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00:00Maybe, you'll stay here tonight, baby, it's alright, maybe, you can stay here tonight.
00:18Out on the street, the loud music of my guitar, it's your babawamba, one of those old fancy cars, she said, hey boy, why don't you get on in, for tonight, I'll be your lover and your friend, she said, baby.
00:48You're on the street, you're on the street, you're on the street.
01:18Is it true?
01:19Simi told Hector that Dr. Durangian said the hospital was up for sale.
01:23They might turn into an ortho center with no ER.
01:25Oh, they're always threatening to shut us down, but they never do.
01:29I don't know. Did you tell her?
01:32I didn't tell the doctors.
01:36Gloria is looking for you.
01:38No guts, no Gloria.
01:39Must be time for my weekly spanking.
01:41That'd be nice for all our sakes.
01:43You sure you're cool being here today?
01:46Yeah.
01:47Why wouldn't I be?
01:48Well, if you need to talk.
01:50Yeah, I won't, but thanks.
01:54Where's Abbott?
01:57Getting some air.
02:10Hey.
02:12You okay in there?
02:17Awesome.
02:18I like to say it goes away, but I had morning sickness for six months with my second daughter.
02:25Hell, who am I kidding?
02:26That one still worries me sick.
02:30Thanks.
02:31That was worth it.
02:33You tell anybody yet?
02:35Oh, no.
02:36Oh, no.
02:37Okay.
02:38Not until I pass 12 weeks.
02:39Not this time.
02:40Nothing but good vibes.
02:42But just so you know, Robbie's working today.
02:45Today's the day Doc Adamson died.
02:47He hasn't worked at him four years.
02:48So why is he here?
02:49All I know is he still blames himself for Adamson's death, so if he's a little prickly today, give
02:58him a pass, okay?
03:00Great.
03:01Great.
03:03Hang in there, kid.
03:04Good morning, Jack.
03:08What are you doing here?
03:09I'm working.
03:10And you?
03:11Well, I don't know.
03:12Had a guy come in, hit by a drunk driver in a crosswalk, 39-year-old vet, survived three
03:38tours without a scratch.
03:43I spent the last two hours coding it.
03:47That's always a rough way to end the night.
03:49Must have had a reason at one time to keep coming back, but I can't think of it right
03:56now.
03:57Because this is the job that keeps on giving.
04:01Nightmares.
04:02Ulcers.
04:03Suicidal tendencies.
04:06Besides, if you jump on my shift, that's just rude, man.
04:22Hope I'm never one of your patients.
04:25That makes two of us, my friend.
04:28I got a pregnant teen coming back today for a mifepristone and a small bowel obstruction
04:35waiting on surgery for the last three hours.
04:38Oh, and unfortunately, the Kraken is still boarding a VA.
04:43Still?
04:44The guy's been here for a week waiting on the site bed.
04:46Yep.
04:47He's only getting worse.
04:48He's catching some Zyprex disease at the moment, but when he wakes up, God help you all.
04:53I wrote a note for the family of my dead vet, if anyone shows.
05:00Oh, and you got the med students and new interns starting today, so good luck with that.
05:06Like you're lugging me.
05:07Sir, come back here!
05:08No more needles!
05:09Who?
05:10Sir!
05:11No more needles!
05:12Stop!
05:13You sure you want to work today, huh?
05:16They're gonna hurt me!
05:17Sir, I promise nobody's going to hurt you!
05:21Sir!
05:26Who left this mess?
05:27They had a rough night.
05:31Good morning, sunshine.
05:32You obviously haven't seen this board.
05:34Ah, we've seen worse.
05:36Nothing like a little challenge every now and then to keep everybody on their toes.
05:39Dr. Rubinovich?
05:40Yep.
05:41Melissa King.
05:42I will be joining you today.
05:43I just came from two months in the VA.
05:45Hey, welcome to the pit.
05:46This is Dr. Jack Abbott.
05:48Nice to meet you.
05:49I can't take how excited I am to be here today, so...
05:52Talk to me at the end of the day.
05:55Ignore him.
05:56He had a rough night.
05:58And is having an ongoing existential crisis.
06:00Don't worry.
06:01You'll get there soon enough.
06:03I married my second husband, Everett, in 1964.
06:07He unfortunately passed in 1976 from a heart attack while we were vacationing in Kissimmee, Florida.
06:14It was awful.
06:15Good morning.
06:16We're gonna round Dr. Moyen.
06:20Excuse me, Estelle.
06:24So, you know we track every residence patients seen for an hour.
06:27I was just taking her history.
06:28It's a brief backstory about what brought them in.
06:30Not an autobiography.
06:31I was almost done.
06:32You hadn't even made it to this century.
06:35Patients, they check in for registration here.
06:38A nurse eyeballs them, makes sure they're not dying.
06:41If not, they're moved to one or two triage rooms for vitals and a quick chair exam,
06:45where you can go to your labs and your x-rays.
06:47And then they come back to the waiting room, until the bed opens up.
06:51For how long?
06:52Eight hours, if they're lucky.
06:54A lot of times, twelve.
06:56Uh, is it always this busy?
06:58Uh, no.
07:00It gets a lot busier.
07:05Take this.
07:06Hey, Matteo.
07:07Good morning, Cass.
07:08This is Sherry.
07:10Hi.
07:11Sherry, I'm Dr. McKay.
07:13I have some student doctors with me today.
07:15Do you mind if they observe?
07:16Sure.
07:17Okay.
07:19What's going on, Sherry?
07:21I burned my hand on a sterno.
07:26What were you doing with a sterno?
07:28Uh, cooking.
07:29You were cooking with a sterno?
07:31Yeah.
07:32We were making s'mores.
07:34Sweet.
07:35This one loves s'mores.
07:37Uh, we've been here for hours, and I have to get them to school.
07:42Do you know how much longer this will take?
07:44Uh, yeah.
07:46Let's see.
07:47You taking anything for the pain?
07:49Uh, not yet.
07:50Thousand of Tylenol, orange ibuprofen, and the saline dressing?
07:52Yes.
07:53Please.
07:54Okay.
07:55We'll go around.
07:56And the fun begins.
07:58All right, Sherry.
07:59We're gonna patch you up and get you out of here as soon as possible, okay?
08:02I'll be back.
08:07As you can see, we have some new faces with us this morning.
08:11Good morning, good morning.
08:12Come on over.
08:13Starting with second-year resident Dr. Melissa King, fresh from the VA.
08:17Everyone calls me Mel.
08:19I'm so happy to be here.
08:20Trinity Santos, intern.
08:23Victoria Javadi, MS3.
08:25Uh, Dennis Whitaker, MS4.
08:28Welcome to the pit.
08:29We got two traumas from the T five minutes out.
08:31Okay, copy that.
08:32Uh, actually, this is the most important person that you're gonna meet today.
08:35This is Dana.
08:36She's our charge nurse.
08:37She is the ringleader of our circus.
08:39Do what she says when she says it.
08:41As you can see, our house is always packed, and our department is mostly clogged up with borders.
08:47Those are admitted patients waiting for a room upstairs, sometimes for days.
08:50Beds are a very precious commodity around here, so please be quick and efficient with your workups.
08:56What else?
08:57We treat the sicker patients back here, but please keep your eye on that waiting room.
09:00Make sure nobody's gonna die out there.
09:02Your senior residents are Dr. Collins and Dr. Langdon.
09:07You report to them, and they report to me.
09:10Okay?
09:11Great.
09:12Senior residents, you got your sign-outs?
09:13Yep.
09:14Yep.
09:15Okay.
09:16Let's do this.
09:18Virgil Straker.
09:19Nine millimeter GSW to the left shoulder.
09:22CT angiogram negative.
09:24Surgery wants to admit for overnight observation.
09:26Good vitals.
09:27They repeat a crit?
09:28Stable crits every two hours times three.
09:30Discharge it on Sefton.
09:32Recheck tomorrow.
09:33He'll get way more rest at home.
09:34Good morning, Mr. Straker.
09:35You want to go home?
09:36Hell yeah.
09:37Okay.
09:38Hey, hey, Ro!
09:39Hey, Ro!
09:40Hey, Ro!
09:41All right.
09:44Murphy Rottenstein.
09:4548-year-old woman with cirrhosis and upper GI bleed intubated and stable after one unit.
09:51Awaiting ICU bed.
09:53Hey, Doc.
09:54Hey, Doc.
09:55And we all know Louie Cloverfield.
09:58Blood alcohol of 420 at 11 p.m.
10:01I've been cutting back.
10:02How is he still breathing?
10:04That's the lethal dose for you and me.
10:05That's happy hour for Louie.
10:06Sobered up.
10:07Had two rounds of lorazepam.
10:08Hold out your hands for me, Louie.
10:12Nothing to lorazepam.
10:13On it.
10:14And a script for Librium.
10:15It's good to see you, Louie.
10:16It's always a pleasure, Doc.
10:18Bar fight.
10:19With complete avulsion of tooth number 8.
10:22Smile, Charlie.
10:23Oh!
10:24Where's your tooth, Charlie?
10:26If I could find out.
10:28Cancel the discharge.
10:30Order a chest x-ray.
10:31Gotta rule out aspiration.
10:32Incoming!
10:3542-year-old male Sam Wallace.
10:37Blunt head with agonal respiration.
10:39Drop down on the T-tracks.
10:40Couldn't tube him.
10:41L a man place.
10:42Suicide attempt?
10:43Rescue.
10:44He's a good Samaritan.
10:45We're helping the woman who fell off the tracks.
10:46She's right behind us.
10:47Okay, trauma one.
10:48Go ahead.
10:49Come on.
10:51Woman falls on T-platform.
10:53Good vitals.
10:54No head injuries.
10:55D-gloving injury.
10:56Right lower leg with open fracture.
10:57Dysmocation of the ankle.
10:59Okay, trauma two.
11:01Trauma two.
11:02Let's go.
11:09How we doing?
11:10Ready?
11:11Here we go.
11:12Ready?
11:13One, two, three.
11:14Good breath sounds bilaterally, but we need to protect his-
11:17Apparently, he jumped down to save the lady.
11:19When he climbed back up, he slipped, fell back and hit his head.
11:21Okay, thanks.
11:22It's more of an R2 procedure.
11:23Um, Mel.
11:24Right?
11:25I need you on the 8 fast.
11:26Pupils, four millimeters and reactive.
11:28Okay, that's encouraging.
11:29What do you want for meds?
11:30120 ketamine, 80 of rock.
11:32AFib on a monitor.
11:33Morrison's clear.
11:34That's a lot more blood than expected.
11:36Um, he's probably anti-coagulated for AFib.
11:39Check his medical records.
11:41See if he's on a DOAC.
11:42Standby with four-factor PCC.
11:43There's a brain bleed.
11:44What's with the PCC?
11:45No.
11:46Uh, clotting factors two, seven, nine, and ten.
11:49Okay, be right back.
11:50Fifty a fan, didn't touch her.
11:52Did she faint or did she trip off the platform?
11:54Nobody knows.
11:55The other guy jumped down, pulled her out the tracks just as the train was rolling in.
11:58Isolated injury to the foot.
11:59The train ran over her foot.
12:00Got caught between the platform and the incoming train.
12:03Ma'am?
12:04Ma'am, what's your name?
12:06Two grams.
12:07Do you speak any English?
12:09Airway and breathing are perfect.
12:11As is circulation, BP 140 over 85.
12:15Students, what might have made her faint on the platform?
12:18TIA, CBA.
12:19Could be an arrhythmia, cardiac event.
12:20Oh, she needs...
12:21EKG and a...
12:22Choponin.
12:23Okay, good, good.
12:24Exactly.
12:25Subway trained to glove her foot with an open fracture dislocation.
12:27Ooh, and I thought my heels were painful.
12:29They're dynamically stable.
12:30CFS negative.
12:31Ma'am, I'm Dr. Yolanda Garcia.
12:32Any pain in your chest or belly?
12:34Can we please push the morphine?
12:38No.
12:39It could cloud her mental status.
12:40I can't do an exam like this.
12:41Push the damn morphine.
12:43We're doing a poplar to a block.
12:45Numbs the lower leg.
12:46No side effects.
12:47Wonderful.
12:48Where's the other guy?
12:49Next door.
12:50He's a bit worse.
12:51Pan scanner, let me know when she stops screaming.
12:54The cords are very anterior.
12:57Yeah, that's because we can't flex the neck.
12:59Keep the hockey stick straight up.
13:02I'm in.
13:03Good.
13:04Well done.
13:05Bring me up to speed.
13:06Intubated for agonal respirations, GCS5, probably anticoagulated.
13:10With what?
13:11First time here.
13:12There's no medical records.
13:13Call for FFP?
13:14No, we got four-factor PCC.
13:16AD of mannitol to reduce brain swelling, then right up to CT.
13:19Hey, give me a favor.
13:20Swap out with Jessie for me, would you?
13:22Of course.
13:23Yeah.
13:24Dr. Rabinovich, can you have a moment?
13:26I'm just a little busy right now, Gloria.
13:28One sec.
13:31The nerve block complete.
13:32Seems like it's starting to work.
13:33Swapping out, Jessie.
13:34Takes ten minutes for the full effect, and the marquee lasts a good four hours.
13:38She's next for CT.
13:39Do you have any idea what language that is?
13:41Well, definitely not Tagalog.
13:43Maybe Hindi or Urdu?
13:44I'm gonna go get language services.
13:46Would you speak like five languages?
13:47Six, but that's not one of them.
13:49Six, and I thought Collins was smart.
13:51Oh, it's way too early for you to start being an ass, London.
13:54Open hostility in front of the patient.
13:56She doesn't speak English.
13:57Judgemental and dismissive.
13:59How we doing?
14:00Vital stable.
14:01Unlike these two.
14:03Oh, good for you.
14:04Princess made a joke.
14:05And I thank you for that beautiful blessing.
14:08Namaste.
14:09Okay.
14:10Do we have a phone or anything with the relative's name on it?
14:12Uh, EMT said the purse got obliterated when the subway ran over it.
14:16Any way I can speak with her?
14:18I highly doubt it.
14:19We don't know what language she speaks.
14:20Hey, um...
14:21Any chance she jumped?
14:24She may have been pushed.
14:26Jesus.
14:27Yeah.
14:28I'm looking at a pause by Ikrom.
14:29I take it you're free now?
14:31We need to talk about your numbers.
14:33Uh, people we've saved?
14:34Metrics.
14:35Our door to balloon times beat federal standards.
14:36I'm talking about press gaining scores.
14:37Patient satisfaction?
14:38If they're still alive, they should be satisfied.
14:39Our goal is 36% to very satisfied with their care.
14:40Your department is at eight.
14:41Do you know how likely patients are to recommend this hospital?
14:43Um, this is an emergency department, not a Taco Bell.
14:44Eleven percent.
14:45Well, if you want people to be happier, don't make them wait for twelve hours.
14:46There's a nursing shortage across the country.
14:47Most of our patients are boarders who are waiting for a bed upstairs.
14:48We don't have the beds.
14:49We don't have the beds.
14:50That's bullshit.
14:51The beds are up there.
14:52You just don't want to hire the staff you need to care for.
14:54Oh, Doc.
14:55Doc, it ain't working.
15:06And whatever they're giving me, it's not working.
15:07No response to Mexico to it.
15:08No response to Mexico to it.
15:09That's bullshit.
15:10The beds are up there.
15:11You just don't want to hire the staff you need to care for.
15:12Oh, Doc.
15:13Doc, it ain't working.
15:16And whatever they're giving me, it's not working.
15:19No response to Mexico to it.
15:21giving me it's not working no response to my exit trade should i send in the fleet okay sir we're
15:27gonna try an enema like i said there's a nursing shortage well if you paid them a living wage
15:33they'd be lying enough to work here our budget can't support that here's a dirty little secret
15:37the hospital saves money keeping patients down here in the pit it's way cheaper than staffing
15:42upstairs i have asked you repeatedly to stop referring to the emergency department as the pit
15:47it is derogatory and incompatible to the institution's image you know what's
15:51incompatible the institution's image me speaking to the media about people who code in our waiting
15:55rooms and people who get shitty care in our hallways waiting for an su bed for days i've heard about
16:00doctors who have tried that and find themselves out of work i know today is difficult every day is
16:06difficult down here boarding is a nationwide problem your predecessor adamson sure as hell knew that or
16:12wasn't that something he taught you fuck wow really yes really other hospitals are managing
16:19this crisis much more effectively so you can either step up your game or you can step aside
16:35good samaritan dude has a small left temporal intraparenchymal bleed no epidural no subdural no
16:40midline shift in the brain that's good news you can recover ct can take her in five let's have a
16:45look bandage scissors all right if an artery is totally transected the smooth muscle and the tunica
16:52media contracts with hemostasis but if it's a partial cut get out your umbrella grab a culture
16:57from the open fibula before you reduce you're up i'll stabilize the need for the reduction dr langdon
17:05we'll be distracting distally before moving medially to clear the tibia good ready
17:25med student down
17:28good catch on bar fight billy he's an aspirated tooth on chest x-ray we've been dead in a week from a
17:33lung abscess that you let him be discharged call on the pulmonary cardiac arrest tta 10 minutes where
17:39should we put it anywhere you might have to put somebody in the hall dr robbie she uh took a fall
17:45i i tripped on the gurney i'm fine
17:50why don't you go get a cool drink in the staff lounge i'm fine really i swear oh i know but it's
17:57hospital policy anytime someone gets a paper cut around here we have to fill out a workers count
18:01report
18:07another way
18:11i was fine until about two weeks ago after the rochester marathon okay any falls or injuries
18:17just tired sore muscles yeah i'd be in bed for a month was this your first triathlon god no no i do one
18:24every few months have you seen a doctor yet um no i went for a run this morning had to quit after a
18:32minute pretty short breath this goes under your tongue no current meds no allergies we're gonna check
18:39a few labs at an ekg draw red and purple top yep
18:42it's at 98.2 take a deep breath from the otis
18:50a little pimp right now okay
18:53otis
18:57otis
18:59otis
19:01didn't take him for a lightweight huh
19:06shit no pulse crash card lean flat
19:08let's check a rhythm saline pads
19:16quick look paddles
19:21v-tech charging at 200
19:24charged clear
19:28all right it's back to normal sinus need a gurney in here
19:30so what's the plan i see you when we can get a bed and admit for supportive care repeat head ct
19:40in three hours or sooner if he blows a pupil want a kepper low order's already in
19:48nice job
19:49do you think he'll wake up maybe maybe not no good deed goes unpunished
20:03oh is anyone um notified the family
20:10i could try otis williams healthy 31 year old v-tech arrest two weeks after triathlon
20:16kind of saw with one shock pulse 98 vp 110 over 60. he's a little young son of mine exactly right
20:22what's the differential dr collins uh drug overdose electrolytes on qt
20:27regatta syndrome wpw how you doing there otis okay what happened v-tech again 200 joules
20:36charged and clear back in sinus otis
20:41otis
20:46oh groaning's good five of nasal o2 cbc cmp ponen and d-dimer what are you doing
20:53one gram calcium glutinate ivy push we don't have the labs back with the monitor wine qrs and peak
20:58t waves hyperkalemia how do you get that intense exercise caused muscle breakdown
21:01rhabdomyolysis knocked out his kidneys now he's not clearing potassium i bet it's over 7.5
21:05wait two minutes for the eyes if you're the rest of you we might not get him back
21:08it's like calcini you could kill him wait it's my ass not yours
21:23pan scan is negative that means you can admit to orthopedics but there may have been a medical
21:27etiology if she fainted that's not surgical get an internal medicine consult or admit to medicine
21:32with ortho consulting either way i'm off the case okay thanks for nothing and sefton i'll grab the
21:38chance did we figure out what she's speaking last interpreter thought she might be from pakistan
21:45there are 77 languages in pakistan okay well i will buy lunch for whoever figures it out
21:51good luck if you need me i'll be saving lives that was wicked
21:58that was gross yeah too much for a little miss crash and burn what'd you do with her nothing i
22:03think she'll be fine are you kidding if that took her out she'll be lucky to make it through this
22:07rotation i got 50 bucks so she doesn't last through this shift come on put your money where your mouth is
22:15no i didn't say anything okay i sure as hell don't have 50 bucks i'll be this lady's age by the
22:21time i pay off my student loans not that you hey you want to sell a kidney i could get you 30k as
22:31sooner this weekend that's just between you and me think about it how you doing yeah qrs is narrowed
22:48much better potassium is 7.7 creatinine 5.6 high potassium and renal failure just what you thought
22:56must be my lucky day ordering 10 units of regular insulin and 25 grams of glucose why insulin glucose
23:05shift the potassium intracellularly exactly but the definitive treatment is hemodialysis alcohol
23:10renal and get a tech down with the machine have you ever seen a dialysis catheter inserted
23:15dr collins are gonna place ephemeral quentin under ultrasound guidance it's an excellent way to learn
23:20oh my chest yeah we had to shock you you're gonna be sore for a while
23:24you shocked my heart long story dr collins will fill you in
23:37you got a sec
23:42you okay why wouldn't i be are you okay why wouldn't i be
23:46you seem annoyed with me already and i just got here it's not always about you robbie
23:57am i gonna be okay yeah you just need to take it easy on yourself muscle breakdown and myoglobin
24:05damaged your kidneys why did you shock my heart when your kidneys don't work potassium builds up and
24:12messes with the electrical activity in your heart
24:15can it happen again we gave you medicine to lower your potassium and you'll need dialysis to clear it
24:21all out then i'll be okay yeah you might need a week or two for your kidneys to recover but yeah
24:29you really need to hydrate like crazy before and after a triathlon
24:33trust me i won't let this happen again good be kind to yourself
24:54oh hey abbott's told me that he's got a pregnant teen coming back today from miffa pristo let me know
24:58when she gets here yep bowel obstruction still waiting on a surgery consult what about garcia she
25:03was just here for the traumas i think she was waiting for her attending to sign off
25:09okay oh one of the med students took a header i parked her in the lounge under the guise of a
25:16work comp report will you just go in there eyeball and make sure she's all right she's gonna
25:20miss the morning arrival of the living dead how many are we expecting we're getting three but one died
25:25on route i don't know who's luckier us or them what's open 14 89 year old woman from a sniff history
25:31of emphysema chf ms b-fib unresponsive to three shocks two rounds of epi what is that lucas chest
25:38compression system robotic cpr
25:40you're gonna get a hold one two three
25:51students are dropping like flies take a break ice the finger you can count on getting a couple
25:56elderly patients every day around 7 30 after the nursing homes and assisted living facilities
26:01through their morning bed checks you can practically set your watch was there an advanced directive no
26:06full coke or the nursing home seriously lucas off
26:12still leave him lucas on one more round of epi one more shock and then we call it
26:23joseph spencer 79 fever and cough from assisted living he has a history of mild alzheimer's
26:28heart rate 130 bp 90 over 60 you gave him 500 cc's normal saline hi mr spencer i'm dr king this is
26:38dr collins how are you feeling today is it dinner time i i'm not really hungry do we have any paperwork
26:45from the facility he has a pulse iv fluids and medications are fine but no intubation and no
26:50chest compressions that's helpful of course ronchi here light middle lobe infiltrate temp 102
26:58call a code sepsis code to make sure we check all of our boxes the federal government audits our
27:04sepsis bundle performance and publishes the data online today it better be perfect two sets of blood
27:10cultures lactic acid 30 cc's per kilo ns a gram of ceftriaxone 500 of azithromycin repeat lactic
27:18then three hours nice charging and stop call it nursing home just faxed us the dnr are you kidding
27:31power out the defibrillator and the lucas waste of time and money who the hell works at that place a
27:35nurse taking care of 60 patients who couldn't find the form she called 911 so she could take care of
27:40the others okay let's move her to the viewing room and notify the family one of the things we do here
27:46is to take a moment of silence when we lose a patient to respect their humanity and also to
27:52remember that this was somebody's child or sibling or parent friend
27:57i'm so sorry maybe leave it on vibrate while you're working
28:20later doc you behave yourself now always
28:22your med student's back on her feet how old's that kid i don't know i didn't ask is she some
28:31sort of savant i don't know maybe dr abedivich i just wanted to apologize for any trouble my
28:36clumsiness might have caused i feel ridiculous oh i can't tell me times i've hit my head on an overhead
28:41lamp twice i needed to get staples why don't you go work with dr mckay and triage that would help both of
28:46us oh i i don't need special treatment good because i don't give it
28:54look i know i might look too young but i studied my ass off to get here
28:58probably harder than the others i earned this okay look i respect your dedication and your
29:04determination but while you're here you're my responsibility and when one of my responsibilities
29:08takes a header wow abbott called for a surgical console in the sbo three hours ago you're very
29:12lucky they didn't perv i'm here to see my daughter i'm sorry is that a patient you're talking to her
29:21am i interrupting no no we're done we're good come find me when you're ready to present your next case
29:28thank you
29:31so how's your first day going it's great yeah really great hey crash they're doing a dialysis
29:37catheter insertion in north one if you want to check it out mm-hmm did she say crash no no no it's
29:45not crash um she said crush because i'm always crushing it um thanks for coming down mom but i've
29:53i've got a patient bye
30:06what do you want um i i i just want to make sure you're comfortable i am taking a dump in dustpan
30:14so what's that fucking tell you um i'm i'm clearly i'm clearly in the wrong room i'm sorry
30:27so it would have been nice if someone had told me that eileen shamsie's daughter
30:31was one of our med students and we're on the surprise was it as awkward as i hoped you had been
30:36you you have a mean streak in you you know that what's the deal with the body in 19. let's have
30:41it's mbc vet from last night still waiting on next to ken supposedly on their way okay can we move
30:46them to the viewing room at least nursing home dnr is heading there joining last night's jane doe
30:50coroner's office is backed up well then our morgan needs to take her then
30:55perla
30:57triathlete otis uh he's stable repeat potassium is 6.1 renal wrote the dialysis order tech should be down
31:0515 minutes good thank you language mystery solved yet no hey what's your take on dogs in what
31:16context for kids kids and puppies go together like fish and chips man's best friend you know well you
31:22don't have a dog i don't have a best friend what am i you're my best resident big difference yeah but
31:28we're still friends not if this conversation goes on with smugger i have a lethargic four-year-old
31:35no pmh no innocent illness no fever vomiting parents just couldn't wake him up this morning what room
31:41oh south 15. there's no nuchal rigidity no skin lesions no focal neuro he looks well fed and cared for
31:52one dka from new onset diabetes no bg85 cbc
32:09can you wake up for me tyler he's not usually this sleepy no and he barely flinched for the blood test
32:15he wakes up at 90 miles an hour and doesn't stop till he passes out at night
32:19he passes out no he just means he goes all day any chance he could have ingested something any
32:25pills vitamins any prescriptions that may have been left around no that's all kept locked in the
32:30medicine cabinet the whole house is child proof uh what about alcohol anything left out no what about
32:37pets no he's usually like quite active very um any injuries lately no bumped his head recently
32:47not that i'm aware of but he does the rough housing with drew but he never gets hurt
32:52oxygen level is normal good pulse and blood pressure no signs of infection we're going to start with
32:57blood and urine tests check for any metabolic abnormalities
33:05it's really throbbing yeah blood's under pressure gotta drain it
33:09no anesthesia or stop before i hit the nail bed i hope
33:20hey eyes down here watch and learn i'm just looking who to see next you're supposed to take them in the
33:25order they arrive yeah i know how it works okay no need to cry about it do you want me to choose for
33:31you no wow pain's gone thank you all right how about a 20 year old coffin eight should be easy and
33:44probably viral i don't need an easy one suit yourself huckleberry i'm gonna take the splitting headache
33:50maybe i'll catch a subarachnoid hemorrhage or something cool hey why do you keep calling me that
33:54huckleberry it's a term of endearment it sounds like sarcasm you think ordering on harassment
34:03where are you from broken bone nebraska jesus where the hell is that it's about three and a half
34:10hours west of omaha oh yeah just a little south of nowhere what the hell do you do there my parents
34:15have a farm so you're a farm boy yeah i guess i rest my case huckleberry
34:31i'm so sorry ma'am we don't understand you me i'm dr heather collins
34:45i'm from here portland oregon you where are you from uh-huh
34:57china india i can't tell where you're pointing to jikistan
35:04nepal you're from nepal nepali
35:08mom's got a bad burn needs wound checks and hand therapy and i got a sneaky suspicion she may be
35:19unhoused i'll talk to her we can offer some help thank you i appreciate it oh you're back
35:25dr robbie suggests that i might be of assistance yeah i could use the company victoria javadi this is
35:30kiara alfaro she's a department social worker which pretty much makes her an angel welcome thanks
35:37thank you so what rotation is this for you um third i've done ob gyn and peds are you any favorites
35:44not really well what are you leaning towards i'm not really sure yet okay well you have time
35:52can i actually ask you a personal question i'm 20 and i've earned the right to be here
35:57oh yeah i don't i don't doubt that for a minute i i was actually wondering if dr eileen shamsie from
36:05surgery is a friend or relative of yours i saw you talking to her in the hall and yeah she's my mother
36:10oh oh wow oh that's cool are you really 20 yeah and for the record my my father also works here
36:23he's an endocrinologist oh so it's like a family business
36:28um i'm sorry that was a joke that was a joke and i'm sure that comes with a lot of pressure
36:32and as for the age thing i'm a 42 year old r2 so i have my own haters trust me
36:36okay um sometimes when it gets busy we'll help the nurses bring back patients okay um okay next
36:45to come back is fred saida knee pain after a fall great hey hi hi doug driscoll uh any chance someone
36:51can see me now i've been here for like two hours unfortunately mr driscoll there's a lot of patients
36:55still ahead of you some of whom are severely ill yeah and i got chest pains that woke me up in the
36:58middle of the night chest pain yeah no it's not plural it's just chest pain not chest pains yeah and if
37:05i have more than one it's chest pains are you even a real doctor she's a student doctor yeah well
37:09keep her the hell away from me i just need to see someone okay not her isn't chest pain an emergency
37:15i don't it looks here like you get an ekg five minutes after arrival so it's not a heart attack yeah
37:19but i'm supposed to get a chest x-ray and blood tests ah and you are next in line for lab tech okay so
37:25listen for your name excuse me fred actually can you get me a wheelchair please uh hi i'm dr mckay
37:34what's going on well i found her on the floor in the bathroom she can't stop puking what's her name
37:39teresa she's my mom hey teresa teresa are you taking any medication no any previous stomach
37:46problems no when did the vomiting begin last night do you have any dizziness or fatigue mystery solved
37:56our lady with the degloved foot is nepali oh hey congratulations otis's bp is crashing 70
38:04over 50 still waiting for dialysis
38:09how you doing there otis okay that's okay 15 liters non-rebreather please
38:14oh crap diastolic collapse at the right atrium and right ventricle tampon now from your remake
38:25effusion that's why his vp is low yep too much fluid and pressure around the heart chambers can't fill
38:29otis you've got some fluid around your heart we need to get it off
38:3325 in propofol 10 cc's of lidocaine with epi pericardia since he's a straight i have to get
38:38the room no no just open a central light kit dr santos take the head of the bed and bag him if he stops
38:42breathing compressions if we lose the carotid prep a drip to subtype wood please 10 cc is a
38:47one percent weight chlorhexidine here 25 or 25 25 thank you
38:54ejecting lidocaine pressure down 60 over 40. all right
39:03wait you can't ultrasound on place i know that's why i'm taking the probe 18 gauge thin
39:07wall 60 cc syringe please dr collins let's go
39:09go you're going in right over the center of my probe advancing very slowly looking for the
39:17hyperechoic tip very very slowly do not hit that hard dr santos you see that sea of black and that's
39:24the effusion we're looking for a little white dot there it is got it aspirating three cc should be
39:32enough good next we'll place the guide wire and then the triple lumen catheter pulse ox is 99 pressure
39:42is up 124 over 78. looks like things are back to normal
39:49that was cool four zelfrans on board that should stop the nausea
39:54uh david have you had any vomiting no anyone else sick at home
40:02it's just us my husband passed away a few years ago from covid i'm so sorry potassium 3.1
40:11is that bad it can cause heart problems but we're going to correct it okay 10 in the bag 20 p.o
40:20do you want any questions um uh david have you two traveled out of the country recently no i never
40:28go anywhere is she enough to stay here if the rest of the tests are good and she responds to treatment
40:37she can go home
40:46mr milton my name is dennis whitaker i'm one of the student doctors here i'll be seeing you first
40:52nice to meet you bp's 150 over 90. okay that's just a touch high i forgot to take my damn enalapro this
40:59morning no we'll get that for you tell me about this belly pain uh started about here um woke me up at
41:08like 2 a.m pretty intense lasted about an hour now it's gone any fever vomiting nah i never get sick okay
41:19uh what did you eat last night oh it was my wife's birthday took her out to sullivan's for a steak
41:27well the exam is pretty benign i'm gonna test for gallstones if there is a stone and you eat fatty
41:35food it can be pain when the gallbladder contracts oh uh bingo one stone there it is
41:44do i need surgery uh you should be able to manage with a low-fat diet but we'll send off labs for
41:52liver and pancreas just let us know if you have any more pain okay thanks uh yeah you bet great
42:02you want any kg for heart attacks can present as upper abdominal pain um yeah no yeah that's a great
42:13idea thank you
42:28i'm going as fast as i can i'm picking up two patients say anything
42:32i uh i need a fresh set of eyes on what 54 year old woman brought in with intractable vomiting
42:40by your 18 year old son i'm um i'm getting a weird vibe how so i don't know maybe she was given
42:49something some sort of elder abuse it's just a strange dynamic i can't quite figure out you're
42:55really good at sensing out that sort of thing i don't know about that uh excuse me dr langdon
43:05almost all of our labs are back on sleeping boy tyler all 100 normal what are we missing
43:16is he waking up no he's he's still fast asleep most of the lab results are in and they look great
43:22no abnormal blood count no uh electrolyte abnormalities no diabetes no um kidney disease so
43:30good so so what's wrong with him we're still trying to figure that out did he have a play
43:36date yesterday by chance no he had preschool but he was fine when i picked him up any kids in his class
43:41bill no my phone tree would have lit up if someone else was sick he eat anything this morning no
43:47why it looks like some sort of gelatin any chance he could have gotten into some uh bath beads or
43:56laundry pods no and there's no such thing in our house what about gummies no we're very strict about
44:02candy right oh danny what about danny your brother he he gave me some gummies he got in cleveland they were
44:17in my coat pocket are you serious pot gummies yes i'm so sorry let me call the lab maybe the
44:26tox cream is back hey this is dr langdon from the ed can i fast track a lab on a little boy last name
44:31jones first name tyler tox cream i'm walk out i mean it why don't we step outside and maybe you can
44:36help me figure out how much you may have taken thanks i appreciate that quick turnaround
44:41labs confirm it your son tested positive for cannabis it's a nightmare
44:54theresa david this is my attending dr robinovich hi dr robbie we need to do a pelvic exam and david i
45:02don't think you want to be in here for that definitely not can you have nurse perla come join me please
45:07you want a coffee or a soda or something why do i need a pelvic exam uh you don't
45:16your son seems like a nice kid he's clearly worried about you
45:20but your exam and your labs are not matching any of the usual diagnoses so i'm not really sure what's
45:25going on i'm not here for me i'm here for david i don't understand he said that you've had
45:32persistent vomiting some i made myself sick with a pacac to induce vomiting why would you do that so
45:40david would bring me here my son has some problems he needs professional help okay what kind of problems
45:49drugs alcohol i found some of his writing
45:53i thought it was school work but it wasn't
46:00it was lists of girls he wanted to hurt
46:03hurt them out he said they should all be eliminated
46:22is david has david seen a therapist no he's not a bad kid but i'm afraid he's troubled and i
46:33didn't want to call the police because i was afraid they'd overreact he's just a kid how old is david
46:38he just turned 18 last month then he's considered an adult and he would have to consent to treatment
46:44do you have any guns in the house no my husband did but i got rid of all of them after he passed
46:54he's a good soul i just don't want to see him hurt anyone or himself
47:01how you feeling crash i'd really appreciate if you didn't call me that why not it's a cool nickname
47:08you earned it you should own it i don't like it it's just a joke
47:19you know if it makes you feel any better i sharted the first time i saw an emergency c-section
47:26really of course not
47:42excuse me i'll be right back
47:45i got a situation 18 year old kid brings in his dehydrated mom dad died during the pandemic mom's
47:51vomiting is self-induced for the sole purpose of getting him here after she finds his death list
47:56for classmates i okay what does she want us to do help him protect him save him where is he now
48:05talking to mckay how are you doing me i'm good i'm always good you know that do i does anybody i'm
48:14an open book not even close you do know you can always come talk to me right
48:19how's it going over here good good uh we're just going over after care instructions prescription
48:28medications special diet for the next few days dr mckay can you check orthostatics on mom i can david
48:34i wanted you to meet kiara she's a social worker here who helps in situations like this
48:39we heard about your father's passing we're really sorry and we know that can put a lot of pressure on
48:45you know somebody your age which combined with school and now having to take care of your mom
48:50that's a lot it's fine we just want to make sure that when your mom goes home you can handle it
48:56we want to make sure you have someone you can talk to if you need to i'm okay i don't need to talk
49:01to anybody after a parent dies the sadness can last a long time how's that going for you
49:08it's not a problem what about school what about it anything you enjoy there not really
49:19a lot of people have thoughts that can disturb them if you've had any it's okay to talk about
49:25what's that have to do with my mom is she gonna be okay yeah she's gonna be fine she's probably got a
49:30stomach virus maybe food poisoning i think she's more worried about you she always worries about me
49:37does she have a reason to no it's almost eight i gotta go
49:44sure you wouldn't prefer to wait with your mom i'm late for school she can just call me when she's
49:48ready it would actually be kind of helpful to talk to you some more hey david
49:55david hey just give me five minutes leave me alone
50:07hey david
50:14robbie robbie got a college kid respiratory rest coming in hot
50:37i don't know
50:52robbie we need pen to be here dr adamson just went down with the full socks of 65
51:05robbie
51:12as
51:26guitar solo
51:56guitar solo
52:26guitar solo
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