just going to have a chat with these lovely paramedics and find out what's been going on okay right so this is Susan and she's falling backwards going to save herself and fured this arm um she's got a productive cough um some green flam we've been struggling to keep her a SATs up started off on 24% didn't do much good with her oxygen ended up having to put it on 100% which did increase it up to in '90s but as soon as you off she desaturates really quick okay Susan's oxygen saturations are very low and if not quickly addressed it could affect her heart and brain what's happened this morning yeah I fell and you fell what happened do you remember falling not really no not really and um tell me about your breathing what's been going on this last couple of days is it worse than usual yeah it is you have to think about what's ultimately going to affect the patient the most and what's going to put their life at risk and it's very unlikely that you're going to die from a broken wrist but unfortunately breathing problems can be that severe so Susan what we need to do is we're going to get some Bloods off you give you some antibiotics and some nebulizers to help with your breathing Susan also has COPD a progressive lung disease so Dr Lee needs to test her lung function the breathing is the main concern at the moment and obviously breathing and Airway is the thing that's going to make you most and well the most quickly Susan's fracture will have to wait to be treated because the next hour is critical if her breathing doesn't improve her life is in danger Susan I've got some antibiotic to give you if that's okay nurse Georgia and Dr leea treating her an ex-ray has been ordered to assess Susan's lungs Susan my name's Becky we're just going to do a test Sr okay sweetheart the hope is it might shed some light on why her oxygen levels are so poor okay Susan keep that chin up breath in try hold it maybe something at the left base so got congested all over it looks like there might be a patch of something down in her left base it could be the infection certainly looks like there's something on there so see what a blood test show and go from there with the X-ray showing signs of infection Susan's blood tests also don't make for good reading it's a little bit acidotic retaining quite a lot of CO2 so the worrying thing if you look at the gases compared to the first one we took is that despite all the treatment we've managed to give her she's uh seems to be getting worse rather than better Susan do you know where you are where are you yeah can you squeeze his hand for me Susan's been struggling with a lung condition for years but now she's deteriorating leg