Pennod 2 Ward Plant


Pennod 2

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-Ysbyty Gwynedd

-serves the largest area in Wales.

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-Some children have to travel

-over an hour to get here.

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-Take out the inhaler,

-shake it and put it back in.

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-You never know

-who will come through the door.

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-I've had a call to see a 7-year-old

-with a rash and neck pain.

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-Could be meningitis. We'll see.

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-This makes it a fantastic training

-hospital for nurses and doctors.

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-It's important to encourage interest

-in medicine amongst young people.

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-They need to be encouraged

-to go for it.

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-They will be responsible for giving

-treatment here in the future.

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-Do you like that bike?

-Let me have a listen.

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-Don't worry. You're not watching

-the wrong programme.

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-Tomos Owens, who used to be

-a member of Y Bandana...

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-..is now Dr Tomos Owens.

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-# Tonight in the Anglesey #

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-Here he is, on his way to work...

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-..on the children's ward

-at Ysbyty Gwynedd.

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-Tomos is one of six doctors

-training to be GPs in Gwynedd.

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-As part of his training...

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-..he's spending six months

-studying paediatrics.

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-I'd never done paediatrics

-before this placement.

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-I did it for about six weeks

-at medical school in Manchester.

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-But this is my first job

-as a doctor.

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-I was worried at first

-but I wanted to make sure...

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-..I'd had experience

-of working on a children's ward.

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-Usually we start at 8.30am

-but I'm a little later today...

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-..because I'm going to the teaching.

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-There's more traffic and parking

-is difficult at this time.

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-I remember deciding

-I wouldn't mind being a doctor...

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-..if I did alright in my exams

-at school in Year 7, 8 and 9.

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-I was going through an emo phase

-at the time.

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-I liked the idea

-of being a forensic pathologist.

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-I knew you had to study medicine

-to do that.

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-So that's why I decided

-to give it a go.

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-Since university

-and starting work...

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-..I've realized I'd rather work

-with people who are alive...

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-..rather than carry out autopsies

-on dead people!

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-But that's the weird reason

-I chose to do medicine!

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-I remember realizing it was

-difficult once I got to university.

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-I went to Ysgol Syr Hugh Owen

-and had a great time there.

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-I went to university and everyone

-there had A grades in everything.

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-Everyone had done

-Grade 8 piano or trumpet.

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-Everyone had been

-head boy or head girl.

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-I thought, "OK." I did Grade 8

-trumpet and Grade 5 piano.

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-I happened to be in a new band

-called Y Bandana!

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-That was a cool, quirky thing

-to put on my application form.

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-I remember getting there and

-thinking everyone was so clever.

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-It was a struggle to cope with

-the workload in the first two years.

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-It was hard and it was a lot of work

-but you have to persevere.

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-The learning continues.

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-Anywhere here, please.

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-What I know is if you're suspecting

-glandular fever...

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-..amoxycillin is not

-the best antibiotic to choose.

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-That's why I'm asking.

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-Tomos is with us for six months and

-we're nearing the end of that time.

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-He's well used to dealing

-with children by now.

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-Around 20% of the population

-are children.

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-Between 20% and 25%

-depending on where you live.

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-Children are high users

-of health services and GPs.

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-So we feel it's important

-that every GP...

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-..spends six months on a children's

-ward looking after sick children.

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-But today, Dr Tomos isn't

-the only one receiving training.

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-Half the ward staff

-are on an emergency care course.

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-This means there aren't enough

-doctors on the ward.

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-So I'll do the ward around here

-and cover on PAU, yeah?

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-We'll sort out upstairs then, yeah.

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-We'll sort out upstairs then, yeah.

-

-Fine.

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-There aren't enough doctors today.

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-It's just me covering downstairs

-with the registrar.

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-There's one other

-junior doctor upstairs.

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-Normally there are at least four.

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-I'm a bit concerned it's going to be

-busy but I hope it'll be OK.

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-PHONE RINGS

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-Hello. Paeds SHO.

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-Hiya.

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-I've just had a call

-for a seven-year-old boy...

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-..with a rash and neck pain.

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-Could be meningitis. We'll see.

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-38.8 temperature.

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-OK. We'll see him on Dewi Ward.

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-Thank you very much. Take care.

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-When a doctor suspects meningitis,

-there's no time to lose.

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-Within fifteen minutes,

-Stephen has arrived.

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-I'm concerned about the neck pain.

-He doesn't want to look up.

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-Sometimes when children

-have a sore throat...

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-..they complain of pain in

-the back of their throat and neck.

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-It doesn't look like

-a meningitis rash.

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-It looks more like an allergy rash.

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-But he has no history of allergies.

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-Often, when children

-present with an allergy...

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-..they have a history

-of other allergies.

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-It looks like an allergy rash so I'm

-going to prescribe an antihistamine.

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-Something like Piriton

-that you can buy over the counter.

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-We'll see if that settles the rash.

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-He also seems quite well.

-He was jumping around.

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-If he was more drowsy,

-I might have taken some bloods.

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-For now, I'm just going to

-keep an eye on him.

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-We'll give him the antihistamine

-and see how he goes.

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-One of the seniors will look at him

-once we've monitored him.

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-This is all part

-of Dr Tomos' training.

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-But in reality, for the doctors

-and nurses of Ysbyty Gwynedd...

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-..the training never ends.

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-This is Jake.

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-Jake has been close to death

-several times...

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-..so that staff know what to do when

-real babies are rushed to hospital.

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-The nurses haven't wasted a second.

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-They've called for a doctor...

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-..and Jake's condition

-deteriorates quickly.

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-What's the temperature?

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-What's the temperature?

-

-36.9.

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-This is an eight-month-old baby...

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-..who's not been very well

-for the last week or so.

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-A bit irritable, not feeding,

-has been vomiting.

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-Been to the GP who has sent the baby

-in an ambulance to us.

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-OK.

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-OK.

-

-Mum is on her way.

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-We hold sessions like this so that

-teams can practise what they do...

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-..with sick children or adults.

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-It doesn't happen that often.

-This isn't Holby City!

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-It's good for teams to come here...

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-..to practise the most challenging

-scenarios that could come up.

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-Is he making excessive sound from

-the airways or is it a clear cry?

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-Just a clear cry.

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-A referral comes through

-telling us exactly what's wrong...

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-..with the child or baby.

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-We then have to act

-exactly as we would on the ward.

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-The temperature was 36, wasn't it?

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-The temperature was 36, wasn't it?

-

-Yeah.

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-OK. I'm not comfortable

-with that heart rate.

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-Would you mind getting the register

-to see who's on call?

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-I can see the SATS are coming up.

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-Back in the real world,

-Sophie has arrived.

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-She fainted when her mother was

-trying to put an earring in her ear.

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-I've just seen Sophie,

-a six-year-old...

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-..referred here

-from the emergency department.

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-She said she felt hot

-and she collapsed.

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-They tried to rouse her

-but she wouldn't wake.

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-She woke up quite quickly when her

-mother gave her a few gentle slaps.

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-We'd be more worried

-if she was groggy or confused.

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-I discovered what I thought

-sounded like a heart murmur...

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-..when I examined her.

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-It's an additional sound

-when you listen to the heart.

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-Usually you just hear the heart

-but there was an additional sound.

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-Some children have them -

-they're called innocent murmurs...

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-BLEEP

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-BLEEP

-

-..and cause no problems.

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-But murmurs can cause some

-to collapse and so on.

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-I've done an ECG just to investigate

-further. It looks OK.

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-It might just be

-a coincidental finding.

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-That's where we are at the moment.

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-In the training room, Jake's heart

-rate has gone through the roof.

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-The medical term for this

-is supraventricular tachycardia.

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-One way of slowing down the heart...

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-..is to put the baby's face

-in ice cold water for 10 seconds.

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-Three, four, five, six...

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-..seven, eight, nine, ten.

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-In this little drama,

-the technique has worked.

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-Jake's heart rate has slowed down.

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-Do you forget they're mannequins?

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-Do you forget they're mannequins?

-

-After a while, yes.

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-You get so absorbed.

-It's a really good way of learning.

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-Jake has survived

-another training session.

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-Until next time. Thank you, Jake.

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-But now there's a real baby

-to see to.

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-Jack is about a month old.

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-He came in over the weekend.

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-He's just not feeding

-and isn't himself.

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-He usually feeds well.

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-Blood tests have come back normal

-but he's had antibiotics.

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-Things are OK.

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-He's also been given ranitidine

-for reflux.

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-He does seem to have improved

-with that.

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-But we'll just keep an eye on him

-for a while longer.

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-I've just heard that the other

-patient referred by the GP is here.

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-Hiya, Liam. Are you OK?

-Who's this with you?

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-Nain.

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-Nain.

-

-Nain. Hello, Nain.

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-I'm Tomos,

-one of the paediatric doctors.

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-.

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-Subtitles

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-Subtitles

-

-Subtitles

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-This young man is Liam. His stomach

-has been hurting for three days.

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-Your GP phoned me earlier and told

-me a little about what's going on.

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-I know he also spoke to

-the surgical team...

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-..because you've had a stomach ache.

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-Is that right?

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-It's pain here.

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-I've had stomach ache as well

-but mostly it's just normal pain.

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-Where exactly is the pain?

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-There.

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-On the right hand side. OK.

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-How long does the pain last?

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-It doesn't stop.

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-OK. So it's there all the time.

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-When did it start?

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-When did it start?

-

-Sunday night.

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-Sunday night. OK.

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-There are a few of us here

-doing the GP training at the moment.

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-There's a good group

-of Welsh speakers.

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-There's a big demand

-for Welsh speakers...

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-..especially on a children's ward

-so paediatrics...

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-..and in mental health.

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-It's important to encourage interest

-in medicine amongst young people.

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-They need to be encouraged

-to go for it.

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-There's nothing worse

-than not trying...

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-..because you think

-you're not good enough.

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-If I asked to give me a number...

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-..where 1 is very little pain and

-10 is the worst pain imaginable...

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-..which number would you say?

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-I'd say six now.

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-I'd say six now.

-

-Has it been worse than six?

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-Yes.

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-When was it at its worst?

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-On Sunday night and at night

-as well.

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-At night? OK.

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-Which number would you say then?

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-Which number would you say then?

-

-Eight.

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-So it goes as high as eight.

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-It's so nice to be able

-to work in Welsh.

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-People appreciate

-Welsh-speaking doctors.

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-It's nice to be able to work

-in the area where I grew up.

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-I lived in Manchester

-for a few years.

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-But I feel there's a demand

-for doctors in this area...

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-..and I want to come back

-so why not?

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-OK. OK. Can you lie down for me?

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-We've done an urine test

-and that's OK.

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-We'll probably do some blood tests.

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-We'll check infection markers

-and make sure your kidneys are OK.

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-Your liver is up here

-and your kidneys are there as well.

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-If it's going to the back

-it could be in your kidneys.

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-Sometimes a kidney infection

-can cause pain.

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-It can sometimes burn

-when you urinate.

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-At out of hours,

-they mentioned it could be stones.

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-It is a possibility but I'd expect

-to see blood in the urine.

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-That is the other thing.

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-It could be a kidney stone

-or a kidney infection.

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-I'll do blood tests to check kidney

-function, liver function and so on.

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-When we have the results back, I'll

-also ask the surgeons to see you.

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-Is that OK? Cool.

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-The registrar has seen him and he

-thinks it could be constipation.

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-Although his bowels open every day,

-sometimes that isn't enough.

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-From what he's described,

-he has quite hard poos.

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-We're going to give him some

-laxatives to see if he feels better.

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-We'll go back to him later

-to see if they've had an effect.

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-He's going to stay in a little bit

-longer just to keep an eye on him.

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-This is Leia.

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-She was sent in by her GP because

-she was having trouble breathing.

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-The doctor has decided to try

-the blue inhaler.

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-There are two reasons for this.

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-It opens the pipes in her lungs

-and works immediately.

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-You need to cover her mouth

-and push this in.

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-You need to hear the valve clicking

-five times.

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-You take out the inhaler,

-shake it and put it back in.

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-Another puff

-and another five clicks.

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-She needs ten of those

-while she's here.

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-Can Dad give you this?

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-So you need ten of these. OK?

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-One. It needs to cover

-the nose and mouth.

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-You need to leave that in.

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-Right, Dad.

-Let Nurse Angharad show you again!

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-Slowly. That's it.

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-Just breathe normally.

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-Pull it out, shake it.

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-We're on the second now.

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-OK?

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-We need to count to ten.

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-That was three. Can you count?

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-Well done.

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-Last one.

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-We'll just assess her oxygen levels

-and her heart rate.

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-If the oxygen levels fall, the

-doctor will come to listen to her.

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-She might need the inhaler sooner.

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-So she'll be OK for two hours now?

-Can she go to play?

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-Yes, just not too much

-running around!

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-It's hard to tell a six-year-old

-girl not to run around!

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-In a brand-new play area.

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-Sophie, the girl with a hear murmur,

-is going home.

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-No, that's fine.

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-Any problems in the meantime,

-you know where we are.

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-One of the seniors

-listened to Sophie's heart...

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-..and he agreed

-there is a heart murmur.

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-He was happy we'd done the ECG

-and everything was OK.

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-She's fine in herself.

-We don't need to keep her in.

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-But we're going to arrange

-an echocardiogram.

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-It's like an ultrasound

-on the heart.

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-Similar to an ultrasound scan

-on pregnant women.

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-We just want to see if there are

-any abnormalities or problems...

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-..causing the murmur.

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-We probably won't find anything...

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-..but we'll investigate

-because we've discovered it.

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-That will take place

-as an outpatient appointment.

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-Hopefully she'll be fine

-in the meantime...

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-..and that the echocardiogram

-doesn't highlight any problems.

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-She's going home in a minute.

-Just keeping you updated.

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-See you later.

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-Is Leia out there?

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-Is Leia out there?

-

-Erm...

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-Yes.

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-Leia came in because

-she couldn't catch her breath.

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-It sounds like she's had a virus

-which has caused her to be wheezy.

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-As you can see,

-she's feeling a bit better now.

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-She's on an inhaler

-every two hours...

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-..and I'm checking

-she doesn't need anything extra.

0:17:390:17:42

-You could think it's asthma

-but it's hard to tell with children.

0:17:420:17:45

-You don't want to put a label on it.

0:17:460:17:47

-Asthma can come and go.

0:17:480:17:50

-With a virus, it happens

-and then it gets better.

0:17:500:17:53

-I'll go and see how she is.

0:17:540:17:56

-Hiya, Leia. Are you OK?

0:17:570:17:59

-Can I have a listen to your chest?

0:18:000:18:02

-Do you like the bike?

0:18:030:18:04

-Do you? OK. Let's have a listen.

0:18:050:18:07

-Did you have the mask earlier?

0:18:080:18:10

-Let's listen.

0:18:110:18:13

-Do you like going on the bike?

0:18:180:18:20

-OK. If you turn around,

-I'll listen to your back.

0:18:240:18:27

-Thank you, Leia.

0:18:280:18:30

-Thank you very much.

-You can carry on playing.

0:18:360:18:38

-Well done. See you later.

0:18:410:18:44

-Her chest doesn't sound too bad.

0:18:440:18:46

-Someone else will listen

-in about an hour...

0:18:470:18:49

-..just to check

-if she needs something.

0:18:500:18:52

-If not,

-we'll stretch to another hour.

0:18:520:18:54

-We like to stretch them four hours

-between inhalers...

0:18:540:18:58

-..before they go home.

0:18:580:19:00

-That will be for the night shift

-to decide.

0:19:000:19:02

-If she needs it more regularly

-or if the oxygen levels rise...

0:19:020:19:06

-..she might have to stay in.

0:19:070:19:08

-I won't know that until tomorrow!

-Hopefully she'll get to go home.

0:19:080:19:13

-We'll see.

0:19:130:19:15

-Someone else

-who hopes to go home is Liam.

0:19:190:19:22

-Hiya, are you OK?

0:19:250:19:26

-So it's worked, has it?

-Has the pain gone?

0:19:270:19:30

-Great.

0:19:300:19:31

-We'll carry on with those sachets

-once you go home...

0:19:310:19:34

-..to keep you regular.

0:19:350:19:36

-I'm glad to see you're much better.

-Has the pain gone completely?

0:19:360:19:40

-Yes.

0:19:400:19:41

-Yes.

-

-Success!

0:19:410:19:42

-Patient of the day. Well done you.

0:19:420:19:44

-Happy?

0:19:450:19:46

-Nice to meet you both. Take care.

0:19:460:19:48

-I've just had a call from the GP

-in Llanfair.

0:19:530:19:56

-A 30-week-old baby's not well.

0:19:560:20:00

-She may have a chest infection...

0:20:000:20:02

-..but he's more concerned that

-she's not keeping down any fluids.

0:20:030:20:07

-They're giving her water

-and paracetamol...

0:20:070:20:10

-..and it's coming straight back up.

0:20:100:20:12

-We'll wait for her to arrive

-and then I'll assess her.

0:20:120:20:15

-I'm just going to do

-some paperwork now.

0:20:150:20:18

-Tomos' day is over.

-No-one was terribly ill.

0:20:190:20:23

-But plenty of variety and experience

-for the aspiring GP.

0:20:230:20:27

-It's handover time at the minute.

-I'll pass on the message. Nice one.

0:20:280:20:32

-..doing something.

0:20:320:20:34

-I enjoy the work

-and that's the most important thing.

0:20:340:20:37

-I wasn't very sure what to expect

-when I was 15 or 16...

0:20:380:20:42

-..and deciding to do medicine.

0:20:420:20:45

-The variety is amazing.

0:20:450:20:48

-There's a job for everyone,

-no matter what their interests.

0:20:480:20:52

-I'd encourage young people

-to go for it.

0:20:520:20:54

-If you're interested and think

-it's something you'd like to do...

0:20:540:20:58

-..go for it.

0:20:580:21:00

-Ellie's come in from the GP with

-what sounded like a chest infection.

0:21:000:21:04

-The GP was more concerned

-about the fact...

0:21:040:21:07

-..she wasn't tolerating oral fluids

-for 24 hours.

0:21:070:21:10

-We may need to have a look and see

-whether she needs IV fluids...

0:21:110:21:15

-..if she's not drinking at all

-and what are they planning to do.

0:21:150:21:20

-That's it. The handover's done

-and my day is over.

0:21:210:21:24

-My colleague, Owen Wilson,

-will carry on.

0:21:240:21:26

-He'll see the patients who've been

-referred that I didn't reach.

0:21:260:21:31

-It's been quite busy. A few

-admissions. Some bloods to do.

0:21:310:21:35

-It's another Monday.

-We'll have more fun tomorrow.

0:21:350:21:39

-I'm going home now.

-I'll see you tomorrow.

0:21:390:21:41

-OK? Ta-ra.

0:21:420:21:43

-But one little girl is still here.

0:21:500:21:53

-She's much better. What we'll do

-is give the inhaler this time.

0:21:570:22:01

-I can only predict but I think

-she'll be able to sustain...

0:22:010:22:06

-..four-hourly without inhalers.

0:22:060:22:09

-Then we'll be able to send you home.

0:22:100:22:12

-Much improved.

0:22:130:22:14

-Much improved.

-

-Much improved.

0:22:140:22:16

-We have to do the pump again.

0:22:190:22:22

-Once more.

0:22:220:22:24

-Leia wasn't seriously ill...

0:22:240:22:27

-..but she was poorly enough

-to stay in hospital.

0:22:270:22:30

-All I did was prescribe some

-inhalers and sort out some steroids.

0:22:310:22:35

-I hope to see her again when she's

-running around and completely well.

0:22:360:22:41

-Stephen's rash disappeared a few

-days after coming to hospital.

0:22:440:22:48

-The specialist decided Sophie

-had no serious heart problems.

0:22:480:22:52

-Liam hasn't had any stomach problems

-for months.

0:22:530:22:56

-Leia now has an asthma pump

-to use when needed.

0:22:570:23:01

-Dr Tomos is currently in Holyhead

-training to be a GP.

0:23:020:23:06

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