, no!

-And as she was using it, the knife slipped and cut her thumb.

-BOTH:

-Ouch!

Was Tab there?

She was downstairs.

So Tab couldn't help, but consultant Matt Rotheram can,

and he's going to take a closer look.

Ooh, that looks like a deep cut.

First the doc checks the movement and sensation in Sophie's hand.

-Can you wiggle your thumb?

-Mm.

-Really good.

Can you feel me touching your thumb on that side?

Looking for damage to the veins and the nerves and the tendons

that control movement.

Your hand contains nerves that give you feeling

and tendons which allow it to move.

Some tendons and nerves are very close to the surface

of your skin, and a deep cut like Sophie's can easily damage them.

It could mean you lose feeling or you're unable to move

your hand properly, which is why

a bad cut often needs surgery to fix it.

Can you bend your thumb at the end, like that?

The doc's checking that Sophie can move her thumb properly.

You're not bending...

She could straighten her thumb

but she didn't seem to be able to bend it.

We have to take that seriously and assume that it could be due

to the injury, so I'm going to get the plastics team to... OK?

I've had to refer her to a specialist.

They can decide whether they need to have

a look at that wound under an anaesthetic.

In the meantime, Sophie's cut is cleaned and patched up

with butterfly stitches, and we'll find out later if she needs surgery.

Ouch!

In hospital, it's not just the doctors and nurses

who help to get you fixed.

There are lots of other heroes working behind the scenes.

-Ah, yes!

-What will happen when we have a go at their amazing jobs?

I'm going to make your eardrums burst.

-BOTH:

-Useless.

This is Operation Takeover.

Today's hospital heroes are ambulance crew Dave and Gemma.

These trained professionals have the skills to get patients

to hospital quickly and safely.

We need to get to the patient in good time.

For serious injuries, we need to be there within eight minutes.

Whilst we do need to drive quickly,

we need to be safe whilst we're doing it.

When we're going to a job, we've got oncoming traffic to think about,

you've also got pedestrians and other road users.

Despite the busy roads, Dave needs to make sure the ride

is silky smooth for the patient and medical team in the back.

With our driving skills,

a lot of the time on the way to hospital,

I forget that we're moving.

To see just how smooth Dave is behind the wheel,

watch this glass of water.

Gemma, Dave's driving,

you really think he's not going to spill this cup of water?

I'd like to hope so.

'Well, let's see how he does.'

It's quite a good visual, because when you're driving,

you are thinking about that cup, thinking about,

"Am I going to spill it, am I going to spill it?"

Still dry back there, Dave.

'Even with a super-smooth driver,

'it still takes lots of skill to treat a patient

'in a fast-moving ambulance, especially since, to do this,

'the seatbelts have to be unbuckled.'

Whoa. Wow, wow, wow. This is very difficult indeed.

-'Steady on, Xand.'

-You're not crashing into everything.

I'm just leaning on the wall now, OK.

So you've got to make your legs as far apart as possible.

-It's surfing, right?

-It is.

That's what you're trying to do, is surfing.

It's like surfing but also you're trying to save someone's life

-while you do it.

-Yeah, yeah.

'And not a drop spilled. Brilliantly done, Dave.'

We've seen how important the driving skills of the ambulance team

are to the running of a big hospital.

But will we have the DRIVE to succeed when we do it for ourselves,

or will our driving just be a little TIRED?

Get it, like the tyre, on a wheel, of an ambulance?

Enough, Xand.

Today's challenge is no joking matter,

especially since I have to wear green.

So, Dave, what have you got for us?

Well, guys, today I've designed a bit of

a driving obstacle course for you.

Yikes, that's not going to be easy.

We're going to have to drive the ambulance forwards

and backwards through some cones... TYRES SCREECH

..then up an alleyway.

We'll even have to be careful of magically moving pedestrians.

And finally, go round

in a loop before coming to a stop!

I'm going to time you,

any obstacles that you hit

will be a ten-second time penalty.

You're going to have me in the front of the vehicle,

and then in the back you're going to have a patient and a paramedic.

And they'll be judging us on

the smoothness of the journey.

Controlled, smooth, safe.

-Absolutely.

-Speedy.

'Time for a nice smooth, relaxing journey. My patient will love it.'

'Let's get the patient to hospital quickly, that's what I'd want.'

'So, Chris' first task is the cone slalom.

'He'll soon be on a collision course with disaster - I hope.'

I think we can fairly say that you're going to hit that one,

so that's ten seconds.

'First penalty against Chris - bring it on.'

-Oh.

-'Yes, and another!'

It's a bit...

'I doubt if Xand can do any better than me.'

OK, am I going to make this cone? Come on.

-Come on!

-'He makes it, but he's SO slow.'

How close was I? Argh...

'Huh, penalty points!'

-REVERSE ALARM BLEEPS

-Did Chris have to reverse at all?

-I can't say anything, yet.

-'Good man, Dave.

'Now, just like real ambulance drivers, we have to reverse.'

'I bet Chris thinks he's pretty good at this.'

Precision driving.

-Well done, and now we're going to go through the barriers.

-Oh, sorry!

You all right back there?

Yeah, we're all right.

'Can Xand handle going in reverse?'

What is interesting is,

I've totally forgotten there's a patient in the back.

Oh, no, no, no.

'Yes - penalty point for Xand.'

Can you really do this?

Like, is it possible?

'Now Chris has to be super-careful.

'It's time for pedestrian alley,

'and just look at how small those kids are.

'"Hiya!" "Oi, watch out!" "Oh, hello!"

'Speedily done, Chris, but I'll be smoother.'

'You're quite steady, Xand, but remember,

'you've got to get patients to the hospital quickly.'

This doesn't feel very professional.

It's like, I don't think you ever

see a paramedic driving like this.

'Watch out for pedestrians, Xand.'

Come on, mate, get out of the way!

'Surely that's going to cost him? And Xand's done.'

-OK, now loop?

-'Easy does it, Chris.

'Keep your patient in one piece!'

It's a good job there's no sick in here.

'And then it's full steam ahead to the finish line.'

Stop.

BANG

SHE LAUGHS

'Chris! What are you doing?'

-'Sorry, I thought something ran out in front of me.'

-Are you all right?

Yeah, I'm fine.

'Xand's turn on the loop. Come on, you have to get to the hospital!'

Arrrrgh!

'I hope his patient's OK.'

How's everyone back there?

-Took a little while.

-Sorry, madam.

Just quicker next time, OK?

OK, so what's the verdict, by how much did I beat Dr Xand?

Chris, you got...

That's including two penalty points.

Xand, your time was...

-..which includes two penalty points.

-I didn't feel that slow.

-I didn't have this beard when I started the course.

-Yeah.

So, Chris wins part one for speed,

but what about part two - smoothness?

The smoother drive was Xand.

-Yes!

-So, it's one apiece, who then has won the challenge?

Let's see the vote.

YES!

'Slow and steady wins the race.

'Xand, your patient would have been quicker walking to hospital.

'Don't be a sore loser, Chris.'

Well, Xand, I think we've learned how important the driving

skills of the ambulance team really are.

And it's time we handed back the keys. Thank you, Dave.

-Thank you, Gemma.

-Thanks.

-Thank you, Emily.

ALARM BLARES

I'm hitting the wards with my Ouch Bleeper, because we've brought

Ouch & About inside the hospital.

Wow.

Dr Xand, Dr Xand!

And I'm hitting the streets to answer your medical mysteries.

In the hospital, Chris is performing a very tricky operation.

Almost there...

BLEEPER CHIMES Ugh!

A question.

And he's off to see Alex, who's just had an operation on his oesophagus.

Hi, Alex. I got your bleep. What's your question?

-Why can't you eat or drink before surgery?

-What's the diagnosis, Doc?

Sounds like a case of...

This question's making me hungry.

Well, I think I can answer the question.

Before you have ANY operation,

the reason you can't eat is because when you've lying down

and you've had an anaesthetic, you can't cough,

and so if food comes back up from your stomach and goes into

your windpipe, your trachea, it can then get into your lungs,

and that'll be really bad,

because you can't then breathe and you'll get pneumonia.

Once you had your operation,

how long was it before you could eat?

-Four hours.

-OK, so what did you eat?

I had two rounds of toast, and then another two rounds,

four chicken goujons, a couple of chips and a bit of salad,

and then after that I had a yoghurt.

Wow, you must have been super-hungry!

You have earned yourself a sticker. I think we should probably try

and put it on your oesophagus, shouldn't we?

-Cheers, Alex.

-Thank you.

-See you soon.

-Bye.

I'm Ouch & About on the street,

and I think someone has a question for me.

-Dr Xand, Dr Xand!

-What?

-I've got a question.

Ah, Heidi, what's your question?

Well, you know when you do this and you point to your finger

without touching it?

OK, try and move this finger.

-You moved the wrong one.

-Why can't I lift the right one?

What's happening is your brain

is getting two different bits of information.

If you do that and you look,

the visual information your brain's getting is very confusing.

You've just got a whole mess of fingers and you can't tell which one

is which. You don't know which finger to send the message to.

But if I touch it, that's easy then, right?

So if you touch the finger, there's a wire, effectively

a nerve, carrying the message exactly to the right bit of

your brain and then your brain knows what to do. Does that make sense?

-Yeah.

-It's a very complicated question,

but a very important one. Thank you.

Back in the hospital, Chris has been bleeped by Amelia.

-Hi, Amelia. What's your question?

-What is a tracheostomy?

What's the diagnosis, doc?

Sounds like a classic case of

I-want-to-know-what- a-tracheostomy-is-itis.

That's easy for you to say!

Why are you interested in what a tracheostomy is?

Because I narrowly avoided getting one.

I was in intensive care for about five weeks with

a really bad lung infection but on the day when I was supposed

to get the tracheostomy, I just started breathing again.

When you were on the intensive care unit,

were you on a thing called a ventilator?

Yeah, a big tube down my throat.

And it blows air in and out of your lungs.

But if you have a tube going through your mouth and into your trachea,

your windpipe, for too long, it does a lot of damage.

So doctors can perform something called a tracheostomy.

Now, any ostomy is a hole between an organ and the skin

so a tracheostomy is when there's a hole between the trachea,

the windpipe, and the skin.

So if you make a little hole in that,

you can put in a tube that someone can then breathe in and out of

or that can be connected to a ventilator.

-Have I answered your question?

-Yes.

-I'll leave you...

-Oh, yeah, I get a sticker.

-All right?

-You can put it on the teddy bear.

-Teddy can get it.

-Thanks, Amelia.

-Thank you, Dr Chris.

-Cheers, Amelia.

-Hope you get better soon.

-Bye.

Job done for today. Clinic closed.

Chris, I wonder how our patient

in the emergency department is getting on?

Well, you're in luck, Xand,

because this is the bit we get to find out.

Oh, it's one of my favourite bits.

Earlier, we met Sophie with her cut thumb in A&E.

Sophie was in her bedroom doing some arts and crafts when she cut

her hand on a sharp knife.

-BOTH:

-Ouch!

Because this may have affected the movement of her hand,

she's here to see a specialist doctor.

Examining the dodgy digit this morning is Dr Helen Richards.

I believe you've had a little accident. Is it very sore?

Worst case scenario, what we'd be looking for is whether

she's damaged one of the tendons.

There's also the possibility of injuring one of the nerves.

And that could mean she needs an operation.

Dr Helen checks how Sophie's thumb is moving today.

Can you wriggle this little thumb? You can?

Now that it's not so sore, it's much better than yesterday.

She could move her thumb fully so that means her tendon's intact.

She's not injured any tendons in there

-so we don't need to do an operation.

-Brilliant.

-Phew! That's good news.

And looking at the scratching, it looks quite superficial.

And Sophie gets a brand-new bandage.

You'll be glad to hear we don't need to see you back here again.

-I'm all better.

-Great. Bye, Sophie!

Bye, Tab.

Still to come...

Rude noises. PARP

Ooh!

See-through swallowing.

We're making an X-ray movie.

And...

My jaw's dislocated again.

Hang on, haven't we met this patient before?

Now, did you know your body can produce

nearly two litres of gas every day?

And this comes out either by burping or farting.

And now to our lab,

but this time we've hidden it in a top-secret location.

So secret that even Xand doesn't know where it is.

HE SPLUTTERS

What are you doing?!

It's time for some amazing experiments.

Just don't try anything you see here at home.

Today, we're finding out what happens when you burp.

HE BURPS

-Oh.

-Xand, what are you doing?

You know I've expressly forbidden you from burping in the lab.

No, Chris!

Today, I am allowed to burp because today's lab is all about burping.

Burping is something we all do, no matter who you are,

and there's even a medical name for it...

Burping is a very important bodily function.

All burps are made of gas that your body wants to get rid of.

It might be because you've swallowed air,

because you gobble your lunch too fast like Xand,

or it might be carbon dioxide from chemical reactions in your stomach

or from the bubbles in a fizzy drink like this.

HE BELCHES

Now, the rumbling sound of a burp is caused when gas escapes

through your oesophagus or food pipe. Now, the internet says

that the sound actually comes from

when it passes over a very important body part

just here in your throat called the epiglottis.

This stops food from going into your windpipe when you swallow.

But we don't think that the internet is actually correct,

so we want to find out,

where does the noise of a burp actually come from

and what would happen if you didn't burp at all?

Let's find out.

To show you where a burp comes from,

we're going to film an actual burp from the inside.

BURP!

Pardon you!

Never in all of human history

-has anyone ever filmed a burp from the inside.

-Really?

Yes, that really is true.

We're going to use a special camera to look down my throat,

but don't you go sticking anything down your throat.

We can only do this because we're doctors.

Away we go.

So now we can see inside Xand's mouth and then as we go back,

you can see the dangly bits at the back of Xand's mouth, the uvula,

and this little flap of tissue here is Xand's epiglottis.

-Hello, Xand's epiglottis.

-Ah-oh!

Now keep your eye on the opening of the oesophagus.

XAND BURPS

And there it is! A burp!

A world first! A burp on camera.

As the air burps out, the soft tissue at the top of the oesophagus

is flapping while the epiglottis does nothing.

So we have proven burping is not the epiglottis flapping,

it's the soft tissues at the top of the oesophagus.

Take that, intranet! You're wrong.

But we're not stopping there.

Remember, burping is a perfectly natural body function

although it's not polite to burp loudly like Xand is doing

in this experiment, but what would happen if you didn't burp at all?

Well, Chris, put these on and I'll show you.

Because I am about to introduce you to a fearsome new machine.

Meet Dr Xand's amazing eructation machines. Ta-da!

Well, show me how it works.

Here we have kitchen vinegar.

We're going to take this and pour it through here.

Now, in the model, this bit represents the back of your throat

and the food is going to flow down the oesophagus, the food pipe,

into our stomachs.

These balloons contain bicarbonate of soda, which will react

with the vinegar and produce gas and we will get burping!

-So how does it work?

-Let me show you.

The liquid goes down the throat into the oesophagus.

And this is what happens when you drink.

Your oesophagus fills up.

We'll close that valve at the top. It's what happens when you swallow.

And then we open this valve, the oesophageal sphincter,

and we let the food into the stomach.

And then we can see it already, gas bubbling up,

the chemicals in the food reacting with the chemicals in the stomach.

You can feel a bit of rumbling. You can feel a burp coming.

You relax this valve at the top,

which is the cricopharyngeus muscle, and...

GAS NOISILY ESCAPES

Ooh!

That is excellent!

But you asked me what would happen if you couldn't burp,

and now we're about to find out.

So get your vinegar and pour it in the top.

Now let the food into the stomach. We can see the gas.

Gas is coming out of the stomach

but it can't escape the closed valve at the top of the oesophagus.

If you can't burp, it means that none of the gas can escape upwards

and so it builds up in the stomach.

You would be getting very uncomfortable right now

if that was your real stomach.

Xand, I'm going to add more blue vinegar.

Chris, it wasn't designed to withstand this kind of pressure!

More gas means more pressure.

Here goes. Oh, Xand!

Oh, here we go!

It's going to go! No-o-o!

BOTH: Argh!

Wow!

That was amazing!

So we've shown you where the burping noise comes from

and how important burps are for getting rid of unwanted gases.

Now, my fake stomach here has exploded, but don't worry.

If you don't burp, you won't actually explode.

You might feel a bit bloated and uncomfortable but eventually

the gas goes through your intestines and you pass it out the other end.

XAND FARTS

Walls can be really annoying sometimes

and make you wish you could see over them or through them.

Xand, you're not eating my cake, are you?

No, no, no cake here, no.

Good. Now, your skin can be a little bit like a wall.

When you get a medical problem on the outside it's easy to see it,

treat it and watch it heal,

but when you get medical mysteries going on inside the body,

there's one hospital department you need to turn to for help -

the radiology department,

because they've got all kinds of cool kit that can actually see

inside the body, a bit like this periscope lets me see over the wall.

Xand!

The new radiology department at Alder Hey

cost a whopping £7 million.

This department X-rays 75,000 patients a year

and more than half of those have their snaps taken on this,

a plain film X-ray machine.

X-rays let doctors look at your bones.

They're like a super powerful version of ordinary light

which can pass through your skin.

When they meet bones, X-rays stop dead in their tracks

and the perfect picture can be taken.

It's not just bones that show up in an X-ray, though.

I'm heading to another part of the radiology department to see

a different type of X-ray machine.

This one is used to study people who have problems swallowing.

Nine-year-old Isabelle is currently fed through a tube in her stomach

as a result of having an operation.

She's come to the radiology department today

for a video fluoroscopy test

to see if it's now safe for her to eat and drink normally.

So I'm wearing this apron and it is very heavy because it's made of lead

and that protects me from radiation.

Radiation isn't dangerous for the patients but if you get a little bit

every day, that could be dangerous so you wear a bit of protection.

I'd have preferred a green one.

We're going to give you some yoghurt to eat, OK?

Isabelle's dad feeds her some special liquid

which X-rays can't pass through, so it shows up black on the image.

Can you see it?

What's amazing is that you're making, if you like, an X-ray movie,

so we can see the liquid going down her throat.

That's a video and that means we can make sure that it's safe for her to

keep swallowing and that none of the food is going down the wrong way.

So Isabelle's oesophagus is working fine.

The fluoroscopy has shown the doctors that it's safe

for her to start eating again. Isn't that amazing?

After a whole year of being fed through a tube.

It's busy in the radiology department today.

Down the corridor, nine-year-old Neve is having another sort of

picture taken called an ultrasound for a mystery swelling in her foot.

Here to do that is...

The way the ultrasound machine is working is it's using

a probe which emits a very, very high frequency noise,

such a high pitch that you can't hear it and those sound waves

bounce back differently depending on whether they hit bone or

whether they hit muscle or different things, and it's listening

for the echoes coming back and then putting those echoes into an image.

This area which looks darker than the normal tissues around the bone,

so bone is here.

So there's something, possibly a splinter,

irritating Neve's foot that will require further investigation.

Have you given it a name?

-Jeff.

-That's a great name.

Bye. Bye, Jeff. "Bye, Xand!"

Without the amazing radiology department at Alder Hey Hospital,

the doctors and other experts would have to spend a lot more time

guessing about diagnosing people's conditions,

but these machines are so powerful, they can see deep inside your body.

They could even see a piece of cake inside your stomach.

Don't tell Dr Chris!

The doctors and nurses in A&E are ready for the next patient.

-I wonder who it's going to be.

-Could be anyone at all.

-Probably a total stranger, someone we've never seen before.

-Probably.

Waiting in the emergency department with her mum is 14-year-old Carmen.

My jaw's dislocated again.

Hang on, she looks familiar!

Yeah, I was on Operation Ouch last year.

Oh, I thought I recognised you. And it's happened again?

It's happened about 50 times now.

Did Carmen say 50? Wow.

So what happened this time?

Carmen was in dance rehearsal for the end of the year school show.

Ooh, was she tap-dancing?

-No, it was a big Beyonce number.

-I love Beyonce!

# If you like it then you should have put a ring on it

# If you like it then you should have put a ring on it... #

-Very tuneful, Xand(!)

-Thanks, Chris.

Anyway, Carmen was really busting some moves,

but when the class finished, her face felt funny.

She looked in the mirror and saw her jaw had dislocated again. Ouch!

Sometimes I'm able to get it back in by pulling my jaw down myself.

Well, now you're here, let's get a professional to take a look.

Meet Dr Naomi Simmons, who's going to check out those chops.

-Can you open your jaw at all at the moment?

-No.

It's the temporomandibular joint which dislocates in the jaw,

which is right up there.

Inside your head are 20 bones which make up the skull.

Two of them are in your jaw.

There's the mandible, which is one of the strongest bones in the body.

And the maxilla. They're linked together by a hinge

which allows you to open and close your mouth.

And this time Carmen's right hinge has become unhinged.

So, I'm going to pop and get some Entonox.

The Entonox is laughing gas, so it will help relax my jaw.

I'm getting quite an expert on this now!

Yes, you are. Dr Naomi brings in the Entonox to our expert.

She also brings tongue depressors that she'll use to straighten that

sore jaw, but once the Entonox kicks in, Carmen has other ideas.

Try, like...

Because this has happened so many times,

Carmen's mum has become really good at popping it back.

She uses the tongue depressors to help ease Carmen's jaw back

to where it should be.

-Is it back in place?

-Uh-huh.

-Is that right?

-I think it is.

Well, it looks right to me. Let's ask our expert.

Yeah, it's back in place now.

-She can talk!

-Good work, Mum!

You know the score from here, really, don't you?

Try to remember not to have any big movements of your jaw...

No more Beyonce boogying for you, Carmen.

I think I'm going to go back to dance right now.

We can't stop you from dancing, can we?

CHRIS AND XAND: Bye!

Next time on Operation Ouch: Hospital Takeover, we do the mail...

-When you do it, does quite a lot end up on the floor?

-No, not really.

..Xand gets jabbed...

Ow! What are you doing?

..and I'm feeling the heat.

Wow! That is very, very hot.

SIREN WAILS

So we'll see you next time for more Operation Ouch.

What? Is it over?

I was really enjoying that.

We're into the unknown of

what can possibly be known about

the science of human burping.

HE BURPS

The absolute end of possible...

HE LAUGHS

Do you think I'll get an OBE for this?

You'll get a No-B-E for this.