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A and E After Dark - Season 7 - Episode 05 Eng Sub
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00:03After dark, while the nation sleeps, the A&E night shift begins.
00:10It can be very dangerous.
00:13We deal with a lot of aggressive patients.
00:16Things can escalate.
00:18It can be quite scary when it's just you and one violent patient.
00:24Across the UK, we join the staff of three of the most challenged emergency departments.
00:29It's always busy, it's always under pressure.
00:31Stop CPR.
00:32Time is of the essence.
00:34And the medics who face danger each shift.
00:37Most shifts, I see more place than nurses.
00:40With the amount of drugs and alcohol admissions rising.
00:43Have you been drinking today?
00:44The risk of violence and abuse looms large every night.
00:48Please don't swear like that.
00:50They try to attack and stop.
00:51I am not possible.
00:53Calm yourself down.
00:54People can become aggressive.
00:56What are you going to do?
00:57You've been punched, kicked.
00:59You see the good, bad and the ugly.
01:00I don't give a ****.
01:02Yeah, we'll get security.
01:03The emergency department is like a battlefield.
01:05It's like organised chaos.
01:19After dark, violence against NHS staff is at a record high.
01:26And doctors and nurses face it every time they're on shift.
01:30You've got to call the police.
01:38You've got to call the police.
01:39You've got to call the police.
01:40You've got to call the police.
01:40They can attack the security, they can attack nurses.
01:44I don't think the public is aware.
01:45They don't understand what we're going through.
01:47****
01:49Violence and aggression doesn't just stop at our doors.
01:52It continues on the streets.
01:54That can be quite scary for us and for everybody.
01:58You all right there?
01:59Have better days, haven't you?
02:00Got into a fight.
02:01I don't want to.
02:1736 year old Nisarg is in Rhesus.
02:24after being assaulted outside his home he's just minutes away from losing his vision
02:36emergency dr fraser will be treating him
02:41we see a lot of patients come in who are victims of assault
02:43being punched in the face can be fatal with this patient he had bleeding behind his eye
02:50the pressure that that bleeding causes can squash the nerve and so you can go blind in the space of
02:57an hour it's a real time-critical emergency this is just oxygen you have to do a procedure called
03:05a lateral canthotomy where you cut the ligaments that keep the eyeball in place and essentially
03:13relieve the swelling that's squashing the nerve that goes into the back of the eye
03:18with the pressure building behind his eye they have just minutes to act
03:24elements going in right i'm gonna make you feel funny just have nice dreams
03:30dr ed administers a fast-acting sedative
03:32hey buddy you there so the night team can fight to save his vision
03:44that looks like ligament there yeah that's the superior ligament let's cut the superior
03:51first cut this superior because it's advisable to cut both in this circumstance so it'll give
03:56us some room to minimum
04:03right
04:06yeah oh that should we try to move through you oh i'm gonna give a little top
04:15up again now
04:25the swelling is making the next cut much more difficult
04:35patient had bleeding under the surface of their eye so it was it was particularly swollen it made
04:41it quite difficult to see exactly what we were supposed to be cutting consultant dr susie is
04:54also on shift when someone has increasing pressure on the back of the eye you will start to get
05:01compression of the nerve fibers that provide the sensation of a vision so if you don't release that
05:07pressure that person will lose their sight and they will become blind and it will be permanent
05:25this lady's new she could probably step down but not to the corridor also working the weekend in
05:30Newham's recess is dr. Ella a patient drifting in and out of consciousness is being brought in by
05:48ambulance okay give us two minutes and then we'll come in all right my name is Ella I'm one of
06:06the
06:06doctors I'm just gonna hear what's going on and then we're gonna make you feel better okay was witness by
06:12bystanders to collapse on the side of the pavement tonight outside of her address planning of abdominal
06:17pain has defecated herself and had five vomits with us okay I'm still complaining of abdominal pain she's
06:24been in and out of a altered conscious state with GCS 14 as her best with us what do we
06:30think is she
06:31has said that for the last three days she's been having crack and heroin I do see drug overdoses all
06:38the time and it's an enormous part of our workload pupils pupils pupils are a size two even reactive
06:43but they may be a size one now the main questions to ask are what have they overdosed on do
06:49we need
06:49to reverse that drug do they need any life support for that overdose can you open your eyes for me
06:56have
06:57you got any pain anywhere there in your stomach sorry honey it's gonna fuse for me here okay vomiting
07:05and a painful hard stomach can indicate life-threatening internal bleeding I want to have a
07:13little listen to your breathing so Gretchen let's do some fluids clean up a little bit I don't think
07:20we need to do any scans or anything now currently we're gonna give us some fluids so anti-sickness so
07:26she can tell us a bit more about why she's vomiting how she feels somebody's nice and soft so I'm
07:30not in a
07:31rush doing any scans right now she's quite young my main concern for her is is she withdrawing from
07:40cracking heroin and it's making her feel really miserable it's gonna be quite hard to manage that
07:45so we might need to give her some other things to make her feel a little bit better can we
07:49clean her
07:49off a bit thanks guys I know it's not the nicest patients who are using drugs they often have an
07:58untold
07:59story and non-confused well person doesn't allow themselves to be covered in excrement it shows
08:07that this person is is clearly in in need of of help yes it does add burden to the NHS
08:13but that is
08:14what we're here for we're here for accidents and emergencies and drug overdoses or emergencies
08:39alcohol related emergencies are on the rise obviously drugs alcohol are a big problem I can witness the
08:50violence and aggression it is difficult to be on the receiving end I think that's definitely gotten
08:56worse from 2023 to 24 the NHS saw over 1 million alcohol related admissions many arriving after dark
09:06so you and you and you and you can f*** off at night everything gets worse when you mix in
09:14alcohol
09:14and violence and aggression against our staff and it can feel like a police station sometimes
09:39in East London 36 year old Nisarg has been violently assaulted outside his home
09:48he's at imminent risk of losing his sight the night team are performing an emergency procedure
09:53we made a small lab will cut through the skin so you just try and buy yourself through the window
09:58procedure we need to do is called the natural canphotomy it's not something that we do very
10:03often it is a time critical intervention identified a bit of the ringement but we couldn't get enough of
10:10it clamped to cut he's got quite a large swelling to the globe itself to relieve the pressure on his
10:17optic nerve the night team have to cut the ligament inside his eye socket if I take away the upper
10:24lid
10:24with the two four steps and now dr. Susie needs to work around the swelling to cut a second one
10:33just kill me though oh I'm gonna give him another 20 okay
10:51I'm just gonna hold it for a little bit
10:59I'm trying to find a very small piece of anatomy to cut was really challenging we will see if we've
11:22been successful
11:24the team must wait to see if Nisarg's site is saved and if the damage goes any deeper
11:31we're going to do a CT just to assess the bones and see if there's any fractures in the socket
11:36itself
11:36be sure that there's nothing beyond that and into the brain
11:42okay it's coming around from your sedation my friend
11:45when someone is punched in the face and with significant force and there were all sorts of
11:51complications you would be thinking about significant brain injury facial fractures
11:56these things can happen in an instant and change that person's life forever and it's something that
12:02we need to do some other investigations
12:16A&E North for Norwich medical trauma
12:19I've got some IV fluids up
12:21nearly 3am in Norwich
12:23so it's been going at this rate since midnight really
12:27Dr Lucia is looking after a patient whose heart is racing out of control
12:33still going fast isn't it
12:34his heart rate on the monitor was 200 beats per minute
12:38the normal rate is 60 to 100
12:41he can't maintain that heart rate of 200 for a long time
12:45eventually it will become tired and potentially stop
12:50all right sweetheart so if you can pop your hands straight for me
12:53that's fine
12:54it is unusual it's rare
12:56erm but sometimes people do have this condition where they go into this spontaneous fast rhythm
13:02even the slightest jolt drove his heart into this fast rate
13:08Dr Lucia consults the cardiology department for the first critical move in his treatment
13:15I've given him a bladder syringe and he's tried about four or five attempts
13:19and basically it's not really changed
13:22so we're going to give you six milligrams of adenosine yes yes
13:27adenosine is a little bit like a jump starting for heart again
13:30you give it quite fast into a vein
13:34it stops the heart and then restarts it
13:37and hopefully it comes back at the right rhythm
13:41between 60 to 100 beats per minute which is the normal rate
13:45all right sweetheart so adenosine going in now
13:49and the flush
13:50the first time I did it a number of years ago
13:53when I gave the adenosine it was quite scary
13:55erm when you didn't see the heart rhythm on the monitor
14:00lift your arm up
14:03raising his arm helps the drug hit his heart in seconds
14:10still going fast isn't it
14:12it is yeah
14:14it's not done it has it
14:16with the heart still racing at 200 beats per minute
14:20the adenosine has failed
14:23so once we're ready
14:26Dr Lucia tries again with double the dose
14:3012 milligrams of adenosine going through
14:32and big flush
14:35there we go
14:36lift his arm up
14:37beautiful
14:39nice breathing
14:41can we get a little bit of oxygen on
14:43if that's all right
14:44two litres
14:46extra oxygen supports the patient's heart
14:48as the night team fight to slow it down
14:51the rate
14:52hasn't made a blind bit of difference has it
14:55so erm I'm going to do 18 now
14:59Dr Lucia administers a third and final dose
15:03any more could stop his heart altogether
15:06okay so we're going to do 18
15:08so
15:11adenosine gone through
15:13flush gone through
15:14lift it up
15:17oh that was awful
15:18sorry sweet
15:21adenosine acts fast
15:23triggering an overwhelming wave of nausea and breathlessness
15:28during that episode when the heart is racing
15:31it is scary
15:32they feel terrible
15:33they tell us that they feel terrible
15:37we're looking promising
15:38we're looking promising
15:43oh hang on
15:47and then it kicks in again
15:50the final dose has failed
15:53the patient's heart is still stuck in critical overdrive
15:57the fact that we've done third one and it hasn't worked
15:59I'll just give her a ring now so she's fully aware
16:03basically the heart's beating differently
16:06erm there's no set pattern
16:09if you don't intervene
16:11ultimately the outcome can be
16:27for it to stop
16:27on average ambulance crews respond to nearly 3,000 falls every 24 hours
16:33bringing some of the most life-changing emergencies into A&E after dark
16:42in the middle of his night shift
16:44Dr. Aditya has been called to see 40-year-old delivery driver Akram
16:52who was brought in by ambulance after falling down the stairs
17:15getting an x-ray as quick as possible is really crucial
17:19because the further we delay the x-rays it can lead to nerve damage can lead to vessel damage
17:25to reveal the impact of Akram's fall
17:28Dr. Aditya needs to check all the bones in his arm
17:31from shoulder to wrist
17:33from shoulder to wrist
17:35from shoulder to wrist
18:01so we need to put it back in the right place
18:26so we need to put it back in the right place
18:31and the other side of the room
18:31Dr. Aditya needs to be a little bit
18:33really good
18:33tonight in Newham
18:35Dr. Rosie's in charge of the Rhesus team
18:37we've got a head injury
18:38a pedestrian versus car
18:40Rhesus can be often the most chaotic place in the whole hospital
18:44can you tell me if you're in pain there?
18:46often the patients are really sick
18:48especially when it's a pedestrian hit by a car
18:50we're super careful about those
18:52because the risk of injuries is really high
18:55after dark pedestrians are over twice as likely to be struck and the consequences can be life
19:02threatening i see you he's here okay yeah um vomit bottles in the back aren't they
19:18okay okay here we go well done well done
19:23our main concern is she's got a significant head injury especially given that she's vomited now two
19:28times um especially when she's lying flat which can suggest a raise in her intracranial pressure
19:35okay hello my name is toasting one of the ane doctors you can just lie your head back for me
19:40okay the night team must run urgent neurological checks in case 63 year old paramuswari has a
19:47critical bleed on the brain deep breath big breath very good again okay my dairy that's fine i'm just
19:58gonna shine this in your eyes okay there's a light coming in your eyes okay good
20:07okay pp is equal and reactive two millimeters any pain in your legs
20:16just the hand okay and your head brilliant let's leave the wrist for now because we'll get it x-rayed
20:21so don't know yeah and then there's this obvious is it boggy it is okay all right okay there's a
20:30particular type of boggy swelling that you can get on the head they're fairly rare but it can suggest a
20:37skull fracture sorry my dear we're going to keep her in that position we're going to sort of ct trauma
20:43series for her we're going to get you some scan for your head okay okay we'll get you some and
20:50some
20:50painkillers okay hopefully we can get her into a scan fairly quickly so we'll know exactly what we're
20:55dealing with following the crash paramuswari's sons called for an ambulance i was in shock when i quickly
21:07came and i saw uh my mother on the floor was the last thing i want to see but i'm
21:12seeing it
21:14strongest woman i've made in my in my life yeah hi how are you doing so i'm raising one of
21:20the
21:20doctors i'm worried about her head at this point so i definitely want to make sure there's nothing
21:23in the head yeah there's lots of reasons people vomit including if they are shocked or an injury but
21:29having something worrying in the brain is a reason why people vomit as well so we're going to see
21:32everything and then x-ray the wrist as well if you have bleeding on the brain it can expand
21:39all that blood expands it has nowhere to go and the skull can't expand so it just compresses the
21:45really critical areas of the brain the ones that control your motor function or your speech
21:55and obviously the worst case is your ability to regulate your breathing and your heart rate as well
22:01as well it can lead to disabilities and possibly death in really severe cases
22:33what's going on everyone seems to be coming in with a fight
22:37after dark a and e's across the country are facing more aggressive patients than ever before
22:43the night shift can be a bit chaotic a bit crazy
22:46it can suddenly make the department feel very unsafe
22:54can really ramp everyone's anxiety levels up
22:57it ain't no matter why you can handle me but many patients on the night shift are also the victims
23:05of
23:05aggression and assault
23:21what
23:23what are you coming coming around in newham dr fraser is looking after 36 year old nissarg
23:30he was attacked outside his home and rushed into emergency eye surgery
23:35i'm just gonna pop this off we don't need the oxygen anymore okay
23:38now the pressure around his eye has dropped the 19 need to check whether they were able to save his
23:44eyesight i just um have a look at your vision again are you awake enough for me to look at
23:49your vision
24:01oh my god okay now i can see that's good cover your left eye yeah can you see my face
24:10eyes i can see your face how many fingers four music to my ears he's had a a punch that's
24:19forceful enough to give him bleeding behind his eyes so what else might that have done is that
24:23broken any bones in his face make sure he's not got any bleeding in his brain
24:27what we need to do now is just because you've had a quite significant head injury
24:31uh we're gonna do a scan of your head okay nissarg is taken for an urgent head scan
24:42to check for any life-threatening injuries
24:50he waits in majors while the night team examine the scans
24:55the thing is celebrating festival with my two-year-old daughter
25:00the guy came you know he's arguing me like i have my daughter in my hand and he's trying to
25:06punch me
25:07and i just pulled her back and that's why my face is like this and he just punched me in
25:15my face and my eyes
25:21is your eye painful yes and now it's been here as well yes the ct scan showed that there's a
25:28broken bone
25:29in your face and around your eye what we're going to need to do is get you followed up by
25:35the facial
25:36surgeons as well for an appointment to see whether they need to do anything sometimes when you've got
25:41you know fractured eye socket then the muscles that move your eye can squish through the uh the gaps in
25:46the broken bones and that can mean that you can't move your eyes properly but the uh immediate priority
25:51for him was was getting him seen by an eye doctor we're gonna get you seen by the ophthalmologists in
25:57the morning all right some of the most dramatic cases of you know injury and trauma from violence
26:03in the community uh will happen at night it was a pretty horrible assault it's what sounds
26:08like a completely trivial argument and someone's punching him in the face so it's pretty horrible
26:12thing to happen
26:28he's still in svt he did revert back five cyber speeds but then just went straight back into
26:35on the night shift dr lucia is looking after a patient whose heart is beating around double the
26:42speed it should be we give six milligrams at 246 no effect and then at 250 i gave 12 milligrams
26:52of
26:53adenosine no effect with the first treatment failing to calm his heart dr lucia calls the cardiology
27:00specialists so we just we just need to dc well i'll have a word with daniel because obviously she
27:06needs to be in resource if we're going to do that as well they devise a new treatment plan
27:12so i've spoken to cardiology so what he's recommended is actually dc cardioversion
27:18oh no i really don't want to do that okay the quickest way to get the heart
27:25back to the normal rhythm is we put defibrillator pads on and jolt the heart with electricity back into
27:34the normal rhythm but you can imagine um that situation not being very very you know pleasant
27:43so you have to put yourself in the position of the patient it makes people really really really
27:50frightened it's more than one way to skin a cat so don't worry it's all good dr lucia refers back
27:59to the
27:59cardiology specialists on what else can be done give him metoprolol what dose would you recommend
28:08there is one other medication they can try metoprolol is a beta blocker this works in a different way
28:16um and slows the heart down yeah so give that a 312. unlike adenosine which resets the heart
28:28metoprolol works the opposite way blocking adrenaline to gently calm the heart rate
28:35it's coming down it's getting there slowly and then once you go back to normal get your nice cup of
28:41tea
28:46nearly nearly nearly
28:52get out of it the rate is is better than what it was whereas before you were sort of like
28:58about 200
28:59you feel better much better good a sigh of relief a sigh of relief as soon as you get the
29:09rate back to
29:10the normal rate the patient just feels miraculously better and that's what we're here to do do an ecg
29:19and then unfortunately you're gonna have to look at our ugly faces for a couple of hours now
29:38in newham 63 year old paramaswari is having urgent scans
29:44after she was hit by a car while walking to temple after dark
29:54her sons are translating for the night team
29:59how's pain at the minute it's terrible we'll give us some morphine
30:05my brother called me saying mom's had an accident you need to come
30:10and she was still regaining consciousness she didn't know what was happening
30:15and then gcs is 15. leading her care dr rosie is reviewing the scans
30:28hello hello how are you doing yeah i've just come to explain about the scan are you guys happy to
30:36translate or do you want a translator here no no are you sure okay so obviously we've scanned um
30:42head neck and all the body here what it does show which is what we were suspecting unfortunately there
30:48is a bleed on the brain okay there's a bleed over where she's got the bump but there's also a
30:55little
31:05scan has showed that she has a bleed on the brain
31:13ct scan only shows exactly what's happening at one point in time so it's really really
31:17important we monitor her carefully um that means doing neurological observations regularly
31:22keep your head nice and still for me just follow finger with your eyes okay
31:32kind of there's lots of things that can happen after you have a bleed on the brain the main concern
31:36is that if you have bleeding it can expand it can compress certain areas of the brain
31:44can you squeeze my hand for me on this side can you pull my hand into you
31:51very good and pull out push out out out so their neurology is assessed in various ways for example
31:59the power of your limbs the coordination your ability to feel on your skin these are all things
32:06that can be affected by the bleed on the brain if i touch her there does she feel that feel
32:12the same
32:12on both sides she can feel it less on this side what about here no less on this side okay
32:25okay what
32:25about here the same feels the same yeah here
32:44on that side she doesn't feel anything this side okay okay okay so we'll have to have a chat with
32:49the neurosurgeons obviously i'm one of the a&e doctors but one of the neurosurgeons will have to
32:53have a look at all the scans and decide what's what's best for her okay all right thank you
33:00at the moment her neurological assessment is actually pretty good but my biggest concern
33:05is the risk of further bleeding she's on a blood thinner as well clopidogrel for previous
33:12stroke which makes it a little bit more concerning blood thinning medication protects paramuswari from
33:17a stroke by preventing her blood from clotting but with the bleed on the brain it could make things far
33:25worse i have spoken to the hematologist at the london and they have suggested to give the platelets
33:32yes one pool of platelets given the risk dr rosie speaks to out of hours blood specialists
33:40platelets are a component you get in your blood so we all have platelets just swimming around in our
33:44blood to help us clot when we bleed this patient is on a anti-platelet agent called clopidogrel and so
33:50we've asked the hematologist and we are giving her some extra platelets sort of help that clotting process
33:57the main concern if she re-bleeds is that we get a big collection of blood in the brain that
34:02then
34:02compresses the brain including a lot of the the major areas that are you know in control of our
34:07you know speech our movements our breathing with the emergency treatment on its way paramuswari stays
34:14in resus under close monitoring giving her the best possible chance of survival it's a shock it's a
34:22massive shock but fingers crossed praying to god that everything will be fine again
34:39no grant i'll try to prioritize him okay thanks to let me know thanks in belfast 83 year old ian
34:46is
34:46brought in teresa's hello taking the lead on his care is dr alice what's brought you in tonight
34:59okay have you had trouble with the tummy before not really no can i have a feel of your tummy
35:06so grab some gloves there's a severe pain there's something see there no not there no no just there
35:16there what came first the pain or the vomiting well the pain the pain came first a bit of a
35:22stiffness
35:23or something where the pain was okay became intense is your health usually good
35:30that's reasonable yeah i'm a farmer i always worry whenever a farmer comes in because you don't come
35:39to see us with nothing no no he's coming with tummy pain he's got a high lactate he's tender and
35:46he's been
35:47vomiting his bowels aren't opening so i'm worried he's either got a blockage in his bowel or a blockage
35:51in an artery supplying the bowel ian's wife has arrived to sit with him i've been married since 1967
36:03a long time and uh we don't really have arguments he has a heart problem he has a pacemaker
36:12fitted quite some time uh but this is different this is around the tummy area
36:19he just felt poorly after he had his evening meal really sick and uh was actually vomiting
36:27it uh it happens with age or as i say too many birthdays so here we are the right place
36:38hi keeva it's alice one of the ed regs in the royal could i chat to you about the ct
36:42abdomen
36:43pelvis i can only feel his tummy and look at him i can't see what's going on
36:47on the inside or as a ct you can give me good images of the abdomen and they can tell
36:52us a bit
36:53more about what's going on uh what did you farm
36:59cattle sheep beef or dairy beef well rare breeds oh still on the farm are you still live on the
37:10chest
37:10yeah all right we'll give you a little bit this morphine okay and then if you need more i can
37:15give you some more in a wee bit okay i was just hoping that you weren't scared of needles because
37:21it's always the big strong men that cope on me whenever i put a needle into them and they do
37:25a
37:28lot of shouting oh i know i snuck in while you were distracted there you did do a bit of
37:45shouting
37:46i said yes you're going to go up for your scan now so we are going for the safety scan
37:52okay
37:55this gentleman i'm worried about a bowel obstruction i'm worried about an aortic aneurysm i'm worried
38:02about mesenteric ischemia i'm worried about pancreatitis any older gentleman that presents
38:07with tummy pain it can be potentially fatal you can feel my heart yeah it's fine everywhere in the
38:32middle of the night 40 year old delivery driver akram has blown his elbow out of its socket
38:39so clearly from the x-rays okay it shows that you have just to get the elbow but it's going
38:44to be
38:44difficult procedure to bring back to care we'll try to sedate you as much as possible with his ability
38:49to drive on the line it needs to be realigned urgently a treatment that requires two senior doctors
38:56dr aditya and dr zoe so i'm going to use a mask just because it makes it a little bit
39:02easier for you
39:03to get gas and air into your system the night team use penthrox for fast acting pain relief
39:10deep breaths you're doing well it will relax akram's muscles within minutes
39:17deep breaths
39:27it's quite physically intensive procedure both for the patient and for the doctors who are performing the
39:32procedure
39:35it requires traction and counter traction and put the bone back in place keep you taking deep breaths
39:43it's still awkward to bend is it the procedure needs extra force while zoe anchors akram's elbow in
39:52place dr aditya pulls the forearm further from the socket giving the joint more opportunity to slot
39:59back into natural alignment
40:04where did i think of this it's all right you know okay you've done so well there
40:11looks better how's it feeling well now the next bit's getting this cast on
40:19so falling down the stairs can be quite serious it can result in head traumas and other severe
40:25traumas like chest trauma how does your elbow feel this is being still being
40:29we'll keep you in here for now okay until the next day are ready to come and get you okay
40:33so all in
40:34all yeah he was pretty lucky to just have a dislocated elbow rather than any other traumas
40:39yeah i didn't feel angry that was stupid did you like that in your language
40:54on the other side of the hospital oh oh emergency dr alice wants to diagnose 83 year old ian's severe
41:04abdominal pain breathe in and hold your breath
41:12he waits for his ct results with wife joan is this still as painful as it was all right
41:18all right up there oh that's right you have a right selection of stuff here as long as you don't
41:24move
41:24all right and have you felt sick again no your report's back
41:32you reported your scans back so it's not actually the tummy at all it's the pancreas
41:40right it's not very happy right now it's got a bit inflamed right
41:46your pancreas can cause loads of issues it's really important in regulating a lot of things
41:51including the sugar levels in your blood but can be incredibly sore it can also become necrotic so it
41:57can die um and then that can make you really really sick and his hasn't reached that stage yet it's
42:02just inflamed um but he needs careful observation and pain management do you have any questions for
42:08me no no we're gonna be here yeah oh well i would say you're coming in for bed and breakfast
42:13he doesn't need to go for theater he can be managed conservatively which is good because
42:17in somebody his age going for a big operation can be very difficult you might want to get yourself home
42:25i'm here okay if you need me most people with pancreatitis you can tell from the front door because
42:32they are screaming and they're writhing in agony he is like just very stoic okay
42:41yes see you in the morning bye-bye okay sorry about all that classic farmer yeah um yeah it's farmers
43:17so we're going to do a few scans for you for the head and the neck
43:31i have checked bags right it's perfect do you feel less pain now it's less pain yeah oh very good
43:46what's next what's next is that the surgeons will come and see you
43:54so
44:05so
44:06so
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