1

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<i>SHOUTING COMMANDS</i>

 

2

00:02:25,424 --> 00:02:28,091

This young man sustained

a mine injury;

 

3

00:02:28,116 --> 00:02:31,049

he badly injured the left leg,

 

4

00:02:33,089 --> 00:02:37,089

so actually he has lost the

ankle and the foot at the field.

 

5

00:02:44,255 --> 00:02:46,388

Landmine it has mechanical force

 

6

00:02:46,413 --> 00:02:48,777

when it blows away

part of the limb,

 

7

00:02:48,802 --> 00:02:54,105

with bones, muscle, nerves,

blood vessels and so on.

 

8

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He have a lot of foreign bodies,

 

9

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the soil, the stone, metallic

fragments, pieces of wood

 

10

00:03:01,072 --> 00:03:03,672

pieces of clothes,

parts of the shoes,

 

11

00:03:03,697 --> 00:03:08,581

anything which was around the

mine, will be taken away

 

12

00:03:08,606 --> 00:03:11,939

by this massive force and

then get into the body.

 

13

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The primary thing is to save

the life of the patient

 

14

00:03:19,424 --> 00:03:22,624

and then the second thing

is salvaging the limb.

 

15

00:03:35,798 --> 00:03:37,977

The worst cases they

die immediately

 

16

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because the injuries are

really; really bad.

 

17

00:03:41,562 --> 00:03:45,196

They very seldom are complaining

about the pain immediately

 

18

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because it is some kind

of reaction from the body

 

19

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that the patient

doesn’t feel the pain.

 

20

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Would you please tell him

 

21

00:04:02,249 --> 00:04:05,382

that he is going to the

Operating Theatre now?

 

22

00:04:08,190 --> 00:04:11,131

This patient probably will

need a blood transfusion

 

23

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and then after the operation but

 

24

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we have to see how much he is

bleeding during the operation.

 

25

00:04:30,921 --> 00:04:34,855

He is extremely traumatized

psychologically at the moment.

 

26

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The physical pain will also

come now after the operation.

 

27

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It depends how the victim

has accidental contact

 

28

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with the mines.

 

29

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If he has stepped on the mine

 

30

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the whole leg will defend

the rest of the body.

 

31

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So usually they

don’t have injury

 

32

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injury to the abdomen or

the chest or the head.

 

33

00:05:05,617 --> 00:05:08,812

It opens the soft

tissue along the bone

 

34

00:05:08,837 --> 00:05:12,837

starting from the ankle to the

next joint, that’s the knee.

 

35

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So the principle is, what

is dead, should be removed.

 

36

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Otherwise it will threaten

the life of the patient.

 

37

00:05:56,709 --> 00:06:07,030

<i>MUSIC</i>

 

38

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He didn’t bleed much luckily.

 

39

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The tibia and the fibula, the

two long bones of the leg were

 

40

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 quite ok but the soft tissue

was injured up to the knee.

 

41

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So a below knee amputation

was performed immediately

 

42

00:07:27,085 --> 00:07:31,959

removing all the dead tissue,

that is the muscle the bone,

 

43

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the skin, the nerves and the

vessels which were dead.

 

44

00:07:37,977 --> 00:07:42,355

And then we left the wound open

to be inspected after five days.

 

45

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And he is lucky enough

to save his knee

 

46

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so he will have a

below knee amputation

 

47

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which will be refashioned after

five days so he will have

 

48

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a prosthesis with his own knee,

that is quite important.

 

49

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<i>MUSIC</i>

 

50

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<i>MUSIC</i>

 

51

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The laparotomy case

from last night...

 

52

00:09:31,048 --> 00:09:33,284

And you will have,

which is yours?

 

53

00:09:33,309 --> 00:09:36,001

We start with this one,

which is the smallest.

 

54

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The nine month one.

 

55

00:09:37,317 --> 00:09:38,207

The little.

 

56

00:09:38,871 --> 00:09:42,402

Emergency surgical Centre

was opened in 1998.

 

57

00:09:42,427 --> 00:09:45,760

The major group was mine victims

 

58

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and we still have between

5 to 10 patients

 

59

00:09:49,183 --> 00:09:52,541

from the mine

explosions every month.

 

60

00:09:54,376 --> 00:09:57,384

And nowadays we are also

getting patients from Vietnam

 

61

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and from Thailand.

 

62

00:10:00,902 --> 00:10:03,595

When the patients are

coming from the rural areas

 

63

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they are normally coming from

the very, very poor families

 

64

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and it’s the threat and the risk

for these people every day.

 

65

00:10:14,753 --> 00:10:15,862

Good morning.

 

66

00:10:16,948 --> 00:10:20,681

Everybody has a relative or

a family member or a friend

 

67

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who is disabled because

of the mine injury.

 

68

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In this country there are

no psychologists who are

 

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supporting these patients

after this kind of accidents.

 

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00:11:17,935 --> 00:11:21,135

So they have to make their

own rehabilitation,

 

71

00:11:21,160 --> 00:11:23,636

the mental rehabilitation,

and in this hospital

 

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it is the other patients

and our nursing staff,

 

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because they have a lot of

experience from the mine victims

 

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so he will get a lot of help

 

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00:11:31,621 --> 00:11:33,954

during the time he

is treated here.

 

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<i>MUSIC</i>

 

77

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Thank you, so we will

organize the wheelchair.

 

78

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We’ll take you to the ward.

You can just lie down.

 

79

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He’s doing amazingly well

 

80

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but the nurses already on

the male ward have said

 

81

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that we have to get this

patient as soon as possible

 

82

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away from the

intensive care unit.

 

83

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Because there are patients there

that are severely injured

 

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and he doesn’t have any

peace on that ward.

 

85

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Go very slowly...

one, two, three!

 

86

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Okay, good.

 

87

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It’s better that he comes

to the normal ward

 

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where its more

peaceful and he can

 

89

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discuss with the other patients

 

90

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and start thinking

about something else

 

91

00:13:22,956 --> 00:13:24,823

other than his own injuries.

 

92

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Yes.

 

93

00:19:34,773 --> 00:19:36,040

Hello, how are you?

 

94

00:19:42,585 --> 00:19:45,652

He has a headache did

he get any Paracetamol?

 

95

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He got already?

 

96

00:19:49,571 --> 00:19:52,072

Let’s hope that his

relatives are coming today

 

97

00:19:52,097 --> 00:19:54,549

and will cheer him

up a little bit more

 

98

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and ah, because it always

is encouraging them

 

99

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to have this idea in

the head that one day

 

100

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I will go home from

this hospital.

 

101

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Okay, good. See you later!

 

102

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He is extremely calm and

it seems that he is not

 

103

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voluntarily starting

any discussions

 

104

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with the other patients.

 

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And I hope that this is

not going to develop

 

106

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into any kind of depression

after this injury.

 

107

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This morning on the ward the

doctors were discussing

 

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about this operation day

tomorrow because it has been

 

109

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planned that he will get

primary closure for the stump.

 

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In case the stump is infected

or not doing very well

 

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00:23:29,582 --> 00:23:32,315

that they have to amputate

above the knee and

 

112

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it means for the patient a lot

because the function of the knee

 

113

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is very important for a

person who wants to walk.

 

114

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We will have another X Ray,

this is the primary one.

 

115

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The plan today is just to

have a look at the wound

 

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and if we found the

wound clean enough

 

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we will do a closure by

refashioning the stump.

 

118

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There you see the skin

has started to die,

 

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the muscles are a

little bit darker,

 

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if the tissues have not died

the bone is not live, leaving

 

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them behind will compromise

the life of the patient.

 

122

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The magnitude of the tissue

destructed is very high.

 

123

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We don’t have any more

chance to save the knee.

 

124

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So now I will go for an

above knee amputation.

 

125

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It is always sad, when you have

to make such a big schism,

 

126

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it is always sad.

 

127

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The main thing is to save

the life of the patient.

 

128

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But for the sake of his life

you have to cut his limb,

 

129

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remove it so that

he can survive.

 

130

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It is bad that he

is losing his knee.

 

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But we can’t do better.

 

132

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You can see the difference

 

133

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between the previous

and this tissue.

 

134

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Here, this is good

and clean tissue.

 

135

00:27:25,462 --> 00:27:30,263

Thank you very much,

thank you guys.

 

136

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I thought that he would make

it with below knee amputation.

 

137

00:27:40,495 --> 00:27:43,095

When we had a look

it was not so good.

 

138

00:27:46,643 --> 00:27:50,157

The skin and the muscle and the

muscle and the bone were not

 

139

00:27:50,182 --> 00:27:53,134

healthy, they were in the

process of slow disease.

 

140

00:27:53,159 --> 00:27:56,150

Then we had to remove

above the knee.

 

141

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We have removed as short

as possible the bones.

 

142

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And I hope this time

he will make it.

 

143

00:31:33,109 --> 00:31:36,101

Today he has been in the

Physio for the first time

 

144

00:31:36,126 --> 00:31:38,827

which is of course a very,

very big experience

 

145

00:31:38,852 --> 00:31:42,309

because they really have to

start training his muscles

 

146

00:31:42,334 --> 00:31:44,800

and he has to find

his balance again

 

147

00:31:44,825 --> 00:31:47,159

and he has to learn

walking again,

 

148

00:31:47,184 --> 00:31:49,584

but now this time

only with one leg.

 

149

00:33:00,469 --> 00:33:01,547

Mr Yorm.

 

150

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This patient no fever and

he at 9.30 on 17th DPC.

 

151

00:33:14,497 --> 00:33:17,764

But does he feel the foot

is where it used to be

 

152

00:33:17,789 --> 00:33:19,455

or the foot is moving up?

 

153

00:33:26,353 --> 00:33:30,086

Especially during the night

he feels that the foot stay.

 

154

00:33:30,111 --> 00:33:33,978

Because what’s going to happen

is his feeling of the foot

 

155

00:33:34,003 --> 00:33:36,865

is going to start

moving up up up

 

156

00:33:36,890 --> 00:33:40,023

and when it reaches the

stump it will go away.

 

157

00:33:40,048 --> 00:33:42,981

This is not forever,

this pain will go away.

 

158

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Happy smiling face.

 

159

00:42:27,786 --> 00:42:29,853

Is he going with the relatives?

 

160

00:42:30,621 --> 00:42:32,421

He call his father already.

 

161

00:42:34,703 --> 00:42:36,503

Excellent, so nice for you.

 

162

00:44:11,462 --> 00:44:14,814

All the best, so see you around

in case you have problems ok?

 

163

00:44:15,620 --> 00:44:17,287

So, your father is there.

 

164

00:44:18,287 --> 00:44:20,126

Good. Ok Bye bye.

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