0:00:04 > 0:00:05RINGING TONE Hello, ambulance service.
0:00:05 > 0:00:08There's a guy just got hit by a bus.
0:00:08 > 0:00:10He was on a bike. He's been really badly injured.
0:00:10 > 0:00:14From the moment an emergency call is made, a clock starts ticking.
0:00:14 > 0:00:19This programme contains scenes which some viewers may find upsetting
0:00:19 > 0:00:21Female lying on the road, struggling to breathe.
0:00:21 > 0:00:26The golden hour is the opportunity that we have to save the patient.
0:00:26 > 0:00:29Deep breaths, George.
0:00:29 > 0:00:31'The longer the clock ticks,'
0:00:31 > 0:00:33the increased likelihood there is of death.
0:00:36 > 0:00:39In the fight for survival, time is the enemy.
0:00:39 > 0:00:41I'm ventilating fast on purpose.
0:00:41 > 0:00:44Yeah. I'm hoping that heart rate will pick up any second.
0:00:44 > 0:00:47Now, new techniques and technology
0:00:47 > 0:00:50are bringing emergency medicine to the roadside...
0:00:50 > 0:00:52We can use the Infrascanner to give us a slightly clearer picture
0:00:52 > 0:00:55of what's going on underneath the skull.
0:00:55 > 0:00:59..breaking new ground and treating patients faster than ever before.
0:00:59 > 0:01:04We can now provide emergency surgery, blood transfusions,
0:01:04 > 0:01:06anaesthesia at the scene of the accident.
0:01:06 > 0:01:09Yeah, through the cords. Tube, please. Tube on.
0:01:12 > 0:01:16We follow three patients through the crucial first hour of care.
0:01:17 > 0:01:20In central London, a man collapses at work
0:01:20 > 0:01:22with a suspected cardiac arrest.
0:01:22 > 0:01:25We are going to anaesthetise him here.
0:01:25 > 0:01:27In Newcastle, a mother of three
0:01:27 > 0:01:31fights for her life after being stabbed.
0:01:31 > 0:01:33How big was the knife?
0:01:33 > 0:01:36And a cyclist in Durham suffers horrific crush injuries,
0:01:36 > 0:01:39after being hit by a bus.
0:01:39 > 0:01:40Let's get the blood in.
0:01:43 > 0:01:4760 minutes that will change their lives for ever.
0:01:47 > 0:01:49You will constantly be surprised
0:01:49 > 0:01:52just what you can bring back from the jaws of death.
0:02:03 > 0:02:06OPERATOR: Emergency ambulance, tell me exactly what's happened.
0:02:06 > 0:02:08WOMAN: He's out cold.
0:02:08 > 0:02:10Is he awake? He wasn't.
0:02:10 > 0:02:12Is he breathing? I don't know,
0:02:12 > 0:02:14I think he might be choking.
0:02:14 > 0:02:15In central London, an emergency call
0:02:15 > 0:02:17has just been received about a man
0:02:17 > 0:02:18who has collapsed from
0:02:18 > 0:02:21a suspected cardiac arrest at work.
0:02:22 > 0:02:24SIREN WAILS
0:02:24 > 0:02:27It's near Charterhouse Street. OK, fine, keep going.
0:02:28 > 0:02:32On duty in London's Air Ambulance's emergency medical car
0:02:32 > 0:02:37are consultant Anne Weaver and paramedic Bill Leaning.
0:02:37 > 0:02:39They are only minutes from the scene.
0:02:39 > 0:02:42'Cardiac arrest is a time-critical incident.
0:02:42 > 0:02:45'It's essential that the patient gets'
0:02:45 > 0:02:49immediate care, that can be from a bystander or a professional.
0:02:49 > 0:02:50It doesn't really matter,
0:02:50 > 0:02:53as long as someone takes action as quickly as possible.
0:02:54 > 0:02:57Do you want to just carry the bag for us? Cheers.
0:02:57 > 0:03:00Come and hold that for me. Cheers, thank you very much.
0:03:02 > 0:03:0562-year-old Michael collapsed in a corridor
0:03:05 > 0:03:06and his heart stopped beating.
0:03:08 > 0:03:12A London Ambulance Service paramedic is already on the scene.
0:03:12 > 0:03:16Michael is now breathing again, but deeply unconscious.
0:03:16 > 0:03:19All right sweetheart, hello. You all right, mate?
0:03:19 > 0:03:22OK. Someone grab a Guedel, thanks.
0:03:22 > 0:03:24Yeah, of course. And some oxygen.
0:03:24 > 0:03:27I can see he's got a facial injury, he's got blood coming from his nose,
0:03:27 > 0:03:31but the most worrying thing is his breathing is not normal.
0:03:31 > 0:03:33He's got a lot of blood in his airway.
0:03:33 > 0:03:35We don't know what his facial damage is,
0:03:35 > 0:03:36but any damage to the airway
0:03:36 > 0:03:39instantly compromises you as a person,
0:03:39 > 0:03:40because you've got to breathe.
0:03:40 > 0:03:42If you're not breathing, you're in trouble.
0:03:42 > 0:03:43Matt, you grab that.
0:03:43 > 0:03:47Anne suspects Michael's body is being starved of oxygen,
0:03:47 > 0:03:48and needs to act fast
0:03:48 > 0:03:51before organs like his brain begin to suffer and die.
0:03:51 > 0:03:53One more. OK.
0:03:53 > 0:03:56What I need you to do is put a finger behind each jaw, each side,
0:03:56 > 0:03:59and just lift it up. Yeah.
0:03:59 > 0:04:00We're trying to stop that snoring noise.
0:04:00 > 0:04:03I'm going to insert a plastic airway into his nose,
0:04:03 > 0:04:05to make sure there is wide-open channels
0:04:05 > 0:04:08for the oxygen to be delivered down to his lungs.
0:04:08 > 0:04:11Knowing that Michael is deeply unconscious,
0:04:11 > 0:04:15Anne urgently needs to find out what happened when he collapsed.
0:04:15 > 0:04:17You're all right, mate.
0:04:17 > 0:04:20Who was here first, or saw him collapse?
0:04:20 > 0:04:22He was following me up the stairs,
0:04:22 > 0:04:25I was walking upstairs from the ground floor to the third floor,
0:04:25 > 0:04:27and he was sort of running behind me.
0:04:27 > 0:04:31He just groaned and fell forward. Onto his face? Yeah. OK.
0:04:31 > 0:04:34For someone to say he just went forward, that's quite worrying.
0:04:34 > 0:04:37'It sounds as though he's completely lost
0:04:37 > 0:04:41'the blood supply to the part of his brain that keeps you awake,'
0:04:41 > 0:04:45and he's literally just gone down very, very hard, immediately.
0:04:45 > 0:04:48Where's that blood coming from? It that from his nose?
0:04:48 > 0:04:51Have we got a bit of gauze to stop it?
0:04:51 > 0:04:52One of the first people to help Michael
0:04:52 > 0:04:55was co-worker Emily, a trained first-aider.
0:04:56 > 0:05:01I very much felt that this person in front of me was about to die.
0:05:01 > 0:05:03He started to go slightly darker purple,
0:05:03 > 0:05:05perhaps a slightly blue colour.
0:05:05 > 0:05:06Did you have to do CPR?
0:05:06 > 0:05:09I had to. Did you have to breathe for him?
0:05:09 > 0:05:12We tried that, but the man at the 999 on the phone said don't do it.
0:05:12 > 0:05:14OK, all right.
0:05:14 > 0:05:17We took the decision to go through the resuscitation routine,
0:05:17 > 0:05:20which includes CPR and the defibrillator.
0:05:20 > 0:05:23Well done, yeah, you've done a good job helping him.
0:05:23 > 0:05:27The prompt actions of Michael's co-workers restarted his heart,
0:05:27 > 0:05:30but the cause of his arrest is still unclear.
0:05:32 > 0:05:35'It's wide open at that point in time, as to what is the cause.
0:05:35 > 0:05:38'There's a possibility that Michael's had a bleed'
0:05:38 > 0:05:40inside his head, that could be
0:05:40 > 0:05:43what we call an intracranial or intracerebral bleed,
0:05:43 > 0:05:46or it could be that he's had a cardiac event,
0:05:46 > 0:05:48he's had an arrhythmia, or he's had a heart attack.
0:05:48 > 0:05:53OK, so we've got a heart rate of 130, sats of 100.
0:05:53 > 0:05:56His pupils are equal, he's breathing,
0:05:56 > 0:05:58but he's fallen onto his face.
0:05:58 > 0:05:59Michael?
0:06:01 > 0:06:03Michael?
0:06:03 > 0:06:05OK, probably GCS 3.
0:06:05 > 0:06:09Yeah. Can we get a 12-lead ECG, please?
0:06:09 > 0:06:13Connecting Michael to an electrocardiogram, or ECG,
0:06:13 > 0:06:16will allow Anne to look for any changes in heart rhythm
0:06:16 > 0:06:18or electrical patterns
0:06:18 > 0:06:20that could point to the cause of his cardiac arrest.
0:06:22 > 0:06:24Anne, there's your ECG.
0:06:27 > 0:06:32OK guys, his ECG isn't entirely normal from a cardiac point of view.
0:06:32 > 0:06:35He's got some ST depression, inferiorly and laterally.
0:06:35 > 0:06:39But I'm slightly worried it could be a cerebral event as well.
0:06:39 > 0:06:41His ECG shows some abnormalities,
0:06:41 > 0:06:46but the changes are not diagnostic of an acute heart attack,
0:06:46 > 0:06:48but they're not entirely normal.
0:06:48 > 0:06:53Those changes could be attributed to a bleed on the brain.
0:06:53 > 0:06:56Anne is concerned that Michael may have had a brain haemorrhage
0:06:56 > 0:06:59that is affecting the area controlling his lungs and heart.
0:06:59 > 0:07:03A further bleed could be life-threatening to him.
0:07:03 > 0:07:04Time is critical,
0:07:04 > 0:07:07whether or not it's Michael's heart or whether it's his brain,
0:07:07 > 0:07:10either way, we need to get a diagnosis as quickly as possible.
0:07:23 > 0:07:2516 minutes ago in Northumberland,
0:07:25 > 0:07:27emergency services received a call
0:07:27 > 0:07:29from a suburban street
0:07:29 > 0:07:31on the outskirts of Newcastle.
0:07:32 > 0:07:34Ambulance service, can you tell me what the problem is?
0:07:34 > 0:07:37Yeah, they put a knife in my wife.
0:07:38 > 0:07:41She's been stabbed? Please, I need an ambulance, please!
0:07:41 > 0:07:43Sir, you need to tell me what's happened.
0:07:43 > 0:07:44Is she breathing?
0:07:44 > 0:07:46Yes... Please...
0:07:46 > 0:07:51Listen, don't worry, an emergency ambulance has been arranged, OK?
0:07:51 > 0:07:53OK, OK.
0:07:53 > 0:07:57North East Ambulance Service senior paramedic Gary Shaw
0:07:57 > 0:08:01is in one of three ambulances dispatched to the scene.
0:08:01 > 0:08:04AMBULANCE RADIO: 'Anyone on the air, got a detail in North Shields.
0:08:04 > 0:08:06'A patient, multiple stabbing.'
0:08:06 > 0:08:09Yeah, roger, just send it on, thanks.
0:08:10 > 0:08:12Multiple stabbings.
0:08:12 > 0:08:16I was given information from our control room that we had a female,
0:08:16 > 0:08:17possibly stabbed in the neck.
0:08:19 > 0:08:22You have major vessels within the neck. If they are damaged,
0:08:22 > 0:08:25you bleed really heavily and quickly from those wounds.
0:08:25 > 0:08:28Stabbed in the neck and the chest.
0:08:28 > 0:08:31Wounds to the chest are obviously very dangerous ones,
0:08:31 > 0:08:33you've got your heart within your chest, your lungs,
0:08:33 > 0:08:35all of your vital organs.
0:08:35 > 0:08:38If that's not dealt with really quickly,
0:08:38 > 0:08:41you're then looking at the potential for a fatality at scene.
0:08:41 > 0:08:45The stab victim is Gidia, a young mother of three.
0:08:47 > 0:08:50Paramedic Phil Blance is rapidly assessing
0:08:50 > 0:08:52where the knife has penetrated.
0:08:52 > 0:08:53Say again? Chest wound?
0:08:53 > 0:08:56Chest wound, deep, possibly full thickness.
0:08:56 > 0:08:58In the sternum?
0:08:58 > 0:09:01Yes, sternum. Both sides of the neck.
0:09:01 > 0:09:03She'd been stabbed in the centre of her chest,
0:09:03 > 0:09:07and she had some lacerations to her neck, as well.
0:09:07 > 0:09:10OK, 134/106.
0:09:10 > 0:09:12Sats are 86.
0:09:12 > 0:09:15'It doesn't have to be long or particularly wide,'
0:09:15 > 0:09:18anything that penetrates that area, because of the major vessels,
0:09:18 > 0:09:21is potentially fatal for the patient.
0:09:22 > 0:09:25Right, we're good. Excuse me, honey,
0:09:25 > 0:09:27we're going to be going on blue lights and sirens, OK?
0:09:27 > 0:09:29We've got access. Yes.
0:09:29 > 0:09:32'Pre-hospitally, I can't see, internally,'
0:09:32 > 0:09:34if there's any damage, you've just got to suspect the worst.
0:09:34 > 0:09:36SIREN WAILS
0:09:36 > 0:09:39Phil is rushing Gidia to the nearest major trauma centre
0:09:39 > 0:09:42at Newcastle's Royal Victoria Infirmary.
0:09:44 > 0:09:46How big was the knife?
0:09:46 > 0:09:47Ten inches?
0:09:47 > 0:09:49A big one? A kitchen knife?
0:09:49 > 0:09:54'I was quite surprised when the lady said it was a ten-inch knife,'
0:09:54 > 0:09:57which does have a different impact on your treatment.
0:09:57 > 0:09:59'The size does matter.
0:09:59 > 0:10:02'We've got to assume it has gone in ten inches,'
0:10:02 > 0:10:04that's the main concern for us.
0:10:04 > 0:10:07And your date of birth?
0:10:07 > 0:10:0901... Yeah? 'Where she was stabbed in the centre of her chest,
0:10:09 > 0:10:13'the knife could have punctured the lung. If the lung collapses'
0:10:13 > 0:10:16due to the stabbing, you have a build-up of air
0:10:16 > 0:10:18in what they call the pleural cavity.
0:10:18 > 0:10:21If air is allowed to build up in her chest,
0:10:21 > 0:10:22Gidia will struggle to breathe.
0:10:25 > 0:10:27'We will place a Russell Chest Seal,
0:10:27 > 0:10:31'which acts as a valve that lets the air out
0:10:31 > 0:10:32'but doesn't let the air in.'
0:10:36 > 0:10:40196, I wonder if you could pre-alert the RVI, please?
0:10:40 > 0:10:42Are you ready for the details? Over.
0:10:42 > 0:10:46Yes, we have a 36-year-old female who has three stab wounds.
0:10:46 > 0:10:47The first stab wound
0:10:47 > 0:10:49is in the centre of her chest, in the sternum.
0:10:49 > 0:10:52There's a Russell Chest Seal in situ.
0:10:52 > 0:10:55Phil phones ahead to Newcastle's RVI Hospital
0:10:55 > 0:10:59to alert the major trauma team to prepare for Gidia's arrival.
0:10:59 > 0:11:03The second stab wound is to the left side of her neck,
0:11:03 > 0:11:06she has a small laceration to the right side of her head.
0:11:06 > 0:11:08Gidia's life will be in the hands
0:11:08 > 0:11:11of emergency medicine consultant Sohom Maitra.
0:11:11 > 0:11:14The sternum and twice in the neck.
0:11:14 > 0:11:16GCS 15, blood pressure OK.
0:11:16 > 0:11:19I think it'll probably be a question of how deep,
0:11:19 > 0:11:20the usual sort of thing.
0:11:20 > 0:11:23My current concern is that she has an injury
0:11:23 > 0:11:26in two areas of the body, the neck and the chest,
0:11:26 > 0:11:28where there are vital organs and vital vessels,
0:11:28 > 0:11:31and I am very concerned that she could have active bleeding
0:11:31 > 0:11:34in and around her heart, or in and around her lungs,
0:11:34 > 0:11:38and also in and around the main vessels of her neck.
0:11:38 > 0:11:41SIREN WAILS
0:11:41 > 0:11:45Sats are up at 97.
0:11:45 > 0:11:49'You are constantly reassessing all the time.'
0:11:49 > 0:11:52Reassessing her airway,
0:11:52 > 0:11:56looking at the monitor to see if her heart rate is increasing.
0:11:56 > 0:11:58Although Gidia appears stable,
0:11:58 > 0:12:01her body could be masking a life-threatening injury.
0:12:02 > 0:12:05Phil knows she could deteriorate at any time.
0:12:05 > 0:12:08Pulse, 82 and regular.
0:12:08 > 0:12:11BM is 11.4.
0:12:11 > 0:12:13You are always aware that things
0:12:13 > 0:12:17can change quite dramatically en route to hospital.
0:12:17 > 0:12:19SIRENS DROWN SPEECH
0:12:34 > 0:12:35In central London,
0:12:35 > 0:12:3762-year-old office worker Michael
0:12:37 > 0:12:40is still unconscious after suffering
0:12:40 > 0:12:43a suspected cardiac arrest at work.
0:12:43 > 0:12:46It may not be his heart, so it's a possibility...
0:12:46 > 0:12:49It could be his head. Better off doing... Yeah.
0:12:51 > 0:12:54Anne urgently needs to get Michael to a hospital
0:12:54 > 0:12:56to diagnose whether the arrest
0:12:56 > 0:12:59was caused by a brain haemorrhage or a heart problem.
0:12:59 > 0:13:01If he has had an intracerebral bleed,
0:13:01 > 0:13:04there may be something that a neurosurgeon can do about it.
0:13:04 > 0:13:06'Equally, if he has had a cardiac event, again,
0:13:06 > 0:13:09'he may need a time-critical intervention.'
0:13:09 > 0:13:13But before she can move him, she needs to address his breathing.
0:13:14 > 0:13:18Michael currently isn't breathing normally. He is breathing,
0:13:18 > 0:13:22but it is not regular and it is not a normal depth or pattern.
0:13:22 > 0:13:23How much O2 have we got left?
0:13:23 > 0:13:26Have we got only one O2 bottle up here?
0:13:26 > 0:13:28Oh, right. Have we only got that cylinder?
0:13:28 > 0:13:30That cylinder at the moment and one on the truck.
0:13:30 > 0:13:35Michael's abnormal breathing risks starving his vital organs of oxygen
0:13:35 > 0:13:38and could cause brain damage or trigger another cardiac arrest.
0:13:38 > 0:13:40You're just going to do a little roll,
0:13:40 > 0:13:42just enough for me to get this side of the scoop in.
0:13:42 > 0:13:43One, two, three.
0:13:46 > 0:13:50Anne decides to anaesthetise Michael and take over his breathing.
0:13:50 > 0:13:53Right, if we've got the oxygen, let's pop that between his legs.
0:13:53 > 0:13:58We are going to anaesthetise him here, so I need total quiet.
0:13:58 > 0:14:00It's really important
0:14:00 > 0:14:03that everything is kept strictly cordoned off now.
0:14:04 > 0:14:07I have taken a lot of thought about whether Michael needs this.
0:14:07 > 0:14:10I have given him some time to see if he recovers
0:14:10 > 0:14:12but he is still deeply unconscious.
0:14:12 > 0:14:15This procedure will mean that his airway is protected
0:14:15 > 0:14:18and, to some extent, we can also control the level of oxygen
0:14:18 > 0:14:20to make sure, if he does have a brain injury,
0:14:20 > 0:14:23we minimise any further insult to his brain.
0:14:23 > 0:14:26OK, straight on to the trolley. Pull that closed. So, people,
0:14:26 > 0:14:29we're going to give him some drugs to put him to sleep, OK?
0:14:29 > 0:14:32Can I get you to just hold his arm straight for me, please? Thanks.
0:14:33 > 0:14:37Michael is given a combination of strong sedative drugs
0:14:37 > 0:14:40to relax his airway and paralyse his chest muscles.
0:14:42 > 0:14:45Sats are 97, pulse rate is 85.
0:14:45 > 0:14:48In simple terms, we are stopping the patient breathing.
0:14:48 > 0:14:49Michael is breathing.
0:14:49 > 0:14:51We are now going to stop him breathing.
0:14:51 > 0:14:54The responsibility that comes with that is massive.
0:14:54 > 0:14:56OK, I'm going to get you to stay there for a minute
0:14:56 > 0:14:57and I'm just going to get you
0:14:57 > 0:15:00to hold his neck while we intubate him, OK?
0:15:02 > 0:15:04Can you just hold his head?
0:15:04 > 0:15:06Right, there's a lot of blood. Suction?
0:15:06 > 0:15:08Now the drugs have taken effect,
0:15:08 > 0:15:11Anne has seconds to insert a breathing tube
0:15:11 > 0:15:13through Michael's vocal cords and down his windpipe.
0:15:15 > 0:15:18Just pop your hand where my finger is, just there.
0:15:18 > 0:15:21OK, bougie, please. Bougie in your hand.
0:15:22 > 0:15:24'It is a very tense moment.'
0:15:24 > 0:15:26Just support the top of it, Phil, the top of the bougie.
0:15:26 > 0:15:29'If I can't get that tube through the cords,'
0:15:29 > 0:15:30Michael isn't going to breathe.
0:15:30 > 0:15:32Someone has to do that for him
0:15:32 > 0:15:35and I need a way of getting oxygen down into his lungs.
0:15:35 > 0:15:38Yeah, through the cords. Tube, please. Tube on the bougie.
0:15:38 > 0:15:39If I fail completely,
0:15:39 > 0:15:42I may have to make a hole in the front of his neck,
0:15:42 > 0:15:46so I'm hoping I can get the tube down first time.
0:15:46 > 0:15:47Tube is through.
0:15:47 > 0:15:50OK, bougie out, please. Watch your eyes.
0:15:50 > 0:15:52Bougie out. OK, let go of the tube, thanks.
0:15:52 > 0:15:54With the tube in place,
0:15:54 > 0:15:57Anne must now manually control Michael's breathing.
0:15:58 > 0:15:59OK, give me a bag.
0:16:02 > 0:16:03And again.
0:16:06 > 0:16:09'It's a huge relief when we know that we can ventilate Michael.'
0:16:09 > 0:16:13We know we can deliver oxygen effectively.
0:16:13 > 0:16:15It's a bit quieter on that side.
0:16:15 > 0:16:19'He is in that place now where he needs definitive treatment'
0:16:19 > 0:16:23and that can only be delivered by a specialist centre.
0:16:23 > 0:16:27What are our sats? Sats are 5 now.
0:16:27 > 0:16:30OK, good, let's just get this out of the way.
0:16:30 > 0:16:32But without a clear cause for Michael's cardiac arrest,
0:16:32 > 0:16:35Anne now faces a difficult decision -
0:16:35 > 0:16:39whether to take Michael to a cardiac centre to investigate his heart,
0:16:39 > 0:16:42or to a major trauma centre to look at his brain.
0:16:45 > 0:16:49I have to decide what I think the top diagnosis is,
0:16:49 > 0:16:51which hospital I am going to take him to.
0:16:51 > 0:16:53If I take him to the cardiac centre,
0:16:53 > 0:16:56they investigate him and treat him for his heart,
0:16:56 > 0:17:00that may involve him having anticoagulation drugs,
0:17:00 > 0:17:01which will thin his blood.
0:17:03 > 0:17:06If he has a brain injury, that could make it worse.
0:17:06 > 0:17:09If they anticoagulated him and he had a bleed inside his head,
0:17:09 > 0:17:11a further bleed could be life-threatening to him,
0:17:11 > 0:17:16so it's important that we rule that out by doing a CT scan.
0:17:16 > 0:17:18Guys, just so everyone is clear,
0:17:18 > 0:17:20we're going to go to the London and get his head scanned.
0:17:20 > 0:17:24So, could we have a lift available, fellas, to go? Thank you.
0:17:26 > 0:17:29Anne is taking Michael to the Royal London Hospital
0:17:29 > 0:17:32where specialist neurosurgeons will be able to find out
0:17:32 > 0:17:34if he has suffered a severe brain haemorrhage.
0:17:36 > 0:17:37Excuse us, mate.
0:17:38 > 0:17:39Thank you.
0:17:39 > 0:17:42There is a big risk, if you go to the London
0:17:42 > 0:17:45and there's nothing wrong with his head,
0:17:45 > 0:17:48now we are, again, into minutes of his heart dying.
0:17:50 > 0:17:52We're going to go to the London. I will put the blue call in.
0:17:52 > 0:17:55I've got a feeling it's going to be the wrong hospital
0:17:55 > 0:17:57but I think we have to get his head scanned first.
0:17:57 > 0:17:59Guys, we're going to do a U-turn and go down...
0:17:59 > 0:18:02Right, so, I've got a male.
0:18:02 > 0:18:04He has collapsed at work in the City
0:18:04 > 0:18:07but has fallen forwards and has got facial injuries.
0:18:07 > 0:18:09It's a possible cardiac event,
0:18:09 > 0:18:11but I'm coming to you cos I think we need to scan his head
0:18:11 > 0:18:13and put him through as a trauma call.
0:18:13 > 0:18:16We'll be with you in eight minutes.
0:18:16 > 0:18:18All right? Yeah, we're good.
0:18:18 > 0:18:19SIREN WAILS
0:18:21 > 0:18:24In Newcastle, it's been 42 minutes
0:18:24 > 0:18:26since an ambulance was called
0:18:26 > 0:18:28to Gidia, a young mother of three,
0:18:28 > 0:18:30stabbed multiple times with a knife.
0:18:32 > 0:18:35Suspecting internal bleeding, the medical team
0:18:35 > 0:18:39are rushing her to the major trauma centre at Newcastle 's RVI.
0:18:47 > 0:18:48OK, ladies and gentlemen,
0:18:48 > 0:18:52this is a 35-year-old lady who, at around 10 o'clock today,
0:18:52 > 0:18:54has suffered multiple stab wounds to the chest and neck.
0:18:54 > 0:18:56Injuries sustained.
0:18:56 > 0:18:59She has a right central stab wound to the chest,
0:18:59 > 0:19:02a deep laceration to the left side of her neck,
0:19:02 > 0:19:04blood pressure 120/60,
0:19:04 > 0:19:06respiratory 70 and sats are 96.
0:19:06 > 0:19:08'It's very difficult to work out,
0:19:08 > 0:19:11'just from looking from the outside, what is underneath.'
0:19:11 > 0:19:13A stab wound could have gone anywhere,
0:19:13 > 0:19:16gone to any depth and involved anything.
0:19:18 > 0:19:22Sohom's urgent priority is to decide if any of Gidia's major organs
0:19:22 > 0:19:24have been struck by the knife.
0:19:24 > 0:19:27OK, we're just having a little look at these wounds, all right?
0:19:27 > 0:19:29GIDIA GROANS I know it's quite sore.
0:19:29 > 0:19:32We're going to give you something for your pain.
0:19:32 > 0:19:34I'm very much worried about the heart and the lungs,
0:19:34 > 0:19:36I'm also worried about the vessels in her neck,
0:19:36 > 0:19:38which supply oxygen and blood to the brain.
0:19:38 > 0:19:40Can I ask you to stick your tongue out?
0:19:40 > 0:19:42That is quite a deep wound.
0:19:42 > 0:19:45Just to the right of the upper part of the sternum.
0:19:45 > 0:19:47Is that sore if I press on your voice box there?
0:19:47 > 0:19:49GIDIA MOANS Yeah, OK.
0:19:49 > 0:19:53'She was a little tender over the top of her voice box,
0:19:53 > 0:19:57'which does create a concern in my mind that there may be damage.
0:19:57 > 0:19:59'It can swell up and block the airway
0:19:59 > 0:20:02'and stop oxygen going to the brain.
0:20:02 > 0:20:05'I am really worried as to how much is she covering
0:20:05 > 0:20:07'for what may be going on underneath.'
0:20:07 > 0:20:10Does it hurt when you move your tongue?
0:20:10 > 0:20:12Although Gidia looks stable,
0:20:12 > 0:20:15Sohom is aware that things can change rapidly.
0:20:15 > 0:20:18She is a young person and young people, particularly, in trauma
0:20:18 > 0:20:21can compensate and hold on to their blood pressure
0:20:21 > 0:20:25and heart rate and oxygen levels for an extremely long time,
0:20:25 > 0:20:27right up until moments or seconds
0:20:27 > 0:20:30before they actually go into cardiac arrest or die.
0:20:33 > 0:20:34Do you want to have a little look,
0:20:34 > 0:20:37if there's any lung points on ultrasound?
0:20:40 > 0:20:43Fearing that Gidia could deteriorate at any minute,
0:20:43 > 0:20:46Sohom saves critical time using a portable ultrasound
0:20:46 > 0:20:48to check her vital organs.
0:20:50 > 0:20:55Ultrasound is fantastic in the resuscitation effort
0:20:55 > 0:20:59and it provides answers very timely at the bedside for...
0:20:59 > 0:21:01"Is the lung affected?" Yes/no.
0:21:01 > 0:21:04"Is the heart affected in a major way?" Yes/no.
0:21:04 > 0:21:06That's fine. And on the right.
0:21:09 > 0:21:11I think you have got enough of a view to say it looks OK.
0:21:11 > 0:21:15OK, Gidia, we are just finishing the ultrasound scan,
0:21:15 > 0:21:17we have looked at the lung and it looks OK so far
0:21:17 > 0:21:20which is good news, and we're just having a look at your tummy as well.
0:21:20 > 0:21:24Whilst Gidia's lungs appear unharmed on the ultrasound,
0:21:24 > 0:21:27Sohom is concerned it can't tell the whole story.
0:21:29 > 0:21:31We want to know more than just a yes/no answer
0:21:31 > 0:21:33as to whether something is affected,
0:21:33 > 0:21:35we want detail, we want major detail.
0:21:35 > 0:21:37Craig, are you all right giving...?
0:21:37 > 0:21:39Would you mind giving them a ring in CT?
0:21:39 > 0:21:43The CT scan will reveal whether Gidia is bleeding internally.
0:21:44 > 0:21:49After this, we will need to do some scans, called CT scans,
0:21:49 > 0:21:52to make sure that there is no injury to anything else.
0:21:52 > 0:21:54Is there something underneath that is slowly building,
0:21:54 > 0:21:57whether it is a small drip-drip effect
0:21:57 > 0:21:59or whether it's something more severe than that,
0:21:59 > 0:22:02whereby, actually, we are about to run into problems very, very quickly
0:22:02 > 0:22:04but we don't know it yet?
0:22:14 > 0:22:1851 minutes ago, at North East Ambulance Service control,
0:22:18 > 0:22:22operators received a call about a man in Durham
0:22:22 > 0:22:26in critical condition after a serious road accident.
0:22:26 > 0:22:30OPERATOR: Hello, ambulance service. Can you tell me what the problem is?
0:22:38 > 0:22:41We will get somebody there as quickly as we can.
0:22:44 > 0:22:47Code red trauma, 20 minutes.
0:22:47 > 0:22:52An air ambulance team are already at the scene and issue a code red alert
0:22:52 > 0:22:54to Newcastle's Royal Victoria Hospital
0:22:54 > 0:22:58to prepare them to receive a patient suffering from severe blood loss.
0:23:00 > 0:23:03He has got pre-hospital blood coming...going
0:23:03 > 0:23:05and he's got bilateral thoracotomies.
0:23:05 > 0:23:07I think the main thing is to move quickly.
0:23:07 > 0:23:10Emergency medicine consultant Bas Sen
0:23:10 > 0:23:12is heading up a specialist team
0:23:12 > 0:23:14that will be treating 31-year-old Ben.
0:23:14 > 0:23:15If you have any blood ready,
0:23:15 > 0:23:17he has a cannula in his right antecubital fossa.
0:23:17 > 0:23:20He probably needs that attaching as soon as you can. OK.
0:23:20 > 0:23:2431-year-old male, injured in Durham about an hour ago.
0:23:24 > 0:23:29He is a cyclist, underneath a bus and had to be extricated.
0:23:29 > 0:23:32Ben has severe injuries to his chest,
0:23:32 > 0:23:35which is deformed, and possible pelvic injury as well,
0:23:35 > 0:23:37he has had two units of red cells en route.
0:23:37 > 0:23:40His last blood pressure was 110 systolic.
0:23:40 > 0:23:42Heart rate is still in the 130s.
0:23:42 > 0:23:45So evidence of severe chest injury and bleeding.
0:23:45 > 0:23:46OK, thanks, Phil.
0:23:46 > 0:23:49The weight of the bus has crushed Ben's chest,
0:23:49 > 0:23:52causing major internal bleeding.
0:23:52 > 0:23:55The concealed haemorrhage is when you bleed into a body cavity
0:23:55 > 0:23:58so you can't see it but it is as serious as external haemorrhage.
0:23:58 > 0:24:01To save Ben's life and get him to hospital,
0:24:01 > 0:24:03the air ambulance team
0:24:03 > 0:24:06have given him two units of blood and anaesthetised him.
0:24:08 > 0:24:11But Ben is still bleeding heavily and his levels are dangerously low.
0:24:15 > 0:24:17Haemorrhagic shock is a condition where
0:24:17 > 0:24:20the patient is losing blood actively
0:24:20 > 0:24:23and there isn't enough blood to go around the system.
0:24:23 > 0:24:28The major organs start to shut down, like your brain and your heart,
0:24:28 > 0:24:31this does mean that Ben is dying if there is no intervention.
0:24:31 > 0:24:34But before the team can start to treat Ben's injuries,
0:24:34 > 0:24:38Bas must address his massive internal bleeding.
0:24:38 > 0:24:42OK, chaps, can we get the blood in and started, please?
0:24:42 > 0:24:44That is our priority.
0:24:45 > 0:24:48Let's get the blood in. Can I have the blood, please?
0:24:48 > 0:24:50In response to the code red call,
0:24:50 > 0:24:54blood products such as red blood cells, plasma and platelets,
0:24:54 > 0:24:57have been ordered and are ready and waiting for Ben.
0:24:59 > 0:25:01Is that blood going?
0:25:01 > 0:25:05He will need a combination of all three just to keep him alive.
0:25:05 > 0:25:08I knew we had to move very quickly into CT scan
0:25:08 > 0:25:11to find out where he was bleeding from.
0:25:11 > 0:25:14Airway, are you happy? OK.
0:25:14 > 0:25:16But Ben is dangerously unstable
0:25:16 > 0:25:19and too ill to be moved to the scanner.
0:25:20 > 0:25:22He has got a pretty bad crush to his chest.
0:25:22 > 0:25:26'The decision I had to make was whether to wait'
0:25:26 > 0:25:30and stabilise his chest further or whether to go straight for CT.
0:25:30 > 0:25:32He has bilateral chest movement.
0:25:32 > 0:25:36So, at the moment, we are happy from a B point of view.
0:25:36 > 0:25:40So, Alan, circulation. Has he got a peripheral pulse?
0:25:40 > 0:25:43He does, he has... a very faint radial.
0:25:43 > 0:25:46He's got a faint radial? OK.
0:25:46 > 0:25:49'We had satisfactory breathing'
0:25:49 > 0:25:51but his circulation was worrying me.
0:25:51 > 0:25:56Can't really feel his femoral, in fact. Not very good.
0:25:56 > 0:25:59Is the blood going, chaps? Yes. All right.
0:25:59 > 0:26:03'Ben was losing a significant amount of blood'
0:26:03 > 0:26:05and we couldn't get a satisfactory radial pulse.
0:26:05 > 0:26:07A weak pulse in Ben's wrist
0:26:07 > 0:26:10means there is not enough blood in his system
0:26:10 > 0:26:12and he is losing it faster than they can replace it.
0:26:13 > 0:26:16If Bas can't increase Ben's blood levels,
0:26:16 > 0:26:19it could trigger a cardiac arrest.
0:26:19 > 0:26:22Miriam, is the peripheral line not working?
0:26:22 > 0:26:26It is not brilliant, we are not getting more than...
0:26:26 > 0:26:29OK, go for it. Go for it.
0:26:30 > 0:26:35I knew that what I needed to do here was to save his circulation.
0:26:35 > 0:26:37I decided to make sure
0:26:37 > 0:26:41that we replaced sufficient blood in his system
0:26:41 > 0:26:45for him to have time to go through a CT scan.
0:26:45 > 0:26:48Have you got a decent pulse there? No, it's very, very...
0:26:48 > 0:26:50That is what I need to know from you guys.
0:26:50 > 0:26:52Are you happy with the stroke volume or not,
0:26:52 > 0:26:54or do you want to transfuse him with more?
0:26:54 > 0:26:58We could do with about five minutes of transfusion.
0:26:58 > 0:27:00OK, that is fine.
0:27:00 > 0:27:02If that is all right.
0:27:02 > 0:27:07Bas must now wait for the transfusion to take effect.
0:27:07 > 0:27:12Only once Ben has a stable pulse and blood pressure can he go to CT.
0:27:12 > 0:27:13Five minutes.
0:27:13 > 0:27:14Yeah.
0:27:23 > 0:27:25In the last 60 minutes,
0:27:25 > 0:27:27emergency clinicians have battled
0:27:27 > 0:27:29to deliver medical interventions
0:27:29 > 0:27:32to three critically ill patients.
0:27:32 > 0:27:34Having survived the cardiac arrest,
0:27:34 > 0:27:38Michael has been anaesthetised and his treatment now rests
0:27:38 > 0:27:41on doctors determining the exact cause.
0:27:41 > 0:27:43Cyclist Ben is being transfused with blood
0:27:43 > 0:27:48and doctors now need to locate the source of his internal bleeding.
0:27:48 > 0:27:50And after a knife attack
0:27:50 > 0:27:54has left mother-of-three Gidia with multiple stab wounds,
0:27:54 > 0:27:55the team are using the latest equipment
0:27:55 > 0:27:58to look for any injury that could threaten her life.
0:28:00 > 0:28:03It has been 20 minutes since cyclist Ben arrived
0:28:03 > 0:28:08at Newcastle's major trauma centre after being crushed by a bus.
0:28:08 > 0:28:10Blood pressure is 124/88.
0:28:10 > 0:28:15Continuous blood transfusions have so far kept Ben alive.
0:28:15 > 0:28:17Bas now needs to scan him
0:28:17 > 0:28:21to find the source of his internal bleeding as soon as possible.
0:28:21 > 0:28:24Marie? No, we don't. OK.
0:28:24 > 0:28:27'The longer you leave it,'
0:28:27 > 0:28:29the more you are risking
0:28:29 > 0:28:33the patient suffering from multi-organ failure.
0:28:33 > 0:28:38I have seen patients die within minutes.
0:28:38 > 0:28:39Bas is finally able to see
0:28:39 > 0:28:43the severity of the injuries Ben has sustained.
0:28:43 > 0:28:45What's the state of his lungs? Can you see them?
0:28:45 > 0:28:47VARIOUS MUTTERED REPLIES
0:28:50 > 0:28:53The bus crushed his chest,
0:28:53 > 0:28:57so this is almost like your chest becomes flat
0:28:57 > 0:29:01and when that happens, all your ribs break.
0:29:01 > 0:29:04Ben's ribs have been severed from his breastbone
0:29:04 > 0:29:08and his shattered ribcage has punctured both lungs.
0:29:15 > 0:29:18OK. We have got gas under there. Mm-hm.
0:29:18 > 0:29:23'Ben's chest showed significant injuries to both his lungs
0:29:23 > 0:29:26'and his lungs had collapsed about 50%.'
0:29:26 > 0:29:29He had almost every abnormality we could find.
0:29:29 > 0:29:32OK, as long as he is not bleeding into his chest.
0:29:32 > 0:29:35But despite a life-threatening injury to Ben's chest,
0:29:35 > 0:29:39the source of his internal bleeding remains unclear.
0:29:39 > 0:29:41As the scan moves down Ben's body,
0:29:41 > 0:29:44Bas must look at one organ at a time.
0:29:44 > 0:29:46As we went into Ben's abdomen,
0:29:46 > 0:29:50it showed that he was bleeding significantly from his spleen
0:29:50 > 0:29:53and I could see by looking at the scans
0:29:53 > 0:29:55that his spleen was in two bits.
0:29:57 > 0:30:00Ben's spleen has been torn into pieces by his shattered ribcage,
0:30:00 > 0:30:02causing catastrophic bleeding.
0:30:05 > 0:30:08He is bleeding into a cavity called the peritoneal cavity,
0:30:08 > 0:30:09which is in the abdomen.
0:30:09 > 0:30:12This artery that feeds into the spleen
0:30:12 > 0:30:15has to be clamped off and tied because you can lose
0:30:15 > 0:30:19your whole blood volume into a cavity like the peritoneum.
0:30:19 > 0:30:21I think the priority is to get the drains in.
0:30:21 > 0:30:24OK, I will make sure that Steve is primed and ready to go.
0:30:24 > 0:30:27It's... We can put the arterial line in any...
0:30:27 > 0:30:29That's not a therapeutic intervention.
0:30:29 > 0:30:32I am just a bit concerned about his abdominal haemorrhage.
0:30:32 > 0:30:35Ben requires immediate surgery on his spleen
0:30:35 > 0:30:37to stop his internal bleeding,
0:30:37 > 0:30:41but the scans show that Ben's lungs are still collapsed
0:30:41 > 0:30:43and air is building in his chest cavity.
0:30:45 > 0:30:49When he took a deep breath in, air leaked out of his lungs
0:30:49 > 0:30:52and the air was trapped in his body.
0:30:52 > 0:30:57If we left the situation as it is, the air would crush his lungs.
0:30:59 > 0:31:02Unless Bas can relieve the pressure on Ben's lungs,
0:31:02 > 0:31:06he won't survive the operation to stop his bleeding.
0:31:06 > 0:31:09OK, chaps, we are going to take him out, take him back,
0:31:09 > 0:31:11put his drains in and then he goes to theatre
0:31:11 > 0:31:14and it will have to be done fairly quickly.
0:31:16 > 0:31:18Bas gains access to Ben's chest cavity
0:31:18 > 0:31:24through holes made in his side by the air ambulance team at the scene.
0:31:24 > 0:31:29Put your finger in and make sure you are in the pleural cavity, yeah?
0:31:29 > 0:31:33Yeah. Can you feel the lung? I can feel the lung, yeah. OK, good.
0:31:33 > 0:31:36Tubes are inserted into the holes to keep them open
0:31:36 > 0:31:39and allow any build-up of pressure
0:31:39 > 0:31:41caused by air or fluids to be released.
0:31:44 > 0:31:46OK, done?
0:31:49 > 0:31:51With Ben's breathing now under control,
0:31:51 > 0:31:55Bas can send him to get the surgery he so desperately needs.
0:32:07 > 0:32:10At the Royal London Hospital,
0:32:10 > 0:32:13office worker Michael is returning to the ambulance
0:32:13 > 0:32:15after undergoing a CT scan of his head.
0:32:16 > 0:32:18Michael's head scan looks normal,
0:32:18 > 0:32:21we can't see any bleeding in the brain or around the brain,
0:32:21 > 0:32:22which is reassuring.
0:32:22 > 0:32:25Good to go? Yeah.
0:32:26 > 0:32:29How long will it take us to get to Barts from here?
0:32:31 > 0:32:33Having ruled out a brain haemorrhage,
0:32:33 > 0:32:35Anne now suspects Michael's cardiac arrest
0:32:35 > 0:32:37to be the result of a heart problem.
0:32:39 > 0:32:41She now urgently needs to get Michael
0:32:41 > 0:32:44to Barts Heart Centre for further investigation.
0:32:44 > 0:32:46Hello, it is Anne Weaver,
0:32:46 > 0:32:48I just rang about a patient we are bringing in,
0:32:48 > 0:32:50we will be with you in about four minutes.
0:32:51 > 0:32:54If he has got a blocked coronary artery, for example,
0:32:54 > 0:32:56or partially blocked, that is still a risk,
0:32:56 > 0:33:00we haven't fixed that and we still need to consider
0:33:00 > 0:33:03that he could have another cardiac arrest at any time.
0:33:05 > 0:33:09Anne is passing over Michael's care to a specialist team, headed up
0:33:09 > 0:33:12by consultant interventional cardiologist John Hogan.
0:33:13 > 0:33:1762-year-old man, we anaesthetised him at the scene in Holborn,
0:33:17 > 0:33:20it could either be cerebral or cardiac.
0:33:21 > 0:33:24It has improved, but he has got...
0:33:24 > 0:33:27John must think carefully about treating Michael's heart
0:33:27 > 0:33:30as any intervention he makes from here
0:33:30 > 0:33:33requires the use of drugs that thin the blood.
0:33:33 > 0:33:36He could be bleeding slowly within the skull
0:33:36 > 0:33:39and that may not be apparent on the first scan
0:33:39 > 0:33:41or there may only be a small bleed
0:33:41 > 0:33:45but if we were to give him our drugs which interfere with blood clotting,
0:33:45 > 0:33:47it may aggravate any tendency to bleed
0:33:47 > 0:33:49and if he was to have a brisk bleed into his skull
0:33:49 > 0:33:50that would be very threatening.
0:34:06 > 0:34:08At the moment, he has got facial fractures
0:34:08 > 0:34:11with some blood in his maxillary sinuses.
0:34:11 > 0:34:13Having spent the last hour thinking hard about this,
0:34:13 > 0:34:16I am more and more convinced that his heart is the problem
0:34:16 > 0:34:18so I'm trying to hand that over to my colleagues.
0:34:20 > 0:34:21All right.
0:34:21 > 0:34:24I think we look, just to look,
0:34:24 > 0:34:25cos we have come this far,
0:34:25 > 0:34:28and just to turn our backs would not be right.
0:34:28 > 0:34:31I think he is a collapse, he needed CPR,
0:34:31 > 0:34:32we don't know if he had...
0:34:32 > 0:34:35so it really is a bit of a fishing expedition, so we do it, OK? Yeah.
0:34:39 > 0:34:41John decides to do the angiogram
0:34:41 > 0:34:44to try to find the cause of Michael's collapse.
0:34:44 > 0:34:47Ready, steady, slide.
0:34:47 > 0:34:49Using detailed X-rays,
0:34:49 > 0:34:53John looks for blockages in the arteries supplying Michael's heart.
0:34:53 > 0:34:56You inject dye into the heart arteries
0:34:56 > 0:34:59and that demonstrates whether they have any narrowing or blockages
0:34:59 > 0:35:02that you may need to do something to safeguard their future.
0:35:19 > 0:35:23In Michael's case, we do see all three coronary arteries are present,
0:35:23 > 0:35:26but we also see hardenings or narrowings within them.
0:35:41 > 0:35:44Michael does have what we call triple vessel disease,
0:35:44 > 0:35:46so he does have some heart disease
0:35:46 > 0:35:50and there is a possibility that he has had a cardiac event today.
0:35:56 > 0:35:59Michael was moving up the stairs fairly rapidly
0:35:59 > 0:36:00and perhaps the coronary arteries
0:36:00 > 0:36:03weren't able to allow the flow of blood and oxygen
0:36:03 > 0:36:06that his heart muscle demanded at that time,
0:36:06 > 0:36:08so it may have exacerbated an event.
0:36:15 > 0:36:18Although the team have found evidence of narrowed arteries,
0:36:18 > 0:36:21they are not immediately life-threatening.
0:36:21 > 0:36:23None of those narrowings appear to be complete,
0:36:23 > 0:36:26so the vessel is not entirely obstructed,
0:36:26 > 0:36:30and the blood flow through the narrowings seems to be reasonable.
0:36:30 > 0:36:33The decision was to leave things as they were
0:36:33 > 0:36:37so that we could reassess the head injury
0:36:37 > 0:36:40to make sure that that was not going to be progressive,
0:36:40 > 0:36:43and because his cardiac circumstances were stable,
0:36:43 > 0:36:45that would allow us to do that.
0:36:45 > 0:36:47Michael may need a procedure
0:36:47 > 0:36:49to widen the narrowings in his arteries,
0:36:49 > 0:36:53but John and his team decide to allow his brain and other injuries
0:36:53 > 0:36:57time to recover before any further treatment.
0:36:57 > 0:37:00Thank you very much for helping us, that is great.
0:37:09 > 0:37:12In Newcastle, Gidia, a young mother-of-three,
0:37:12 > 0:37:15has been stabbed multiple times with a knife.
0:37:18 > 0:37:21Although her condition has so far remained stable,
0:37:21 > 0:37:25Sohom can't be sure Gidia won't suddenly deteriorate.
0:37:25 > 0:37:29He needs to get Gidia to CT for an urgent scan.
0:37:31 > 0:37:34The journey to CT is one that is very fraught,
0:37:34 > 0:37:36the time clock is still ticking,
0:37:36 > 0:37:39and we are still not sure what is going on with Gidia,
0:37:39 > 0:37:43are there any major injuries that we are not seeing at the moment?
0:37:45 > 0:37:47OK, Gidia, we are just doing the CT scan now
0:37:47 > 0:37:49and we will look at the neck and chest
0:37:49 > 0:37:52and see if there is any injury underneath those wounds.
0:37:52 > 0:37:54It will be a bit sore going across.
0:37:54 > 0:37:57OK, honey? Ready, steady, slide.
0:37:57 > 0:37:58Having a stab wound to the neck
0:37:58 > 0:38:00always raises the possibility in my mind
0:38:00 > 0:38:02of whether or not there could be major bleeding
0:38:02 > 0:38:06that can threaten the windpipe and threaten the airway.
0:38:06 > 0:38:08Ten-inch non-serrated knife.
0:38:09 > 0:38:11The chances for her having major bleeding,
0:38:11 > 0:38:14particularly in the left-hand side of her neck,
0:38:14 > 0:38:16is still extremely high.
0:38:16 > 0:38:20Gidia has been stabbed in the area occupied by major blood vessels,
0:38:20 > 0:38:22including the jugular vein.
0:38:23 > 0:38:27Sohom can see from the scans exactly where the knife has penetrated.
0:38:30 > 0:38:33The stab wounds were millimetres from her heart,
0:38:33 > 0:38:37her great vessels around the heart and the vessels in her neck,
0:38:37 > 0:38:40by that, the carotid artery and the jugular vein.
0:38:40 > 0:38:42To the amazement of the doctors,
0:38:42 > 0:38:46Gidia has narrowly avoided suffering a severe internal bleed.
0:38:46 > 0:38:50The knife has missed vital organs like her heart.
0:38:50 > 0:38:53Gidia is extremely lucky at the moment.
0:38:53 > 0:38:55She has come, really, within millimetres
0:38:55 > 0:38:59of the stab wound affecting major vessels and organs
0:38:59 > 0:39:02and, really, for her to be clear of this
0:39:02 > 0:39:04is an excellent position for her to be in.
0:39:04 > 0:39:07But Gidia's wounds are deep and she will need to have
0:39:07 > 0:39:10exploratory surgery to assess the damage.
0:39:10 > 0:39:13We are looking at about... five inches.
0:39:13 > 0:39:15That will need to be explored, won't it?
0:39:15 > 0:39:17Give us two seconds.
0:39:17 > 0:39:21I can see that it has gone through the top few layers of muscle,
0:39:21 > 0:39:23it has gone through the skin,
0:39:23 > 0:39:26and it is a good few centimetres deep into her neck,
0:39:26 > 0:39:30and I will need a formal look inside, in an operating theatre,
0:39:30 > 0:39:32to know exactly what has been damaged
0:39:32 > 0:39:34and how deep things have gone.
0:39:34 > 0:39:36The main issue I am ringing you for is for a wound
0:39:36 > 0:39:39which is over the border of the left sternomastoid.
0:39:39 > 0:39:43Sohom pre-alerts the specialist maxillofacial surgeons
0:39:43 > 0:39:45who will operate on Gidia.
0:39:45 > 0:39:48It is not impossible by any means
0:39:48 > 0:39:51that the operating surgeons can find an injury pattern
0:39:51 > 0:39:54or bits of bleeding that the scans did not show.
0:39:54 > 0:39:57No scan ever reaches 100% accuracy.
0:40:10 > 0:40:13Two-and-a-half hours after being crushed by a bus,
0:40:13 > 0:40:16cyclist Ben is being rushed to emergency theatre
0:40:16 > 0:40:19where consultant general surgeon Peter Coyne
0:40:19 > 0:40:23will attempt to tackle the most urgent threat to Ben's survival -
0:40:23 > 0:40:26the heavy internal bleeding from his spleen.
0:40:26 > 0:40:28How much has he had? He had some on the road, didn't he?
0:40:28 > 0:40:33Five and two of platelets. Five of...? Blood, two platelets, OK.
0:40:33 > 0:40:35The type of surgery that Ben needs is a damage-control approach,
0:40:35 > 0:40:37damage-control surgery,
0:40:37 > 0:40:39and essentially, that means opening his abdomen
0:40:39 > 0:40:42and dealing with the things that are going to kill him
0:40:42 > 0:40:43in the next half an hour to an hour.
0:40:43 > 0:40:46The anaesthetist ventilating him is fairly happy
0:40:46 > 0:40:49that his chest side of things, at the moment, is stable
0:40:49 > 0:40:51and the thing that will kill him quickest
0:40:51 > 0:40:53is his spleen that is actively bleeding.
0:40:53 > 0:40:56We will get control and then get a proper look at everything.
0:40:57 > 0:40:58OK to start? Yeah.
0:40:58 > 0:41:01Are you? OK, starting.
0:41:02 > 0:41:06To gain access to Ben's spleen, Peter must cut open his abdomen.
0:41:06 > 0:41:08Time is critical,
0:41:08 > 0:41:09not only to stop the bleed,
0:41:09 > 0:41:12but for every minute Ben's abdomen is open,
0:41:12 > 0:41:14he is losing heat rapidly.
0:41:16 > 0:41:17What you don't want
0:41:17 > 0:41:20is to have a patient on the table for a number of hours.
0:41:20 > 0:41:23By that point, he has probably got cold,
0:41:23 > 0:41:24his acid levels are high
0:41:24 > 0:41:26and his blood clotting factors will be low,
0:41:26 > 0:41:28and that cascade, which we call a deathly triad,
0:41:28 > 0:41:31usually means that his blood doesn't clot
0:41:31 > 0:41:33and he starts oozing from everywhere, and that is usually fatal.
0:41:33 > 0:41:36The key thing is to fix what needs to be fixed quickly
0:41:36 > 0:41:39and then get him back to ITU and get him better.
0:41:39 > 0:41:43Peter uses sterile swabs to pack the space in Ben's belly
0:41:43 > 0:41:46to absorb the blood that has accumulated.
0:41:46 > 0:41:48And the pack, thanks.
0:41:52 > 0:41:53And again.
0:41:54 > 0:41:58By putting pressure on the vessels and organs in Ben's abdomen,
0:41:58 > 0:42:00Peter stems the bleeding temporarily.
0:42:00 > 0:42:05This buys him time to search for the fragments of Ben's torn spleen.
0:42:05 > 0:42:07The spleen had essentially been squashed.
0:42:07 > 0:42:11It is well protected normally by the ribcage, and it sits under the back,
0:42:11 > 0:42:13underneath the ribs, and they usually protect,
0:42:13 > 0:42:16but as they have been fractured, they have clearly punctured into it.
0:42:25 > 0:42:29The spleen is a mop, it is a sponge, and essentially, its main function
0:42:29 > 0:42:31is to sponge up all the dead blood cells,
0:42:31 > 0:42:35so because of that, the turnover of blood going through it is very high.
0:42:37 > 0:42:40He had a spleen that was in multiple fragments
0:42:40 > 0:42:42and all of those were actively bleeding.
0:42:45 > 0:42:47Half a spleen.
0:42:47 > 0:42:49First half.
0:42:49 > 0:42:51Ben's spleen is so badly damaged,
0:42:51 > 0:42:54Peter has no choice but to remove it completely.
0:42:56 > 0:42:57Second half.
0:42:57 > 0:43:01'If you don't have a spleen, you are more susceptible to infection.
0:43:03 > 0:43:06'It is preferable, if you can, to have it, but in Ben's case,'
0:43:06 > 0:43:07that is simply not possible.
0:43:12 > 0:43:16Thank you, could you take Lorna's right hand?
0:43:16 > 0:43:19That would be great. Could you put a hand over there?
0:43:20 > 0:43:22Fab.
0:43:22 > 0:43:24Peter now has control of the bleeding artery
0:43:24 > 0:43:27that supplies Ben's ruptured spleen.
0:43:31 > 0:43:34I've just sutured off, hopefully, the blood supply to it,
0:43:34 > 0:43:38and then... That is great, thanks.
0:43:38 > 0:43:40Have a look here again.
0:43:40 > 0:43:44That is OK, don't go digging down there. That side is fine.
0:43:44 > 0:43:46But just as Peter finishes,
0:43:46 > 0:43:49he is alerted to a problem with Ben's chest drains.
0:43:55 > 0:43:58The increased bubbling of the chest drains
0:43:58 > 0:44:02means Ben's punctured lungs are leaking air at an alarming rate.
0:44:02 > 0:44:04At that stage, the question
0:44:04 > 0:44:06is whether we need to explore his chest.
0:44:06 > 0:44:10Peter immediately makes a phone call to a specialist thoracic surgeon.
0:44:10 > 0:44:12During the procedure, his left chest drain
0:44:12 > 0:44:14has been bubbling quite extensively.
0:44:14 > 0:44:18Ben's chest remains badly damaged. He needs a procedure
0:44:18 > 0:44:22to look for any injuries to his airway or bleeding in his chest.
0:44:22 > 0:44:26But Peter knows another operation could kill him.
0:44:26 > 0:44:29We suspect it is a parenchymal lung injury on the left side,
0:44:29 > 0:44:31from bony segments. We didn't know whether
0:44:31 > 0:44:34you'd want to do anything about that while he is on the table.
0:44:34 > 0:44:36If he had complex rib injuries and we were to fix those,
0:44:36 > 0:44:38that would take four or five hours.
0:44:38 > 0:44:40OK.
0:44:40 > 0:44:43The chest guys are happy, they think it might stop,
0:44:43 > 0:44:46so they will leave him at the moment rather than doing the operation.
0:44:46 > 0:44:49Leave him for the moment, see how he goes in ITU overnight.
0:44:49 > 0:44:51The human body is a magnificent thing,
0:44:51 > 0:44:53but at some point, it reaches a point of no return.
0:44:55 > 0:44:57At this stage, they thought
0:44:57 > 0:44:59that going in to explore his chest, inflate his lungs,
0:44:59 > 0:45:01would be too big an insult for Ben to get through
0:45:01 > 0:45:03given what he had already been through
0:45:03 > 0:45:04from his abdomen and blood loss.
0:45:04 > 0:45:07The surgeons have no option but to wait to see
0:45:07 > 0:45:10if the air leaking out of Ben's punctured lungs reduces.
0:45:12 > 0:45:16Ben will now be moved to Intensive Care where, over the coming days,
0:45:16 > 0:45:18doctors and nurses will keep a watchful eye on him.
0:45:20 > 0:45:21Only if and when he recovers
0:45:21 > 0:45:24can they attempt to fix his shattered ribs.
0:45:35 > 0:45:38In the operating theatre of Newcastle's RVI,
0:45:38 > 0:45:42stab victim Gidia is about to undergo emergency surgery.
0:45:43 > 0:45:46Consultant maxillofacial surgeon Matthew Kennedy
0:45:46 > 0:45:49needs to explore the wounds by eye
0:45:49 > 0:45:52for any injuries that the scans have failed to pick up.
0:45:52 > 0:45:55Can we get a couple of skin hooks, please?
0:45:55 > 0:45:57'You can only rule out damage to vessels
0:45:57 > 0:46:01'once you have seen the full extent of the wound.'
0:46:01 > 0:46:02I need to be able to see into the wound
0:46:02 > 0:46:04as far as that blade has travelled.
0:46:04 > 0:46:09OK, that has obviously just come in here and straight out.
0:46:09 > 0:46:13One of these is just an entry and an exit wound.
0:46:13 > 0:46:16It has come down very superficially.
0:46:16 > 0:46:18If you leave a bit unexplored,
0:46:18 > 0:46:21there could be a small artery that has had the end severed
0:46:21 > 0:46:25and that could start bleeding again at any moment.
0:46:25 > 0:46:27Let's have a look at this one.
0:46:27 > 0:46:30Matthew concentrates on the wound to Gidia's chest.
0:46:32 > 0:46:35This one is a different kettle of fish.
0:46:35 > 0:46:39I'll tell you what. I'll extend it a little bit, just to get more of...
0:46:39 > 0:46:41He cuts the skin to open the wound wider
0:46:41 > 0:46:45to see and feel how far the knife has penetrated
0:46:45 > 0:46:46and what it hit on the way.
0:46:48 > 0:46:50I feel there is a little chip of bone
0:46:50 > 0:46:52come off the clavicle in there as well.
0:46:53 > 0:46:57The blade has skirted straight over the top of the clavicle.
0:46:59 > 0:47:05The knife had essentially skimmed over the top of her collarbone.
0:47:05 > 0:47:09A centimetre lower and it could have skirted underneath the collarbone,
0:47:09 > 0:47:14and then lung, major vessels, would certainly have been injured
0:47:14 > 0:47:17and it could have been a very different picture.
0:47:18 > 0:47:21Take a little bit of bone off the top.
0:47:21 > 0:47:23Matthew removes a fragment of Gidia's collarbone,
0:47:23 > 0:47:26chipped off by the knife's blade.
0:47:26 > 0:47:29We have to be careful, prodding around right at the back here.
0:47:31 > 0:47:34That is ten centimetres deep.
0:47:34 > 0:47:37Only when he is satisfied there is no bleeding
0:47:37 > 0:47:40does Matthew stitch the wound.
0:47:40 > 0:47:43Finally, he tackles the remaining and largest wound,
0:47:43 > 0:47:44on the left side of Gidia's neck.
0:47:47 > 0:47:52Some more lignocaine...2% with adrenaline, 180,000 going in.
0:47:52 > 0:47:55The one on the left side of her neck, towards the back,
0:47:55 > 0:47:57is quite obviously deep.
0:47:57 > 0:48:01It is the bigger of the wounds, and you can clearly see
0:48:01 > 0:48:04that it has gone through the muscle there.
0:48:04 > 0:48:07Matthew inserts a drain to siphon any excess blood and fluids
0:48:07 > 0:48:11away from the injured area, and stitches the wounds closed.
0:48:12 > 0:48:14Can I have a damp swab, as well, please?
0:48:14 > 0:48:17Gidia's risk of internal bleeding is now low,
0:48:17 > 0:48:20but she will need to return to surgery at a later date
0:48:20 > 0:48:23to repair the damage to her muscles.
0:48:35 > 0:48:37It has been nine days since office worker Michael
0:48:37 > 0:48:40collapsed in cardiac arrest after running up the stairs.
0:48:42 > 0:48:45After further tests and heart scans,
0:48:45 > 0:48:48doctors have now confirmed that Michael's cardiac arrest
0:48:48 > 0:48:51was caused by the narrowings in his arteries.
0:48:51 > 0:48:55Sharp scratch in the wrist, it is the anaesthetic.
0:48:55 > 0:48:58Now an interventional cardiology team,
0:48:58 > 0:49:00led by consultant Roshan Weerackody,
0:49:00 > 0:49:03is attempting to widen Michael's arteries with stents
0:49:03 > 0:49:06to restore their normal blood flow.
0:49:06 > 0:49:08If you have got a tube that is narrowed
0:49:08 > 0:49:11and it is interrupting the flow of blood through the tube
0:49:11 > 0:49:14when the heart demands more oxygen or nutrients,
0:49:14 > 0:49:16it can't deliver that demand
0:49:16 > 0:49:19and those narrowings can cause a heart attack.
0:49:19 > 0:49:22Roshan wants to tackle the most severe narrowing,
0:49:22 > 0:49:24in the main artery at the front of the heart.
0:49:25 > 0:49:29In Michael's case, the length of disease is quite long,
0:49:29 > 0:49:31over 60 millimetres.
0:49:31 > 0:49:35Bit of pushing at your arm, that will be me pushing the tube in.
0:49:35 > 0:49:37It might be a bit uncomfortable.
0:49:37 > 0:49:41Roshan uses continuous X-rays to help run a tiny guide wire
0:49:41 > 0:49:44from Michael's wrist to the blockage in his artery.
0:49:44 > 0:49:46Just take a deep breath in, sir.
0:49:46 > 0:49:49We have got the tube in the main artery
0:49:49 > 0:49:52and we will start taking some pictures.
0:49:52 > 0:49:54Before we put the stent in,
0:49:54 > 0:49:57we inflate a balloon to expand the narrowing,
0:49:57 > 0:50:00which allows us more space for the stent to come in,
0:50:00 > 0:50:01because it is slightly bulkier.
0:50:01 > 0:50:05The narrowed areas contain fatty deposits that have calcified,
0:50:05 > 0:50:08causing them to become rigid.
0:50:08 > 0:50:13I can see the calcium's ridge, so bring the fine cross back a bit.
0:50:13 > 0:50:17And that's very hard material, and simple ballooning techniques
0:50:17 > 0:50:19that we have normally doesn't work.
0:50:19 > 0:50:21OK, so you are going to hear a noise now.
0:50:21 > 0:50:24It is just my drill, don't worry.
0:50:24 > 0:50:25DRILL BUZZES
0:50:27 > 0:50:30Come off now, please, so that we can see the distal wire.
0:50:30 > 0:50:33Roshan needs to unblock the artery with a drill.
0:50:34 > 0:50:38The diamond encrusted head of the drill destroys that calcium
0:50:38 > 0:50:44into smaller material, that gets washed away down the artery.
0:50:44 > 0:50:48The section where I have to use the drill is probably the most critical
0:50:48 > 0:50:50and most dangerous part of the procedure.
0:50:58 > 0:51:02The drill head will only follow the path of the guide wire
0:51:02 > 0:51:06that is placed inside the artery, and it will only take away
0:51:06 > 0:51:09the artery wall where it is hardened with calcium.
0:51:09 > 0:51:10So, we are through the lesion.
0:51:10 > 0:51:13We're through the narrowing in the artery with the drill, so we will
0:51:13 > 0:51:16stretch the artery open with the balloon
0:51:16 > 0:51:18and then put a couple of stents in, OK?
0:51:18 > 0:51:23So, the stent is like a mesh cylinder made out of cobalt chromium,
0:51:23 > 0:51:28a metal scaffold which is left behind, and it'll keep the artery open.
0:51:28 > 0:51:31You might get a bit of tightness in the chest, sir.
0:51:31 > 0:51:33It's just the balloon going up inside your artery.
0:51:33 > 0:51:36Can I have a 275-20 non-compliant, please?
0:51:36 > 0:51:40The stent is mounted on a tiny balloon, which Roshan must direct
0:51:40 > 0:51:44down the guide wire and position precisely within the artery.
0:51:46 > 0:51:49And as you inflate the balloon, the stent gets expanded
0:51:49 > 0:51:53and gets deposited within the artery and it doesn't move,
0:51:53 > 0:51:54it stays there for ever.
0:51:54 > 0:51:56So we've put one stent in.
0:51:56 > 0:51:58We're going to put another one in
0:51:58 > 0:52:01and, hopefully, that will be it for this artery.
0:52:01 > 0:52:03Same artery, yes.
0:52:03 > 0:52:06Michael's stent contains a drug which will help the artery
0:52:06 > 0:52:10heal correctly and stop it from re-narrowing.
0:52:10 > 0:52:12The drug that is embedded in the stent
0:52:12 > 0:52:15will disappear after two to three months,
0:52:15 > 0:52:20and what is left behind will be covered in the lining of the artery.
0:52:24 > 0:52:28The artery, after it's treated, it looks bigger and fatter,
0:52:28 > 0:52:32and there is brisker blood flow down the artery.
0:52:32 > 0:52:34I'm just going to clean your arm.
0:52:36 > 0:52:38So, this is what we started off with.
0:52:38 > 0:52:40This was your main artery in front of the heart.
0:52:40 > 0:52:44We can see, in several places here, it is severely narrowed, and now...
0:52:44 > 0:52:49That is with the stents put in. It's much fatter, the artery. Wow!
0:52:49 > 0:52:51You've got the stent... Thanks, guys.
0:52:51 > 0:52:54..running from here to here, and that's keeping... All that way?
0:52:54 > 0:52:57Yes. Blooming heck, I didn't realise that.
0:52:57 > 0:53:00Although Roshan has fixed one of Michael's arteries, he will need
0:53:00 > 0:53:04a similar procedure for any other narrowed vessels at a later date.
0:53:04 > 0:53:08Thanks so much. Good stuff. OK, sir?
0:53:08 > 0:53:09All right?
0:53:22 > 0:53:27Gidia was literally millimetres from death.
0:53:27 > 0:53:30The scan confirms that the stab wound was millimetres
0:53:30 > 0:53:34from her heart, her great vessels around the heart and her neck.
0:53:34 > 0:53:39Gidia's injury pattern and her surviving this injury
0:53:39 > 0:53:41is only by millimetres.
0:53:56 > 0:54:01I think she's doing very well. I'm very hopeful for the future.
0:54:01 > 0:54:06With an attack like this, there are physical and emotional scars.
0:54:06 > 0:54:11Physical wounds tend to heal quicker than emotional ones,
0:54:11 > 0:54:13but everyone's different.
0:54:25 > 0:54:28At the moment, she is troubled with stiffness, and I think that is due
0:54:28 > 0:54:31to scarring in the muscles, but with time,
0:54:31 > 0:54:35I would hope that that would settle and she'll be able to,
0:54:35 > 0:54:38before too long, put all this behind her.
0:55:06 > 0:55:09Michael has gone on to have intervention,
0:55:09 > 0:55:13which, hopefully, will reduce his risk of having any further events,
0:55:13 > 0:55:16and I'm glad that he got to the hospital in the end
0:55:16 > 0:55:18and that they were able to help him.
0:55:26 > 0:55:29I tend to walk fast, very fast, and going up the stairs,
0:55:29 > 0:55:33I was walking very fast, and I was just about to go round a corner
0:55:33 > 0:55:37and I felt dizzy, and that's all I know, that's all I remember.
0:55:37 > 0:55:42I was taking a deep breath and that was it, the lights went out.
0:55:42 > 0:55:45Michael was very lucky that he had colleagues at work who were near him
0:55:45 > 0:55:49when he collapsed, who immediately jumped into action.
0:55:49 > 0:55:52The fact that the ambulance service cycle paramedic was very close,
0:55:52 > 0:55:54was there within a couple of minutes,
0:55:54 > 0:55:57and then we were literally only about a minute away,
0:55:57 > 0:55:58which may have been the difference
0:55:58 > 0:56:01between him having a good neurological outcome as he did,
0:56:01 > 0:56:04or perhaps he could have been left in a worse state.
0:56:06 > 0:56:08The people in work, oh, yes, brilliant,
0:56:08 > 0:56:11absolutely fantastic what they did.
0:56:11 > 0:56:15I talked to them all afterwards and that was just fantastic,
0:56:15 > 0:56:19getting to know what happened and to know that they did that.
0:56:19 > 0:56:21We have fixed the mechanical problem,
0:56:21 > 0:56:24but the interim weeks and months to come,
0:56:24 > 0:56:28that same process that caused the narrowing in the artery
0:56:28 > 0:56:31in the first place is not going to go away, so we need to address that
0:56:31 > 0:56:35with tablets, lifestyle changes and so on.
0:56:36 > 0:56:40I think I had let myself down before because I wasn't going to the gym
0:56:40 > 0:56:43and I wasn't probably exercising enough.
0:56:43 > 0:56:45I just wanted to live life to the full.
0:56:45 > 0:56:48I realise living life to the full can be done better.
0:56:55 > 0:56:58A lot of patients we see with that mechanism,
0:56:58 > 0:56:59so a heavy weight crushing them,
0:56:59 > 0:57:02have injuries that simply cannot be fixed.
0:57:11 > 0:57:13Everything was pretty numb.
0:57:13 > 0:57:16I remember sort of vaguely realising I was under the bus and thinking,
0:57:16 > 0:57:20"This doesn't hurt too much, maybe things aren't so bad."
0:57:23 > 0:57:25I remember being told it was very important to not die,
0:57:25 > 0:57:28so I did try very hard not to die,
0:57:28 > 0:57:32and everybody else tried very hard not to let me die.
0:57:35 > 0:57:39Statistically, Ben really should not have survived.
0:57:41 > 0:57:45However, I think because everything worked really well that day,
0:57:45 > 0:57:49Ben did survive and he is one of our unexpected survivors,
0:57:49 > 0:57:52and that is what the team is proud of.
0:57:56 > 0:57:58I've got to take antibiotics for the rest of my life
0:57:58 > 0:57:59because of the lack of spleen.
0:57:59 > 0:58:01That's just a couple of pills each day.
0:58:02 > 0:58:07I should make an almost entirely full recovery.
0:58:07 > 0:58:10You do realise that things could have been very different.
0:58:10 > 0:58:12So, yeah, you step back and think,
0:58:12 > 0:58:14"I could very easily have not been here."
0:58:16 > 0:58:21It's strange sometimes, you almost feel a little bit like a ghost.
0:58:53 > 0:58:54..three, four...
0:58:54 > 0:58:57One, two, three, four...
0:58:57 > 0:59:00OK, my love, I'm going to tell you how to give him mouth to mouth, OK?
0:59:00 > 0:59:02When resources stretch to breaking point,