1 00:00:07,785 --> 00:00:11,587 Sync and corrections by btsix www.addic7ed.com 2 00:00:13,924 --> 00:00:16,050 - Robby. - Yep. 3 00:00:16,051 --> 00:00:18,177 Cellulitis on the dorsum of the foot, 4 00:00:18,178 --> 00:00:20,179 now spreading up the leg. 5 00:00:20,180 --> 00:00:21,388 Hello, I'm Dr. Robby. 6 00:00:21,389 --> 00:00:23,099 Mind if I take a look? 7 00:00:23,100 --> 00:00:25,184 How long do you think this is gonna take? 8 00:00:25,185 --> 00:00:26,769 I took an early lunch break. 9 00:00:27,938 --> 00:00:29,105 I don't know that you're gonna 10 00:00:29,106 --> 00:00:30,981 make it back to work today. 11 00:00:30,982 --> 00:00:32,650 Erythema and warmth halfway up her knee. 12 00:00:32,651 --> 00:00:33,776 When did you see her, Donnie? 13 00:00:33,777 --> 00:00:36,278 He didn't. I did. 14 00:00:36,279 --> 00:00:37,780 - When? - About four hours ago. 15 00:00:37,781 --> 00:00:39,156 Gave her a dose of Keflex, 16 00:00:39,157 --> 00:00:40,699 told her to come back if things got worse. 17 00:00:40,700 --> 00:00:42,660 Things have definitely gotten worse. 18 00:00:42,661 --> 00:00:43,661 Dana, what's open? 19 00:00:43,662 --> 00:00:45,121 Trauma Two. 20 00:00:45,122 --> 00:00:46,622 Jesse, can you get her started in Trauma Two 21 00:00:46,623 --> 00:00:47,915 with some vanco and blood cultures, please? 22 00:00:47,916 --> 00:00:49,375 - Got it, boss. - I'm coming with. 23 00:00:49,376 --> 00:00:51,460 Suit yourself. 24 00:00:51,461 --> 00:00:54,755 Santos, you want in on Trauma Two? 25 00:00:54,756 --> 00:00:57,716 Too much charting, too little time. 26 00:00:57,717 --> 00:01:01,470 62-year-old male presents with chief complaint 27 00:01:01,471 --> 00:01:02,638 of left lower back pain. 28 00:01:02,639 --> 00:01:04,140 - Considered the diagnosis... - Hey. 29 00:01:04,141 --> 00:01:05,307 Oh, Jesus Christ. 30 00:01:05,308 --> 00:01:06,809 I'm charting. 31 00:01:06,810 --> 00:01:08,310 Sorry. 32 00:01:09,312 --> 00:01:10,855 Did I do something wrong? 33 00:01:10,856 --> 00:01:12,648 Besides interrupting me? Probably. 34 00:01:12,649 --> 00:01:14,233 Then I apologize. 35 00:01:14,234 --> 00:01:17,862 I know that second year of residency can be stressful, 36 00:01:17,863 --> 00:01:21,073 so if there's anything I can do to help you... 37 00:01:21,074 --> 00:01:22,324 like stop talking. 38 00:01:22,325 --> 00:01:24,660 - That's a great idea. - Yeah. 39 00:01:24,661 --> 00:01:28,831 Considered the diagnosis of aortic aneurysm or dissection. 40 00:01:28,832 --> 00:01:30,541 Got a new one for you in 13. 41 00:01:30,542 --> 00:01:33,169 I'm 20 charts behind, and the new attending 42 00:01:33,170 --> 00:01:34,336 is threatening to make me repeat 43 00:01:34,337 --> 00:01:35,504 a year if I can't catch up. 44 00:01:35,505 --> 00:01:36,714 Cry me a river. 45 00:01:36,715 --> 00:01:37,840 Old lady with bad abdominal pain. 46 00:01:37,841 --> 00:01:39,008 Somebody's gotta see her. 47 00:01:39,009 --> 00:01:40,509 Dana, please do me a solid. 48 00:01:40,510 --> 00:01:42,178 Holiday weekend. 49 00:01:42,179 --> 00:01:43,846 Westbridge is down, and our waiting room's on overdrive. 50 00:01:43,847 --> 00:01:45,181 I'm sorry, but your charting's gonna have to wait 51 00:01:45,182 --> 00:01:47,641 until after your shift. 52 00:01:47,642 --> 00:01:49,101 Ogilvie. 53 00:01:49,102 --> 00:01:52,980 Dr. Santos needs you to pick up a new patient in 13. 54 00:01:52,981 --> 00:01:56,859 Y-yes, ma'am. I'm on it. 55 00:01:56,860 --> 00:01:58,152 Chart while you supervise. 56 00:01:58,153 --> 00:01:59,945 Best I can do. 57 00:02:03,033 --> 00:02:05,951 Setting up a GoFundMe, that's what her generation does. 58 00:02:05,952 --> 00:02:07,870 That's how they support each other. 59 00:02:07,871 --> 00:02:08,913 Doctor, tell him. 60 00:02:08,914 --> 00:02:10,539 Your wife's right. 61 00:02:10,540 --> 00:02:12,875 Staying here's gonna cost more than we can afford. 62 00:02:12,876 --> 00:02:14,710 Look, I'm feeling better. 63 00:02:14,711 --> 00:02:16,253 I'll just leave. 64 00:02:16,254 --> 00:02:19,215 Mr. Diaz, even if your blood sugar is back to normal, 65 00:02:19,216 --> 00:02:21,175 we have to continue with the insulin drip 66 00:02:21,176 --> 00:02:23,093 until we clear the ketones from your bloodstream. 67 00:02:23,094 --> 00:02:25,638 Otherwise, you could experience electrolyte disorders, 68 00:02:25,639 --> 00:02:26,972 heart and kidney problems... 69 00:02:26,973 --> 00:02:30,517 Mi amor, your health is what matters. 70 00:02:30,518 --> 00:02:31,977 I'll make you a deal. 71 00:02:31,978 --> 00:02:33,812 You agree to stay on the insulin drip, 72 00:02:33,813 --> 00:02:35,314 and I'll go find our case manager 73 00:02:35,315 --> 00:02:37,233 to discuss cost-cutting options for your stay. 74 00:02:37,234 --> 00:02:38,609 Deal. 75 00:02:38,610 --> 00:02:40,903 And I'm sitting here making sure he doesn't move. 76 00:02:40,904 --> 00:02:42,988 - You should go look for Ana. - Mm-hmm. 77 00:02:42,989 --> 00:02:44,073 I can find her. 78 00:02:44,074 --> 00:02:45,700 BRB. 79 00:02:47,827 --> 00:02:49,036 Hanging vanco. 80 00:02:49,037 --> 00:02:50,579 What's vanco? 81 00:02:50,580 --> 00:02:53,082 A really strong antibiotic to kill skin germs. 82 00:02:53,083 --> 00:02:55,626 - Need a hand? - No. We got this. 83 00:02:55,627 --> 00:02:57,461 I'll just observe. 84 00:02:57,462 --> 00:02:58,921 Pretend I'm not even here. 85 00:02:58,922 --> 00:03:02,383 Let's send off a CBC, blood cultures, and CMP. 86 00:03:02,384 --> 00:03:05,427 And also a lactic acid, CRP, and calcitonin. 87 00:03:05,428 --> 00:03:07,513 Wait, she's not febrile, not tachycardic. 88 00:03:07,514 --> 00:03:09,139 No evidence of SIRS. 89 00:03:09,140 --> 00:03:11,100 - Yet. - What's SIRS? 90 00:03:11,101 --> 00:03:14,853 Systemic inflammatory response syndrome. 91 00:03:14,854 --> 00:03:15,938 Sorry. 92 00:03:15,939 --> 00:03:17,606 An exaggerated defense response. 93 00:03:17,607 --> 00:03:18,941 A what? 94 00:03:18,942 --> 00:03:20,985 Sometimes the human body can have an overreaction 95 00:03:20,986 --> 00:03:22,903 to an infection, so we're gonna monitor you 96 00:03:22,904 --> 00:03:24,530 to make sure that this does not progress. 97 00:03:27,284 --> 00:03:28,742 It's my boss. 98 00:03:28,743 --> 00:03:30,744 Sorry, I have to take this, or he's gonna fire me. 99 00:03:30,745 --> 00:03:32,830 OK. 100 00:03:32,831 --> 00:03:34,373 Hello. 101 00:03:34,374 --> 00:03:38,002 No, I'm still at the hospital. 102 00:03:38,003 --> 00:03:39,503 Being seen right now. 103 00:03:39,504 --> 00:03:40,796 Ow. 104 00:03:40,797 --> 00:03:43,966 No, they just stuck me with a needle. 105 00:03:43,967 --> 00:03:45,676 I don't know. 106 00:03:45,677 --> 00:03:48,137 You wanna talk to them? 107 00:03:48,138 --> 00:03:51,140 They're kind of busy right now. 108 00:03:51,141 --> 00:03:52,599 I know you are. 109 00:03:52,600 --> 00:03:54,059 Second IV's in. 110 00:03:54,060 --> 00:03:55,769 No, I'm not overreacting. 111 00:03:55,770 --> 00:03:58,105 My body's overreacting. 112 00:03:58,106 --> 00:04:00,107 Please... please don't fire me. 113 00:04:00,108 --> 00:04:01,400 I... 114 00:04:01,401 --> 00:04:02,860 This is Dr. Michael Robinavitch. 115 00:04:02,861 --> 00:04:04,903 I am the chief of emergency medicine at PTMC. 116 00:04:04,904 --> 00:04:06,864 If you fire her, she will sue you, 117 00:04:06,865 --> 00:04:09,867 and I will testify on her behalf. 118 00:04:09,868 --> 00:04:12,161 OK. 119 00:04:12,162 --> 00:04:14,080 Don't worry about it. We got you. 120 00:04:18,918 --> 00:04:20,878 Do you know how long Jackson's gonna be asleep? 121 00:04:20,879 --> 00:04:24,131 So there's no exact timeline with the sedatives we gave him, 122 00:04:24,132 --> 00:04:25,841 but he should be awake soon. 123 00:04:25,842 --> 00:04:27,509 Have you spoken to your parents yet? 124 00:04:27,510 --> 00:04:29,136 Yeah, they're on their way back from Columbus. 125 00:04:29,137 --> 00:04:31,597 Maybe you should take some time for yourself 126 00:04:31,598 --> 00:04:33,015 before they arrive. 127 00:04:33,016 --> 00:04:34,683 Yeah, cafeteria's right down the hall. 128 00:04:34,684 --> 00:04:35,726 Decent grilled cheese. 129 00:04:35,727 --> 00:04:36,852 Stay away from the tuna. 130 00:04:36,853 --> 00:04:38,896 Thanks, but I'm not hungry. 131 00:04:38,897 --> 00:04:41,607 You know, I just can't believe that a campus security guard 132 00:04:41,608 --> 00:04:43,067 tased my brother. 133 00:04:43,068 --> 00:04:44,568 Aren't they supposed to be helping students 134 00:04:44,569 --> 00:04:46,695 and protect them, not shoot at them? 135 00:04:46,696 --> 00:04:48,364 You have every right to be upset, 136 00:04:48,365 --> 00:04:51,033 and you should absolutely pursue accountability. 137 00:04:51,034 --> 00:04:53,327 But right now, we are taking care of your brother. 138 00:04:53,328 --> 00:04:56,163 And you should really take care of yourself. 139 00:04:56,164 --> 00:04:57,748 I... I have your number. 140 00:04:57,749 --> 00:05:00,125 I'll text you as soon as Jackson's LP results get back 141 00:05:00,126 --> 00:05:02,336 or if he wakes up. 142 00:05:02,337 --> 00:05:04,046 OK. 143 00:05:04,047 --> 00:05:05,381 OK, thank you. 144 00:05:05,382 --> 00:05:06,548 Of course. 145 00:05:06,549 --> 00:05:09,718 - Oh. - OK. 146 00:05:09,719 --> 00:05:11,387 Hypoactive bowel sounds. 147 00:05:11,388 --> 00:05:14,223 Soft, with moderate tenderness in the left lower quadrant. 148 00:05:14,224 --> 00:05:17,476 Mrs. Randolph, do you take Percocet every day? 149 00:05:17,477 --> 00:05:19,395 - No. - Huh. 150 00:05:19,396 --> 00:05:20,896 And what about your water intake, 'cause... 151 00:05:20,897 --> 00:05:22,398 Pause. 152 00:05:22,399 --> 00:05:24,566 Mrs. Randolph, you said you don't take Percocet every day, 153 00:05:24,567 --> 00:05:26,568 but when was the last time you took some? 154 00:05:26,569 --> 00:05:29,863 Maybe three or four times last week. 155 00:05:29,864 --> 00:05:33,492 Assisted living had a ballroom dance competition, 156 00:05:33,493 --> 00:05:35,702 - and I tweaked my back. - Mm. 157 00:05:35,703 --> 00:05:39,790 Any further questions, Ogilvie? 158 00:05:39,791 --> 00:05:43,502 When was your last bowel movement? 159 00:05:43,503 --> 00:05:46,004 I don't know. Sometime last week. 160 00:05:46,005 --> 00:05:49,007 I've been stopped up for at least five or six days. 161 00:05:49,008 --> 00:05:52,469 Mm-hmm, painkillers can cause constipation. 162 00:05:52,470 --> 00:05:53,762 I know. 163 00:05:53,763 --> 00:05:56,306 That's why they put me on a stool softener, 164 00:05:56,307 --> 00:05:57,641 and then they tried an enema. 165 00:05:57,642 --> 00:05:59,685 - And... and no movements? - Yep. 166 00:05:59,686 --> 00:06:02,980 And then they gave me this horrible drink. 167 00:06:02,981 --> 00:06:04,606 Mag citrate. 168 00:06:04,607 --> 00:06:05,649 Yeah. 169 00:06:05,650 --> 00:06:07,985 Mag citrate. 170 00:06:07,986 --> 00:06:09,278 Made me puke. 171 00:06:09,279 --> 00:06:11,488 All right, what's next, Ogilvie? 172 00:06:11,489 --> 00:06:13,532 Let's get you an X-ray and see how we can help you, 173 00:06:13,533 --> 00:06:14,533 Mrs. Randolph. 174 00:06:14,534 --> 00:06:16,452 - Thank you. - Yeah. 175 00:06:16,453 --> 00:06:18,620 Differential? 176 00:06:18,621 --> 00:06:20,289 Probable stool impaction. 177 00:06:20,290 --> 00:06:21,832 But with her history of cholecystectomy, 178 00:06:21,833 --> 00:06:23,625 it could be small bowel obstruction. 179 00:06:23,626 --> 00:06:24,710 Or worse. 180 00:06:24,711 --> 00:06:26,962 Sigmoid volvulus? 181 00:06:26,963 --> 00:06:29,339 But that's a surgical emergency. 182 00:06:29,340 --> 00:06:30,883 Wouldn't she have tons of pain? 183 00:06:30,884 --> 00:06:34,387 Not always, especially when you're in your 80s. 184 00:06:39,976 --> 00:06:41,643 I am getting concerned. 185 00:06:41,644 --> 00:06:44,188 This is a millimeter past the line. 186 00:06:44,189 --> 00:06:45,564 Or my line was sloppy. 187 00:06:45,565 --> 00:06:47,149 - Any increase in pain? - Oh. 188 00:06:47,150 --> 00:06:49,693 OK, sorry. Let's try four morphine. 189 00:06:49,694 --> 00:06:51,028 White count's only 10,000. 190 00:06:51,029 --> 00:06:53,071 It'd be over 12,000 for SIRS. 191 00:06:53,072 --> 00:06:54,865 There are other criteria. 192 00:06:54,866 --> 00:06:56,325 Still afebrile. 193 00:06:56,326 --> 00:06:57,910 Did you ask about past history of MRSA? 194 00:06:57,911 --> 00:06:59,703 Not specifically, but she's never been hospitalized. 195 00:06:59,704 --> 00:07:01,205 Any evidence of an immunocompromised state? 196 00:07:01,206 --> 00:07:02,456 - No, she's healthy. - Steroid use? 197 00:07:02,457 --> 00:07:03,457 Never. 198 00:07:03,458 --> 00:07:05,000 Maximum heart rate's only 89. 199 00:07:05,001 --> 00:07:06,168 Is that OK? 200 00:07:06,169 --> 00:07:08,253 That's good, very good. 201 00:07:08,254 --> 00:07:09,254 Stay with her. 202 00:07:09,255 --> 00:07:10,839 Monitor her closely. 203 00:07:10,840 --> 00:07:12,674 If there's any change in her condition, come find me. 204 00:07:12,675 --> 00:07:13,843 I mean any change. 205 00:07:16,930 --> 00:07:19,598 Roxie Hamler, 42, home hospice patient 206 00:07:19,599 --> 00:07:21,183 with a history of lung cancer. 207 00:07:21,184 --> 00:07:24,394 New-onset tonic-clonic seizure with right lower leg pain. 208 00:07:24,395 --> 00:07:26,522 She hit it on the coffee table. 209 00:07:28,191 --> 00:07:29,983 Initially nonverbal, now coming around. 210 00:07:29,984 --> 00:07:31,485 That's normal after a seizure. 211 00:07:31,486 --> 00:07:33,070 - Hi, I'm Dr. Al-Hashimi. - Do you need a hand? 212 00:07:33,071 --> 00:07:34,863 - Nope, we got it. - She hit her head? 213 00:07:34,864 --> 00:07:36,031 No. I was there. 214 00:07:36,032 --> 00:07:37,658 - I caught her. - No IV? 215 00:07:37,659 --> 00:07:38,951 Couldn't get one in. 216 00:07:38,952 --> 00:07:40,452 Gave her four of IM versed for the seizure, 217 00:07:40,453 --> 00:07:41,995 - 25 of fent for the pain. - OK. 218 00:07:41,996 --> 00:07:43,872 - Dana, where to? - Trauma One. 219 00:07:43,873 --> 00:07:45,123 This way. 220 00:07:45,124 --> 00:07:47,459 Haven't seen you guys in a hot minute. 221 00:07:47,460 --> 00:07:50,045 Pickup from SCI Jones Forge. 222 00:07:50,046 --> 00:07:51,547 Was supposed to go to Westbridge but got 223 00:07:51,548 --> 00:07:52,548 diverted to you. 224 00:07:52,549 --> 00:07:53,966 Yeah, you and everybody else. 225 00:07:53,967 --> 00:07:55,551 Princess, I need you pivot to Central 9. 226 00:07:55,552 --> 00:07:56,885 Got it. 227 00:07:56,886 --> 00:07:58,554 Gus Varney, 54, victim of assault 228 00:07:58,555 --> 00:07:59,930 with diffuse blunt trauma. 229 00:07:59,931 --> 00:08:01,932 He's got bruising to the face, the right chest, 230 00:08:01,933 --> 00:08:03,600 10-centimeter laceration to the left arm. 231 00:08:03,601 --> 00:08:05,185 BP's 136 over 84, pulse 102, 232 00:08:05,186 --> 00:08:07,938 good sats, 95 on room air. 233 00:08:07,939 --> 00:08:09,648 How you feeling there, Mr. Varney? 234 00:08:09,649 --> 00:08:11,149 - Fucking hurts. - Where? 235 00:08:11,150 --> 00:08:13,485 - Everywhere. - I am Dr. Robby. 236 00:08:13,486 --> 00:08:14,778 This is Dr. Al-Hashimi. 237 00:08:14,779 --> 00:08:16,238 We'll get you something for the pain. 238 00:08:16,239 --> 00:08:17,781 I've got a progressing cellulitis in Trauma Two. 239 00:08:17,782 --> 00:08:19,408 - Go. I'm good. - Thank you. 240 00:08:19,409 --> 00:08:21,451 Gus, do you know who hurt you? 241 00:08:21,452 --> 00:08:24,121 One of the fine, upstanding citizens of cell block 6. 242 00:08:24,122 --> 00:08:27,082 It's a deep lac through the muscle fascia. 243 00:08:27,083 --> 00:08:28,584 Can we get the cuffs off once he settles? 244 00:08:28,585 --> 00:08:29,751 Not a chance. 245 00:08:29,752 --> 00:08:31,712 Orange jumpsuit. He's cuffed for a reason. 246 00:08:31,713 --> 00:08:33,798 Let's go. 247 00:08:44,142 --> 00:08:47,686 OK, everyone, on my count. 248 00:08:47,687 --> 00:08:49,313 1, 2... 249 00:08:49,314 --> 00:08:50,815 Hold on. 250 00:08:54,402 --> 00:08:57,988 - Go. - 1, 2, 3. 251 00:08:57,989 --> 00:08:59,489 Mel, E-FAST. 252 00:08:59,490 --> 00:09:01,074 Whitaker, primary assessment. 253 00:09:01,075 --> 00:09:02,327 On it. 254 00:09:07,457 --> 00:09:08,624 Oh, weird bruise. 255 00:09:08,625 --> 00:09:09,958 Did he fall on something? 256 00:09:09,959 --> 00:09:11,460 Footprint, got stomped. 257 00:09:11,461 --> 00:09:13,379 Jesus. 258 00:09:14,631 --> 00:09:16,340 Is it... is that necessary? 259 00:09:16,341 --> 00:09:18,508 Afraid so. 260 00:09:18,509 --> 00:09:21,136 Airway's patent. 261 00:09:21,137 --> 00:09:23,889 Good lung sliding on the left. 262 00:09:23,890 --> 00:09:25,140 Sorry. 263 00:09:25,141 --> 00:09:26,391 Good on the right, too. 264 00:09:26,392 --> 00:09:27,809 How are the lungs? 265 00:09:27,810 --> 00:09:28,894 Good breath sounds. 266 00:09:28,895 --> 00:09:31,647 - No crepitus. - No effusion. 267 00:09:31,648 --> 00:09:34,941 Pulse ox 97, BP 118 over 78, heart rate 112. 268 00:09:34,942 --> 00:09:36,318 Tachycardic from the pain. 269 00:09:36,319 --> 00:09:37,861 Start with four of morphine. Repeat prn. 270 00:09:37,862 --> 00:09:38,862 On it. 271 00:09:38,863 --> 00:09:40,989 OK. Swollen mandible. 272 00:09:40,990 --> 00:09:42,407 Open your mouth for me, Gus. 273 00:09:42,408 --> 00:09:44,242 Little wider. 274 00:09:44,243 --> 00:09:45,494 Can't. 275 00:09:45,495 --> 00:09:46,870 Whitaker, you know the tongue blade exam? 276 00:09:46,871 --> 00:09:48,330 Yeah. 277 00:09:48,331 --> 00:09:49,790 It's a great test for mandible fracture. 278 00:09:49,791 --> 00:09:53,001 Gus, bite down hard on this for me. 279 00:09:55,213 --> 00:09:56,588 Sorry, Gus. 280 00:09:56,589 --> 00:09:58,715 Positive test. 281 00:09:58,716 --> 00:10:00,258 No free fluid in the belly. 282 00:10:00,259 --> 00:10:01,259 Any idea how long this will take? 283 00:10:01,260 --> 00:10:02,636 Too soon to tell. 284 00:10:02,637 --> 00:10:03,720 Whitaker, your assessment? 285 00:10:03,721 --> 00:10:05,180 Fractured left mandible, 286 00:10:05,181 --> 00:10:07,349 multiple rib fractures. 287 00:10:07,350 --> 00:10:08,850 Complex forearm lac. 288 00:10:08,851 --> 00:10:10,852 OK, log roll to the left, then pan scan. 289 00:10:10,853 --> 00:10:12,771 Where were you when Mr. Varney got assaulted? 290 00:10:12,772 --> 00:10:14,356 I just move 'em. I don't get to know 'em. 291 00:10:14,357 --> 00:10:16,108 CT's ready for us. 292 00:10:16,109 --> 00:10:17,943 Cycling the BP. 293 00:10:17,944 --> 00:10:20,612 OK, this redness is now a centimeter over that line, 294 00:10:20,613 --> 00:10:22,114 and this might be a bulla forming. 295 00:10:22,115 --> 00:10:23,407 The vanco takes a little time to work. 296 00:10:23,408 --> 00:10:26,952 Vital signs are still stable, 122 over 78. 297 00:10:26,953 --> 00:10:28,036 I got it. 298 00:10:28,037 --> 00:10:31,039 How are you feeling, Debbie? 299 00:10:31,040 --> 00:10:32,708 I'm feeling a little warm. 300 00:10:32,709 --> 00:10:34,126 That can happen with vanco. 301 00:10:34,127 --> 00:10:36,086 Thanks, man. 302 00:10:36,087 --> 00:10:39,131 Lactic acid 4.2. 303 00:10:39,132 --> 00:10:40,924 - OK. - What's wrong? 304 00:10:40,925 --> 00:10:43,635 That can be a sign of a more serious infection, 305 00:10:43,636 --> 00:10:45,262 but the good news is, we know what to do. 306 00:10:45,263 --> 00:10:48,974 Jesse, 2 liters of LR wide open. 307 00:10:48,975 --> 00:10:50,434 This is severe sepsis. 308 00:10:50,435 --> 00:10:52,060 I know, but at 7:00 AM, it was a simple cellulitis. 309 00:10:52,061 --> 00:10:53,687 Anyone would have given her Keflex. 310 00:10:53,688 --> 00:10:55,689 We could add carbapenem or Zosyn to broaden 311 00:10:55,690 --> 00:10:56,732 our antibiotic coverage. 312 00:10:56,733 --> 00:10:57,899 OK, I got it. 313 00:10:57,900 --> 00:10:59,317 Thanks. 314 00:10:59,318 --> 00:11:02,320 Jesse, 1 gram meropenem, 900 milligrams clinda, 315 00:11:02,321 --> 00:11:04,364 and page Dr. Garcia, please. 316 00:11:04,365 --> 00:11:05,782 What's going on? 317 00:11:05,783 --> 00:11:07,242 We're adding new antibiotics. 318 00:11:07,243 --> 00:11:08,660 It's serious? 319 00:11:08,661 --> 00:11:09,911 We wanna get ahead of it and make sure 320 00:11:09,912 --> 00:11:11,706 it doesn't become serious. 321 00:11:13,332 --> 00:11:14,416 What else can I do? 322 00:11:14,417 --> 00:11:15,584 I think you've done enough. 323 00:11:15,585 --> 00:11:16,753 You can go. 324 00:11:20,465 --> 00:11:21,465 All good in there? 325 00:11:21,466 --> 00:11:22,591 Code sepsis. 326 00:11:22,592 --> 00:11:23,925 Stable for the moment. 327 00:11:23,926 --> 00:11:25,260 How about you? 328 00:11:25,261 --> 00:11:27,596 Perfect vitals, E-FAST negative, off to CT. 329 00:11:27,597 --> 00:11:28,805 Good. 330 00:11:28,806 --> 00:11:30,432 Keep me posted. 331 00:11:30,433 --> 00:11:31,726 Ditto. 332 00:11:35,313 --> 00:11:36,772 How's it going? 333 00:11:36,773 --> 00:11:38,732 Great, if you ignore the hot mess in chairs. 334 00:11:38,733 --> 00:11:40,650 Any update on our little baby Jane Doe? 335 00:11:40,651 --> 00:11:42,652 Security's reviewing the CCTV from last night 336 00:11:42,653 --> 00:11:43,905 and this morning. 337 00:11:46,240 --> 00:11:47,699 You two kiss and make up yet? 338 00:11:47,700 --> 00:11:49,284 I think someone needs to smoke a cigarette. 339 00:11:49,285 --> 00:11:50,702 I'm trying to quit. 340 00:11:50,703 --> 00:11:52,245 Why don't you quit when I'm on my trip? 341 00:11:52,246 --> 00:11:53,497 Everyone's glad to have you back. 342 00:11:53,498 --> 00:11:56,000 - Asshole. - Well, not everyone. 343 00:11:57,460 --> 00:11:59,920 Hey, you want in on this betting board? 344 00:11:59,921 --> 00:12:02,881 Look, all you gotta do is pick why Westbridge went down, 345 00:12:02,882 --> 00:12:04,508 how many of their patients we're gonna get, 346 00:12:04,509 --> 00:12:06,134 and when they'll be back in action. 347 00:12:06,135 --> 00:12:08,887 Hey, already up to $500. 348 00:12:08,888 --> 00:12:11,223 Oh, ah, gotta pass. 349 00:12:11,224 --> 00:12:13,391 Still catching up on rehab bills. 350 00:12:13,392 --> 00:12:15,895 Respect. 351 00:12:17,480 --> 00:12:18,647 All right. 352 00:12:18,648 --> 00:12:20,315 What's the rules on me changing my bet? 353 00:12:20,316 --> 00:12:22,526 Only if you double down. 354 00:12:24,570 --> 00:12:25,988 Sinkhole. 355 00:12:28,658 --> 00:12:32,160 You watch too many movies, man. 356 00:12:32,161 --> 00:12:35,205 Considered the diagnosis of aortic aneurysm 357 00:12:35,206 --> 00:12:37,499 or dissection, but the point-of-care ultrasound was... 358 00:12:37,500 --> 00:12:40,043 You done want that gridlocked granny? 359 00:12:40,044 --> 00:12:41,962 Ordered an acute abdominal series 360 00:12:41,963 --> 00:12:43,213 to rule out obstruction. 361 00:12:43,214 --> 00:12:44,464 - Still waiting on the X-rays. - Great. 362 00:12:44,465 --> 00:12:45,590 Then you're free to treat our latest 363 00:12:45,591 --> 00:12:46,800 and greatest in South 16. 364 00:12:46,801 --> 00:12:49,594 Oh, come on, D, it's like, every time 365 00:12:49,595 --> 00:12:51,179 I get a moment to chart, I barely get 366 00:12:51,180 --> 00:12:53,890 - a sentence out before I get... - Interrupted? 367 00:12:53,891 --> 00:12:55,934 Sucks to be you, but trust me, it sucks worse 368 00:12:55,935 --> 00:12:57,853 for the poor gal in 16. 369 00:12:57,854 --> 00:13:00,605 I'm beginning to think you enjoy torturing me. 370 00:13:00,606 --> 00:13:02,732 Perks of the job. 371 00:13:02,733 --> 00:13:04,068 Ogilvie, let's go. 372 00:13:07,655 --> 00:13:10,408 Hold out your hand, Louie. 373 00:13:11,367 --> 00:13:13,034 A little shaky. 374 00:13:13,035 --> 00:13:14,035 No surprise. 375 00:13:14,036 --> 00:13:16,204 I've been here since 4:00 AM. 376 00:13:16,205 --> 00:13:17,581 We can get you something for that. 377 00:13:17,582 --> 00:13:18,915 Or I can take care of it myself 378 00:13:18,916 --> 00:13:21,042 if you cut me loose right now. 379 00:13:21,043 --> 00:13:23,211 Let's get Louie 50 milligrams of Librium. 380 00:13:23,212 --> 00:13:24,797 I'll put in the order. 381 00:13:26,883 --> 00:13:29,677 I will get it from the PDS. 382 00:13:33,222 --> 00:13:35,765 I'm already assigned as Louie's treating physician. 383 00:13:35,766 --> 00:13:38,226 Just makes sense that I put it in. 384 00:13:38,227 --> 00:13:40,313 Yeah. Yeah, yeah. Of course. 385 00:13:45,401 --> 00:13:47,903 Any changes with our septic waitress? 386 00:13:47,904 --> 00:13:49,029 Not yet. 387 00:13:49,030 --> 00:13:50,113 Wait, if you have a second, I... 388 00:13:50,114 --> 00:13:51,281 I don't. 389 00:13:51,282 --> 00:13:52,699 But the point-of-care ultrasound 390 00:13:52,700 --> 00:13:54,117 was negative for both. 391 00:13:54,118 --> 00:13:56,536 I considered the diagnosis of cauda equina syndrome. 392 00:13:56,537 --> 00:13:59,664 You writing the great American novel? 393 00:13:59,665 --> 00:14:01,625 Charting and supervising. 394 00:14:01,626 --> 00:14:02,667 It's Dana's idea. 395 00:14:02,668 --> 00:14:04,210 Who's the lucky patient? 396 00:14:04,211 --> 00:14:06,087 Unhoused woman with a bad cough. 397 00:14:06,088 --> 00:14:07,881 Ogilvie's all over it. 398 00:14:07,882 --> 00:14:09,257 OK. 399 00:14:09,258 --> 00:14:10,800 Say "eee." 400 00:14:10,801 --> 00:14:12,552 Eee. 401 00:14:12,553 --> 00:14:14,304 OK, deep breath in. 402 00:14:14,305 --> 00:14:16,264 Blow it out real hard. 403 00:14:16,265 --> 00:14:17,974 You haven't heard enough already? 404 00:14:17,975 --> 00:14:22,020 I need to check for wheezing with forced exhalation. 405 00:14:25,191 --> 00:14:27,150 Fucking cough is killing me. 406 00:14:27,151 --> 00:14:28,777 You smoke, Mrs. Yardley? 407 00:14:28,778 --> 00:14:30,946 Yeah, but I haven't been able to 408 00:14:30,947 --> 00:14:32,364 for a couple days 'cause of this cough. 409 00:14:32,365 --> 00:14:34,616 Mm. You ever consider quitting? 410 00:14:34,617 --> 00:14:38,079 You ever considered minding your own business? 411 00:14:41,958 --> 00:14:44,209 Well, the good news is that your test from earlier 412 00:14:44,210 --> 00:14:46,419 came back negative for both COVID and influenza, 413 00:14:46,420 --> 00:14:48,088 but I'm gonna order a chest X-ray 414 00:14:48,089 --> 00:14:49,631 so that we can see what's really going on in those lungs. 415 00:14:49,632 --> 00:14:51,592 You got time to let us do that? 416 00:14:52,843 --> 00:14:55,804 Where the fuck else you think I gotta be? 417 00:14:55,805 --> 00:14:57,597 And we're in. 418 00:14:57,598 --> 00:14:59,265 3 grams Keppra over 10 minutes. 419 00:14:59,266 --> 00:15:00,976 That'll prevent another seizure. 420 00:15:00,977 --> 00:15:02,060 Thank you. 421 00:15:02,061 --> 00:15:03,979 Nobody can ever get an IV in her. 422 00:15:03,980 --> 00:15:05,939 Yeah, midline cath is the way to go 423 00:15:05,940 --> 00:15:07,565 when your veins are shot. 424 00:15:07,566 --> 00:15:12,153 Tachy to 114, BP 94 over 70, sat 91 on 2 liters. 425 00:15:12,154 --> 00:15:14,864 - OK. - Cold. 426 00:15:14,865 --> 00:15:18,326 Is it possible to get her a blanket and some socks? 427 00:15:18,327 --> 00:15:20,078 Can do. 428 00:15:20,079 --> 00:15:22,664 When was she diagnosed? 429 00:15:22,665 --> 00:15:24,582 Seven years ago. 430 00:15:24,583 --> 00:15:27,168 Resected a lobe. 431 00:15:27,169 --> 00:15:29,713 Four cycles of platinum chemo gave us a couple good years, 432 00:15:29,714 --> 00:15:32,173 but then it spread to the bones. 433 00:15:32,174 --> 00:15:34,384 Has she had radiation therapy? 434 00:15:34,385 --> 00:15:36,845 Shrunk down the mets, but they're still there. 435 00:15:36,846 --> 00:15:38,847 That's why you're at hospice at home. 436 00:15:38,848 --> 00:15:39,848 Yep. 437 00:15:39,849 --> 00:15:41,850 I'm sorry. 438 00:15:41,851 --> 00:15:43,184 Me too. 439 00:15:43,185 --> 00:15:45,729 Ah. 440 00:15:45,730 --> 00:15:46,855 Sorry. 441 00:15:46,856 --> 00:15:48,398 You have kids? 442 00:15:48,399 --> 00:15:50,859 Yeah, two boys. 443 00:15:50,860 --> 00:15:52,944 15 and 9. 444 00:15:52,945 --> 00:15:54,529 My son's 12. 445 00:15:54,530 --> 00:15:56,740 Goes fast. 446 00:15:56,741 --> 00:15:58,575 Too fast. 447 00:15:58,576 --> 00:16:03,204 Swelling and bruising over the distal tibia. 448 00:16:03,205 --> 00:16:05,832 50 of fentanyl once her systolic's over 100. 449 00:16:05,833 --> 00:16:08,419 What do you usually take for pain? 450 00:16:11,380 --> 00:16:14,591 MS Contin, 30 milligrams twice a day, 451 00:16:14,592 --> 00:16:17,010 oxycodone for breakthrough, and sublingual Actiq 452 00:16:17,011 --> 00:16:20,805 for when it gets really bad. 453 00:16:20,806 --> 00:16:21,973 That's a lot. 454 00:16:21,974 --> 00:16:23,767 You handle her pain meds? 455 00:16:23,768 --> 00:16:24,893 Sometimes. 456 00:16:24,894 --> 00:16:26,728 All the time. 457 00:16:26,729 --> 00:16:29,606 A hospice nurse comes by a few times a week, 458 00:16:29,607 --> 00:16:31,983 but I was alone when she had the seizure. 459 00:16:31,984 --> 00:16:33,943 They told us that it could happen, 460 00:16:33,944 --> 00:16:35,570 but she couldn't breathe. 461 00:16:35,571 --> 00:16:39,991 And I freaked out, and I called 911. 462 00:16:39,992 --> 00:16:42,285 I'm so sorry. 463 00:16:42,286 --> 00:16:44,245 I'm sorry. 464 00:16:44,246 --> 00:16:46,082 I'm sorry. 465 00:16:55,716 --> 00:16:58,885 Due to your family income, you make too much 466 00:16:58,886 --> 00:17:00,762 to be eligible for either PENNIE 467 00:17:00,763 --> 00:17:03,181 or the hospital's "charity care." 468 00:17:03,182 --> 00:17:05,308 But we can't afford health-care premiums. 469 00:17:05,309 --> 00:17:08,103 It's unfortunately very common for people 470 00:17:08,104 --> 00:17:09,395 to fall between the cracks. 471 00:17:09,396 --> 00:17:11,523 It's an imperfect system. 472 00:17:11,524 --> 00:17:13,691 Can PTMC help with the costs in any way? 473 00:17:13,692 --> 00:17:16,152 We can offer financial assistance. 474 00:17:16,153 --> 00:17:17,987 You'd pay the same that Medicare 475 00:17:17,988 --> 00:17:19,614 and Medicaid would pay. 476 00:17:19,615 --> 00:17:20,782 How much is that? 477 00:17:20,783 --> 00:17:24,661 You pay 60%, we cover 40%. 478 00:17:24,662 --> 00:17:26,037 Thank you. 479 00:17:26,038 --> 00:17:27,915 Uh-huh. 480 00:17:29,125 --> 00:17:31,167 Where have you been? 481 00:17:31,168 --> 00:17:33,670 - How are you doing? - I'm sorry, mijita. 482 00:17:33,671 --> 00:17:36,798 You were being thoughtful, and I just blew up. 483 00:17:36,799 --> 00:17:39,676 Well, Ms. Noelle was just telling us that the hospital 484 00:17:39,677 --> 00:17:41,386 is gonna give us a big discount. 485 00:17:41,387 --> 00:17:44,055 We can knock 40% off your final bill. 486 00:17:44,056 --> 00:17:46,015 - That's great. - Mm-hmm. 487 00:17:46,016 --> 00:17:47,892 I stay here for a few days, 488 00:17:47,893 --> 00:17:50,146 my bill could be over $100,000, right? 489 00:17:51,814 --> 00:17:53,565 Yes, unfortunately. 490 00:17:53,566 --> 00:17:55,650 It could end up being lower, 491 00:17:55,651 --> 00:17:58,069 depending on your level of needed care. 492 00:17:58,070 --> 00:18:00,071 Or higher? 493 00:18:00,072 --> 00:18:04,033 So we would still have to pay $60,000? 494 00:18:04,034 --> 00:18:05,577 Which we don't have. 495 00:18:05,578 --> 00:18:07,787 He has to stay here to get better, right? 496 00:18:07,788 --> 00:18:10,165 - Yes. - No. 497 00:18:10,166 --> 00:18:11,416 Excuse me? 498 00:18:11,417 --> 00:18:13,626 I mean, not necessarily. 499 00:18:13,627 --> 00:18:16,296 Couldn't we just admit him to med-surg instead of ICU? 500 00:18:16,297 --> 00:18:18,131 Wouldn't that be a lot cheaper? 501 00:18:18,132 --> 00:18:20,258 Med-surg won't accept him with an insulin drip. 502 00:18:20,259 --> 00:18:22,051 Usually true. 503 00:18:22,052 --> 00:18:25,722 But let me talk to the charge nurse upstairs, and I'll... 504 00:18:25,723 --> 00:18:26,890 I'll see what she says. 505 00:18:26,891 --> 00:18:28,392 Thank you. 506 00:18:30,352 --> 00:18:32,395 Food poisoning in the hall's asking to leave, 507 00:18:32,396 --> 00:18:34,439 wants to take her kids to the water park. 508 00:18:34,440 --> 00:18:37,025 Those places are cesspools. 509 00:18:37,026 --> 00:18:38,526 Preaching to the choir. 510 00:18:38,527 --> 00:18:40,111 If she's feeling fine on Zofran, she's good to go. 511 00:18:40,112 --> 00:18:41,571 All right. 512 00:18:41,572 --> 00:18:43,531 Louie's in South 15. Meds are coming down. 513 00:18:43,532 --> 00:18:45,533 Another couple hours of monitoring, and he can broom. 514 00:18:45,534 --> 00:18:46,784 Straight to the liquor store. 515 00:18:46,785 --> 00:18:47,911 Don't pass "go." 516 00:18:47,912 --> 00:18:48,912 What about that clamshell case 517 00:18:48,913 --> 00:18:50,371 that went up... anything? 518 00:18:50,372 --> 00:18:52,373 Out of surgery, in recovery, still sedated. 519 00:18:52,374 --> 00:18:54,250 Good. Keep me posted on that. 520 00:18:54,251 --> 00:18:55,628 Will do. 521 00:18:57,796 --> 00:18:59,130 Three times in one day. 522 00:18:59,131 --> 00:19:00,715 To what do we owe the pleasure? 523 00:19:00,716 --> 00:19:02,425 I came down for a consult 524 00:19:02,426 --> 00:19:04,844 and to persuade Ahmad to start a new betting board. 525 00:19:04,845 --> 00:19:06,429 Why, is the Westbridge board full already? 526 00:19:06,430 --> 00:19:08,473 Mm-hmm, was gonna ask him to start one about you 527 00:19:08,474 --> 00:19:10,767 and your midlife crisis trip. 528 00:19:10,768 --> 00:19:12,769 I give it four weeks. 529 00:19:12,770 --> 00:19:15,313 Seven, tops. 530 00:19:15,314 --> 00:19:16,564 Ye of little faith. 531 00:19:16,565 --> 00:19:19,317 Not about faith, just facts. 532 00:19:19,318 --> 00:19:20,610 Facts? 533 00:19:20,611 --> 00:19:22,528 Based on my experience, you're a seven-week-itch 534 00:19:22,529 --> 00:19:23,988 kind of guy. 535 00:19:23,989 --> 00:19:26,241 Hey, Robby, med student's got a pickleball player 536 00:19:26,242 --> 00:19:28,159 in the North Hall with possible Achilles rupture, 537 00:19:28,160 --> 00:19:29,160 asking for your opinion. 538 00:19:29,161 --> 00:19:30,745 Thank you, Perlah. 539 00:19:30,746 --> 00:19:32,914 At least somebody down here has a little faith in me. 540 00:19:35,501 --> 00:19:38,253 You know what Motorcycle Mike's sabbatical is really about? 541 00:19:38,254 --> 00:19:41,089 I never try to guess what's going on in that head of his. 542 00:19:41,090 --> 00:19:44,300 Three months being on the open road by himself. 543 00:19:44,301 --> 00:19:46,469 Man can't stand to be alone for more than a few hours. 544 00:19:46,470 --> 00:19:49,514 He sleeps with the TV on in his bedroom. 545 00:19:49,515 --> 00:19:52,351 I really don't think I needed to know that. 546 00:19:53,769 --> 00:19:56,938 Look, maybe he's looking for something new 547 00:19:56,939 --> 00:19:59,857 or trying to outrun some old ghosts. 548 00:19:59,858 --> 00:20:03,152 Well, I hope he finds what he's looking for. 549 00:20:03,153 --> 00:20:05,321 Man deserves some peace. 550 00:20:05,322 --> 00:20:06,698 Amen. 551 00:20:06,699 --> 00:20:09,367 I considered the diagnosis of cauda equina syndrome, 552 00:20:09,368 --> 00:20:11,202 but the motor and sensory exam 553 00:20:11,203 --> 00:20:13,579 were both intact in the sacral nerve root... 554 00:20:13,580 --> 00:20:14,914 Our unhoused cougher has pneumonia. 555 00:20:14,915 --> 00:20:17,792 I'm cursed, fucking cursed. 556 00:20:17,793 --> 00:20:19,294 Fuck. 557 00:20:19,295 --> 00:20:21,045 What? 558 00:20:21,046 --> 00:20:23,464 That is a cavitary lesion in the right upper lobe. 559 00:20:23,465 --> 00:20:25,258 Active TB. 560 00:20:25,259 --> 00:20:27,635 What's next? 561 00:20:27,636 --> 00:20:29,178 AFB stain to confirm, 562 00:20:29,179 --> 00:20:31,723 move her to a negative airflow room, start her on meds. 563 00:20:31,724 --> 00:20:33,850 Call infection control and public health. 564 00:20:33,851 --> 00:20:36,144 And now you get to sign in as a patient 565 00:20:36,145 --> 00:20:38,646 and get your blood drawn for a QuantiFERON Gold. 566 00:20:38,647 --> 00:20:40,648 It's too soon to be positive. 567 00:20:40,649 --> 00:20:41,816 Yeah, but you were exposed. 568 00:20:41,817 --> 00:20:43,401 You need a baseline test 569 00:20:43,402 --> 00:20:46,654 and then again in eight weeks to see if you convert. 570 00:20:46,655 --> 00:20:47,989 And if I do? 571 00:20:47,990 --> 00:20:50,074 Then meds every day for three or four months 572 00:20:50,075 --> 00:20:52,994 with regular blood tests to check for toxicity. 573 00:20:52,995 --> 00:20:54,329 - Jesus. - All right. 574 00:20:54,330 --> 00:20:55,830 Let Dana know what's up. 575 00:20:55,831 --> 00:20:58,875 And for the love of God, mask up when you move her. 576 00:21:07,343 --> 00:21:09,552 - Dr. Langdon. - Hey, man. Alex. 577 00:21:09,553 --> 00:21:10,721 Let's take a look. 578 00:21:13,307 --> 00:21:16,267 Ah. 579 00:21:16,268 --> 00:21:17,268 Is it bad? 580 00:21:17,269 --> 00:21:18,811 It's not good. 581 00:21:18,812 --> 00:21:21,439 Sorry, your chart says you were burned with dry ice? 582 00:21:21,440 --> 00:21:23,483 - What happened? - My jack-off brother. 583 00:21:23,484 --> 00:21:25,068 Does he not like you? 584 00:21:25,069 --> 00:21:28,696 I asked him to do it, just not like this exactly. 585 00:21:28,697 --> 00:21:30,281 What? Why? 586 00:21:30,282 --> 00:21:31,949 He was gonna brand me like I branded him. 587 00:21:31,950 --> 00:21:33,785 Branded? Like cattle? 588 00:21:33,786 --> 00:21:36,913 Instead of hot branding, you stick the iron in dry ice, 589 00:21:36,914 --> 00:21:39,874 let it get super cold, and then you put it on your skin. 590 00:21:39,875 --> 00:21:41,542 Cool, huh? 591 00:21:42,753 --> 00:21:44,045 Let's get some LET on this. 592 00:21:44,046 --> 00:21:45,756 I'll get some snips to debride. 593 00:21:48,217 --> 00:21:49,884 You good? 594 00:21:49,885 --> 00:21:52,220 Yeah. Yeah, good. 595 00:21:52,221 --> 00:21:53,638 You sure? 596 00:21:53,639 --> 00:21:56,724 Doesn't seem like Robby's all that happy I'm back. 597 00:21:56,725 --> 00:21:59,394 Well, he's not going to be here, 598 00:21:59,395 --> 00:22:01,145 and I'm happy you're back. 599 00:22:01,146 --> 00:22:03,065 Thanks. 600 00:22:07,403 --> 00:22:11,573 Head and neck CT is negative, except for mandible fracture. 601 00:22:12,491 --> 00:22:13,866 OK, let's get him off the board. 602 00:22:13,867 --> 00:22:15,159 Roll him, right side up. 603 00:22:15,160 --> 00:22:16,912 Hey, we're gonna need the cuffs off. 604 00:22:19,915 --> 00:22:22,750 Ready. And 1, 2, 3. 605 00:22:22,751 --> 00:22:25,128 Ah, gentle. 606 00:22:25,129 --> 00:22:26,796 Dr. King, how are the chest and belly? 607 00:22:26,797 --> 00:22:30,049 We have three anterior rib fractures 608 00:22:30,050 --> 00:22:31,968 and a small pulmonary contusion. 609 00:22:31,969 --> 00:22:33,261 - Not too bad. - Mm-mm. 610 00:22:33,262 --> 00:22:34,929 When do pulmonary contusions peak? 611 00:22:34,930 --> 00:22:36,347 After a few hours. 612 00:22:36,348 --> 00:22:37,932 And do we always admit for three-rib fractures? 613 00:22:37,933 --> 00:22:39,267 In the elderly, yes, 614 00:22:39,268 --> 00:22:41,018 but not if a patient can manage the pain 615 00:22:41,019 --> 00:22:43,020 and doesn't need supplemental oxygen. 616 00:22:44,273 --> 00:22:45,773 OK, he's really hurting here. 617 00:22:45,774 --> 00:22:47,442 You think you could set us up with a serratus anterior 618 00:22:47,443 --> 00:22:48,651 - field block? - No problem. 619 00:22:48,652 --> 00:22:50,778 Oh, as long as that's OK 620 00:22:50,779 --> 00:22:51,946 with Dr. Al-Hashimi. 621 00:22:51,947 --> 00:22:54,115 If the patient consents. 622 00:22:54,116 --> 00:22:57,952 Mr. Varney, we wanna give you a shot to numb your broken ribs 623 00:22:57,953 --> 00:22:59,120 so you can breathe easier. 624 00:22:59,121 --> 00:23:00,371 Uh-huh. 625 00:23:00,372 --> 00:23:02,039 OK, get Mr. Varney prepped and draped. 626 00:23:02,040 --> 00:23:03,624 Dr. Mohan, you're in charge. 627 00:23:03,625 --> 00:23:05,460 Let's identify the landmarks. 628 00:23:05,461 --> 00:23:06,587 Cuffs. 629 00:23:07,921 --> 00:23:09,589 Yeah, you can just leave them off, man. 630 00:23:09,590 --> 00:23:12,508 He's clearly not moving on his own. 631 00:23:12,509 --> 00:23:14,093 We follow protocol, 632 00:23:14,094 --> 00:23:17,472 for his safety and yours. 633 00:23:19,183 --> 00:23:20,850 Do you need to get that? 634 00:23:20,851 --> 00:23:23,686 Nope. It's my mom. 635 00:23:23,687 --> 00:23:25,938 Ignore it. Just ignore it. 636 00:23:25,939 --> 00:23:27,773 - Amen, sister. - Forearm is numb. 637 00:23:27,774 --> 00:23:29,066 We can irrigate. 638 00:23:29,067 --> 00:23:30,651 If I ignore a problem for long enough, 639 00:23:30,652 --> 00:23:32,278 it just goes away, right? 640 00:23:32,279 --> 00:23:34,530 I wish I could ignore my deposition. 641 00:23:34,531 --> 00:23:36,824 That, you can't ignore. 642 00:23:36,825 --> 00:23:38,034 But you'll be fine. 643 00:23:38,035 --> 00:23:39,577 What's up with you, Whitaker? 644 00:23:39,578 --> 00:23:41,078 Trouble in roomie land? 645 00:23:41,079 --> 00:23:42,663 No, not really. 646 00:23:42,664 --> 00:23:45,917 I think I overstepped with Dr. Langdon earlier. 647 00:23:45,918 --> 00:23:47,168 Oh. 648 00:23:47,169 --> 00:23:49,837 He was trying to prescribe a patient benzos, 649 00:23:49,838 --> 00:23:52,715 and I told Langdon that it'd be better if I did it. 650 00:23:52,716 --> 00:23:54,175 Oof. 651 00:23:54,176 --> 00:23:56,552 Only because I was already the assigned physician. 652 00:23:56,553 --> 00:23:58,387 But yeah, now I feel like an asshole. 653 00:23:58,388 --> 00:23:59,680 Langdon's fine. 654 00:23:59,681 --> 00:24:02,016 He went to rehab, he's working the steps, 655 00:24:02,017 --> 00:24:06,562 and hopefully it's all behind him. 656 00:24:06,563 --> 00:24:08,272 Place the needle in-plane, 657 00:24:08,273 --> 00:24:10,149 superficial to the serratus anterior, 658 00:24:10,150 --> 00:24:12,401 between it and the latissimus dorsi. 659 00:24:12,402 --> 00:24:13,736 Mm-hmm. 660 00:24:13,737 --> 00:24:15,905 You can see the fluid dissect and diffuse... 661 00:24:15,906 --> 00:24:17,240 Dr. Mohan, we need you. 662 00:24:17,241 --> 00:24:18,866 We've got two more rigs from Westbridge 663 00:24:18,867 --> 00:24:21,077 pulling up right now. 664 00:24:21,078 --> 00:24:22,578 Go. We got this. 665 00:24:22,579 --> 00:24:23,579 Thanks. 666 00:24:23,580 --> 00:24:26,082 How we doing in here? 667 00:24:26,083 --> 00:24:29,710 Spiked a temp to 102, gave Tylenol. 668 00:24:29,711 --> 00:24:31,462 Check out her leg. 669 00:24:31,463 --> 00:24:33,381 That is a definite bulla. 670 00:24:33,382 --> 00:24:34,840 Did surgery come down yet? 671 00:24:34,841 --> 00:24:36,592 - Not yet. - I need surgery? 672 00:24:36,593 --> 00:24:37,718 Page them again. 673 00:24:37,719 --> 00:24:39,470 Surgery would be a last resort. 674 00:24:39,471 --> 00:24:41,806 We would like them to come down and check out your leg 675 00:24:41,807 --> 00:24:44,392 in case we need to remove this infected skin. 676 00:24:44,393 --> 00:24:45,893 I thought it was just a little swelling 677 00:24:45,894 --> 00:24:47,094 'cause I'm on my feet all day. 678 00:24:48,814 --> 00:24:50,731 BP's down to 85 over 40. 679 00:24:50,732 --> 00:24:52,400 - How much LR is in? - Full bolus. 680 00:24:52,401 --> 00:24:54,068 Do another liter and then start Levophed. 681 00:24:54,069 --> 00:24:55,570 Titrate to a MAP of 65. 682 00:24:56,822 --> 00:24:58,406 Can someone please tell me what's going on? 683 00:24:58,407 --> 00:24:59,448 Pulse ox down to 89. 684 00:24:59,449 --> 00:25:00,950 100% non-rebreather. 685 00:25:00,951 --> 00:25:03,995 Sometimes an infection can cause your blood pressure 686 00:25:03,996 --> 00:25:06,914 to drop and lower the amount of oxygen in your blood. 687 00:25:06,915 --> 00:25:08,082 Am I gonna be OK? 688 00:25:08,083 --> 00:25:09,292 We're doing everything that we can 689 00:25:09,293 --> 00:25:10,585 to make sure that you are. 690 00:25:10,586 --> 00:25:11,837 Jesse. 691 00:25:14,214 --> 00:25:15,590 What's up? 692 00:25:15,591 --> 00:25:16,924 Be ready to intubate if you need to. 693 00:25:16,925 --> 00:25:18,426 - You want me to call Langdon? - No. 694 00:25:18,427 --> 00:25:20,011 I will be right back, and you can call surgery 695 00:25:20,012 --> 00:25:21,721 and tell them to get their heads out of their asses 696 00:25:21,722 --> 00:25:23,348 and get down here. 697 00:25:31,857 --> 00:25:33,274 Did you bring Langdon back here? 698 00:25:33,275 --> 00:25:35,026 No, Al-Hashimi did. 699 00:25:35,027 --> 00:25:36,402 You banished him to scut purgatory. 700 00:25:36,403 --> 00:25:37,570 He did everything you would've done 701 00:25:37,571 --> 00:25:39,196 with that cellulitis patient. 702 00:25:39,197 --> 00:25:40,698 If you think he missed something, tell him. 703 00:25:40,699 --> 00:25:42,283 Well, we're probably gonna need to intubate. 704 00:25:42,284 --> 00:25:43,868 We're definitely gonna need an ICU bed. 705 00:25:43,869 --> 00:25:45,119 What happened? 706 00:25:45,120 --> 00:25:47,288 She is in septic shock, on pressors. 707 00:25:47,289 --> 00:25:49,123 Open shoulder dislocation is back. 708 00:25:49,124 --> 00:25:50,958 Westbridge shut down all their ORs, so they told us 709 00:25:50,959 --> 00:25:52,793 - to bring them back here. - You joking? 710 00:25:52,794 --> 00:25:53,794 This ain't the Radisson. 711 00:25:53,795 --> 00:25:54,962 Not my problem. 712 00:25:54,963 --> 00:25:56,505 - Where should we park him? - Grab a wall. 713 00:25:56,506 --> 00:25:57,965 Call Noelle. Call ortho. 714 00:25:57,966 --> 00:25:59,216 Call the OR and tell them we got a patient back 715 00:25:59,217 --> 00:26:00,801 that needs surgery and admission. 716 00:26:00,802 --> 00:26:02,803 Hey, so sorry about this ambulance tour 717 00:26:02,804 --> 00:26:04,805 of Allegheny County, Mr. Billings, 718 00:26:04,806 --> 00:26:06,390 but we got you from here, I promise. 719 00:26:06,391 --> 00:26:07,808 Yeah, I'm starving. 720 00:26:07,809 --> 00:26:09,310 Is there any way I can get something to eat? 721 00:26:09,311 --> 00:26:11,103 Sorry, not before surgery. 722 00:26:11,104 --> 00:26:12,355 Can I have a visitor? 723 00:26:12,356 --> 00:26:13,856 Sure. 724 00:26:13,857 --> 00:26:15,650 Any word from Gloria about what's going on at Westbridge? 725 00:26:15,651 --> 00:26:17,276 Radio silence from the ivory tower. 726 00:26:17,277 --> 00:26:18,944 And the charge nurse over there isn't responding. 727 00:26:18,945 --> 00:26:20,571 Must be bad. 728 00:26:20,572 --> 00:26:21,947 I wonder if it's something that security needs to know about. 729 00:26:21,948 --> 00:26:23,449 I'll keep you posted. 730 00:26:23,450 --> 00:26:25,242 Hey, you're kind of buds with Gloria. 731 00:26:25,243 --> 00:26:26,535 Did she say anything to you about what's 732 00:26:26,536 --> 00:26:28,287 - happening at Westbridge? - No. You? 733 00:26:28,288 --> 00:26:30,831 Nope. How are your patients? 734 00:26:30,832 --> 00:26:33,250 Our prisoner, Gus, has stable injuries, 735 00:26:33,251 --> 00:26:35,461 and our law student in Central 10 is awake, 736 00:26:35,462 --> 00:26:37,672 normal LP, and awaiting a psych consult. 737 00:26:37,673 --> 00:26:39,006 Good. 738 00:26:39,007 --> 00:26:40,675 Quicker we can treat 'em, street 'em, move 'em 739 00:26:40,676 --> 00:26:42,176 up the food chain, the better. 740 00:26:42,177 --> 00:26:44,220 Question. 741 00:26:44,221 --> 00:26:48,516 Why are you treating me like one of your residents? 742 00:26:48,517 --> 00:26:49,684 I'm not. 743 00:26:49,685 --> 00:26:51,519 As the attending, I like to know the status 744 00:26:51,520 --> 00:26:53,229 of all the patients and doctors in the ED 745 00:26:53,230 --> 00:26:55,523 in case I need to jump in quickly. 746 00:26:55,524 --> 00:26:56,524 Makes sense. 747 00:26:56,525 --> 00:26:58,943 Now your turn. 748 00:26:58,944 --> 00:27:00,277 What? 749 00:27:00,278 --> 00:27:02,405 As your fellow attending in our ED, 750 00:27:02,406 --> 00:27:04,198 it only makes sense for me to know the status 751 00:27:04,199 --> 00:27:06,283 of all the patients and all the doctors 752 00:27:06,284 --> 00:27:09,870 in case I need to jump in on a moment's notice. 753 00:27:09,871 --> 00:27:11,331 Touché. 754 00:27:14,000 --> 00:27:16,627 You have a non-displaced fracture, distal tibia. 755 00:27:16,628 --> 00:27:18,796 So if you look at the bone here, it's pretty well aligned. 756 00:27:18,797 --> 00:27:20,172 Sorry. Hi. 757 00:27:20,173 --> 00:27:22,550 Hi, I was in the shower, and I came as soon 758 00:27:22,551 --> 00:27:23,676 as I got Paul's message. 759 00:27:23,677 --> 00:27:25,302 - Lena? - Hi. 760 00:27:25,303 --> 00:27:27,179 What happened? 761 00:27:27,180 --> 00:27:28,639 I had a seizure. 762 00:27:28,640 --> 00:27:30,266 You load her with Keppra? 763 00:27:30,267 --> 00:27:31,642 Yeah. 764 00:27:31,643 --> 00:27:33,644 Yeah, she's back to baseline mental status. 765 00:27:33,645 --> 00:27:35,896 I'm sorry, I'm confused. Aren't you off duty? 766 00:27:35,897 --> 00:27:39,066 - I'm Roxie's death doula. - Oh. 767 00:27:39,067 --> 00:27:40,776 Her... her what? 768 00:27:40,777 --> 00:27:42,778 I help advocate for people like Roxie 769 00:27:42,779 --> 00:27:45,781 to make their transition to death a more peaceful process. 770 00:27:45,782 --> 00:27:48,784 It's like a birth doula but for the end of life. 771 00:27:48,785 --> 00:27:52,413 She's been a real lifesaver for our family. 772 00:27:52,414 --> 00:27:55,249 My husband cracking jokes while I'm dying. 773 00:27:55,250 --> 00:27:57,001 See why I married him? 774 00:27:57,002 --> 00:27:58,836 Whatever you have to say about my condition, 775 00:27:58,837 --> 00:28:00,755 you can share with Lena too. 776 00:28:00,756 --> 00:28:02,757 We were just explaining that Roxie 777 00:28:02,758 --> 00:28:05,926 has a pathological fracture through a metastatic lesion. 778 00:28:05,927 --> 00:28:07,428 Can you fix that? 779 00:28:07,429 --> 00:28:10,264 The bones are well aligned, so she won't need surgery. 780 00:28:10,265 --> 00:28:11,766 The treatment is immobilization 781 00:28:11,767 --> 00:28:12,933 and a long leg boot. 782 00:28:12,934 --> 00:28:14,643 Oh! 783 00:28:14,644 --> 00:28:16,187 Maybe we up her pain meds. 784 00:28:16,188 --> 00:28:17,730 Yeah, sure. 785 00:28:17,731 --> 00:28:19,106 We can do that. 786 00:28:19,107 --> 00:28:21,400 The bones should heal in about six weeks. 787 00:28:21,401 --> 00:28:23,987 If I live that long. 788 00:28:25,864 --> 00:28:26,906 Still numb here? 789 00:28:26,907 --> 00:28:28,491 Yeah, bro. 790 00:28:28,492 --> 00:28:30,826 Great. 791 00:28:30,827 --> 00:28:32,703 You think it's gonna leave a scar? 792 00:28:32,704 --> 00:28:36,749 I don't think it. I know it. 793 00:28:36,750 --> 00:28:38,542 Holy shit. 794 00:28:38,543 --> 00:28:40,085 Fuck are you doing here? 795 00:28:40,086 --> 00:28:41,086 I'm sorry, who are you? 796 00:28:41,087 --> 00:28:42,213 Concerned brother. 797 00:28:42,214 --> 00:28:44,715 That looks not too bad. 798 00:28:44,716 --> 00:28:46,091 You gooning me? 799 00:28:46,092 --> 00:28:47,718 Yeah, it's nasty. 800 00:28:47,719 --> 00:28:49,136 Thanks to you. 801 00:28:49,137 --> 00:28:50,304 You did this? 802 00:28:50,305 --> 00:28:51,705 Oh, yeah. You wanna see the video? 803 00:28:53,850 --> 00:28:55,810 - Yes. - Definitely. 804 00:28:55,811 --> 00:28:57,229 Got you. 805 00:28:58,480 --> 00:29:00,981 All right. All right, get in close. 806 00:29:00,982 --> 00:29:02,650 Brothers unite! 807 00:29:02,651 --> 00:29:04,318 - Ooh! - Ooh! 808 00:29:04,319 --> 00:29:06,153 Dude, why in the world 809 00:29:06,154 --> 00:29:07,822 would you ask to have that done to you? 810 00:29:07,823 --> 00:29:11,409 He was trying to brand me with our family crest. 811 00:29:13,745 --> 00:29:15,996 Your family crest is the Penguins logo? 812 00:29:15,997 --> 00:29:17,748 We were gonna be bonded for life. 813 00:29:17,749 --> 00:29:19,583 You already are, with DNA. 814 00:29:19,584 --> 00:29:20,751 Yeah. 815 00:29:20,752 --> 00:29:22,294 I love you, man. 816 00:29:22,295 --> 00:29:24,129 - I'm real sorry. - It's OK. 817 00:29:24,130 --> 00:29:27,800 Doc said it's gonna take some time, but it'll heal OK. 818 00:29:27,801 --> 00:29:29,343 Awesome. 819 00:29:29,344 --> 00:29:31,136 So maybe we can try again in a couple of months or... 820 00:29:31,137 --> 00:29:32,597 No. 821 00:29:34,015 --> 00:29:35,725 OK, bag her. 822 00:29:37,727 --> 00:29:39,186 Yellow on the end-tidal. 823 00:29:39,187 --> 00:29:40,938 - Sorry, got backed up. - Sounds a little wet. 824 00:29:40,939 --> 00:29:42,064 Someone asked for a surgical consult? 825 00:29:42,065 --> 00:29:43,315 That's because all the fluid. 826 00:29:43,316 --> 00:29:44,733 TKO the lines for now. 827 00:29:44,734 --> 00:29:47,069 Vent settings 50%, tidal volume 500, AC 12? 828 00:29:47,070 --> 00:29:48,445 Yep, that's perfect. 829 00:29:48,446 --> 00:29:49,780 Surgery here. Hello. 830 00:29:49,781 --> 00:29:51,365 Hey, it's about time. Where's Garcia? 831 00:29:51,366 --> 00:29:53,200 Stuck in the ER. She sent me down. What you got? 832 00:29:53,201 --> 00:29:54,702 Septic shock, respiratory failure, 833 00:29:54,703 --> 00:29:56,370 and possible necrotizing fasciitis. 834 00:29:56,371 --> 00:29:58,080 She needs to go to the OR ASAP. 835 00:29:58,081 --> 00:30:00,374 The infection was isolated to the dorsum of the foot 836 00:30:00,375 --> 00:30:01,959 five hours ago, but now we're almost to the knee 837 00:30:01,960 --> 00:30:03,627 with bullae, crepitus, and edema. 838 00:30:03,628 --> 00:30:05,296 - Yeah. - You seen nec fasc before? 839 00:30:05,297 --> 00:30:06,547 In a textbook. 840 00:30:06,548 --> 00:30:08,716 I was a med student two weeks ago. 841 00:30:10,552 --> 00:30:13,095 - Gotta show this to Dr. Garcia. - OK. OK. Jesus Christ. 842 00:30:13,096 --> 00:30:14,763 Go get anybody else from your service down here... 843 00:30:14,764 --> 00:30:16,056 Shamsi, Miller, Walsh... 844 00:30:16,057 --> 00:30:17,224 I don't know any of this people, but... 845 00:30:17,225 --> 00:30:18,559 Don't take this personally. 846 00:30:18,560 --> 00:30:21,604 I just need a fucking grown-up down here. 847 00:30:21,605 --> 00:30:23,564 Nice job on the sub-Qs. 848 00:30:23,565 --> 00:30:25,316 Really took the tension off the wound. 849 00:30:25,317 --> 00:30:26,400 Thanks. 850 00:30:26,401 --> 00:30:28,068 I can help with the skin layer. 851 00:30:28,069 --> 00:30:30,071 Four hands are faster than two. 852 00:30:32,490 --> 00:30:33,908 - Whoa. - Whoa. 853 00:30:33,909 --> 00:30:36,243 That just tore right through the skin. 854 00:30:36,244 --> 00:30:37,578 You may need to take bigger bites 855 00:30:37,579 --> 00:30:39,288 farther away from the wound edges. 856 00:30:39,289 --> 00:30:41,624 Yep. 857 00:30:41,625 --> 00:30:44,961 Skin seems pretty fragile. 858 00:30:49,049 --> 00:30:50,507 Oh. 859 00:30:50,508 --> 00:30:52,176 Yeah, this is not working. 860 00:30:52,177 --> 00:30:54,136 He has the skin strength of an 80-year-old. 861 00:30:54,137 --> 00:30:56,305 Put down Steri-Strips with benzoin, 862 00:30:56,306 --> 00:30:59,600 not across the wound but along each wound edge, both sides. 863 00:30:59,601 --> 00:31:01,143 It'll hold the sutures. 864 00:31:01,144 --> 00:31:04,605 - Yup. - What say you, Dr. Robby? 865 00:31:04,606 --> 00:31:06,607 Great. MacGyver move. 866 00:31:06,608 --> 00:31:09,485 Go for it. 867 00:31:09,486 --> 00:31:13,280 Does a Dr. MacGyver work here? 868 00:31:13,281 --> 00:31:15,783 I don't know. 869 00:31:15,784 --> 00:31:17,701 The patient symptoms are consistent with lumbar 870 00:31:17,702 --> 00:31:21,664 radiculopathy at L4, L5, most likely due to disc herniation. 871 00:31:21,665 --> 00:31:23,165 Coughing patient admitted to isolation 872 00:31:23,166 --> 00:31:25,125 for verified medication administration 873 00:31:25,126 --> 00:31:26,502 and started on RIPE therapy. 874 00:31:26,503 --> 00:31:28,045 Yeah, why do I even bother? 875 00:31:28,046 --> 00:31:29,088 Just fail me now. 876 00:31:29,089 --> 00:31:30,255 OK. 877 00:31:30,256 --> 00:31:31,757 Get in touch with a social worker. 878 00:31:31,758 --> 00:31:33,258 They're gonna wanna do contact tracing 879 00:31:33,259 --> 00:31:35,094 and help her figure out transitional housing 880 00:31:35,095 --> 00:31:36,470 for when she's discharged. 881 00:31:36,471 --> 00:31:37,805 Got it. 882 00:31:37,806 --> 00:31:39,765 And make sure infection control responded. 883 00:31:39,766 --> 00:31:41,225 The people in the waiting room could have been exposed. 884 00:31:41,226 --> 00:31:44,561 They need to be notified and tested. 885 00:31:44,562 --> 00:31:45,813 OK. 886 00:31:45,814 --> 00:31:48,732 Relax. 887 00:31:48,733 --> 00:31:50,985 You can take the mask off. You don't have TB. 888 00:31:50,986 --> 00:31:54,154 At least not yet. 889 00:31:54,155 --> 00:31:56,699 Oh, great. 890 00:31:56,700 --> 00:31:59,660 This is fucked up. 891 00:31:59,661 --> 00:32:01,912 How are you so calm? 892 00:32:01,913 --> 00:32:03,580 Expected job hazard. 893 00:32:03,581 --> 00:32:04,832 You get used to it. 894 00:32:04,833 --> 00:32:06,417 Yeah, no, thanks. 895 00:32:06,418 --> 00:32:09,003 70% of doctors in training at urban hospitals 896 00:32:09,004 --> 00:32:11,338 get exposed to TB and wind up on meds. 897 00:32:11,339 --> 00:32:13,674 - Jesus. - Mm-hmm. 898 00:32:13,675 --> 00:32:16,051 They don't teach you that in med school. 899 00:32:16,052 --> 00:32:18,220 Mrs. Randolph's back. 900 00:32:18,221 --> 00:32:20,097 Pulled up her X-ray. 901 00:32:20,098 --> 00:32:21,265 OK. 902 00:32:21,266 --> 00:32:23,392 No volvulus, no air fluid levels. 903 00:32:23,393 --> 00:32:25,978 What do you think of this? 904 00:32:25,979 --> 00:32:28,063 Fecal material? 905 00:32:28,064 --> 00:32:29,773 A shit ton. 906 00:32:29,774 --> 00:32:31,400 Sorry, had to be said. 907 00:32:31,401 --> 00:32:32,985 So, what, she needs an enema? 908 00:32:32,986 --> 00:32:34,570 No. Tried and failed, remember? 909 00:32:34,571 --> 00:32:35,571 Yeah. 910 00:32:35,572 --> 00:32:37,239 Time to dig in. 911 00:32:37,240 --> 00:32:38,866 How are we gonna do that? 912 00:32:38,867 --> 00:32:42,829 Oh, there is no "we" in disimpaction. 913 00:32:47,751 --> 00:32:50,002 I haven't done one before. 914 00:32:50,003 --> 00:32:52,963 Shouldn't I observe first? 915 00:32:52,964 --> 00:32:55,550 I know just the guy to teach you. 916 00:33:04,768 --> 00:33:07,603 I spoke to the charge nurse in med-surg. 917 00:33:07,604 --> 00:33:08,896 They can take Orlando today. 918 00:33:08,897 --> 00:33:10,731 - Yes! - That's wonderful. 919 00:33:10,732 --> 00:33:12,274 They know he's on an insulin drip? 920 00:33:12,275 --> 00:33:14,818 They know, and they can change to a SQUID protocol. 921 00:33:14,819 --> 00:33:15,819 SQUID? 922 00:33:15,820 --> 00:33:17,571 Sub-Q insulin in DKA. 923 00:33:17,572 --> 00:33:19,281 So no IV drip? 924 00:33:19,282 --> 00:33:22,076 Just shots of short-acting insulin every four hours prn. 925 00:33:22,077 --> 00:33:25,496 The med-surg nurses have time to check a glucose every hour? 926 00:33:25,497 --> 00:33:26,497 They say so. 927 00:33:26,498 --> 00:33:28,540 And five days on med-surge 928 00:33:28,541 --> 00:33:32,294 is gonna cut your hospital bill down by 2/3. 929 00:33:32,295 --> 00:33:34,171 OK. 930 00:33:34,172 --> 00:33:36,048 So what's that gonna cost? 931 00:33:36,049 --> 00:33:37,466 Well, I can't give you an exact amount, 932 00:33:37,467 --> 00:33:39,551 but roughly $35,000. 933 00:33:39,552 --> 00:33:42,679 So after about 40%, I'll still have to pay, 934 00:33:42,680 --> 00:33:44,515 what, like, 20 grand? 935 00:33:44,516 --> 00:33:46,767 The hospital can work out a payment plan. 936 00:33:46,768 --> 00:33:48,477 Orlando, we'll be OK. 937 00:33:48,478 --> 00:33:50,020 We'll figure it out. 938 00:33:50,021 --> 00:33:52,481 I'll take on extra shifts at the coffee shop. 939 00:33:52,482 --> 00:33:55,484 We got you, Dad. 940 00:33:55,485 --> 00:33:58,695 Let's give you some private time with your family. 941 00:33:58,696 --> 00:34:01,198 Thanks. 942 00:34:01,199 --> 00:34:02,825 Sorry. Thank you. 943 00:34:02,826 --> 00:34:04,451 I was worried he might bail. 944 00:34:04,452 --> 00:34:05,661 My pleasure. 945 00:34:05,662 --> 00:34:07,371 The real thanks goes to the newbie here 946 00:34:07,372 --> 00:34:09,082 for thinking outside the box. 947 00:34:11,793 --> 00:34:13,710 Sorry I doubted your med-surg pitch. 948 00:34:13,711 --> 00:34:15,295 Oh, no sweat. 949 00:34:15,296 --> 00:34:17,506 How'd you think of that? 950 00:34:17,507 --> 00:34:20,175 My family had to think of a lot of creative ways 951 00:34:20,176 --> 00:34:23,220 to help my uninsured grandma. 952 00:34:23,221 --> 00:34:24,805 Leukemia. 953 00:34:24,806 --> 00:34:28,142 System doesn't work for you, you gotta work the system. 954 00:34:28,143 --> 00:34:30,352 She survive? 955 00:34:30,353 --> 00:34:32,563 For a while, till she didn't. 956 00:34:32,564 --> 00:34:35,023 She died before my freshman year in college. 957 00:34:35,024 --> 00:34:37,359 Sorry. 958 00:34:37,360 --> 00:34:39,528 Her death taught me a lot. 959 00:34:39,529 --> 00:34:42,448 Mainly that I don't wanna be around people dying. 960 00:34:44,284 --> 00:34:46,952 So they got her, and we can get out of here soon? 961 00:34:46,953 --> 00:34:48,412 Yeah. Oh, I think so. 962 00:34:48,413 --> 00:34:49,830 - I think so, yeah. - OK. 963 00:34:49,831 --> 00:34:53,083 Hi. 964 00:34:53,084 --> 00:34:55,669 Morphine PCA looks ready to go. 965 00:34:55,670 --> 00:34:57,671 This should do the trick. 966 00:34:57,672 --> 00:34:59,089 Do you notice a difference? 967 00:34:59,090 --> 00:35:00,090 Better. 968 00:35:00,091 --> 00:35:02,593 Oh, great. Great. 969 00:35:02,594 --> 00:35:04,344 How does this thing work? 970 00:35:04,345 --> 00:35:06,763 There's a baseline rate of morphine. 971 00:35:06,764 --> 00:35:08,849 And if you're having pain, you can push this button. 972 00:35:08,850 --> 00:35:09,850 You'll get some extra. 973 00:35:09,851 --> 00:35:11,185 And you can push for another dose 974 00:35:11,186 --> 00:35:12,603 every 10 minutes if needed. 975 00:35:12,604 --> 00:35:14,814 Your very own morphine butler. 976 00:35:17,358 --> 00:35:18,525 Amazing. 977 00:35:18,526 --> 00:35:20,068 She can go home with this? 978 00:35:20,069 --> 00:35:21,612 Yeah. 979 00:35:21,613 --> 00:35:23,739 Though you'll need more equipment for the house 980 00:35:23,740 --> 00:35:25,949 now that she can't bear weight on her leg. 981 00:35:25,950 --> 00:35:27,868 OK. Like what? 982 00:35:27,869 --> 00:35:32,039 A wheelchair to go to the bathroom, a shower chair, 983 00:35:32,040 --> 00:35:34,249 wall bars, if you don't already have them. 984 00:35:34,250 --> 00:35:37,377 And a hospital bed could be helpful too. 985 00:35:37,378 --> 00:35:38,712 How do we get all that? 986 00:35:38,713 --> 00:35:40,589 You don't. I do. 987 00:35:40,590 --> 00:35:42,466 I will get everything so that the two of you 988 00:35:42,467 --> 00:35:44,676 can get out of here and back to the kids. 989 00:35:44,677 --> 00:35:46,804 - At home. - Thank you. 990 00:35:53,853 --> 00:35:55,812 Nice of you to join us, Huckleberry. 991 00:35:55,813 --> 00:35:57,105 What do you need? 992 00:35:57,106 --> 00:35:58,900 Some help with a disimpaction. 993 00:36:00,735 --> 00:36:02,778 That is a med student procedure. 994 00:36:02,779 --> 00:36:04,238 Oh, you know the old adage... 995 00:36:04,239 --> 00:36:06,448 see one, do one, teach one. 996 00:36:06,449 --> 00:36:08,742 Say hello to teaching young Ogilvie here. 997 00:36:08,743 --> 00:36:11,411 OK. 998 00:36:11,412 --> 00:36:13,497 - Double glove, Ogilvie. - All right. 999 00:36:13,498 --> 00:36:14,998 Mrs. Randolph, we're going to need 1000 00:36:14,999 --> 00:36:17,626 to manually unblock your rectum so that we can 1001 00:36:17,627 --> 00:36:19,127 get your bowels moving again. 1002 00:36:19,128 --> 00:36:20,128 I know. 1003 00:36:20,129 --> 00:36:22,923 Here we go. 1004 00:36:22,924 --> 00:36:26,009 Mrs. Randolph, I would like you to relax 1005 00:36:26,010 --> 00:36:28,929 like you're having a bowel movement. 1006 00:36:28,930 --> 00:36:31,515 Nice and deep. 1007 00:36:31,516 --> 00:36:33,809 OK. 1008 00:36:33,810 --> 00:36:38,021 Curve the finger like an ice cream scoop. 1009 00:36:38,022 --> 00:36:42,651 And bring it out. 1010 00:36:42,652 --> 00:36:44,445 You're up, Ogilvie. 1011 00:36:48,700 --> 00:36:50,909 Some more pressure, Mrs. Randolph. 1012 00:36:50,910 --> 00:36:52,412 I'm ready. 1013 00:36:59,127 --> 00:37:03,255 And here I thought you weren't a quick study. 1014 00:37:03,256 --> 00:37:05,173 Keep going. 1015 00:37:05,174 --> 00:37:07,384 Mrs. Randolph, in order to prevent this 1016 00:37:07,385 --> 00:37:08,802 from happening again, I think you 1017 00:37:08,803 --> 00:37:10,387 need a better stool softener. 1018 00:37:10,388 --> 00:37:11,972 You can try MiraLAX. 1019 00:37:11,973 --> 00:37:14,474 Just a tablespoon with a big glass of water every morning 1020 00:37:14,475 --> 00:37:15,475 should do the trick. 1021 00:37:15,476 --> 00:37:16,685 OK. 1022 00:37:18,896 --> 00:37:19,896 Oh. 1023 00:37:19,897 --> 00:37:21,481 Sorry. 1024 00:37:21,482 --> 00:37:22,649 Passing gas is good. 1025 00:37:22,650 --> 00:37:24,359 Means we're making progress. 1026 00:37:24,360 --> 00:37:26,069 Does that mean that I can... I can stop? 1027 00:37:26,070 --> 00:37:27,864 No. Nope. Keep going. 1028 00:37:32,869 --> 00:37:36,121 OK, Ogilvie, you... you might wanna... 1029 00:37:36,122 --> 00:37:37,874 Oh! 1030 00:37:41,711 --> 00:37:43,254 Much better. 1031 00:37:44,255 --> 00:37:46,256 MAP's holding on Levophed. 1032 00:37:46,257 --> 00:37:48,216 1 mike per kg per minute. 1033 00:37:48,217 --> 00:37:49,426 Do me a favor. 1034 00:37:49,427 --> 00:37:50,635 Give me some 4x4s on some Betadine. 1035 00:37:50,636 --> 00:37:51,928 Sorry, we're getting killed 1036 00:37:51,929 --> 00:37:53,347 with transfers from Westbridge. 1037 00:37:53,348 --> 00:37:55,515 Mesenteric ischemia, perforated bowel. 1038 00:37:55,516 --> 00:37:56,516 Got a hot one here. 1039 00:37:56,517 --> 00:37:57,517 Yeah. 1040 00:37:57,518 --> 00:37:58,643 Possible nec fasc. 1041 00:37:58,644 --> 00:38:00,020 Possible? 1042 00:38:00,021 --> 00:38:01,396 Need CT with contrast to confirm. 1043 00:38:01,397 --> 00:38:03,106 This is spreading like wildfire. 1044 00:38:03,107 --> 00:38:04,483 By the time you get your CT, it's gonna be up to her waist. 1045 00:38:04,484 --> 00:38:05,567 She's gonna need a hemicorporectomy. 1046 00:38:05,568 --> 00:38:06,902 She needs a CT scan. 1047 00:38:06,903 --> 00:38:09,571 How about a stainless steel scan? 1048 00:38:09,572 --> 00:38:11,782 For Christ's sake. Robinavitch! 1049 00:38:11,783 --> 00:38:15,243 Robby, what the fuck are you doing? 1050 00:38:15,244 --> 00:38:16,953 Oh, God, I think I might puke. 1051 00:38:16,954 --> 00:38:19,414 That's called dirty dishwater exudate without purulence. 1052 00:38:19,415 --> 00:38:21,625 There's a gray appearance to the fascia, and in the OR, 1053 00:38:21,626 --> 00:38:23,877 you'll see easy separation in the tissue planes. 1054 00:38:23,878 --> 00:38:25,212 When do you start your sabbatical? 1055 00:38:25,213 --> 00:38:26,922 - Tomorrow. - Not a moment too soon. 1056 00:38:26,923 --> 00:38:28,883 Thanks for coming down. 1057 00:38:32,053 --> 00:38:35,639 I'm catching up on my charting as fast as I can. 1058 00:38:35,640 --> 00:38:38,517 Why don't you give my generative AI app a try? 1059 00:38:38,518 --> 00:38:41,019 It's 30% more efficient, and providers report 1060 00:38:41,020 --> 00:38:42,896 increased job satisfaction. 1061 00:38:42,897 --> 00:38:45,899 And you'll rarely have to stay overtime to complete charts. 1062 00:38:45,900 --> 00:38:47,651 Yeah? 1063 00:38:47,652 --> 00:38:48,944 OK. 1064 00:38:48,945 --> 00:38:50,529 Yeah, I'm usually here at least a couple hours 1065 00:38:50,530 --> 00:38:52,406 after every shift trying to catch up, so... 1066 00:38:52,407 --> 00:38:54,825 Sure, AI will make doctors more efficient, 1067 00:38:54,826 --> 00:38:57,119 but hospitals will expect us to treat more patients 1068 00:38:57,120 --> 00:38:59,121 without any extra pay, of course, 1069 00:38:59,122 --> 00:39:00,914 all the while eliminating staff positions 1070 00:39:00,915 --> 00:39:02,624 for attending and residents. 1071 00:39:02,625 --> 00:39:04,209 Oh, Dr. Robby, I am not an advocate 1072 00:39:04,210 --> 00:39:06,336 for erasing my own profession. 1073 00:39:06,337 --> 00:39:09,840 But I am advocating for getting to spend more time with my son. 1074 00:39:09,841 --> 00:39:12,801 Nothing can replace family. 1075 00:39:12,802 --> 00:39:14,803 What's the status of your septic patient? 1076 00:39:14,804 --> 00:39:17,597 Nec fasc. Surgery's taking her up. 1077 00:39:17,598 --> 00:39:20,142 Think they'll be able to save her leg? 1078 00:39:20,143 --> 00:39:22,102 Right now, I'm just hoping they can save her life. 1079 00:39:22,103 --> 00:39:24,688 Hey, how's Ogilvie doing? 1080 00:39:24,689 --> 00:39:28,525 A little TB exposure, a touch of ass-plosion. 1081 00:39:28,526 --> 00:39:30,652 All in all, pretty good day so far. 1082 00:39:30,653 --> 00:39:31,945 Kaison, you came. 1083 00:39:31,946 --> 00:39:33,488 Hey, ain't no way I was gonna let you 1084 00:39:33,489 --> 00:39:35,449 miss Peter and Aubrey's epic Fourth of July party. 1085 00:39:35,450 --> 00:39:37,617 Come on, now. Hey. 1086 00:39:37,618 --> 00:39:39,286 Brought some brew. 1087 00:39:39,287 --> 00:39:40,662 Oh, you are the man. 1088 00:39:40,663 --> 00:39:42,122 Appreciate the bromance over here, 1089 00:39:42,123 --> 00:39:44,458 but no food 'cause you might go into surgery. 1090 00:39:44,459 --> 00:39:47,086 And no beer 'cause we're a goddamn hospital. 1091 00:39:50,673 --> 00:39:52,883 Starting your sabbatical early? 1092 00:39:52,884 --> 00:39:54,718 I know someone who could really use a drink right now. 1093 00:39:54,719 --> 00:39:56,011 In the hospital? 1094 00:39:56,012 --> 00:39:58,473 As a parting gift. 1095 00:40:02,477 --> 00:40:04,102 How's it looking? 1096 00:40:04,103 --> 00:40:05,353 Good. 1097 00:40:05,354 --> 00:40:07,314 The Steri-Strips did the trick. 1098 00:40:07,315 --> 00:40:08,440 CT's ready. 1099 00:40:08,441 --> 00:40:10,066 We already scanned him. 1100 00:40:10,067 --> 00:40:12,486 Head and neck want thin cuts and a 3D reconstruction 1101 00:40:12,487 --> 00:40:14,488 of the mandible before they decide 1102 00:40:14,489 --> 00:40:15,906 if Mr. Varney needs surgery. 1103 00:40:15,907 --> 00:40:17,824 Have they even come down to examine him in person? 1104 00:40:17,825 --> 00:40:19,409 No, they must be backed up. 1105 00:40:19,410 --> 00:40:23,205 Or there's a July Fourth sale at the BMW dealership. 1106 00:40:23,206 --> 00:40:24,498 Labs are back. 1107 00:40:24,499 --> 00:40:26,333 Albumin's low. Total protein's low. 1108 00:40:26,334 --> 00:40:27,918 He also has megaloblastic anemia. 1109 00:40:27,919 --> 00:40:29,169 - Malnutrition. - Probably. 1110 00:40:29,170 --> 00:40:30,337 Jail cuisine. 1111 00:40:30,338 --> 00:40:31,713 Whitaker, what labs should we add? 1112 00:40:31,714 --> 00:40:33,840 B12, folate, iron levels. 1113 00:40:33,841 --> 00:40:35,342 Good. 1114 00:40:35,343 --> 00:40:37,010 We're gonna run some more tests, Mr. Varney. 1115 00:40:37,011 --> 00:40:38,346 Hang in there. 1116 00:40:42,934 --> 00:40:45,435 I have to pee. 1117 00:40:45,436 --> 00:40:46,895 There's no PureWick here. 1118 00:40:46,896 --> 00:40:48,146 But here you go, hon. 1119 00:40:48,147 --> 00:40:50,106 - I'll help you get on. - No. No. 1120 00:40:50,107 --> 00:40:52,526 No bedpan. I can walk to the bathroom. 1121 00:40:52,527 --> 00:40:54,194 - I just need a little help. - Are you sure? 1122 00:40:54,195 --> 00:40:55,278 I'm here, babe. 1123 00:40:55,279 --> 00:40:56,780 Oh, we got this Mr. Hamler. 1124 00:40:56,781 --> 00:41:00,033 You'll have to bring your IV and portable oxygen. 1125 00:41:00,034 --> 00:41:02,035 Please? 1126 00:41:02,036 --> 00:41:04,454 I'll grab a wheelchair. 1127 00:41:04,455 --> 00:41:06,414 Let's try to sit you up and dangle your legs. 1128 00:41:06,415 --> 00:41:07,917 OK. 1129 00:41:10,586 --> 00:41:13,965 1, 2, 3. 1130 00:41:19,637 --> 00:41:21,388 This is not a good idea. 1131 00:41:21,389 --> 00:41:23,473 I don't think we're gonna need this. 1132 00:41:23,474 --> 00:41:25,100 Hey, Paul, Paul, 1133 00:41:25,101 --> 00:41:27,269 why don't you come grab a cup of coffee with me? 1134 00:41:27,270 --> 00:41:29,229 I'm still zonked from my all-nighter, 1135 00:41:29,230 --> 00:41:32,899 and I wanna go over some delivery instructions with you. 1136 00:41:32,900 --> 00:41:35,569 Sure. 1137 00:41:35,570 --> 00:41:37,445 Rox, you OK? 1138 00:41:37,446 --> 00:41:40,324 - Mm-hmm. - Yeah. It's OK. 1139 00:41:46,998 --> 00:41:49,000 Bedpan it is. 1140 00:41:56,966 --> 00:41:58,842 You lose your pulse ox again, bud? 1141 00:42:04,390 --> 00:42:05,807 Louie. 1142 00:42:05,808 --> 00:42:07,684 Louie! 1143 00:42:07,685 --> 00:42:10,270 He kept pulling off his pulse ox. 1144 00:42:10,271 --> 00:42:11,688 It's on. It's at 71. 1145 00:42:11,689 --> 00:42:13,149 Louie, wake up. 1146 00:42:14,734 --> 00:42:16,526 - I'm not getting a carotid. - I got the airway. 1147 00:42:16,527 --> 00:42:19,696 Hey, Perlah, crash cart, intubation tray, please. 1148 00:42:28,466 --> 00:42:33,405 Sync and corrections by btsix www.addic7ed.com