1 00:00:10,298 --> 00:00:12,298 Sync and corrections by btsix www.addic7ed.com 2 00:00:12,299 --> 00:00:13,717 Dr. Al? 3 00:00:15,970 --> 00:00:17,179 Dr. Al. 4 00:00:19,515 --> 00:00:21,392 Trauma's at the back door. 5 00:00:26,856 --> 00:00:29,233 Let me know when the rest of her labs are back. 6 00:00:31,652 --> 00:00:33,945 The girlfriend hasn't been much help. 7 00:00:33,946 --> 00:00:36,948 - Is she being uncooperative? - No, not really. 8 00:00:36,949 --> 00:00:38,950 Apparently, she's only been going out 9 00:00:38,951 --> 00:00:40,952 with the little girl Kylie's father for a few months. 10 00:00:40,953 --> 00:00:44,080 - Where is he now? - He's in New Castle for work. 11 00:00:44,081 --> 00:00:45,957 I left him a message to come in. 12 00:00:45,958 --> 00:00:47,959 Okay, come find me when he gets here. 13 00:00:47,960 --> 00:00:49,711 You talk to the trauma counselor this week? 14 00:00:49,712 --> 00:00:51,337 I'm going to. 15 00:00:51,338 --> 00:00:52,881 - Promise. - Okay, good. 16 00:00:52,882 --> 00:00:54,674 - Medics are rolling in. - I'll be right there. 17 00:00:54,675 --> 00:00:56,968 How's our little girl who took a stair tumble? 18 00:00:56,969 --> 00:00:58,970 I'm going to check for internal hemorrhage 19 00:00:58,971 --> 00:01:00,472 with an ultrasound. 20 00:01:00,473 --> 00:01:02,390 - What is your gut telling you? - Her gut? 21 00:01:02,391 --> 00:01:05,351 Yeah, it's this thing that AI will never have. 22 00:01:05,352 --> 00:01:06,978 I don't want to think 23 00:01:06,979 --> 00:01:09,189 about what my gut is saying right now. 24 00:01:09,190 --> 00:01:10,982 Come find me when you know more. 25 00:01:10,983 --> 00:01:12,817 - Us, if you don't mind. - I don't mind. 26 00:01:12,818 --> 00:01:14,319 Us... come find us when you know more. 27 00:01:14,320 --> 00:01:15,904 Do you want to jump on this trauma? 28 00:01:15,905 --> 00:01:17,405 I've got my hands full. 29 00:01:17,406 --> 00:01:18,990 I don't want this one getting away from me. 30 00:01:18,991 --> 00:01:20,408 We don't know what this is yet. 31 00:01:20,409 --> 00:01:21,993 Don't go jumping to conclusions. 32 00:01:21,994 --> 00:01:23,411 I'm not jumping to anything. 33 00:01:23,412 --> 00:01:25,497 I'm just looking out for my patient. 34 00:01:28,000 --> 00:01:30,335 Uh, something I should know about Santos? 35 00:01:30,336 --> 00:01:33,004 Very confident, not afraid to get her hands dirty, 36 00:01:33,005 --> 00:01:34,422 strong patient advocate, fearless. 37 00:01:34,423 --> 00:01:36,216 Seems like you were suggesting 38 00:01:36,217 --> 00:01:38,009 - she jumps to conclusions. - No, no, no, no. 39 00:01:38,010 --> 00:01:40,011 I was merely suggesting or reminding her not to. 40 00:01:40,012 --> 00:01:42,013 - Yeah. - Uh, 58-year-old guy. 41 00:01:42,014 --> 00:01:43,848 Tripped with a scaphoid fracture. 42 00:01:43,849 --> 00:01:47,352 Epistaxis, non-focal neuro, but denies head trauma. 43 00:01:47,353 --> 00:01:48,645 But every time I check on him, 44 00:01:48,646 --> 00:01:50,897 his affect has drastically changed. 45 00:01:50,898 --> 00:01:53,942 My gut is telling me something's not right. 46 00:01:57,029 --> 00:01:58,655 - What? - Nothing. 47 00:01:58,656 --> 00:01:59,948 Your play. 48 00:01:59,949 --> 00:02:01,449 Start with a head CT. 49 00:02:01,450 --> 00:02:03,076 If normal, LP, rule out encephalitis. 50 00:02:03,077 --> 00:02:04,619 Put in your orders. 51 00:02:04,620 --> 00:02:06,079 - Has he been here before? - No. 52 00:02:06,080 --> 00:02:07,872 Have you called the family to rule out 53 00:02:07,873 --> 00:02:09,874 - any psychiatric history? - No, but I will. 54 00:02:09,875 --> 00:02:11,876 Do you want to jump on this trauma in the meantime? 55 00:02:11,877 --> 00:02:13,378 - What is it? - It's a surprise. 56 00:02:13,379 --> 00:02:14,463 Wonderful. 57 00:02:16,924 --> 00:02:18,842 Mel, you want to jump on this? 58 00:02:18,843 --> 00:02:21,052 - What is it? - It's a surprise. 59 00:02:21,053 --> 00:02:22,679 What do you got for us, Amboy? 60 00:02:22,680 --> 00:02:24,848 Allen Billings... Pallet of roofing tiles 61 00:02:24,849 --> 00:02:28,143 fell eight feet, hit his upper arm with an open dislocation. 62 00:02:28,144 --> 00:02:29,727 Ouch. 63 00:02:29,728 --> 00:02:31,729 Two rounds of fent, 1 then 0.5 per kilo. 64 00:02:31,730 --> 00:02:33,273 A and O, with good vitals. 65 00:02:33,274 --> 00:02:35,608 - Mel, hold the arm steady. - Sure. 66 00:02:35,609 --> 00:02:37,652 Uno, dos, tres. 67 00:02:39,071 --> 00:02:41,072 Mr. Billings, I'm Dr. McKay. 68 00:02:41,073 --> 00:02:42,782 And I'm Dr. Garcia from surgery. 69 00:02:42,783 --> 00:02:44,742 - And this is Dr. King. - Hi. 70 00:02:44,743 --> 00:02:46,286 - Oh, it really hurts. - Give us a minute. 71 00:02:46,287 --> 00:02:47,996 And we're gonna take care of that, okay? 72 00:02:47,997 --> 00:02:49,706 Any headache, chest or belly pain? 73 00:02:49,707 --> 00:02:51,958 - No, just the arm. - Sats 99. Pulse 104. 74 00:02:51,959 --> 00:02:53,501 BP 116/78. 75 00:02:53,502 --> 00:02:54,836 What do you think, Dr. King? 76 00:02:54,837 --> 00:02:57,088 Oh, um, it is an open dislocation. 77 00:02:57,089 --> 00:02:59,507 Can you be more specific? 78 00:02:59,508 --> 00:03:01,801 I think it's inferior, yeah? 79 00:03:01,802 --> 00:03:04,637 Do you remember the name for that? 80 00:03:07,141 --> 00:03:09,767 Sounds like a Harry Potter spell. 81 00:03:09,768 --> 00:03:12,979 - I... - Luxatio erecta. 82 00:03:12,980 --> 00:03:14,981 Correct. Check the neuro-circ. 83 00:03:14,982 --> 00:03:17,108 Sir, can you feel me touching you? 84 00:03:17,109 --> 00:03:18,651 Okay. 85 00:03:18,652 --> 00:03:21,446 - Can you wiggle your fingers? - Yeah. 86 00:03:21,447 --> 00:03:24,407 - Good radial pulse. - E-FAST is negative. 87 00:03:24,408 --> 00:03:28,328 - Okay, what's next, Dr. McKay? - Ancef and gentamicin. 88 00:03:28,329 --> 00:03:30,747 Sedate for traction, countertraction. 89 00:03:30,748 --> 00:03:33,333 And he needs a CT angiogram to rule out vascular injury. 90 00:03:33,334 --> 00:03:34,834 That sounds like a plan. 91 00:03:34,835 --> 00:03:36,169 But with an open joint, he needs a washout 92 00:03:36,170 --> 00:03:37,795 - in the OR with ortho. - Agreed. 93 00:03:37,796 --> 00:03:39,505 Instead of wasting time down here, 94 00:03:39,506 --> 00:03:42,133 it should be easier to reduce under general anesthesia 95 00:03:42,134 --> 00:03:44,135 - with fewer risks. - Possibly. 96 00:03:44,136 --> 00:03:45,970 Let's get an opinion from ortho. 97 00:03:47,389 --> 00:03:49,390 You're definitely new, Doctor... wishful thinking. 98 00:03:49,391 --> 00:03:51,059 Ortho like to take their sweet time. 99 00:03:51,060 --> 00:03:52,894 Okay, sedation orders, Dr. McKay. 100 00:03:52,895 --> 00:03:54,979 100 of propofol. Titrate to effect. 101 00:03:54,980 --> 00:03:56,689 Be back with that. 102 00:03:56,690 --> 00:03:57,983 Excuse me. 103 00:04:01,570 --> 00:04:04,614 - How's your day going, Doc? - Yeah, pretty good. 104 00:04:04,615 --> 00:04:07,534 Looks like your albumin's infusing. 105 00:04:09,828 --> 00:04:12,580 Oh, uh, medical students Ogilvie and Kwon 106 00:04:12,581 --> 00:04:13,706 are gonna be working with me. 107 00:04:13,707 --> 00:04:15,333 - Hello. - Student doctors. 108 00:04:15,334 --> 00:04:16,751 You want them to try it? 109 00:04:16,752 --> 00:04:18,711 They got to learn sometime. 110 00:04:18,712 --> 00:04:21,172 Uh, it's best if they watch the first one. 111 00:04:21,173 --> 00:04:22,882 - I can prep and drape. - Yeah. 112 00:04:22,883 --> 00:04:26,386 - After your albumin's in. - That's correct. 113 00:04:26,387 --> 00:04:28,972 Uh, to prevent hypotension, we introduce albumin 114 00:04:28,973 --> 00:04:31,599 if we anticipate more than five liters. 115 00:04:31,600 --> 00:04:33,101 Last time it was six. 116 00:04:33,102 --> 00:04:35,645 That's, like, a gallon and a half. 117 00:04:35,646 --> 00:04:38,439 Of high-octane premium. 118 00:04:38,440 --> 00:04:40,400 Okay, you need anything else, Mr. Louie? 119 00:04:40,401 --> 00:04:41,693 - No, ma'am. - Okay. 120 00:04:41,694 --> 00:04:43,903 - Grab me when you're ready? - Yeah. 121 00:04:43,904 --> 00:04:47,031 Whitaker, wife of your DNR this morning is in Central 8. 122 00:04:47,032 --> 00:04:49,033 Does she know her husband died? 123 00:04:49,034 --> 00:04:51,202 Not till you tell her. 124 00:04:51,203 --> 00:04:52,620 I'll be right there. 125 00:04:52,621 --> 00:04:56,457 Uh, yeah, uh, always make sure 126 00:04:56,458 --> 00:04:58,251 your entry point is safe 127 00:04:58,252 --> 00:05:00,295 by identifying the pocket of fluid. 128 00:05:00,296 --> 00:05:02,213 That's not a pocket. That's a lake. 129 00:05:02,214 --> 00:05:04,090 Yeah, but you do not want to hit a vein or artery 130 00:05:04,091 --> 00:05:06,592 on the way in, so make sure you check with color Doppler. 131 00:05:06,593 --> 00:05:08,970 Huh. 132 00:05:08,971 --> 00:05:10,555 Joy? 133 00:05:10,556 --> 00:05:12,932 I can't see. I can't see anything. 134 00:05:12,933 --> 00:05:14,559 That's 'cause your eye is shut. 135 00:05:14,560 --> 00:05:15,893 I can't open it. It's glued shut. 136 00:05:15,894 --> 00:05:17,729 I was trying to put on lashes. 137 00:05:17,730 --> 00:05:21,232 Oh, my God. Am I gonna go blind? 138 00:05:21,233 --> 00:05:23,234 No, no, I'm pretty sure this is something we can fix. 139 00:05:23,235 --> 00:05:25,237 Just take a deep breath. 140 00:05:26,697 --> 00:05:30,867 Okay, so you, uh, glued your eye shut with what exactly? 141 00:05:30,868 --> 00:05:32,410 - Super glue. - Okay. 142 00:05:32,411 --> 00:05:34,120 Well, is it something you typically use 143 00:05:34,121 --> 00:05:35,538 to apply your lashes? 144 00:05:35,539 --> 00:05:37,248 No, it's typically something you use 145 00:05:37,249 --> 00:05:39,125 to glue shit you break, like coffee mugs and stuff. 146 00:05:39,126 --> 00:05:40,918 You know what I'm talking about. 147 00:05:40,919 --> 00:05:43,504 - It's... it's... it's super glue. - Okay, okay. Yeah, got it. 148 00:05:43,505 --> 00:05:45,506 Can I just talk to Dr. J? 149 00:05:45,507 --> 00:05:47,300 She'll know what to do. 150 00:05:47,301 --> 00:05:49,260 Is that an ophthalmologist? 151 00:05:49,261 --> 00:05:51,637 No, she works here in the ER. 152 00:05:51,638 --> 00:05:53,264 Yeah, I don't think so. 153 00:05:53,265 --> 00:05:55,266 But I know what I'm doing... 154 00:05:55,267 --> 00:05:56,727 most of the time. 155 00:05:59,480 --> 00:06:02,482 For a Z-track, we pull up the skin 156 00:06:02,483 --> 00:06:06,069 before advancing into the peritoneal space. 157 00:06:06,070 --> 00:06:08,738 - Looks good. - Fluid's clear. 158 00:06:08,739 --> 00:06:10,865 Does that hurt as much as it looks? 159 00:06:10,866 --> 00:06:13,493 Oh, it's not too bad. 160 00:06:13,494 --> 00:06:15,453 Ogilvie, spike the bottle for me. 161 00:06:15,454 --> 00:06:17,663 What tests do we want on these fluids? 162 00:06:17,664 --> 00:06:19,457 Uh, Cell count to rule out spontaneous 163 00:06:19,458 --> 00:06:20,958 - bacterial peritonitis. - Ding. 164 00:06:20,959 --> 00:06:23,044 What would make that diagnosis, Joy? 165 00:06:23,045 --> 00:06:24,629 Um... 166 00:06:24,630 --> 00:06:26,339 Absolute neutrophil count over 250. 167 00:06:27,966 --> 00:06:31,511 - How are we doing in here? - They are doing great. 168 00:06:31,512 --> 00:06:33,222 I think they got this. 169 00:06:37,059 --> 00:06:38,935 Hey, Dana, can you get Kiara down here for me? 170 00:06:38,936 --> 00:06:40,728 She isn't answering her Spectralink. 171 00:06:40,729 --> 00:06:43,314 She's not working today. It's, uh... 172 00:06:43,315 --> 00:06:45,066 I forget. I'll find out and get 'em down here. 173 00:06:45,067 --> 00:06:46,567 What else you need? 174 00:06:46,568 --> 00:06:49,320 How about a double espresso martini? 175 00:06:49,321 --> 00:06:51,823 I like the way you think. 176 00:06:51,824 --> 00:06:54,534 Hey, Trudy, it's Dana. What's going on up there? 177 00:06:54,535 --> 00:06:56,202 What's up, Crash? 178 00:06:56,203 --> 00:06:59,205 You mean besides my mother driving me insane? 179 00:06:59,206 --> 00:07:02,542 Just tell her that her efforts would be better suited 180 00:07:02,543 --> 00:07:04,961 endorsing someone like myself. 181 00:07:04,962 --> 00:07:08,464 If you're seriously thinking of a double residency, 182 00:07:08,465 --> 00:07:11,342 let me save you the trouble... you can't do it. 183 00:07:11,343 --> 00:07:14,178 Why? Just because you couldn't do it? 184 00:07:14,179 --> 00:07:17,181 Honestly, yes. 185 00:07:17,182 --> 00:07:19,767 Because you're a genius. 186 00:07:19,768 --> 00:07:21,185 Yes. 187 00:07:21,186 --> 00:07:23,020 What's the square root of 841? 188 00:07:23,021 --> 00:07:25,022 I'm not a human calculator. 189 00:07:25,023 --> 00:07:26,691 Social worker Dylan Easton is covering 190 00:07:26,692 --> 00:07:28,109 for Kiara this weekend. 191 00:07:28,110 --> 00:07:29,986 - They're on their way down. - Thank you. 192 00:07:29,987 --> 00:07:31,028 Yep. 193 00:07:31,029 --> 00:07:32,655 Oh, shit. 194 00:07:32,656 --> 00:07:34,740 I have a nun with conjunctivitis. 195 00:07:34,741 --> 00:07:36,075 Her swab is showing 196 00:07:36,076 --> 00:07:37,910 gram-negative intracellular diplococci. 197 00:07:37,911 --> 00:07:39,245 Gonorrhea? 198 00:07:39,246 --> 00:07:41,581 Come to Jesus. 199 00:07:41,582 --> 00:07:43,749 Well, the lab... the lab must have made a mistake. 200 00:07:43,750 --> 00:07:46,127 Maybe it's an immaculate infection. 201 00:07:46,128 --> 00:07:48,045 I'll call the lab supe, clear this up. 202 00:07:48,046 --> 00:07:49,589 Tread carefully, missy. 203 00:07:49,590 --> 00:07:53,302 There's a nun with gonorrhea in her eye. 204 00:07:55,387 --> 00:07:57,805 Seriously, you guys are gonna take this away from me? 205 00:07:57,806 --> 00:07:59,724 I'm disappointed in you two. 206 00:07:59,725 --> 00:08:01,267 29. 207 00:08:01,268 --> 00:08:02,602 What? 208 00:08:02,603 --> 00:08:04,937 The square root of 841. 209 00:08:04,938 --> 00:08:06,772 How we doing with Mr. Digby? 210 00:08:06,773 --> 00:08:08,608 He's in a gown in South 21. 211 00:08:08,609 --> 00:08:10,610 Is there someplace we can get this laundered? 212 00:08:10,611 --> 00:08:12,612 Those are going right in the incinerator. 213 00:08:12,613 --> 00:08:14,405 We'll get him a whole new wardrobe. 214 00:08:14,406 --> 00:08:16,240 - You ever use a cast saw before? - Uh... 215 00:08:16,241 --> 00:08:18,409 Of course you haven't. Well, today's your lucky day. 216 00:08:18,410 --> 00:08:19,911 Follow me. 217 00:08:19,912 --> 00:08:22,413 - Dr. Mohan, you got a minute? - Yeah. 218 00:08:22,414 --> 00:08:25,666 Have you met Emma? First day. New grad RN. 219 00:08:25,667 --> 00:08:27,251 - Hi. - Nice to meet you. 220 00:08:27,252 --> 00:08:29,170 Emma needs to learn cast removal. 221 00:08:29,171 --> 00:08:30,838 How long has the cast been on? 222 00:08:30,839 --> 00:08:32,632 Months, maybe years. 223 00:08:32,633 --> 00:08:34,593 Probably gonna want to breathe through your mouth. 224 00:08:37,304 --> 00:08:39,430 All right, Mr. Digby. 225 00:08:39,431 --> 00:08:42,183 Dr. Mohan can cut your cast off now. 226 00:08:42,184 --> 00:08:43,851 How long's the cast been on? 227 00:08:43,852 --> 00:08:46,729 I don't know, but it's really getting itchy. 228 00:08:46,730 --> 00:08:49,440 Okay, this cuts the cast... 229 00:08:49,441 --> 00:08:51,108 Not the skin. 230 00:08:51,109 --> 00:08:53,487 This should relieve the itching. 231 00:09:06,291 --> 00:09:09,127 - Get the cast spreader. - Oh, uh... 232 00:09:14,216 --> 00:09:17,301 Thank you. 233 00:09:17,302 --> 00:09:19,053 Okay. 234 00:09:22,891 --> 00:09:24,601 Okay. 235 00:09:29,481 --> 00:09:31,649 Oh, I see you brought some friends. 236 00:09:31,650 --> 00:09:33,860 - Oh, my God, are those... - Maggots. 237 00:09:39,491 --> 00:09:42,535 I'll need ethyl chloride spray to freeze them off. 238 00:09:42,536 --> 00:09:45,330 Never saw that in nursing school, am I right? 239 00:09:50,544 --> 00:09:53,087 Now irrigate like hell, Mel. 240 00:09:53,088 --> 00:09:54,131 Okay. 241 00:09:58,677 --> 00:10:00,803 Okay, on my count. 242 00:10:00,804 --> 00:10:04,765 One, two, three. 243 00:10:04,766 --> 00:10:06,767 Come on, motherfucker. 244 00:10:06,768 --> 00:10:08,686 Humeral head is not reducing. 245 00:10:08,687 --> 00:10:10,938 - Should be done in the OR. - I am the OR. 246 00:10:10,939 --> 00:10:12,440 Okay, we're gonna get this back in 247 00:10:12,441 --> 00:10:14,358 before ortho even answers the page. 248 00:10:14,359 --> 00:10:16,944 Mel, stick four fingers under that humeral head. 249 00:10:16,945 --> 00:10:18,279 Really? 250 00:10:18,280 --> 00:10:20,197 Yeah, get in there really, really deep. 251 00:10:20,198 --> 00:10:23,034 And when you feel the traction and lift it above the glenoid, 252 00:10:23,035 --> 00:10:25,036 that will convert this to an anterior dislocation, 253 00:10:25,037 --> 00:10:27,371 and it should pop right back in. 254 00:10:27,372 --> 00:10:29,206 Okay. 255 00:10:29,207 --> 00:10:30,541 Ready to go. 256 00:10:30,542 --> 00:10:33,878 One, two, three. 257 00:10:33,879 --> 00:10:35,713 Okay. 258 00:10:35,714 --> 00:10:37,965 - Ooh. - Oh, very cool. 259 00:10:37,966 --> 00:10:40,176 Sterile saline dressing. 260 00:10:40,177 --> 00:10:42,637 - Shoulder immobilizer and CT. - Okay. 261 00:10:42,638 --> 00:10:44,931 Guess you guys don't need me anymore. 262 00:10:47,184 --> 00:10:49,852 - You all right, Dr. King? - Yeah. 263 00:10:49,853 --> 00:10:52,355 You don't seem all right. 264 00:10:52,356 --> 00:10:54,774 Well, my deposition is today. 265 00:10:54,775 --> 00:10:57,151 Ah, do you want to talk about it? 266 00:10:57,152 --> 00:10:58,819 I'm not allowed to. 267 00:10:58,820 --> 00:11:00,780 No, we don't have to talk about the deposition, 268 00:11:00,781 --> 00:11:03,449 but we can talk about how it is affecting you. 269 00:11:03,450 --> 00:11:04,867 Average emergency physician 270 00:11:04,868 --> 00:11:06,744 catches a med-mal case every seven years. 271 00:11:06,745 --> 00:11:08,579 Nine times out of ten, the doctor wins. 272 00:11:08,580 --> 00:11:10,247 I've been sued four times myself. 273 00:11:10,248 --> 00:11:12,583 Dr. Al? 274 00:11:12,584 --> 00:11:15,253 I've never been named in a lawsuit. 275 00:11:16,838 --> 00:11:19,423 Mm, mm, mm... 276 00:11:19,424 --> 00:11:23,427 Um, but sometime... 277 00:11:25,764 --> 00:11:27,473 Sister Grace... 278 00:11:27,474 --> 00:11:29,767 this is one of my residents, Dr. Mohan. 279 00:11:29,768 --> 00:11:31,519 - Nice to meet you. - You as well. 280 00:11:31,520 --> 00:11:33,813 I wish we could recruit as dedicated 281 00:11:33,814 --> 00:11:35,940 and talented young women as you two. 282 00:11:35,941 --> 00:11:38,651 I imagine it's a calling, much like medicine. 283 00:11:38,652 --> 00:11:41,237 Yes, very much so. 284 00:11:41,238 --> 00:11:44,365 Sister Grace, under the microscope, 285 00:11:44,366 --> 00:11:47,910 we're seeing something called a gram-negative bacteria. 286 00:11:47,911 --> 00:11:49,620 Is that serious? 287 00:11:49,621 --> 00:11:51,789 It can be if left untreated. 288 00:11:51,790 --> 00:11:54,291 But, fortunately, we can give you a shot of antibiotics, 289 00:11:54,292 --> 00:11:55,960 irrigate your eye with a liter of saline, 290 00:11:55,961 --> 00:11:58,504 and give you drops to use at home every few hours. 291 00:11:58,505 --> 00:12:00,298 How did I get it? 292 00:12:02,050 --> 00:12:05,302 So the... the appearance of the bacteria in your eye 293 00:12:05,303 --> 00:12:07,263 suggests that it's... 294 00:12:07,264 --> 00:12:08,973 it's gonorrhea. 295 00:12:08,974 --> 00:12:10,850 Um, traditionally, that's a sexually... 296 00:12:10,851 --> 00:12:12,977 I know what gonorrhea is, Dr. Javadi. 297 00:12:12,978 --> 00:12:15,354 I'm a nun, not a numbskull. 298 00:12:15,355 --> 00:12:18,691 I do a lot of work at an unhoused shelter. 299 00:12:18,692 --> 00:12:21,402 Are... are you handling dirty sheets, 300 00:12:21,403 --> 00:12:24,864 - pillowcases, soiled clothes? - Yes. 301 00:12:24,865 --> 00:12:29,076 Uh, part of my day is spent doing laundry, making beds, 302 00:12:29,077 --> 00:12:31,203 disposing of old clothes. 303 00:12:31,204 --> 00:12:33,080 Do you wear gloves? 304 00:12:33,081 --> 00:12:35,374 - When they're available. - Okay. 305 00:12:35,375 --> 00:12:37,835 Uh, well, let's... let's get you your shot 306 00:12:37,836 --> 00:12:39,920 and set up for irrigating your eye. 307 00:12:39,921 --> 00:12:42,089 I bet we can scrounge up a couple boxes of gloves 308 00:12:42,090 --> 00:12:43,507 while you're here. 309 00:12:43,508 --> 00:12:46,051 It's important to protect yourself. 310 00:12:46,052 --> 00:12:47,721 We'll be back. 311 00:12:49,681 --> 00:12:51,807 Why am I here? 312 00:12:51,808 --> 00:12:53,768 I'm not sick. 313 00:12:53,769 --> 00:12:57,521 Oh, we took care of your husband, Ethan, earlier today. 314 00:12:57,522 --> 00:13:00,524 Is Ethan sick? 315 00:13:00,525 --> 00:13:03,194 Well, he was very ill. 316 00:13:03,195 --> 00:13:06,530 And, um, we did everything we could to treat him, 317 00:13:06,531 --> 00:13:09,408 but his heart stopped beating. 318 00:13:09,409 --> 00:13:10,701 And... 319 00:13:10,702 --> 00:13:13,079 I'm so sorry to say that he died. 320 00:13:15,123 --> 00:13:17,583 He died? 321 00:13:17,584 --> 00:13:19,210 Ethan? 322 00:13:19,211 --> 00:13:22,463 No, no. 323 00:13:22,464 --> 00:13:24,382 Are you sure? 324 00:13:26,468 --> 00:13:28,427 Yes. 325 00:13:28,428 --> 00:13:31,222 No, no, no, no, no. 326 00:13:31,223 --> 00:13:33,557 Ethan isn't sick. 327 00:13:33,558 --> 00:13:35,059 No! 328 00:13:35,060 --> 00:13:37,895 I-I know how difficult this must be for you. 329 00:13:44,319 --> 00:13:46,445 Uh, kidneys look good on ultrasound. 330 00:13:46,446 --> 00:13:48,197 No intra-abdominal injury. 331 00:13:48,198 --> 00:13:50,157 - Hey, Dylan. - Robby. 332 00:13:50,158 --> 00:13:52,117 Is this the "tumble down the stairs" kid... Kylie? 333 00:13:52,118 --> 00:13:53,661 - Yeah. - And? 334 00:13:53,662 --> 00:13:55,538 I'd like to talk to the girlfriend first, 335 00:13:55,539 --> 00:13:57,456 - away from the little girl. - We can arrange that. 336 00:13:57,457 --> 00:13:59,166 - Okay. - Keep us informed. 337 00:13:59,167 --> 00:14:01,752 Yes, keep us informed. 338 00:14:01,753 --> 00:14:05,548 More labs are back on our abandoned baby Jane Doe. 339 00:14:05,549 --> 00:14:07,758 Everything looks normal so far, 340 00:14:07,759 --> 00:14:10,928 but you seemed really concerned earlier. 341 00:14:10,929 --> 00:14:12,763 She still needs a cathed urine. 342 00:14:12,764 --> 00:14:14,224 Or not. 343 00:14:15,642 --> 00:14:17,852 You can't trust a bagged urine. 344 00:14:17,853 --> 00:14:20,187 Agreed, but we can avoid the trauma of a catheter. 345 00:14:20,188 --> 00:14:22,147 With a suprapubic tap? 346 00:14:22,148 --> 00:14:25,026 Oh, I may have a trick or two up my sleeve, Dr. Al-Hashimi. 347 00:14:28,113 --> 00:14:30,614 Hey, Princess, hold up. 348 00:14:30,615 --> 00:14:31,991 Hi. 349 00:14:31,992 --> 00:14:34,201 - How you feeling, Mr. Williams? - Okay. 350 00:14:34,202 --> 00:14:36,453 A little nervous about going in the machine. 351 00:14:36,454 --> 00:14:38,622 I can get a tad claustrophobic. 352 00:14:38,623 --> 00:14:40,207 Yeah, well, um... 353 00:14:40,208 --> 00:14:42,543 we're sending you for a CT, not an MRI. 354 00:14:42,544 --> 00:14:45,004 So it's like a open doughnut. 355 00:14:45,005 --> 00:14:46,714 Oh, good. I like doughnuts. 356 00:14:48,466 --> 00:14:51,093 There you are. Thought you forgot about me. 357 00:14:51,094 --> 00:14:54,680 Oh, no. I was just with other patients. 358 00:14:54,681 --> 00:14:57,683 So what do you do for fun? 359 00:14:57,684 --> 00:14:59,560 I mainly do what my sister likes. 360 00:14:59,561 --> 00:15:01,729 Um, she loves Kennywood and the zoo. 361 00:15:01,730 --> 00:15:04,356 No, what about you? 362 00:15:04,357 --> 00:15:06,401 What do you like to do? 363 00:15:09,571 --> 00:15:13,741 Um, I used to like, um, the Renaissance fair. 364 00:15:13,742 --> 00:15:15,743 - Really? - Yeah. 365 00:15:15,744 --> 00:15:17,745 Isn't that kind of dorky, though, where everybody 366 00:15:17,746 --> 00:15:19,204 dresses up like somebody they're not? 367 00:15:19,205 --> 00:15:20,664 Yeah, but that's the fun, you know? 368 00:15:20,665 --> 00:15:22,499 You can be anyone or anything you want. 369 00:15:22,500 --> 00:15:24,877 I, um, actually had this alter ego 370 00:15:24,878 --> 00:15:26,503 that was a 17th-century French woman... 371 00:15:26,504 --> 00:15:28,714 Stop! 372 00:15:31,843 --> 00:15:33,761 You okay, kid? 373 00:15:33,762 --> 00:15:36,680 That was a doozy. 374 00:15:36,681 --> 00:15:38,766 Okay, are we ready? 375 00:15:38,767 --> 00:15:40,392 Cleaned and dried with sterile gauze. 376 00:15:40,393 --> 00:15:42,353 - Is that water cold? - Right out the fridge. 377 00:15:42,354 --> 00:15:44,063 Okay, Jesse, you can take the armpits. 378 00:15:44,064 --> 00:15:46,065 I'm gonna take the legs. 379 00:15:46,066 --> 00:15:47,650 One, two, three, up. 380 00:15:47,651 --> 00:15:49,860 Dr. Al-Hashimi, you're gonna be our catcher. 381 00:15:49,861 --> 00:15:52,529 And, Samira, you're gonna do suprapubic circles 382 00:15:52,530 --> 00:15:54,031 with that gauze. 383 00:15:54,032 --> 00:15:56,659 And the cold should stimulate voiding. 384 00:15:56,660 --> 00:15:58,911 Even if she pees, it's likely to be contaminated. 385 00:15:58,912 --> 00:16:00,829 Not according to the "British Medical Journal." 386 00:16:00,830 --> 00:16:02,414 They did the wee-search. 387 00:16:02,415 --> 00:16:05,334 Any leuks or nitrates, and we cath. 388 00:16:05,335 --> 00:16:08,504 Oh. Oh. Dr. Al-Hashimi, get it. 389 00:16:08,505 --> 00:16:10,673 I was gonna invite you to join the softball team, 390 00:16:10,674 --> 00:16:12,883 but now I'm not so sure. 391 00:16:12,884 --> 00:16:14,343 There we go. 392 00:16:14,344 --> 00:16:16,345 Looks like you got a good midstream sample. 393 00:16:16,346 --> 00:16:17,888 Here's a fresh blanket. 394 00:16:17,889 --> 00:16:20,140 Okay. Plan. 395 00:16:20,141 --> 00:16:23,560 Ceftriaxone, two-day admit till blood culture is negative. 396 00:16:23,561 --> 00:16:24,770 Next steps? 397 00:16:24,771 --> 00:16:26,146 Foster care. 398 00:16:26,147 --> 00:16:27,731 Oh, yeah. 399 00:16:27,732 --> 00:16:29,316 Ha. 400 00:16:29,317 --> 00:16:32,111 Someone must have been in a bad way 401 00:16:32,112 --> 00:16:34,738 to walk away from you, little one. 402 00:16:34,739 --> 00:16:37,324 We need to call the police? 403 00:16:37,325 --> 00:16:39,744 Let me know what the urine dip shows. 404 00:16:42,330 --> 00:16:46,500 We will let you know what the urine dip shows. 405 00:16:46,501 --> 00:16:49,253 You must be Dr. Al-Hashimi. 406 00:16:49,254 --> 00:16:51,088 And you must be Dr. Langdon. 407 00:16:51,089 --> 00:16:53,048 I've heard all about you. 408 00:16:53,049 --> 00:16:54,550 Welcome back. 409 00:16:54,551 --> 00:16:57,261 - And this is? - Uh, Linda Stevens. 410 00:16:57,262 --> 00:17:00,097 One episode of substernal chest pressure resolved with rest. 411 00:17:00,098 --> 00:17:01,932 12-lead negative for STEMI. 412 00:17:01,933 --> 00:17:04,393 Heading for North 4. 413 00:17:04,394 --> 00:17:07,271 Hello, I'm Dr. Al-Hashimi. 414 00:17:07,272 --> 00:17:09,940 - Nice to meet you. - Nice to meet you. 415 00:17:09,941 --> 00:17:12,026 Ma'am, this is a teaching hospital. 416 00:17:12,027 --> 00:17:14,361 Is it okay if some of our trainees join me? 417 00:17:14,362 --> 00:17:16,405 Not... not a problem. 418 00:17:16,406 --> 00:17:20,367 Dr. Whitaker, Javadi, Ogilvie, Joy... 419 00:17:20,368 --> 00:17:22,619 gather round. 420 00:17:22,620 --> 00:17:25,164 Dr. Langdon, you are more than welcome to stay, too. 421 00:17:25,165 --> 00:17:28,000 Uh, maybe for a minute. We're pretty busy in triage. 422 00:17:28,001 --> 00:17:29,626 Okay. 423 00:17:29,627 --> 00:17:31,962 Ms. Stevens... 424 00:17:31,963 --> 00:17:33,630 I have an app on my phone 425 00:17:33,631 --> 00:17:35,632 that can listen to our conversation 426 00:17:35,633 --> 00:17:37,676 and the details of my physical exam 427 00:17:37,677 --> 00:17:39,887 and write it all up in your medical record. 428 00:17:39,888 --> 00:17:41,805 Wow. 429 00:17:41,806 --> 00:17:45,517 It's protected, confidential, doesn't even stay on my phone. 430 00:17:45,518 --> 00:17:47,478 - And it means I can... - What's going on? 431 00:17:47,479 --> 00:17:49,646 Some A-hole perp took off when he saw the cops, 432 00:17:49,647 --> 00:17:51,398 knocked her backwards off a stool. 433 00:17:51,399 --> 00:17:53,609 - Oh, Jesus. - Head trauma, no LOC. 434 00:17:53,610 --> 00:17:55,611 Okay, you need to get checked out. 435 00:17:55,612 --> 00:17:57,780 - I'm fine. - No choice. It's work-related. 436 00:17:57,781 --> 00:17:59,615 Let's, uh... let's find her a room 437 00:17:59,616 --> 00:18:02,409 - and prep for a burr hole. - What? 438 00:18:02,410 --> 00:18:04,411 Oh... 439 00:18:04,412 --> 00:18:08,082 I forgot how much you like to joke, Captain Scurvy. 440 00:18:08,083 --> 00:18:10,501 Who the hell's Captain Scurvy? 441 00:18:10,502 --> 00:18:12,544 It's an inside thing. 442 00:18:12,545 --> 00:18:15,798 - How's our shoulder guy? - Oh, he slept like a baby. 443 00:18:15,799 --> 00:18:18,634 CT angio shows no vascular injury. 444 00:18:18,635 --> 00:18:22,221 What about your slip-and-fall guy with a labile affect? 445 00:18:22,222 --> 00:18:24,223 Mm, Michael Williams. 446 00:18:24,224 --> 00:18:26,100 He's still in the scanner. 447 00:18:26,101 --> 00:18:28,352 He seems to have settled down, so he doesn't need babysitting. 448 00:18:28,353 --> 00:18:29,937 Good. Maybe he's coming around. 449 00:18:29,938 --> 00:18:32,022 Ortho can take Mr. Billings here up for surgery. 450 00:18:32,023 --> 00:18:33,440 Belay that order, sailor. 451 00:18:33,441 --> 00:18:36,026 - Dr. Robinavitch. - Nurse Hastings. 452 00:18:36,027 --> 00:18:37,694 You can call me Robby. 453 00:18:37,695 --> 00:18:39,447 You can call me Noelle. 454 00:18:41,866 --> 00:18:45,035 Uh, you could just tell me what the hell's going on here. 455 00:18:45,036 --> 00:18:47,037 This is Noelle. She's our, um... 456 00:18:47,038 --> 00:18:48,747 Bed control manager. No, we met. 457 00:18:48,748 --> 00:18:50,040 Case manager. 458 00:18:50,041 --> 00:18:51,625 And this guy won't be staying. 459 00:18:51,626 --> 00:18:53,544 Oh, he needs surgery. 460 00:18:53,545 --> 00:18:56,338 Which his insurance will pay for at Westbridge Memorial, 461 00:18:56,339 --> 00:18:58,090 not here. 462 00:18:58,091 --> 00:19:01,718 - Wait, so we have to transfer? - If... if he's stable. 463 00:19:01,719 --> 00:19:03,428 I believe that he is. 464 00:19:03,429 --> 00:19:04,972 Look on the bright side. 465 00:19:04,973 --> 00:19:07,141 We're gonna free up a bed, discharge a patient. 466 00:19:07,142 --> 00:19:09,685 I mean, that's great for us, not so good for him. 467 00:19:09,686 --> 00:19:11,937 He will get great care at Westbridge. 468 00:19:11,938 --> 00:19:14,523 Don't you agree, Robby? 469 00:19:14,524 --> 00:19:17,359 - I'm sure that he will. - Yeah. 470 00:19:17,360 --> 00:19:19,278 What am I missing? 471 00:19:19,279 --> 00:19:21,488 Is there something else happening with Allen Billings 472 00:19:21,489 --> 00:19:23,198 that I don't know about? 473 00:19:23,199 --> 00:19:24,658 Not medically. 474 00:19:24,659 --> 00:19:28,078 This is just a simple insurance transfer. 475 00:19:28,079 --> 00:19:30,206 Mm, yeah, okay. 476 00:19:34,419 --> 00:19:36,753 What's that about? 477 00:19:36,754 --> 00:19:39,756 - Nothing. - Didn't feel like nothing. 478 00:19:39,757 --> 00:19:42,092 Dr. McKay has a very heightened sense of empathy. 479 00:19:42,093 --> 00:19:43,594 Meaning? 480 00:19:43,595 --> 00:19:45,929 Meaning she's good at picking up on stuff. 481 00:19:45,930 --> 00:19:47,931 You didn't say anything, did you? 482 00:19:47,932 --> 00:19:49,266 Nope. 483 00:19:49,267 --> 00:19:51,310 I subscribe to the Falstaff advice. 484 00:19:51,311 --> 00:19:53,103 Discretion is the better part of valor. 485 00:19:53,104 --> 00:19:54,479 Oh. 486 00:19:54,480 --> 00:19:56,315 You still planning on leaving tonight? 487 00:19:56,316 --> 00:19:58,233 Yep. 488 00:19:58,234 --> 00:20:02,112 I don't understand why you can't leave in the morning. 489 00:20:02,113 --> 00:20:03,822 Will you excuse me for a second? 490 00:20:03,823 --> 00:20:05,657 I got to go talk to a patient while she's separated 491 00:20:05,658 --> 00:20:06,992 - from her caregiver. - Oh, yeah. 492 00:20:06,993 --> 00:20:08,744 - That doesn't sound ideal. - It's not ideal. 493 00:20:08,745 --> 00:20:10,746 I got to figure out what's going on. 494 00:20:10,747 --> 00:20:12,915 And I'll find you before I leave. 495 00:20:12,916 --> 00:20:14,375 Okay. 496 00:20:17,045 --> 00:20:20,589 Okay, you got to stop this. 497 00:20:20,590 --> 00:20:22,674 Hastings. 498 00:20:22,675 --> 00:20:24,051 Evans. 499 00:20:24,052 --> 00:20:25,969 Hope you know what you're doing. 500 00:20:25,970 --> 00:20:28,972 What is that supposed to mean? 501 00:20:28,973 --> 00:20:31,475 I'm a big girl. 502 00:20:31,476 --> 00:20:34,645 Okay, big girl. 503 00:20:34,646 --> 00:20:35,979 I'm fine. 504 00:20:35,980 --> 00:20:37,941 That's good. Follow my finger. 505 00:20:39,567 --> 00:20:41,068 How's the head? 506 00:20:41,069 --> 00:20:42,986 It's a little sore. 507 00:20:42,987 --> 00:20:45,864 Lean forward. Let me take a look. 508 00:20:45,865 --> 00:20:48,909 Yeah, you're gonna have a pretty good goose egg. 509 00:20:48,910 --> 00:20:51,370 - Headache? - A little. 510 00:20:51,371 --> 00:20:52,996 I can get you some Tylenol, 511 00:20:52,997 --> 00:20:54,665 unless you need something stronger. 512 00:20:54,666 --> 00:20:57,376 Oh, no, that's okay. I'm not very drug tolerant. 513 00:20:57,377 --> 00:20:59,295 Lucky you. 514 00:21:01,798 --> 00:21:03,799 You know, I'm glad you're back. 515 00:21:03,800 --> 00:21:08,095 Thanks. Yeah, I'm glad to be back. 516 00:21:08,096 --> 00:21:10,389 - You know why I was away? - I should see my patient... 517 00:21:10,390 --> 00:21:13,016 Um, no, not really. 518 00:21:13,017 --> 00:21:14,685 I mean, I heard rumors, but I learned 519 00:21:14,686 --> 00:21:16,144 a long time ago not to listen. 520 00:21:16,145 --> 00:21:17,521 - I was in rehab... - Oh. 521 00:21:17,522 --> 00:21:19,564 For an addiction to benzos. 522 00:21:19,565 --> 00:21:21,525 Oh. 523 00:21:21,526 --> 00:21:24,194 Yeah, but I'm... I'm clean now. 524 00:21:24,195 --> 00:21:25,988 A-and it never affected my work. 525 00:21:25,989 --> 00:21:27,614 I just... 526 00:21:27,615 --> 00:21:30,326 needed to get it all out of my system once and for all. 527 00:21:32,578 --> 00:21:35,872 Yeah, I-I didn't handle things the way I should have. 528 00:21:35,873 --> 00:21:40,711 I thought I could treat myself, and I let a lot of people down. 529 00:21:40,712 --> 00:21:43,422 I'm sorry, Mel. 530 00:21:43,423 --> 00:21:46,425 You never let me down. 531 00:21:46,426 --> 00:21:47,634 Yeah. 532 00:21:47,635 --> 00:21:49,428 Yeah, I did. 533 00:21:49,429 --> 00:21:52,431 I should be setting an example, not a cautionary tale. 534 00:21:54,225 --> 00:21:55,976 Hey. 535 00:21:55,977 --> 00:21:58,228 - How you doing? - I'm okay. 536 00:21:58,229 --> 00:22:00,981 Listen, I'm really sorry about all that. 537 00:22:00,982 --> 00:22:02,941 The guy robbed a liquor store last night. 538 00:22:02,942 --> 00:22:05,027 He tried to get away on a bicycle 539 00:22:05,028 --> 00:22:06,737 but wiped out and took off on foot. 540 00:22:06,738 --> 00:22:08,322 He must've hobbled in here... 541 00:22:08,323 --> 00:22:10,657 more so to hide out than to get stitched up, I think. 542 00:22:10,658 --> 00:22:12,367 - You catch him? - We will. 543 00:22:12,368 --> 00:22:14,244 Anything you could tell us about him will help. 544 00:22:14,245 --> 00:22:16,204 You think he gave legit information? 545 00:22:16,205 --> 00:22:19,708 Probably not, but it's all we have at the moment. 546 00:22:19,709 --> 00:22:21,376 If we do find him, 547 00:22:21,377 --> 00:22:24,421 you may have to testify in court, Dr. King. 548 00:22:24,422 --> 00:22:26,757 - "In court"? - As a material witness. 549 00:22:26,758 --> 00:22:29,676 Attest to his injuries, his treatments... 550 00:22:29,677 --> 00:22:31,178 simple stuff. 551 00:22:31,179 --> 00:22:32,929 Yeah, but we'll cross that bridge 552 00:22:32,930 --> 00:22:34,765 when we come to it, right? 553 00:22:34,766 --> 00:22:36,850 Mel? 554 00:22:36,851 --> 00:22:38,935 Rest here a minute. I'll be right back. 555 00:22:38,936 --> 00:22:40,104 Mm. 556 00:22:42,440 --> 00:22:44,691 You know, I'm... I'm fine, really. I should... 557 00:22:44,692 --> 00:22:47,111 Ten minutes, please. Doctor's orders. 558 00:22:49,614 --> 00:22:52,325 ER can be a little bright and noisy. 559 00:22:56,996 --> 00:22:59,122 Dorsalis pedis 560 00:22:59,123 --> 00:23:02,667 and posterior tibial pulses 2 plus and equal. 561 00:23:02,668 --> 00:23:04,336 Your exam is perfect, ma'am. 562 00:23:04,337 --> 00:23:06,421 Oh, that is good to hear. 563 00:23:06,422 --> 00:23:08,965 I will be back when your blood tests are ready. 564 00:23:08,966 --> 00:23:11,051 Let us know if the chest pain returns. 565 00:23:11,052 --> 00:23:13,512 - Thank you. - You are so welcome. 566 00:23:15,348 --> 00:23:16,765 What do you think? 567 00:23:16,766 --> 00:23:18,350 Well, I don't think it's cardiac. 568 00:23:18,351 --> 00:23:20,143 I mean, what do you think of the app? 569 00:23:20,144 --> 00:23:22,729 I mean, it's hard to say without seeing the full thing. 570 00:23:22,730 --> 00:23:25,273 Take a look. 571 00:23:25,274 --> 00:23:26,733 Oh, my God. 572 00:23:26,734 --> 00:23:28,693 Do you know how much time this will save? 573 00:23:28,694 --> 00:23:31,988 Studies show you can spend 80% less time charting. 574 00:23:31,989 --> 00:23:33,740 You'll get out of here sooner, 575 00:23:33,741 --> 00:23:35,992 improving both patient and physician satisfaction. 576 00:23:35,993 --> 00:23:37,577 Oh, excuse me. 577 00:23:37,578 --> 00:23:39,996 It says here she takes Risperdal, an antipsychotic. 578 00:23:39,997 --> 00:23:42,374 She takes Restoril when needed for sleep. 579 00:23:42,375 --> 00:23:43,750 So is that, um... 580 00:23:43,751 --> 00:23:46,211 AI, "almost intelligent." 581 00:23:46,212 --> 00:23:49,923 Generative AI is 98% accurate at present. 582 00:23:49,924 --> 00:23:51,758 You must always carefully proofread 583 00:23:51,759 --> 00:23:53,343 and correct the minor errors. 584 00:23:53,344 --> 00:23:54,928 It's excellent but not perfect. 585 00:23:54,929 --> 00:23:57,347 This is amazing. 586 00:23:57,348 --> 00:23:59,015 Moteshakeram. 587 00:23:59,016 --> 00:24:01,768 Khahesh mikonam. 588 00:24:01,769 --> 00:24:04,729 - You speak Farsi? - I did my undergrad at UCLA. 589 00:24:04,730 --> 00:24:06,565 A lot of my friends were Persian. 590 00:24:06,566 --> 00:24:08,275 So you learned the language? 591 00:24:08,276 --> 00:24:10,235 Enough to break the ice. 592 00:24:10,236 --> 00:24:12,405 I am impressed. 593 00:24:13,614 --> 00:24:15,157 Me too... 594 00:24:15,158 --> 00:24:16,741 that you had friends. 595 00:24:16,742 --> 00:24:19,035 Dr. Whitaker, I said hello to your widow 596 00:24:19,036 --> 00:24:21,121 with Alzheimer's, but she only wants to talk to a doctor. 597 00:24:21,122 --> 00:24:23,373 She's also very overdue for a diaper change. 598 00:24:23,374 --> 00:24:25,375 Okay. Yeah, thank you. 599 00:24:25,376 --> 00:24:27,420 Uh, Ogilvie, you're with me. 600 00:24:28,796 --> 00:24:30,005 Come on. 601 00:24:30,006 --> 00:24:32,717 Ah, Mrs. Bostick? 602 00:24:34,844 --> 00:24:36,136 Takotsubo? 603 00:24:36,137 --> 00:24:37,387 - Broken heart syndrome? - Uh, no. 604 00:24:37,388 --> 00:24:38,430 Aah! 605 00:24:38,431 --> 00:24:39,890 Hello? 606 00:24:39,891 --> 00:24:41,391 Hey. 607 00:24:41,392 --> 00:24:43,226 Um, you wanted to see me? 608 00:24:43,227 --> 00:24:44,978 No. 609 00:24:44,979 --> 00:24:47,147 Who are you? 610 00:24:47,148 --> 00:24:48,940 I'm Dr. Whitaker. 611 00:24:48,941 --> 00:24:51,067 We talked about your husband? 612 00:24:51,068 --> 00:24:53,904 Oh, Ethan. 613 00:24:53,905 --> 00:24:56,781 Oh, can he please come see me? 614 00:24:56,782 --> 00:24:59,117 Um... 615 00:24:59,118 --> 00:25:01,578 um... 616 00:25:01,579 --> 00:25:03,497 no. 617 00:25:03,498 --> 00:25:07,083 Unfortunately, he was very sick... 618 00:25:07,084 --> 00:25:09,462 and he died. 619 00:25:11,672 --> 00:25:13,632 Ethan? 620 00:25:13,633 --> 00:25:15,842 Died? 621 00:25:15,843 --> 00:25:17,260 No. 622 00:25:17,261 --> 00:25:18,595 Oh, no. 623 00:25:18,596 --> 00:25:21,223 No, that's impossible. 624 00:25:21,224 --> 00:25:24,226 No. 625 00:25:24,227 --> 00:25:27,270 No, no, no, no, no. 626 00:25:27,271 --> 00:25:29,439 What do you like to do for fun? 627 00:25:29,440 --> 00:25:30,857 I love horseback riding. 628 00:25:30,858 --> 00:25:32,901 - Does your dad take you? - Yep. 629 00:25:32,902 --> 00:25:34,486 Sometimes he even rides, 630 00:25:34,487 --> 00:25:36,738 but most of the time, he just watches me. 631 00:25:36,739 --> 00:25:39,449 Have you ever fallen off? Have you ever been thrown? 632 00:25:39,450 --> 00:25:42,452 Nope. I'm a very good rider. 633 00:25:42,453 --> 00:25:44,788 - Do you have your own horse? - I wish. 634 00:25:44,789 --> 00:25:46,998 We live in an apartment. 635 00:25:46,999 --> 00:25:49,668 Okay, Kylie, we need to take some blood now. 636 00:25:49,669 --> 00:25:51,378 Do you have to do that? 637 00:25:51,379 --> 00:25:54,297 Yeah, but I promise it'll go super fast 638 00:25:54,298 --> 00:25:56,841 and only hurt for, like, a moment, okay? 639 00:25:56,842 --> 00:26:00,470 So I'm just gonna put this rubber band 640 00:26:00,471 --> 00:26:03,473 around your arm to help me find your vein better. 641 00:26:03,474 --> 00:26:07,644 And then this makes sure no germs get in your body 642 00:26:07,645 --> 00:26:09,521 when we do it. 643 00:26:09,522 --> 00:26:12,482 Okay, now you're just gonna feel this teeny little prick. 644 00:26:12,483 --> 00:26:14,527 But you can look away, okay? 645 00:26:16,612 --> 00:26:18,739 Worst part's over. 646 00:26:20,866 --> 00:26:22,784 Tough little girl. 647 00:26:22,785 --> 00:26:24,369 Yeah, well, little girls can be 648 00:26:24,370 --> 00:26:26,705 just as tough as little boys, even tougher. 649 00:26:26,706 --> 00:26:29,291 Yes. I just hope it's not because she's become 650 00:26:29,292 --> 00:26:30,959 accustomed to pain. 651 00:26:30,960 --> 00:26:33,295 At the very least, she's gonna need a visual exam 652 00:26:33,296 --> 00:26:35,422 of external genitalia to look for signs of trauma. 653 00:26:35,423 --> 00:26:37,299 I can have Dr. Al-Hashimi... 654 00:26:37,300 --> 00:26:39,343 No, she's my patient. I can do it. 655 00:26:47,768 --> 00:26:49,853 Nice and clear. 656 00:26:49,854 --> 00:26:54,524 Uh, with an infection, it'd be kind of cloudy. 657 00:26:54,525 --> 00:26:56,526 Joy, get ready to spike the third bottle here 658 00:26:56,527 --> 00:26:57,902 after I clamp. 659 00:26:57,903 --> 00:26:59,738 - All good in here? - Yes. 660 00:26:59,739 --> 00:27:02,532 Uh, Dr. Whitaker was just explaining that with SBP, 661 00:27:02,533 --> 00:27:04,743 we would see a turbid appearance. 662 00:27:04,744 --> 00:27:07,579 However, he failed to mention that bloody fluid indicates 663 00:27:07,580 --> 00:27:09,623 either a traumatic tap or the likelihood 664 00:27:09,624 --> 00:27:11,207 of hepatocellular carcinoma, 665 00:27:11,208 --> 00:27:13,752 in which case, we would send for cytology. 666 00:27:13,753 --> 00:27:15,003 That is correct. 667 00:27:15,004 --> 00:27:16,838 Kid knows his shit. 668 00:27:16,839 --> 00:27:19,467 He's so smart. 669 00:27:22,553 --> 00:27:24,846 - Oh, hey. - Hey. 670 00:27:24,847 --> 00:27:26,890 How's it feel to officially be a doctor? 671 00:27:26,891 --> 00:27:29,017 It's pretty cool, actually. 672 00:27:29,018 --> 00:27:30,810 Uh, I get my first paycheck today. 673 00:27:30,811 --> 00:27:33,772 It's only for the first week, but I will take it. 674 00:27:33,773 --> 00:27:37,609 - How are the med students? - Um, Joy is pretty peculiar. 675 00:27:37,610 --> 00:27:40,570 And the other guy, Ogilvie, is really smart 676 00:27:40,571 --> 00:27:42,781 and likes to show people. 677 00:27:42,782 --> 00:27:45,283 - He's obnoxious. - Well... 678 00:27:45,284 --> 00:27:47,786 What he is, is your competition. 679 00:27:47,787 --> 00:27:50,831 - He's a gunner. - Yeah, right. 680 00:27:53,584 --> 00:27:55,835 He's not my competition. 681 00:27:55,836 --> 00:27:58,922 He's from out of state for a four-week sub-internship. 682 00:27:58,923 --> 00:28:01,591 You don't think he's angling for an emergency residency spot 683 00:28:01,592 --> 00:28:03,426 here next year? 684 00:28:03,427 --> 00:28:06,596 - I mean, even if he was... - What? 685 00:28:06,597 --> 00:28:10,518 He couldn't possibly compete with your gigantic brain? 686 00:28:14,105 --> 00:28:17,066 I'd step it up if I were you, Crash. 687 00:28:19,402 --> 00:28:22,320 Oh, she's still calling you that, huh? 688 00:28:22,321 --> 00:28:24,114 I don't really even care anymore. 689 00:28:24,115 --> 00:28:26,032 I mean, she still calls you Huckleberry. 690 00:28:26,033 --> 00:28:29,035 Yeah, but, you know, friends now, so... 691 00:28:29,036 --> 00:28:32,038 Friends don't give each other shitty nicknames. 692 00:28:32,039 --> 00:28:35,126 You think Huckleberry is a shitty nickname? 693 00:28:36,585 --> 00:28:37,836 No. 694 00:28:37,837 --> 00:28:39,838 No, H-Huckleberry is cute. 695 00:28:39,839 --> 00:28:41,172 Oh. 696 00:28:41,173 --> 00:28:43,842 It's cool. It's not like Crash. 697 00:28:43,843 --> 00:28:46,052 Oh, come on, man. Crash is pretty cool. 698 00:28:46,053 --> 00:28:48,304 It's, like, you know... Crash. 699 00:28:48,305 --> 00:28:50,974 It's got momentum. 700 00:28:50,975 --> 00:28:53,560 Dr. Javadi, Dr. Whitaker. 701 00:28:53,561 --> 00:28:55,478 Oh, I'm... I'm still a student doctor. 702 00:28:55,479 --> 00:28:57,313 Whitaker's the real deal now. 703 00:28:57,314 --> 00:28:59,315 Right. 704 00:28:59,316 --> 00:29:00,984 Welcome back. 705 00:29:00,985 --> 00:29:03,069 Thanks. Yeah, thank you. 706 00:29:03,070 --> 00:29:05,072 It's good to be back. 707 00:29:06,866 --> 00:29:10,994 Okay, I will be in exile on Triage Island 708 00:29:10,995 --> 00:29:12,871 with the rest of the drug addicts, 709 00:29:12,872 --> 00:29:15,206 if anyone needs me. 710 00:29:15,207 --> 00:29:17,667 - That was weird. - Very. 711 00:29:20,504 --> 00:29:21,547 What? 712 00:29:40,107 --> 00:29:41,817 Mm-hmm. 713 00:29:43,611 --> 00:29:45,987 Ooh! That's got to hurt. 714 00:29:45,988 --> 00:29:48,531 Dr. Langdon, Clint Hansen, his cousin Mona. 715 00:29:48,532 --> 00:29:49,741 How'd this happen? 716 00:29:51,118 --> 00:29:53,244 Bacon grease from a big griddle. 717 00:29:53,245 --> 00:29:54,913 Oh, looks like more than a splatter. 718 00:29:54,914 --> 00:29:56,706 Yeah, some fool poured it in the sink 719 00:29:56,707 --> 00:29:58,374 - while I was washing dishes. - I was so far away. 720 00:29:58,375 --> 00:29:59,959 You reached for the soap without even looking. 721 00:29:59,960 --> 00:30:01,294 You couldn't hear me? 722 00:30:01,295 --> 00:30:02,879 No, not with the water running. 723 00:30:02,880 --> 00:30:04,714 Who the hell pours bacon grease down the drain? 724 00:30:04,715 --> 00:30:06,549 - There's a jar under the sink. - You could have told me that. 725 00:30:06,550 --> 00:30:08,218 You're a guest in my house, 726 00:30:08,219 --> 00:30:09,803 and now you've totally fucked up my plumbing. 727 00:30:09,804 --> 00:30:11,596 Okay, how about we focus on treating this burn? 728 00:30:11,597 --> 00:30:13,223 I'll grab the LET. 729 00:30:13,224 --> 00:30:14,557 We're gonna need to trim off some of the dead skin 730 00:30:14,558 --> 00:30:15,892 so it doesn't get infected. 731 00:30:15,893 --> 00:30:17,477 I'm in charge of the brunch buffet. 732 00:30:17,478 --> 00:30:19,395 - Can you make it fast? - Sure. Yeah, we... 733 00:30:19,396 --> 00:30:21,356 This one came in by car. All I got is a name. 734 00:30:21,357 --> 00:30:22,941 - Orlando Diaz. - What's the story? 735 00:30:22,942 --> 00:30:24,400 He tripped over some rebar. 736 00:30:24,401 --> 00:30:25,902 - Tripped or fainted? - I don't know. 737 00:30:25,903 --> 00:30:28,238 Orlando, open your eyes. 738 00:30:28,239 --> 00:30:29,906 - Hit his head? - I guess. 739 00:30:29,907 --> 00:30:31,741 - Why didn't you call 911? - He wouldn't let me. 740 00:30:31,742 --> 00:30:33,368 He was talking... not so much now. 741 00:30:33,369 --> 00:30:35,745 Orlando. Mr. Diaz. 742 00:30:35,746 --> 00:30:37,455 - Jesus. - He drunk? 743 00:30:37,456 --> 00:30:38,706 No. Ketones on his breath. 744 00:30:38,707 --> 00:30:40,291 - He diabetic? - I don't know. 745 00:30:40,292 --> 00:30:42,377 Altered head trauma, possible DKA. 746 00:30:42,378 --> 00:30:43,796 Call it overhead. 747 00:30:45,548 --> 00:30:48,591 Code trauma tier one now. Code trauma tier one now. 748 00:30:48,592 --> 00:30:51,594 Dr. Whitaker, your assessment was spot-on. 749 00:30:51,595 --> 00:30:54,097 Your Alzheimer's widow definitely needs placement. 750 00:30:54,098 --> 00:30:55,974 Do you have a nursing home that can take her today? 751 00:30:55,975 --> 00:30:57,517 I wish. 752 00:30:57,518 --> 00:30:59,519 Medicare requires a three-day hospitalization 753 00:30:59,520 --> 00:31:01,020 before they'll approve that. 754 00:31:01,021 --> 00:31:02,981 I don't really have a reason to admit her. 755 00:31:02,982 --> 00:31:05,775 But I do. She's gravely disabled. 756 00:31:05,776 --> 00:31:08,111 I'll put her on a cycle. We'll make it work. 757 00:31:08,112 --> 00:31:10,780 Thank you, Caleb. 758 00:31:10,781 --> 00:31:13,116 Yeah, you have a few moments, Michael? 759 00:31:13,117 --> 00:31:15,118 Actually, I do not. 760 00:31:15,119 --> 00:31:18,288 But once I get things settled here, I will come and find you. 761 00:31:18,289 --> 00:31:19,290 Okay. 762 00:31:21,458 --> 00:31:23,334 Dr. Robby, Dylan just talked to the girlfriend. 763 00:31:23,335 --> 00:31:24,752 Robby! 764 00:31:24,753 --> 00:31:26,671 You'll have to fill me in in a minute. 765 00:31:26,672 --> 00:31:28,214 - What do you got? - AMS. 766 00:31:28,215 --> 00:31:30,008 I can't tell if he fell 'cause he was altered 767 00:31:30,009 --> 00:31:31,968 or he's altered because he fell. 768 00:31:31,969 --> 00:31:35,430 - There's ketones on his breath. - Okay, I got this. Thank you. 769 00:31:35,431 --> 00:31:37,223 All right, I guess it's just us. 770 00:31:37,224 --> 00:31:39,142 Um, what did the girlfriend have to say? 771 00:31:39,143 --> 00:31:41,436 Well, Gina seems a little confused and on edge by this, 772 00:31:41,437 --> 00:31:43,271 but I'm not suspicious about abuse on her part. 773 00:31:43,272 --> 00:31:44,814 What about Kylie's father? 774 00:31:44,815 --> 00:31:46,357 Well, I'm a social worker, not a mind reader. 775 00:31:46,358 --> 00:31:47,567 I need to speak with him. 776 00:31:47,568 --> 00:31:49,235 Yeah, he's supposed to come in. 777 00:31:49,236 --> 00:31:51,279 If he doesn't, looks pretty guilty. 778 00:31:51,280 --> 00:31:53,489 Let's not jump to any conclusions just yet. 779 00:31:53,490 --> 00:31:54,908 I'm not jumping. 780 00:31:54,909 --> 00:31:58,036 I'm just saying, if this dude doesn't show up, 781 00:31:58,037 --> 00:32:00,163 hell, I'll go find him myself. 782 00:32:00,164 --> 00:32:02,665 Kidding. 783 00:32:02,666 --> 00:32:05,251 I will speak to Kylie before her dad gets here. 784 00:32:05,252 --> 00:32:07,170 If he shows up. 785 00:32:07,171 --> 00:32:08,922 Yes. 786 00:32:08,923 --> 00:32:11,507 That's definitely ketones. We need to do an Accu-Check. 787 00:32:11,508 --> 00:32:13,217 I'm on it. He's tachy at 124. 788 00:32:13,218 --> 00:32:16,179 Pulse ox 97. BP's 106/72. 789 00:32:16,180 --> 00:32:18,890 - Lung sliding bilaterally. - Good bowel sounds. 790 00:32:18,891 --> 00:32:20,558 Abdomen is soft, non-tender. 791 00:32:20,559 --> 00:32:23,019 How do you know it's non-tender? 792 00:32:23,020 --> 00:32:25,063 Because I didn't see any grimacing. 793 00:32:25,064 --> 00:32:27,774 He's altered. He didn't even flinch for the IV start. 794 00:32:27,775 --> 00:32:30,652 - I meant to say non-rigid. - Huh. 795 00:32:30,653 --> 00:32:32,236 Toes down... going bilaterally. 796 00:32:32,237 --> 00:32:33,738 No evidence of upper motor neuron deficit. 797 00:32:33,739 --> 00:32:35,114 Good. 798 00:32:35,115 --> 00:32:37,075 - E-FAST negative. - How can I assist? 799 00:32:37,076 --> 00:32:39,911 You can check in with Dr. McKay or Dr. Santos. 800 00:32:39,912 --> 00:32:41,579 If you don't mind, I'd like to observe, 801 00:32:41,580 --> 00:32:43,247 learn how you handle things. 802 00:32:43,248 --> 00:32:45,083 Whoa, blood sugar's critical high... it's over 500. 803 00:32:45,084 --> 00:32:46,501 Ding, ding, ding, ding. 804 00:32:46,502 --> 00:32:48,294 Sounds like diabetic ketoacidosis. 805 00:32:48,295 --> 00:32:50,088 We need to start treating that, then right to CT 806 00:32:50,089 --> 00:32:51,923 to rule out an intracranial bleed. 807 00:32:51,924 --> 00:32:53,841 Severe respiratory distress coming in... ETA three minutes. 808 00:32:53,842 --> 00:32:55,301 - I'll stick them in Trauma 1. - Yep. 809 00:32:55,302 --> 00:32:57,095 Would you like me to take that? 810 00:32:57,096 --> 00:32:58,471 Yes, please. Thank you. 811 00:32:58,472 --> 00:33:00,306 This guy needs an insulin drip, right? 812 00:33:00,307 --> 00:33:01,724 0.1 units per kilo? 813 00:33:01,725 --> 00:33:03,559 No, not without knowing his potassium. 814 00:33:03,560 --> 00:33:05,561 Insulin causes an intracellular shift. 815 00:33:05,562 --> 00:33:07,563 And if the potassium is under 3.5, the drip would kill him. 816 00:33:07,564 --> 00:33:08,940 That is very true. 817 00:33:08,941 --> 00:33:10,733 We can start with lactated ringers. 818 00:33:10,734 --> 00:33:12,485 1 liter per hour until we get the results 819 00:33:12,486 --> 00:33:14,237 from the chem-7 and the VBG. 820 00:33:14,238 --> 00:33:15,738 Why is he in DKA? 821 00:33:15,739 --> 00:33:17,115 Maybe he's not taking enough insulin. 822 00:33:17,116 --> 00:33:18,574 More frequently, a precipitating event 823 00:33:18,575 --> 00:33:20,076 can be identified, such as pneumonia, 824 00:33:20,077 --> 00:33:21,619 urinary tract infection, stroke, 825 00:33:21,620 --> 00:33:23,121 myocardial infarction, pancreatitis. 826 00:33:23,122 --> 00:33:24,956 Yeah, we always check for those. 827 00:33:24,957 --> 00:33:28,376 They're part of the standard order set, right, Dr. Mohan? 828 00:33:36,176 --> 00:33:38,136 He's from crazy Grandpa Jimmy's side. 829 00:33:38,137 --> 00:33:39,929 She's from my grandfather's brother's side. 830 00:33:39,930 --> 00:33:41,848 Grandpa Ricky is still a psycho. 831 00:33:41,849 --> 00:33:44,434 - Clearly runs in the family. - Well, hold on. 832 00:33:44,435 --> 00:33:47,562 Your grandparents are Ricky and Jimmy Hansen... 833 00:33:47,563 --> 00:33:49,230 from the racing family? 834 00:33:49,231 --> 00:33:50,773 Unfortunately. 835 00:33:50,774 --> 00:33:52,900 I got something that needs attention. 836 00:33:52,901 --> 00:33:54,611 Not another baby. 837 00:33:56,572 --> 00:33:58,407 Sorry. Excuse me. 838 00:34:00,784 --> 00:34:02,660 This is Mr. Randall. 839 00:34:02,661 --> 00:34:05,371 He's been erect for the last eight hours. 840 00:34:05,372 --> 00:34:07,123 Should have gone down by now, right? 841 00:34:07,124 --> 00:34:08,541 It happens. 842 00:34:08,542 --> 00:34:10,043 It's a good thing you came in, Mr. Randall. 843 00:34:10,044 --> 00:34:11,544 I'll take him right back. 844 00:34:11,545 --> 00:34:13,379 Do you mind finishing up with the Bickersons? 845 00:34:13,380 --> 00:34:14,630 I'd rather not. 846 00:34:14,631 --> 00:34:17,133 - So, Mr. Randall... - Ian. 847 00:34:17,134 --> 00:34:19,385 Ian, did you take anything 848 00:34:19,386 --> 00:34:21,637 that might have led to this condition? 849 00:34:21,638 --> 00:34:24,640 I used an ED injection... two, actually. 850 00:34:24,641 --> 00:34:28,394 I gave myself a second shot, one on each side. 851 00:34:28,395 --> 00:34:31,606 So double the recommended dosage? 852 00:34:31,607 --> 00:34:33,399 Uh... 853 00:34:33,400 --> 00:34:35,693 It's our wedding anniversary. 854 00:34:35,694 --> 00:34:37,612 Ah. Is this a big one? 855 00:34:37,613 --> 00:34:40,281 The anniversary, is it important? 856 00:34:40,282 --> 00:34:42,867 Like, uh, significant? Like, a milestone or... 857 00:34:42,868 --> 00:34:44,660 - It's our 20th. - Oh, nice. 858 00:34:44,661 --> 00:34:47,955 Well done. Congratulations. 859 00:34:47,956 --> 00:34:49,332 Glucose 521. 860 00:34:49,333 --> 00:34:50,708 Sodium 129. 861 00:34:50,709 --> 00:34:52,668 Potassium's 3.7. 862 00:34:52,669 --> 00:34:54,337 Chloride's 97. 863 00:34:54,338 --> 00:34:56,297 - Bicarb's 8. - Meaning? 864 00:34:56,298 --> 00:34:59,509 We can start the insulin drip and add 20 of K to each liter. 865 00:34:59,510 --> 00:35:01,719 Big anion gap of 24. 866 00:35:01,720 --> 00:35:03,096 It should be under 10. 867 00:35:03,097 --> 00:35:04,847 We follow it to assess progress. 868 00:35:04,848 --> 00:35:07,517 Actually, the 2024 international guidelines 869 00:35:07,518 --> 00:35:09,435 state that anion gap should not be used, 870 00:35:09,436 --> 00:35:11,687 as they can be misleading in the presence 871 00:35:11,688 --> 00:35:14,524 of hyperchloremic metabolic acidosis. 872 00:35:14,525 --> 00:35:17,026 I-I recently had a case in the ICU. 873 00:35:17,027 --> 00:35:19,570 VBG is back... pH of 6.97. 874 00:35:19,571 --> 00:35:20,696 Normal's 7.4. 875 00:35:20,697 --> 00:35:22,281 What causes the acidemia? 876 00:35:22,282 --> 00:35:24,242 Without insulin, the body can't use glucose, 877 00:35:24,243 --> 00:35:26,244 so it breaks down fat-producing ketones, 878 00:35:26,245 --> 00:35:28,538 leading to severe acidosis, which can cause cardiac arrest. 879 00:35:28,539 --> 00:35:30,873 But the hyperglycemia causes the body to excrete more water 880 00:35:30,874 --> 00:35:33,042 and electrolytes, leading to severe dehydration, 881 00:35:33,043 --> 00:35:34,919 cardiac and renal dysfunction. 882 00:35:34,920 --> 00:35:36,671 Insulin drip, fluids with KCL, 883 00:35:36,672 --> 00:35:39,549 capillary glucose every hour, chem-7 every four hours. 884 00:35:39,550 --> 00:35:41,175 ICU is gonna want a double lumen midline, too. 885 00:35:41,176 --> 00:35:42,426 I can do it. 886 00:35:42,427 --> 00:35:43,886 - 61/2 gloves. - 71/2 gloves. 887 00:35:43,887 --> 00:35:45,263 Can I just say, we evaluate our students 888 00:35:45,264 --> 00:35:46,889 not only on their fund of knowledge 889 00:35:46,890 --> 00:35:48,724 and on their procedural mastery, 890 00:35:48,725 --> 00:35:50,268 but, also, maybe more importantly, 891 00:35:50,269 --> 00:35:52,186 on their skills as team players? 892 00:35:52,187 --> 00:35:54,856 - He can do it. - She... she can do it. 893 00:35:54,857 --> 00:35:56,649 Otero, will you update everyone? 894 00:35:56,650 --> 00:35:58,985 Barry Mitchell. Eating breakfast at Pamela's. 895 00:35:58,986 --> 00:36:00,653 Sudden onset respiratory distress. 896 00:36:00,654 --> 00:36:02,113 Some stridor. 897 00:36:02,114 --> 00:36:04,073 Decent pulse ox but trouble speaking. 898 00:36:04,074 --> 00:36:06,075 - And they tried the Heimlich? - Three times. 899 00:36:06,076 --> 00:36:08,745 Any history of asthma? 900 00:36:10,497 --> 00:36:12,456 - Set up for intubation. - Agreed. 901 00:36:12,457 --> 00:36:15,084 Okay, sir, scoot across. 902 00:36:15,085 --> 00:36:17,837 Always a good sign when they slide over on their own. 903 00:36:17,838 --> 00:36:20,423 Came from a diner with an upper-airway obstruction. 904 00:36:20,424 --> 00:36:22,133 Didn't clear with abdominal thrusts. 905 00:36:22,134 --> 00:36:23,426 We got to take a look. 906 00:36:23,427 --> 00:36:25,761 Heart rate's 118. Pulse ox 96. 907 00:36:25,762 --> 00:36:27,597 Mr. Mitchell, we're gonna sedate you 908 00:36:27,598 --> 00:36:29,140 to look down your throat, okay? 909 00:36:29,141 --> 00:36:31,017 Draw up ketamine and rocuronium. 910 00:36:31,018 --> 00:36:33,436 What about ketamine only? 911 00:36:33,437 --> 00:36:35,313 No, we need full paralysis 912 00:36:35,314 --> 00:36:37,231 for a successful first-pass intubation. 913 00:36:37,232 --> 00:36:39,817 Might not need an intubation if it's just a foreign body. 914 00:36:39,818 --> 00:36:41,444 We can't assume that. 915 00:36:41,445 --> 00:36:43,487 It could be subglottic stenosis, epiglottitis. 916 00:36:43,488 --> 00:36:45,324 I got ketamine and roc. 917 00:36:47,159 --> 00:36:50,119 Ketamine only, 80 milligrams. 918 00:36:50,120 --> 00:36:54,165 In that case, I'll leave this in your capable hands. 919 00:36:54,166 --> 00:36:58,461 Cetacaine spray and a Yankauer, please. 920 00:36:58,462 --> 00:37:01,130 30 minutes ago, I told you I'd never been sued. 921 00:37:01,131 --> 00:37:03,341 - I'd like to keep it that way. - Mm. 922 00:37:05,135 --> 00:37:07,678 Instead of showing up here, you'd think 923 00:37:07,679 --> 00:37:10,348 he'd put an eight-hour hard-on to good use. 924 00:37:10,349 --> 00:37:12,475 Well, it is a medical emergency. 925 00:37:12,476 --> 00:37:14,393 If left untreated, priapism can cause 926 00:37:14,394 --> 00:37:16,020 permanent damage to the penis 927 00:37:16,021 --> 00:37:17,688 and erectile dysfunction forever. 928 00:37:17,689 --> 00:37:19,357 Thanks for the PSA. 929 00:37:19,358 --> 00:37:21,150 Pharmacist mixed up phenylephrine. 930 00:37:21,151 --> 00:37:23,736 10 cc's of 100 mikes per cc. 931 00:37:23,737 --> 00:37:25,154 Great. That's the maximum dose. 932 00:37:25,155 --> 00:37:26,530 Sterile bolus saline. 933 00:37:26,531 --> 00:37:27,990 You might need to refill 934 00:37:27,991 --> 00:37:29,909 since they'll be flushing over and over again. 935 00:37:29,910 --> 00:37:32,370 Hold out the empty basin to catch whatever they pull out. 936 00:37:32,371 --> 00:37:34,330 - Got it? - I think so. 937 00:37:34,331 --> 00:37:35,998 Holler if you need me. 938 00:37:35,999 --> 00:37:38,334 - How we doing? - Oh, he's out from Versed. 939 00:37:38,335 --> 00:37:40,962 Did a lidocaine block to the dorsal penile nerves 940 00:37:40,963 --> 00:37:43,089 - at 10 and 2. - Yeah, he's ready. 941 00:37:43,090 --> 00:37:44,799 Excellent. 942 00:37:44,800 --> 00:37:47,802 Enter the dorsal side to hit the corpus cavernosum. 943 00:37:47,803 --> 00:37:49,011 I'll hold the glans. 944 00:37:49,012 --> 00:37:51,973 - How deep? - 2 centimeters. 945 00:37:51,974 --> 00:37:53,892 Ah, now aspirate. 946 00:37:56,395 --> 00:38:00,356 You guys do this, like, every day? 947 00:38:00,357 --> 00:38:02,400 If we're lucky. 948 00:38:02,401 --> 00:38:03,609 Come here. 949 00:38:06,697 --> 00:38:10,032 Okay, let's lay him down and take a look. 950 00:38:10,033 --> 00:38:11,867 Okay. 951 00:38:18,208 --> 00:38:21,043 Good view of the epiglottis. 952 00:38:21,044 --> 00:38:24,213 And mystery solved. 953 00:38:24,214 --> 00:38:27,425 This is what you get for eating broccoli for breakfast. 954 00:38:27,426 --> 00:38:29,427 Get a good grip on it. 955 00:38:29,428 --> 00:38:30,470 Okay. 956 00:38:32,431 --> 00:38:34,349 Okay. 957 00:38:39,730 --> 00:38:42,648 I can see why the Heimlich didn't work. 958 00:38:42,649 --> 00:38:44,526 Rotate a little bit. 959 00:38:47,904 --> 00:38:50,072 Voilà! 960 00:38:50,073 --> 00:38:52,825 That is why you give ketamine alone, 961 00:38:52,826 --> 00:38:54,452 because if we gave a paralytic, 962 00:38:54,453 --> 00:38:57,705 we would have to intubate and ventilate for an hour. 963 00:38:59,458 --> 00:39:02,043 All right, this guy is going to Westbridge for surgery. 964 00:39:02,044 --> 00:39:04,211 Trauma 1 will move out shortly. 965 00:39:04,212 --> 00:39:06,672 And our Alzheimer's widow, Evelyn Bostick, 966 00:39:06,673 --> 00:39:08,799 can see her husband in the viewing room. 967 00:39:08,800 --> 00:39:10,343 God bless her. 968 00:39:10,344 --> 00:39:12,470 My CT results back on Michael Williams? 969 00:39:12,471 --> 00:39:14,472 Not yet... neither are the labs on our little girl, Kylie. 970 00:39:14,473 --> 00:39:16,015 That's not me. 971 00:39:16,016 --> 00:39:17,933 I did, however, get a few things back 972 00:39:17,934 --> 00:39:19,268 on our abandoned baby Jane Doe. 973 00:39:19,269 --> 00:39:20,519 Still not me. 974 00:39:20,520 --> 00:39:22,104 I'll take those. 975 00:39:22,105 --> 00:39:24,482 Just keeping you informed. 976 00:39:24,483 --> 00:39:26,359 Yep. 977 00:39:26,360 --> 00:39:28,611 Okay. 978 00:39:28,612 --> 00:39:31,864 We're just trying to get her upstairs. 979 00:39:31,865 --> 00:39:34,450 Okay. All right, got it. 980 00:39:34,451 --> 00:39:37,620 Superbaby's urine dipped negative 0 WBCs. 981 00:39:37,621 --> 00:39:39,622 Respiratory panel is positive for rhinovirus, 982 00:39:39,623 --> 00:39:40,998 giving us a benign source. 983 00:39:40,999 --> 00:39:42,666 Procalcitonin and CRP are pending. 984 00:39:42,667 --> 00:39:44,752 Now peds is saying they want a urine tox screen 985 00:39:44,753 --> 00:39:46,837 and an HIV antigen before they'll take her. 986 00:39:46,838 --> 00:39:48,714 That sounds excessive. 987 00:39:48,715 --> 00:39:50,758 I feel like they're just trying to keep her down here. 988 00:39:50,759 --> 00:39:52,468 Can you blame them? 989 00:39:52,469 --> 00:39:54,595 Never met a peds nurse yet that wasn't a little wacky. 990 00:39:54,596 --> 00:39:56,514 You know what 12 hours of crying babies does 991 00:39:56,515 --> 00:39:57,848 to a person's psyche? 992 00:39:57,849 --> 00:39:59,308 I almost went into peds. 993 00:39:59,309 --> 00:40:00,976 Good thing you didn't, trust me. 994 00:40:00,977 --> 00:40:03,104 Too long up there, you're cuckoo for Cocoa Puffs. 995 00:40:03,105 --> 00:40:05,773 - You are very punchy today. - Punchy's my new baseline. 996 00:40:05,774 --> 00:40:07,942 Anyone even looks at me funny, I'm taking them out, 997 00:40:07,943 --> 00:40:09,443 going right for the eyes. 998 00:40:09,444 --> 00:40:10,945 I'll eye-gouge you. 999 00:40:10,946 --> 00:40:12,738 Bet you never knew that about me. 1000 00:40:12,739 --> 00:40:14,407 I did not. 1001 00:40:14,408 --> 00:40:16,325 - Where is Dr. Al-Hashimi? - In North 5 with the priapism. 1002 00:40:16,326 --> 00:40:18,160 Ha! Better her than me. 1003 00:40:18,161 --> 00:40:20,162 I did not intend for that 1004 00:40:20,163 --> 00:40:22,164 to come off as sexual in any way. 1005 00:40:22,165 --> 00:40:23,999 And on that note, I'm gonna go check on Louie, 1006 00:40:24,000 --> 00:40:25,876 and then I'm gonna get some air in the ambulance bay. 1007 00:40:25,877 --> 00:40:27,753 So if anybody needs me, that's where I'll be. 1008 00:40:27,754 --> 00:40:29,213 Got it, Cap. 1009 00:40:29,214 --> 00:40:31,924 Ah, ah, ah! 1010 00:40:31,925 --> 00:40:34,718 It looks like some pus at the base of the lateral incisor. 1011 00:40:34,719 --> 00:40:37,012 We can drain that for you. 1012 00:40:37,013 --> 00:40:40,182 - Sounds like it's gonna hurt. - No, we'll numb you up. 1013 00:40:40,183 --> 00:40:42,768 Make sure you... you use the good stuff. 1014 00:40:42,769 --> 00:40:45,229 It'll be top shelf, Louie, I promise. 1015 00:40:45,230 --> 00:40:47,940 - How we doing in here? - Good. 1016 00:40:47,941 --> 00:40:50,025 Almost 4 liters out. 1017 00:40:50,026 --> 00:40:52,820 I already feel like a million bucks. 1018 00:40:52,821 --> 00:40:55,114 I just needed an oil change. 1019 00:40:55,115 --> 00:40:57,408 And I'm just about to drain an apical abscess. 1020 00:40:57,409 --> 00:40:59,368 That's what I'm talking about. 1021 00:40:59,369 --> 00:41:01,745 I feel like I'm having a spa day. 1022 00:41:03,540 --> 00:41:06,460 Keep it up, Whitaker. 1023 00:41:08,336 --> 00:41:10,212 How long does this take? 1024 00:41:10,213 --> 00:41:13,007 Up to an hour, sometimes two. 1025 00:41:13,008 --> 00:41:14,676 Mel, any suggestions? 1026 00:41:17,053 --> 00:41:19,597 Mel, you did these at the VA. 1027 00:41:19,598 --> 00:41:22,057 How can we facilitate detumescence? 1028 00:41:22,058 --> 00:41:25,978 Oh, um, sometimes massaging the shaft can help. 1029 00:41:25,979 --> 00:41:27,771 Oh, that's what she said. 1030 00:41:27,772 --> 00:41:31,734 You can break up the clots with massage or compression. 1031 00:41:31,735 --> 00:41:33,402 Got it. 1032 00:41:33,403 --> 00:41:34,737 You okay, Mel? 1033 00:41:34,738 --> 00:41:38,073 She's thinking about her deposition. 1034 00:41:38,074 --> 00:41:40,075 Just stick with the facts of the case, 1035 00:41:40,076 --> 00:41:41,619 and it always goes well. 1036 00:41:41,620 --> 00:41:43,746 I thought you said you hadn't been sued. 1037 00:41:43,747 --> 00:41:46,332 I haven't, but I know many colleagues who have. 1038 00:41:46,333 --> 00:41:49,043 I also know your work, Dr. King. 1039 00:41:49,044 --> 00:41:51,045 Your medical decision-making in the chart 1040 00:41:51,046 --> 00:41:52,796 is always extremely thorough. 1041 00:41:52,797 --> 00:41:54,590 Now we're getting somewhere. 1042 00:41:54,591 --> 00:41:57,010 First signs of flaccidity. 1043 00:42:00,222 --> 00:42:02,389 I don't know how I could ever thank you. 1044 00:42:02,390 --> 00:42:04,600 Mm, well, I think you just did. 1045 00:42:04,601 --> 00:42:06,644 You saved my life. 1046 00:42:06,645 --> 00:42:08,229 I didn't do anything. 1047 00:42:08,230 --> 00:42:09,897 This is what happens 1048 00:42:09,898 --> 00:42:12,274 when your wife starts being a Nazi about your diet. 1049 00:42:12,275 --> 00:42:14,568 She's got me keeping a food journal. 1050 00:42:14,569 --> 00:42:16,570 It's a good way to count calories. 1051 00:42:16,571 --> 00:42:18,322 What calories? 1052 00:42:18,323 --> 00:42:21,283 She insists I eat five servings of vegetables a day. 1053 00:42:21,284 --> 00:42:23,786 A rabbit don't even eat that many vegetables. 1054 00:42:23,787 --> 00:42:27,039 I ain't never choked on a Sausage Egg McMuffin. 1055 00:42:27,040 --> 00:42:29,625 I feel like I've been here all day. 1056 00:42:29,626 --> 00:42:31,293 It's actually only been 1057 00:42:31,294 --> 00:42:33,379 a couple of hours, Mrs. Bostick. 1058 00:42:33,380 --> 00:42:35,881 Well, where are we going now? 1059 00:42:35,882 --> 00:42:37,299 Um... 1060 00:42:37,300 --> 00:42:39,677 I thought you... 1061 00:42:39,678 --> 00:42:42,638 might like to see your husband. 1062 00:42:42,639 --> 00:42:45,891 Is Ethan still here? 1063 00:42:45,892 --> 00:42:47,309 - Yeah. - Oh. 1064 00:42:47,310 --> 00:42:49,896 Yes, yes, please. 1065 00:42:51,481 --> 00:42:52,941 Oh. 1066 00:42:55,819 --> 00:42:57,695 Oh... 1067 00:42:57,696 --> 00:43:01,282 this has been such a long day. 1068 00:43:01,283 --> 00:43:04,118 I'm so glad to see you resting, 1069 00:43:04,119 --> 00:43:07,079 but I think it's time. 1070 00:43:07,080 --> 00:43:09,164 We should be going home. 1071 00:43:09,165 --> 00:43:11,292 Uh, if... if we stop at the store on the way, 1072 00:43:11,293 --> 00:43:14,211 I can pick up what I need to make your shepherd's pie. 1073 00:43:14,212 --> 00:43:16,714 But not if it's hot out. 1074 00:43:16,715 --> 00:43:19,091 You know how I hate using the oven in the heat. 1075 00:43:21,177 --> 00:43:23,305 We're ready to leave now. 1076 00:43:30,937 --> 00:43:33,230 Dr. Robby, is this a good time? 1077 00:43:33,231 --> 00:43:36,734 That depends on what you have in mind, Dr. Al-Hashimi. 1078 00:43:36,735 --> 00:43:38,944 I'd hoped you would have viewed my ideas 1079 00:43:38,945 --> 00:43:41,238 for improving the department. 1080 00:43:41,239 --> 00:43:43,365 I was looking forward to getting some feedback from you. 1081 00:43:43,366 --> 00:43:45,367 Okay, well, I think the department functions 1082 00:43:45,368 --> 00:43:46,744 pretty well, all things considered. 1083 00:43:46,745 --> 00:43:48,370 I mean, we face the same challenges 1084 00:43:48,371 --> 00:43:49,872 that most emergency departments face. 1085 00:43:49,873 --> 00:43:51,832 Let's take generative AI, for instance. 1086 00:43:51,833 --> 00:43:54,293 ER doctors spend 40% of their time charting, 1087 00:43:54,294 --> 00:43:57,171 only 28% of their time at the bedside. 1088 00:43:57,172 --> 00:44:00,341 That doesn't sound accurate. 1089 00:44:00,342 --> 00:44:02,259 I've included the study in my packet. 1090 00:44:02,260 --> 00:44:03,677 Right. 1091 00:44:03,678 --> 00:44:05,346 And patient passports have been shown 1092 00:44:05,347 --> 00:44:06,722 to increase satisfaction 1093 00:44:06,723 --> 00:44:08,474 because they show the time required 1094 00:44:08,475 --> 00:44:10,309 - for each phase of the visit. - Yeah, I got it right here. 1095 00:44:10,310 --> 00:44:11,935 - What do you got? - Combative college kid. 1096 00:44:11,936 --> 00:44:13,228 Flipped out in the library, 1097 00:44:13,229 --> 00:44:15,189 Tased in the neck by campus security. 1098 00:44:15,190 --> 00:44:17,316 - 5 midazolam didn't touch him. - Will you get the fuck off me? 1099 00:44:17,317 --> 00:44:19,693 2901! 2901, motherfucker! 1100 00:44:19,694 --> 00:44:21,987 Get off! Fuck you, man! 1101 00:44:21,988 --> 00:44:24,573 Want to tell me some more about your ideas? 1102 00:44:24,574 --> 00:44:26,116 - Maybe later. - Let me out. 1103 00:44:26,117 --> 00:44:29,829 Let me the fuck out! Let me out! Let me out! 1104 00:44:29,830 --> 00:44:31,830 Sync and corrections by btsix www.addic7ed.com