You going to mug me? I got to mug you. Is that gorgeous or what? Eh, and I believe I can run the marathon. Download VI now. Where is it? Hello. Royal So Resource ready to go. Cardiac arrest [music] 5 minutes. X-ray. Hello resource. unconscious gurgling. Small seizure, painful. Yes, I'm [music] a bit nervous to see actually can I do something for him or is it too late? There is a chance that this could just split all together. And obviously that happens, you won't survive. [music] Um, we have got Dr. Hall who is the trauma team leader. Is it about the patient who's coming in? Yeah. Hold on one second. Yeah. Hello. Yeah. Okay. Put her across to me. Fine. Okay. That's great. Cheers, mate. Okay, chaps. Update. A young gentleman who's been involved in a road traffic accident 3 hours ago. Sounds like they're very seriously ill. It is a strange thought to think that most of the people who are coming through here are going about their normal life and then suddenly something happens and they end up in the emergency department. Okay. And ready, steady, lift. Okay. Can we stop? changing over monitors and can we have a silent hand over please? Okay. Um, hi everybody. This is Kieran. He's 25. At 5:00 this morning, his van went off the road. Right sideed impact to the uh driver's side. He was trapped in his vehicle for approximately 3 hours. He's got a right sideed chest injury and pneumthorax on that side. [music] He's had a thoricosttomy on the right side and the lung was down. He's tender and guarding in his abdomen and query pelvic injury. Okay. Lots of glass around people. Just can we just get a second line and get some blood out, please? My job is to coordinate things. Make sure people have the correct jobs to do. Can we get the sats on that or get at least get a blood and an VBG or an ABG out? [music] Does it sound like they're bleeding? Have they got a fast heart rate? Where's X-ray? Uh chest and pelvis, [music] please. Can you start with pelvis, please? Have they done anything to the chest from a breathing point of view? Air entry. Okay, good air entry on the left. Do have air entry on the right. Finger that right sided thoracicosttomy. We just need to know that the uh lung that had collapsed is up. Uh one of my juniors is just popped his finger into the chest to make sure that's up. Up down. Okay. Can we pop the chest train in that side then please? We want to make sure that that given the best opportunity to reinflate. So, we're going to pop that in before we go to CT and then get to scan so that we can see whether he's bleeding into his tummy or into his pelvis. Okay, we're going to be x-raying in five. So, can if you've not got lead on, can you get out, please? You come in from his left just cuz we're putting a chest brain in on that side. Carry on. Carry on. Just pull. Just get crack on. Okay. Sometimes we almost have to make [music] patients worse before we make them better and take a risk of what we're going to do. Okay, we got the chest drain bottle there and that's when it becomes [music] really challenging. Okay. Anything coming out there, Paul? No, there was blood when I fingered it. Yeah, that's what concerns me. Are you through the chest wall? You getting through? It's just kinkedked on the chest wall. Okay, you've got blood dripping out. This is going to be a heo. There we go. Okay, we put the bottle in. Bottle in. Can we get the level one? Can we get the two O neg flies out, please? Bottle in. Just I'm just cramping it at the top. Right. Okay. But it's still right. Drop that down. See how much is in the ground. Can you ring cardiothoracics [music] and tell them that we're going to need them. Thank you. Okay, Paul, [music] get your finger out if you can. Just just worry about that. That's a bit better at the back. I'm not happy at the back. I'm not happy at [music] the back. That's stopping on. That looks widened. Yeah. Yeah, I agree. Okay. So, suture that in at that, please. And then we'll get ready to go. So, what we found is there's not just air inside of the chest, there's also blood in the side of the chest. So, what we need to do is find how bad it is from the CT scan and see if there's a bleeding point within there. I'm very worried at the moment. Uh worried about the blood that he's got in his chest. Worried that um he's cold, which is a sign that his body is reacting to the trauma that he's having. Um and worried that he's still maybe bleeding from somewhere. So um until I've got these images, I'm still a bit in the dark. liver's in bits. Yeah, he's got massive laceration. Yeah, that's just a mess. That liver and his kidneys on this blood. Yeah, it looks like it's all in his belly. What is life-threatening is his risk of bleeding to death. Yeah, we need a plan on theater for him. The time is now. Uh, very very important. Has everyone got a bit? Yeah. You never leave a patient thinking I've done a half-hearted job on that patient. You throw everything into [music] every patient you look at. Uh, surgeons are here. So, I'm going to speak to them now. I'm going to go [music] and speak to the consultant now cuz we need someone who can pack his belly. Can we take that out? So, I think we're waiting for the surgeons to come and review this man. He's came in with some chest pain. um blood tests were raised, but I think his symptoms weren't really consistent just with a heart attack. So, they [music] decided to do some other tests which showed he's got a dissection. He's got an aortic dissection, could be a life-threatening emergency. Um it's got high mortality [music] rate, so it needs to be fixed surgically if it can be. My name is Mr. Warrick and I'm one of the uh consultant heart surgeons here. So, you've had this pain. I just thought I'd pulled a muscle in my chest cuz that had batch of vomiting. Right. Just pain down my sternum. Has anyone told you what's happened or what they found? Yeah. What have they told you? That the the main aort split. Torn. Yes. Exactly. Your aorta is the big pipe that comes out of your heart. And when this pain occurred is is probably when this thing has split. We very seldom have emergencies when it comes to heart operations, okay? But having an aortic dissection is one of those rare occasions where it does fall into this emergency bracket. Now, doing an operation is by no means a small undertaking. There are a whole array of potential complications. Bleeding, wound infections, kidney problems, bowel problems, all of these things can potentially happen. Now the risk of you dying is actually pretty large. We're probably talking around about 20 25% but you know we have to weigh up the risks and benefits really and then think potentially you know the longer we leave this per se the worse it's going to get into it there there is a greater chance that this thing could actually rupture completely um and obviously that happens you won't survive and ultimately you know the decision falls on upon you more than anything else you know my job here is not really a decision take is there? No, there isn't. You know, no most sensible people obviously, you know, especially in light of your age and everything as well. But, you know, it's you just have to be fully aware of what this all entails and it is no small undertaking. Okay. All right. See you in a minute. Take care. Just concentrate on this vessel here. This is his ascending a water. And as we're going down, we're coming closer and closer towards the part that comes out of his heart. You'll see in a minute. There it splits and that's where it's torn and the rest of his aort looks absolutely pristine. Every hour the chance of it rupturing increases by about 10%. There's a potential dissection. Are we okay to do it? Yes. Fine. Yeah. Gone stage. Everything's good to go. Do you know who's the anist uncle? He will in essence feel relatively okay apart from the discomfort that he had to begin with. And that's the reason why sometimes when they come in like this, you know, I've had this pain but I feel okay. You know what what's happening? And that's the reason why they are so shocked the fact that, you know, I'm just about to potentially have an operation which I may not survive from. You know, and here he is 48 years old. I'm thinking about me son. He'll be eight on Sunday. I'm just hoping I get a chance to see him again. I'll come in. Thanks, mate. Bye-bye. So, what's going to happen now? The team are going to get ready and we'll take you down to theater. Yeah. Well, hopefully within the next half an hour or so, give or take. I've just rang me dad to bring me son up. So I'll bring him and say I'm going down. Well, no. Oh, if your son's coming up, it's very important you you speak to your son. I mean, as I mentioned to you before, I mean, yeah, but I wouldn't want to delay this either. It's important you speak to your son. Okay. The last thing I want, I don't want to be so melodramatic is the fact that, you know, you don't have a chance to uh speak to your son. Have you thought about what you're going to talk to your son about? I'm just going to tell him that I've got to go for an operation and not to worry. But it will destroy him if I don't make it cuz he lives with me. Stop. Just gives just give me more reason to make it, don't it? We've got a trauma in. and he's a young lad, 25, who's been involved in an RTC. Yeah, it's a crust [music] injury that he's got. Okay, so that's a urologist looking at his films. Okay, the problem is that his liver is um severely damaged from the impact and he's got an injury to his kidney and it looks like it may actively be bleeding. So what we need to [music] do now is work out whether he needs to go to theater to have his belly opened and have a look inside and everything packed and stabilized or whether it's uh can be done by going to interventional radiology and that's go in through the groin identify the blood vessel under X-ray control [music] and then put coils or foam or glue down that bleeding blood vessel to see whether you can [music] stop it that way. We don't know whether that can be done. We're asking the experts on that at the moment. When you get a major trauma patient, it's not just about you. It's about having [music] multiple people caring for one patient. It's not unusual in a trauma [music] to have four, five, six consultants involved. Hello, Aaron. Hello. We need to understand each other's thought processes. Right. So, it's the story, morning. We need to be able to move that patient to the right place. So this is a 25-year-old young lad who's been in Wales. At about 5:00 this morning, crashed his van. He was trapped for 3 hours. [snorts] How is he? He's tackyardic, but his blood pressure is okay. He doesn't have like much uh bleeding as I said to uh correspond with like this is not a liver trauma. So the only liver injury is this bit there. Kidney is not being diffused, liver's not being diffused. Do we know if the renal artery is attached or we don't know that? But it's not bleeding. It's okay. You can leave it. And you could even embleize that stump to stop it having a problem later on because he's hemodynamically stable with a normal blood pressure. Best thing for him is to bring him to the IR suite. You can embolize a right renal and have a look at the celiac and try and see if you can get a wire across it. Fantastic. Before opening him up, that's what I'd do. Brilliant. Thank you, Aaron. Can we do that then? Can we get him down to uh we might make things worse though? Yeah, we have to take that chance and we do him in the suite and we open his belly in the suite if we need to. Sound like a plan, chaps? Everyone happy? Excellent. Thank you. Cheers, Aaron. Okay, we'll get him down here to get it done. He's got an injury to the blood vessel that comes off that goes to his kidney and he's actually torn that off. Okay, that kidney now would unfortunately died. Um, and there's nothing they can do about it. What they do need to do though is make sure that's stumped. Yeah. What they do need to do is make sure that that stump doesn't bleed from where the kidney is broken. So, they're going to take him to the interventional suite to prevent that from bleeding any further. To make the decision on his surgical care, has taken a consultant radiologist, in fact, two in the room who looked at the film, two vascular surgeons who've looked at the film, a general surgeon, and a urology surgeon. All consultants. So, another six surgeons involved in this gentleman's care so far. [music] [music] [music] Death is part of [music] our job. As long as you can walk away thinking, [music] I did my best, then there's not much more we can do. It's hard sometimes [music] emotionally to deal with, but we have to deal with it. We have to deal with it individually. [music] We have to deal with it as a team. We have to support our team. But every doctor will have [music] a case that sticks with them for life. Oh, and it goes again. Hello. Fallen skylight 20 foot 8 minutes. Okay, thanks. Bye. Bye. Right. Good news. Your son and your father are here. Okay. have an operation. Are you going to be back tomorrow? No, I don't want to be home tomorrow. Oh, you will be or No, for your birthday. [music] Okay, so I love you. Thank you, D. I'll see you tomorrow. [snorts] You disappoint the day. Yeah. I'll see you in a while. [snorts] [music] to go. [snorts] Byebye. Bye. See you later, mate. Byebye. [snorts] Thank you. Okay. Had a little bit more pain, which is a bit worrying. So, we just need to crack on as quick as we can. Okay. Let's go. Hello resource. Is this a gentleman who's fallen? About 20. Yeah. Split into two, please. Jonathan fallen approximately 20 foot through a skylight on the barn roof. Landed in the stable. The stable's got rubber matting on it. He remembers landing, but then witnesses say he became unconscious, gurgling, small seizure. So deep breath. Lower left side of his back. He's got some pain. Out. Happy with the airway. In again and out. You got equal air entry through out. Deep breath. I can just see it out. And out. Just go steady. You need a way. Terrible. Need a way. Okay, we shall work around that. Can we get bloods off, please? And a VBG on that, please. their blood pressure that I'm whipped. What was his blood pressure on arrival? Over 45 was literally only just come on. So [music] we've had two hypotensive blood pressures back to back. Back to back. Yeah. Okay. That's not right. Since he's been with us, we've had two blood pressures where his blood pressure has been well below what we would expect for a young gentleman. Um that means that he could be bleeding from his fall that we haven't identified. So, um, the only way to find out why his blood pressure is doing that is to pop him through the CT scanner. Painful. No. Painful. No. Painful. No. No. Yeah. Yes. We need to start to act fast on this gentleman. Uh, blood's off. Yeah. Gary has a life-threatening problem that if it isn't sorted out within the next 24 hours, then the risk of his aorta splitting and him just dying becomes very Great. I'm nervous. I'm really scared in all honesty. I'm operating on someone knowing that the patient could die on the operating table. Are you happy to start? [screaming] back on, please. Two small swap. It's not just the individual that you worry about. It's the consequences that potentially can happen to the rest of his family if this goes wrong. Could end up with an 8-year-old son not having a father. It's very daunting because ultimately the responsibility falls with you. In order to do this operation, we're going to have to stop the heart. The rest of the body still requires to be perused and oxygenated. So, we're going to have to put the patient on the bypass machine, which will keep the patient alive. So, we're just [music] going to connect that up. All right. You want to go up? Yeah, we'll do bypass now. You happy with everything, Nick? Yeah. So far so good. Yeah. Okay, good. So, we've transected a water. So what you can see is this flap which is your dissection flap where it's torn. Okay, it's split. So this is the cause of the problem there. So what we do need to do, we need to take all of this out, put a new route in and reattach the arteries as well. Yeah. So the next step now is to take the valve out. You generally have one chance to get it right. If you make a mistake, the potential complications can be disastrous. If someone dies on the operating table despite what you do, then it's just like, you know, the atmosphere. Everyone's so deflated. But if you can walk away and say that I've done my best, then no one else can ask for anything more. enough tissue there. Haven't we? We've got an artificial valve tour replaces torn aort. So it has a valve already sewn into it which is just there. This is and and this part will mimic the part that's all diseased which is called the aortic root and this will be the ascending aorta. So now we just need to attach these sutures onto the valve and then and slot it into place. Hopefully you know there there won't be much bleeding. ready, steady, [music] slide. This patient fallen 20 foot out of a skylight and we're going to see T scan this gentleman's head, his neck, um his chest, his abdomen, and his pelvis. Excuse me. What is your name, please? J did have an episode where he dropped his blood pressure. So potentially he's bleeding from somewhere. So we need to find the source of that. Breathe normally. Pressure is waving again. 101 systolic. Now just if someone's got like a fluctuating blood pressure just makes you a little bit more on edge. Is it because he's got someone going bleeding? So, we'll see what the scan shows. It's got a he to just there this there. Yeah, I assume it's a hematoma because I can't see any other obvious injuries. Did you say small amount of blood as well as the hemod or Yeah. Well, like there's some fluid potentially there's fluid in there, but small amount that I don't know where it's come from. I'll have a look. Okay. Yeah. No, no. So, just so you know. What we're looking for. Give us a shout if you find anything extra. We need to know. Looks like he does have a clot, a hematoma within his pelvis. So potentially has bled from somewhere within his abdomen and that's why our radiology team are going back through that scan to find out if there is a source of bleeding that they can identify. We just need to be very careful with him. Wheelchair I'm in I'm in pain in me back. I feel pissed off because I've done this and I'm a worker and a manual worker and I have to support my family and and I'm more annoyed about that. If I couldn't work, I'd be in the mess. Hopefully I won't won't be a permanent damage. Um but you have to think confident about it, don't you? It's no good not being but I don't know. I'm just worried [music] about internally whether there's what what's going on in there. So yeah, no problem. Okie dokie. We've attached the artificial valve into the aorta. Hopefully, we've done a good enough job in protecting the heart. That will allow us to restart it again. That should be it, Carl. So, we've released the clamp. Now, you've done the operating part of it, the sewing part of it. You've taken the clamp off. The heart receives its blood again, but your conscious that is the heart going to start to beat again. As you can see, it's starting to beep, which is a good sign. Once it starts to beep, then that's a great that's a big sight. All right. Should we just try and come off? Yeah. Okay. Coming down to off now. We are off bypass there. So, the patient's off the heart lung machine. He's beating for himself. So, we're hopefully the bleeding will settle down. The human body is a phenomenal organ and you are always amazed by it because no matter how bad it gets, it would do its very best to stay alive. It really does. Still lots of things that can go wrong, but the most important thing from my point of view is the fact that we've managed to, uh, do a repair to the point that we've managed to close the chest and and he looks very stable. So, uh, fingers crossed everything goes well. Go nice and gentle, please. Very slowly, very steady, slowly. [snorts] The chances of of anything going wrong now from his aorta is very minimal. It means that once he gets over the operation, assuming there's no major complications, that we'll go on and and have a pretty productive life, you know. So, so hopefully we've done a good job. We've been going for a good eight and a bit hours. So, it's been a very long night to say the least. We'll stay resource. One, two, three going out and two more standby. Yeah. Who's got bed sevens? Right. Cheers. Be dry. Bye. Drop. I just want to see him a slightly better color than what he is cuz you're a bit green. Let's hope there's not anything too serious. John's broken his pelvis on one side. Um he's bled a little bit and it's stopped bleeding. Um he's broken a few ribs and he's broken a bit of the what we call spinous processes which are the little bits that come out of the spinal um bones down the back. Um he's been seen by the orthopedic doctors and the trauma doctors. Um and they're going to manage him on the ward. I'm happy that he's behaving himself. Have you ever been in a situation like this before? Yeah, I'd cut me left thumb off 20 years ago on a saw bench behind a tractor for cutting up firewood, you know. And then uh about 7 years ago, I uh had an incident with a battery on a tractor that blew up in my face. Consequently, it broke a bone in my shoulder. You're good at injuring yourself? Yeah. Think you landed on your bum? I think it landed on your back, but it happened so that bloody quick. I can't remember. Right. Frightened me to death. She's worried she might have to wipe me out for the rest of the year. Jonathan, don't say that. We also resource staff nurse multiple stabbins to the chest. She's taken [music] five fluoxitine, eight paracetamol, 16 briefing, six tramodol. See you in 5 minutes. Thank you. Bye-bye. Okay. Is this a patient [laughter] from Princess Royal? Yes. What's the gentleman's name? Um, Michael Roy. Roy, hello. Yeah. How are you? Hi, Dr. Migara, one of the consultants. Uh, you're down with us at Royal Stoke. Okay. How are you feeling now? Okay, that's fine. Okay. How old are you? I'm going to ask you a few questions before we get on and examine. How old are you? And what month is it now? What month? Oh, another patient. Give me two minutes. I thought so. Okay, that's fine. Don't worry. Don't worry. Don't worry. Don't worry. Can you close your eyes for me? That's fine. Open them now. Good. We're just going to sit you up. Okay, that's fine. Just lean back now. Look at me, Roy. Okay. I'm just going to check your vision. All right. Yeah. I'm going to close this eye with the other eye. How many fingers am I holding up? Three. And now god I don't I don't Okay. Okay. Relax. How many now? Throw one. Okay. That's fine. Can you repeat these words for me? Right. Baby hippopotamus. All right. Okay. That's fine. Right. Hello. Hello. Hi. Dr. Mud, one of the stroke consultants. Okay. What we're looking at is yes, he's clearly had a stroke. Okay. He's affected his word finding difficulties which is what he's having at the moment. He's also got some right facial weakness and he's got no real limb weakness as such. Tina, what I could do is take him down for a scan now. Right. How you're dealing with it. Absolutely. Okay. Are you ready? Yeah. This afternoon he woke up and uh he he couldn't get up off the seti where he was lying down and I I was sitting in the chair opposite and he said, "Oh, oh, weird." And I said, "You're all right." And he didn't answer me. And he shoved himself up. But then he his hand went all limp down the side of him. So I went over to him. I said, "You're all right." And he couldn't get his words out and he's had that glaze look. You know, one minute he was talking to me. The next thing I know, lights and ambulances and you just go, "Woof. Is he moving his right or left side? Right side. Right sideed weakness. Yeah. Michael, move your right arm tremendously. And the right leg and move your right leg. That's your left, my sweet. Move your right one. This is a patient who has already had symptoms for a good few hours. So I'm a bit nervous to see um actually can I do something for him or is it too late? That's that's been my big worry. Are you okay? Stay very still. [music] Look at that. This is your This is fresh clot. Okay. And I think with this clot there, I would open this up. Do you want to go for it? Let's do it. Let's Let's do it. Okay. Yeah. Perfect. Okay. Very steady. This patient he's having this kind of episodes because he's got a clot in one of the main vessels of the neck the carroted vessel. He's not able to sustain the flow because the flow should come from this side and it's not going all the way up. If you don't mind sir taking him back to recess 5. [music] If we don't do anything in this case there is a high possibility that that clot might dislodge or even if it doesn't dislodge that occlusion might cause significant symptoms and he will have uh some form of permanent disability. this group of patients who had these [music] staging symptoms, every minute we're losing 1.9 million neurons. So if if we're [music] looking at an hour worth of bloodlessness or decreased blood supply to the brain, we're closely looking at 120 million neurons being lost, that [music] in itself could entitle to around 3 to 3.5 years of loss of uh life. So that's a huge [music] impact on a patient. We'll come back. Okay. So, just started something that's going to make you feel a little bit strange, a little bit more relaxed. All right. This is just something to stop you feeling better. he may have a a permanent paralysis of one of his side of his body. He may not be able to speak. So that's something we want to prevent. And um hopefully with this procedure, we should be able to achieve that. Get me a 4x40 and 4x20 ready. Both of them. The number one priority is to make sure that you get the clot out quickly. You got a flow switch. But moving [music] catheterss and wire inside a patient, there's a very little margin for error. A little bit of error can cause a hemorrhage into the brain. It can cause uh death to the patient. Can we have the wire as well, please? Okay. We ready? Okay. Here we go. Sharp breath, sir. Okay. Okay. So, I want you to lie still if you're hearing me. Nice deep breath. We make a cut in the groin and insert a wire and go all the way up to the neck and then into the brain [music] if needed. And then we'll try and suck the clot out. Okay, there we go. Just follow this up for me, please. Okay, there we go. Okay, there's occlusion there. Complete occlusion. Give me another aspiration, please. Okay, I'll see if I can get the clot out. If it's a soft clot, just give me a tumor wire. My daughter's been ringing me and my son's been ringing me, but sitt there on me own. It's [music] very hard not knowing what's going on and missing him. Seeing him go down there, it was a bit together 40 odd years. So long time hoping and praying that he comes back to me. That's all really. How's the patient? Is he okay? Is he sleepy or what is it? Open your eyes for me. There we go. He's sleeping. Okay. You tend not to be emotional about that person, but you are consciously aware they someone's dad or husband and you want to make sure that the family and the patient himself are happy with the outcome. It's a hard clot. Let's see if we can get past if needed. If the vessel is completely narrowed up here uh in the neck, [music] we might have to either do an angoplasty or put a stent in to keep that open. So that flows through that. So um there's a lot coming. Okay. So my my colleague is getting excited as [music] you can see. Are we able to see some? There's a clot. Yeah. I'm hoping that the koted will be open now. Can you see it's nicely opened up? Beautiful. Very nice. Okay. Now, let's go to the brain. Yeah, we are. Yeah. Everything is fine. Yeah. Yeah. It looks fine. It's fine. It's perusing very well. Okay. All done. Okay. Great. When you love your job and when you are very passionate and when you tend to give the best for the patient and you also tend to do it from your heart. This is helping to maintain the blood flow to the brain. the brain will now peruse normally from the normal side and hopefully tomorrow morning I'm I'm hopeful um he's going to have breakfast in the morning set up and he should be I mean I'm hopeful. Let's see. Thank you. See you later. I'm just hoping obviously averted catastrophic stroke. How are you feeling? Yeah. Yeah. Yeah. Good man. Good man. Okay. You can say hi. Yeah. Hi, puppet. Yeah. You all right? Load off in behind. Long as he's come back to me, that's all I care about. Nice to see you. Hello, sweetheart. Hello. Where are you? On your feet. Thank you. Oh, the darling bit. I knew you would. I knew you would. No, you're darling. You're definitely getting better. He loves being called darling. Hello, oh god. Oh, you've nicked it. You've had it back. Yeah. The great thing about medicine is there is a job for everybody. We believe you're having a heart attack. We want people who love the heart, who want to be cardiologists. We do a procedure to clear that blockage out. Magic. Well, not quite magic. [laughter] We want neuro [music] radiologists who want to put wires in groins and remove clots from brains. Give me a hand. I'll see you again. Okay. She feels sick. And [music] in an emergency department, you want someone who wants the excitement. You cut you. Sorry. Who wants to make decisions? Should we get line and get blood? So, this is Adwina. She's 47 years old. 1320 is driving a car down the A41 that's had a head-on collision 50 mph road with a HGV. She's got a closed fracture of her right forearm which is angulated but with distal profusion complaining of pelvic and back pain. Get chest and pelvis in here please. Who's got the hardest job in there? It's certainly not the consultant. Any pain in the top of this leg? Um it just feels really stingy sore in my groin. We'll have a look as consultants. Um, yes, we take overarching responsibility for the patient. Okay, fine. Yeah, pelvic ring [music] looks okay. Possible pubic ray on the left. [music] We're making critical decisions about them. Orthopedics. Do you want to have a look at the limbs and everything and work out what we need? But they're being delivered not by the consultant. They're being delivered by a team. Can you feel touching you here? Can you move your ankle up and down for me? the doctor team, the nursing team. I'm just gonna support your arm on your ride, sweetheart, and then roll you over. She's now stable enough to go around to the main X-ray department to have her limbs that look like they're broken image so we can work out what uh further treatments we need to do for that. Okay, we're ready to rock and roll, chaps. I'm ches. We as consultants have the easy part and we can think about what's coming in next. Another trauma in motorcyclist versus car t-bone, lots of injuries, sternal flail chest. So, we're getting a consultant andist coming in now. Uh, have we got another ventilator? Could we get a propol infusion, some rock and fentinel as well, please? My usual combination. John John So, we are dealing with three wounds. It's full of blood. Stings hide a multitude [music] of sins. Blood pressure has dropped 80 to 52. It's not good. Everybody stand back. We've got a 17-year-old footballer. Can't feel from his [music] waist down. This 45 minutes is taking forever. Just want to know what's happened.