- 14 hours ago
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00:15Preptain to bait.
00:16Ketamine and rock on board.
00:17Chest tube is in. Hook me up.
00:19Yellow zone, we are running out of everything.
00:22Only change bandages that are completely bled through.
00:26Yo.
00:27Over heard a nurse say the shooter's here.
00:29Holy shit.
00:30Oh my god.
00:31Sorry, he's handcuffed, but he's in a room.
00:34He gets a room while the rest of us are stacked up like firewood.
00:38Sorry to interrupt.
00:39Anything you can tell us about the shooter? Is he here?
00:41Where'd you hear that?
00:42Nurses be talking.
00:44I don't know anything about that.
00:45Yeah, let's keep the rumor mill in check.
00:47The cops will alert us when they know something.
00:49Okay.
00:50Uh, Dawn, how are you doing? Do you need anything?
00:52I'm better. I'm kinda hungry, though.
00:54Well, we can discontinue your IV, give you a sandwich so your sugar doesn't tank,
00:58and then you can go home.
00:59Thanks. My phone died at Pit Fest, so I wasn't getting any alerts from my glucose monitor.
01:04Uh, what about me? Can I go home?
01:06Since you OD'd, we need to keep you here for a couple more hours.
01:09Make sure you don't need any more Narcan.
01:11How's your pain doing, Buster?
01:12I mean, my arm still hurts pretty bad.
01:14Hey, can I get a sandwich, too?
01:16Uh, we can up your pain meds, but you're on the list for the OR, so we need to keep
01:19you
01:20NPO.
01:21Meaning?
01:21Nothing more to eat will keep you hydrated with IV fluids.
01:25At least get a blanket. It's so cold now.
01:28Yeah, I, uh...
01:29All the blankets are in peds.
01:32The morgue.
01:35Rock, paper, scissors?
01:36Uh, yeah, but I think it's just soft tissue.
01:40Shit.
01:42Don, I can charge your phone for you.
01:46Fucking circus.
01:48Is Robbie here?
01:49No, check trauma rooms.
01:58500 cc's from the chest table already.
01:59We're out of one egg again.
02:00Hang the cell safe with broader transfusion.
02:02This is weird.
02:03What?
02:04Shot in the chest, but nothing out of the throat cost to me, too.
02:07You got through the pleural okay?
02:08Yeah, I definitely felt the lung with my finger.
02:10I lost the radio pulse.
02:11I got ephemeral.
02:12This guy's bleeding out.
02:13Probably tore through the spleen.
02:15How?
02:15Okay, nipples to navel is no man's land.
02:17If he got shot while exhaling, the bullet possibly passed below the tongue.
02:20I got a diaphragm.
02:21Start a second IO.
02:23Transfuse two units O positive.
02:24Where's Robbie?
02:25Let's find him and call Walsh.
02:27This guy needs the next OR immediately.
02:30Stay down.
02:31Yeah.
02:32Have you seen Robbie?
02:33I was about to ask you the same thing.
02:34McKay?
02:36Yeah?
02:36You seen Robbie?
02:38Uh, no, not in pain.
02:42I was at the festival with my husband and my daughter.
02:49My husband is in a wheelchair from MS.
02:53I did my best to protect him.
02:56A bullet went through my arm and through his head.
03:07The medics declared him dead.
03:10What about your daughter?
03:12What's her name?
03:15Morgan.
03:17Some family members are meeting in the cafeteria.
03:19I can see if she's there.
03:23How do you deal with all this death and carnage?
03:29I don't...
03:30I don't know.
03:32Any more poor vax in pink?
03:34Maybe.
03:35What do you need?
03:36A couple units of blood.
03:37Good luck.
03:37Princess.
03:38I don't know how to finish it, right?
03:40What?
03:41Sana nga.
03:42Hino ko na sa PH2 Do yung shooter.
03:54Oh!
03:55Jeez.
03:58Dr. Robbie?
04:00Dr. Robbie, you okay?
04:28You have to go.
04:29You have to go.
04:30They need you out there.
04:31We need you out there.
04:40Okay, come on.
04:41Give me your hand.
04:43I can't.
04:45You have to.
04:47Because if you don't,
04:49we're fucked.
05:18I'll see you out there, Captain.
05:35Once your phone is charged and able to monitor your blood sugar, we'll let you go.
05:41Any update on the guy who did this?
05:43Nothing yet.
05:44I'm kind of glad I was out of it when the shit went down.
05:47You OD'd.
05:47You could have died.
05:50You okay, Huckleberry?
05:51Yeah.
05:52You sure?
05:54I know it's tough in there with all the bodies.
05:56Yeah.
05:56Can I get help with the pressure dressing here?
05:58Yeah, I'm on it.
05:59Two grams of ANSF?
06:00Primes for your leg guy.
06:02Pleasure.
06:08You okay, Dr. Robbie?
06:10Do you need something to eat or drink?
06:15No, no.
06:15I'm good.
06:17Uh, it's me.
06:19Your team's doing a great job staying on top of all this.
06:21Um, I need another four morphine here.
06:23Yeah, coming right up.
06:26Uh, yeah, that's two.
06:27Tonic, it's down on MCI-9.
06:29Looks dry.
06:29No, no, no, no.
06:30That's just some...
06:30Good job, Whitaker.
06:31Donahue.
06:33I know LMC, no vomiting.
06:35It just feels...
06:38Dr. King, keep it up.
06:45All right, maintenance fluids at 125 an hour for all NPOs.
06:49Heard.
06:50Just turn them down.
06:51Oh, looks like you have everyone tucked in, Huckleberry.
06:53Yeah, we're getting there.
06:55Well, I'm gonna leave you in charge of the boring yellow stuff.
06:57Where are you going?
06:58Get in on the red zone action.
07:05Robbie, you okay?
07:08Right.
07:08Well, I've got some good news.
07:10County Public Health is sending in a truckload of supplies from the Key Women's in Mercy.
07:15Corey, are we gonna have to call them our blood tenners?
07:17Already done.
07:17Donated.
07:19I don't.
07:20Um, my blood and my needles.
07:23Choppers are coming from blood banks in Erie and Youngstown.
07:27Oh, thank God.
07:28I appreciate the way you've had the logistics today.
07:30Wait, hold on.
07:32What does she mean?
07:33Uh, more blood donors?
07:35You didn't use on-screen blood donations, did you?
07:39We did what we had to do to save as many people as we could.
07:40You're killing me, Rabinovich.
07:41And for the love of God, can you tell me that you didn't know about a shooter's hit list and
07:47then you let him go this morning?
07:48He didn't do it.
07:49Police confirmation?
07:51No.
07:52Then this nightmare...
07:53Jesus!
07:54Gloria!
07:56The police are still looking.
07:57Why don't you go back to your micromanagerial ivory tower and let us get the fuck back to work?
08:03Shattered arteries.
08:07Robbie!
08:08Get some air, brother.
08:09Check on triage.
08:12Dr. Abbott, I got your carotid bypass guy up to DOR.
08:17Vascular surgery says to give you mad props.
08:21Okay.
08:23You think you tell Jake his girlfriend died?
08:25Yeah.
08:26Fuck.
08:36Hi.
08:38Hi.
08:49How's it going out here?
08:50Good.
08:51Twelve minutes since the last pinker, Red.
08:53I think it's quieting.
08:54Jesus.
08:55What?
08:56Don't say that.
08:57Come on, don't tell me you believe in that superstitious shit.
09:00It's like saying Macbeth in the theater.
09:02Yeah, and you call yourself a person of science.
09:04Watch out!
09:09They're coming in for head-to-head.
09:10I want you to get up to you.
09:11Hands up!
09:12No weapons?
09:13Everyone stand back!
09:14No, no weapons.
09:15All clear!
09:18Are you okay, sir?
09:20Yeah, I'm good.
09:21The guy in the back needs help.
09:22Sorry about the parking job.
09:23Getting a little woozy.
09:24Okay, what happened?
09:26Found him in the festival parking lot.
09:27Gave Narcan for my kid, but he didn't respond.
09:30Maybe Benzels, I don't know.
09:31You a medical worker?
09:31Maybe Corman.
09:34Okay.
09:35Your leg does not look okay.
09:36I got shot through and through.
09:38Stayed to help as long as I could.
09:40Bullets flying everywhere.
09:41It was a fucking nightmare.
09:42Hey, Ellis, how's the passenger?
09:43No sign of trauma, but he's pretty cyanotic.
09:46Needs oxygen.
09:48Let's move on, man.
09:49Grabbing a gurney.
09:50Any headache, neck pain, chest pain, belly pain?
09:54Sir?
09:55No, I'm good.
09:56I'm going to get a wheelchair.
09:57Do not try to walk.
10:01Must have missed the bone.
10:03Look, it's like it's...
10:04Whoa, whoa, whoa, whoa.
10:05Cancel the wheelchair.
10:05Bring a gurney.
10:06Gurney!
10:09Any new customers for the OR?
10:10Yes.
10:11Yeah.
10:11This one looked like chest, but it was intra-abdominal.
10:14Nipples to navels, no man's land.
10:16Am I the only one who missed that day in medical school?
10:21Need high-flow O2.
10:22Maybe buy a pet for this guy.
10:24Summer room's open?
10:25No, still getting clean.
10:26South 15 to bail.
10:27Okay, South 15 it is.
10:29Find out if the ICU is ready for her.
10:31All right, get me a tech and an RT and I'll take them off.
10:34Yeah, I'm on it.
10:36Hey, McKay?
10:37There's someone from Allegheny County Court.
10:39Help someone like...
10:40Not now!
10:42I'm in, Becker.
10:43Dr. McKay, you have a visitor.
10:45I said not now!
10:46Gee.
10:48Sorry, Dad.
10:49Hey, thank you so much for coming in to pick a parison.
10:52Are you okay?
10:53I mean, relatively speaking, I'm fan-fucking-tastic.
10:58Good.
10:59Hey, Dr. Abbott, can you keep an eye on this one?
11:01Stable after one unit PRPCs?
11:04No problem.
11:05Ellis, get him started.
11:06Holler if you need me.
11:07Copy.
11:11Dana?
11:12Hypertens have been altered.
11:14Untreated GSW to the thigh.
11:15Perfect timing.
11:16Trauma one's open, but be careful.
11:18Floor's probably still wet.
11:19Mohan, you're on this.
11:20Okay.
11:27Dr. Abbott, do you need anything?
11:29Check with Ellis and South 15.
11:37What do we got?
11:38Pulse aux is low, 85 on room air.
11:41100% non-rebreather mask.
11:42This guy needs a major workup.
11:50Everyone in yellow is stable.
11:52Okay, uh, check in with Robbie.
11:55See if we can use another set of hands.
11:57Okay, great.
11:58Thanks.
12:00Trauma one?
12:01I know that guy.
12:01His sister's in the cafeteria.
12:03Her husband was shot and killed today.
12:05Sweet Jesus.
12:05Do you think I can bring the lady in to see her brother?
12:09Uh, Robbie.
12:10Lady in the cafeteria.
12:12Dead husband, brother in trauma one.
12:13Can we bring her back?
12:14Seems like it's slowing down around here.
12:16Go ahead.
12:17Um, I have a patient in Central 9.
12:18She was shot trying to protect her husband,
12:20who, um, died, but her daughter's in the cafeteria.
12:23I don't think I can spare any doctors right now.
12:25In fact, why don't you go cover triage
12:27until Shannon and Ellis get back?
12:29Okay.
12:30Give me her name.
12:31I'll find her.
12:31Oh, thank you so much.
12:33Um, her name is Morgan.
12:34Her mom is Trish Gregory.
12:39Okay, if we bring her up here, too?
12:41Sure.
12:41Why not?
12:44Pulse Ox is still 85 on high-flow oxygen.
12:46BP is borderline.
12:47Dr. Santos, differential diagnosis of cyanosis.
12:51Hypoxia, low oxygen from lung disease,
12:54pneumonia, pee, asthma.
12:55Good breath sounds.
12:56No crackles, no wheezing.
12:58Pulmonary problems shouldn't approve with O2.
12:59What else?
13:00Heart disease, heart failure.
13:02No B-line.
13:03Uh, right to left shunt.
13:04That's usually in congenital heart disease.
13:06PDA, tetralogy of flow.
13:08Cardiac echo looks good.
13:10Normal injection fraction.
13:12No valvular disease.
13:13Hmm, what else could it be?
13:15Is Dr. Ellis running this resuscitation, or are you?
13:17Because last time I checked, you're not supposed to be here.
13:20We both are.
13:20The senior resident's job is to teach.
13:23What else, Dr. Santos?
13:25Uh, hemoglobinopathies.
13:27Excellent.
13:28Blood is chocolate brown.
13:31Uh, Santos.
13:32Uh, met hemoglobinemia?
13:34Bingo.
13:34Put him on BiPAP.
13:36Send off the blood gas order, methylene blue.
13:38Meteorology.
13:39Drugs, toxins.
13:40Smart money is poppers.
13:41Ammonitrates.
13:42Partied a little too hard at Pit Fest.
13:44Langdon, got a sec?
13:46Yep.
13:48Keep me posted.
13:50Uh, can I do the intubation?
13:51Not necessary yet.
13:52But his pulse ox is low, he's altered.
13:55Yeah, all the oxygen in the world won't fix that.
13:57His met hemoglobin level is sky high.
13:59Methylene but methylene blue will help.
14:00I'll run the blood gas up to the lab, see if they're caught up on all the traumas yet.
14:04First day?
14:05Yeah.
14:07What's the beef with Langdon?
14:10Are you good here?
14:12Yeah, met hemoglobinemia.
14:14Order methylene blue.
14:15Perfect.
14:16Keep it up.
14:18Will do.
14:21Yes.
14:22Hey!
14:24How's my favorite grandchild?
14:27I'm your only grandchild.
14:32Chadwick Harrison Ashcropper III.
14:35Please don't call me that.
14:36Douchebag name for a douchebag guy.
14:39Dad?
14:40Are you ready?
14:40Because grandma is making me your favorite.
14:44Carbonara.
14:45Thanks for taking him, dad.
14:47You save some pasta for me?
14:49Okay.
14:55Tapping in.
14:56Thanks, brother.
14:57Yeah.
14:58EFAS normal.
14:59No abdominal hemorrhage.
15:00No tamponade.
15:01Ball socks borderline 89% on 15 liters.
15:05BP's only 95 over 58.
15:07Didi Rivera.
15:09Is he here?
15:10I'm not sure, man.
15:12I'm so sleepy.
15:14Were you tired right after you got shot?
15:16Um, no.
15:18I helped move 20, 30 people.
15:20What's causing his oxygen levels to tank?
15:23Up the oxygen.
15:2415's as high as it goes.
15:26Gauge only goes to 15.
15:27Keep cranking.
15:28You can get to 50.
15:29Brian?
15:31Somebody got shot.
15:33I sucked him with the first car I saw.
15:36Is he okay?
15:40You fight, Brian.
15:41Okay?
15:42You fight like the stubborn bastard you are.
15:46I tried, man.
15:47I tried.
15:48I tried.
15:58No, no, thanks.
15:59It's not coffee.
16:00It's bourbon.
16:02That was a joke.
16:05Robbie did everything he could to save your girlfriend.
16:10If he couldn't save her, nobody could.
16:13Activation call extension 4240.
16:16Activation 4240.
16:22Wait, wait, wait.
16:23What do you mean neutralized?
16:25It means he's dead.
16:26Wait, I thought the kid in BH2 was the shooter.
16:30What's going on?
16:33Swap found the shooter.
16:35Self-inflicted gunshot to the head.
16:38He had a duffel bag full of ammo.
16:40He was in some bushes down by the river with his AR-15.
16:48Do we know why he did it?
16:50Does it matter?
16:52Are we expecting any more victims?
16:55Swat cleared the festival grounds.
16:57Probably no more coming our way.
16:59What you've done down here.
17:03All the lives you've saved.
17:06There aren't adequate words.
17:15We need to prep to open back up to the public.
17:18Walk-ins only.
17:19No traumas until we get word from surgery that a few ORs have cleared.
17:22That could be ours.
17:24Buti nalang tapos na shift natin.
17:31Everybody seems to know exactly what to do.
17:33Is this kind of thing normal?
17:34Thankfully no.
17:35But preparing for the worst and hoping for the best.
17:38It's what we do.
17:51Is Dr. King still on set?
17:53Yep.
17:54We don't need a doctor covering triage.
17:55We can bring her back in.
17:58And everybody else, let's process these remaining patients.
18:02So my day shift can finally go home.
18:04On it, Cap.
18:18Ah, you hear that?
18:21You hear what?
18:22It's quiet.
18:23It's over.
18:27Oh, son of a...
18:33Yo, yo.
18:35We're closed.
18:36We're way over capacity.
18:37Take him to West Penn.
18:38Hit an extremist.
18:40You were the closest EDAP.
18:41Thirteen-year-old hypoxic and hypotensive.
18:44He looks pale and tachypidic.
18:46Flynn Edwards humble on with his little sister.
18:48Cough, fever, rash, altered.
18:50Tech hit 150, BP 80 over 55.
18:53Breathing at 36 and satting low 80s on the face mask.
19:00Hi.
19:01What's your name?
19:03Georgia.
19:04Hi, Georgia.
19:04I'm Mel.
19:08Oh, yeah.
19:08That's scary.
19:09Yep.
19:16Georgia, where are your parents?
19:18At the movies.
19:20Did you try calling them?
19:21I texted.
19:22Can you give us their numbers?
19:24Do you remember what happened before you called 911?
19:26Flynn was talking weird.
19:28Okay.
19:29Um, and then after he was talking weird?
19:31He got super sleepy and then I couldn't wake him up.
19:36Um, this is Princess.
19:38I have to go help your brother now, but Princess is going to get you a snack.
19:41I already brushed my teeth.
19:42I said maybe just a glass of water.
19:44I said maybe just a glass of water.
19:50My count.
19:51One, two, three.
19:56Flynn, open your eyes, buddy.
20:01Start a second line.
20:02Two liters of ringers wide open.
20:04100% non-rebreather.
20:06Oh, my God.
20:08Crackles bilaterally.
20:09Temp 101.
20:10OT set only up to 82.
20:12Oh, shit.
20:12It's code sepsis.
20:14Blood cultures, labs, portable chest, gram of septriaxone.
20:17Dr. King, what are you thinking?
20:19Uh, well, rash.
20:22Altered with sepsis.
20:23Could be meningococcus.
20:25Strep pneumo.
20:27Um, something viral like disseminated HSV.
20:30Encephalitis.
20:31BP's 82 over 49.
20:33Start up to 87.
20:34What about the rash?
20:35Well, it's more prominent on the lower body.
20:38Not much on the face.
20:39There's no vesicles.
20:40It doesn't look like chicken pox or typical Lyme rash.
20:44Agreed.
20:45Do you know what this is?
20:46Nope.
20:47Resuscitate first, diagnose later.
20:50We're moving patients from the yellow zone into real rooms along the south and central corridors.
20:55Till now, all these patients have just been numbers to us.
20:57Time to ask them their names.
20:59So we scan their wristbands and put them into the big board.
21:01Yeah, and then Dana and I will assign rooms based on medical priority.
21:04Ortho extremity wounds, go get x-rays.
21:09Dr. McKay.
21:11Can you finish up whatever it is you're doing and come meet me in BH2?
21:16Uh, yeah.
21:17Sure.
21:20I told you you didn't do it.
21:22I know.
21:23But you said yourself his threats were serious.
21:26At least now we're nipping it in the bud.
21:28Do you think this is that easy?
21:30Think again.
21:35He's on 100% oxygen.
21:36His pulse ox is still only 88.
21:38How's it going upstairs?
21:40Regular spa day at the OR.
21:42Forty-two x-laps and theracotomies.
21:44Impressive.
21:45What do you got?
21:46GSW, through and through the thigh, not arterial, now hypotensive and hypoxic.
21:50Sounds like blood loss.
21:51No.
21:52Hemoglobin times two is stable.
21:54V-noccava is plump.
21:55It would be flat with hemorrhage.
21:56Actually a little too plump.
21:58Let me see the phased array probe.
22:00Any history of heart disease?
22:01Not sure, but he's a strong guy.
22:04Got shot, strapped a t-shirt and a belt around his thigh, and ran around helping people for a few
22:08hours.
22:09Holy shit. Check out the four-chamber apical view.
22:13Dilated right atrium and right ventricle.
22:15Right-sided strain with bowing of the septum.
22:17Sounds like a P.
22:18You throw a clot from having the tourniquet on?
22:20Way too soon for a DVT.
22:21Okay, let's get him in left lateral decubitus.
22:24One, two.
22:26Vandelenburg, ASAP.
22:27What for?
22:29Intracardiac air embolism, all that running around, introduced air into the femoral vein, right up to the heart.
22:33Now it's blocking blood flow to the lungs.
22:35Need a CT to confirm.
22:36They're still backed up with other patients.
22:37Well, maybe the cath lab can take them.
22:39They have fluoro.
22:40I'll go check.
22:41Yeah, good luck with that.
22:45I need a central line kit and a five-french pigtail catheter.
22:48I got it.
22:49He doesn't have a collapsed lung.
22:50Yeah?
22:51So, what are you going to do?
22:53I'm not going to do anything.
22:55You are.
23:05Thank you, Casey.
23:06Hey, David.
23:07How are you doing?
23:09Hey, David.
23:13I didn't shoot anybody.
23:17I wouldn't do that.
23:18I know.
23:26Did you make a list of girls you wanted to hurt?
23:31Where's my mom?
23:32Did you make a list?
23:33I want to go home.
23:35You're going to get to go home.
23:37But first, we have to keep you here for a mandatory 72-hour hold.
23:40What?
23:41Why?
23:42I didn't do anything.
23:43I know you're upset.
23:45We're only doing what we think is in your best interest.
23:48Fuck you.
23:48You don't know me.
23:50You don't know anything about me.
23:55Look, I know it's a lot to process, but...
23:57No, no.
23:58I want to see my mom.
24:00Where is she?
24:01Is she out there?
24:03I...
24:03Mom?
24:04Mom?
24:05This is not...
24:07Mom!
24:09Mom!
24:10I'm helping your case.
24:11Well, fuck you!
24:15I don't want to see my mom!
24:18Please!
24:21Please, I'm...
24:22Mom!
24:25Mom!
24:28Mom!
24:30BP's 92 over 60 after two liters.
24:32Still tacky.
24:33Sats are way down at 84 on the non-rebreather.
24:36Lynn, open your eyes.
24:38How you doing, bud?
24:39He's still having trouble breathing.
24:42He's more lethargic than before.
24:43Let's give him a third liter and prep her intubation.
24:45Can we do that without parental content?
24:46We wait, he dies.
24:48Tech is here for a portable chest.
24:50Dr. King, what are your intubation meds?
24:52Atomidate and rock.
24:53Great, gather up everything you need.
24:55What size tube?
24:56Age divided by four plus three would be...
24:596.5 cuffed.
25:01Let's do it.
25:02We'll find these parents.
25:03Let's prep these.
25:10Tom, you start today.
25:127 a.m.
25:15Thanks.
25:16Can I get one of those?
25:17We're starving.
25:19No can do.
25:20But I'm hungry.
25:22We can't give you any food in case you need surgery.
25:25You might aspirate.
25:28You need to work on your bedside manner.
25:30Asshole reporter.
25:32ABG back on the blue, ma'am?
25:34Not yet.
25:34Should we just give him the methylene blue?
25:36Hmm.
25:36Postdoc's holding at 85.
25:37We can wait a little.
25:43Dr. Santos, how do we evaluate methemoglobinemia and determine a treatment plan?
25:52Um...
25:56Tired?
25:58Yeah.
26:00Feet hurt?
26:01Brain feeling like mush?
26:03Absolutely.
26:05That patient doesn't give a shit.
26:08He needs you.
26:11Met hemoglobinemia.
26:13Let's go.
26:22Robbie?
26:23Hey, Jamie.
26:25Where's Jake?
26:26I got here as fast as I could, but there were street closures.
26:29He's okay.
26:29He's okay.
26:31He had some minor injuries that are going to need to be treated, but he's okay.
26:33He's going to go home today.
26:35Oh, thank God.
26:39Um...
26:39Leah didn't make it.
26:42She's dead?
26:45Oh, my God.
26:47He, um, is kind of blaming me for not saving her.
26:52Robbie, he's just a kid.
26:55So is she.
26:58Don't do that to yourself.
27:00Hey, look at me.
27:05Jake loves you, okay?
27:09Where is he?
27:10Hey, Dana.
27:11You remember Janie?
27:13Of course.
27:13Thank you for calling me.
27:14Do you mind taking her to go find Jake?
27:15Yeah, no problem.
27:16Come on.
27:17I don't know.
27:18I don't know.
27:24Tubes in.
27:25The color changed.
27:28Nicely done.
27:29Present.
27:31Uh, we have a septic 13-year-old with pneumonia.
27:33I just intubated and ceftriaxone is on board.
27:36Patchy consolidation.
27:38Maybe some nodules.
27:39Could be viral pneumonia with or without bacterial superinfection.
27:42Kid's got a weird rash, too.
27:44Oh, and it's maculopapular on the legs.
27:48Pretty faded on the neck and chest.
27:51Starting to descomate.
27:56You ever seen anything like this before?
27:58Nope.
27:58Neither.
28:00Well, that just goes to show you how old I am.
28:02This looks like measles.
28:03Measles?
28:04Holy shit.
28:05Any travel history?
28:07He wasn't able to talk before he intubated.
28:09Measles is super contagious.
28:10It's not contagious if it's resolving.
28:11We need more history.
28:13Where are the parents?
28:14Oh, they're at the movies.
28:15I'm sure their phone's off.
28:16But he came in with his little sister.
28:18We can talk to her.
28:19What theater?
28:20I don't know.
28:22Shen, try every theater.
28:23It's got to be over a dozen.
28:25Start with the ones closest to where they live.
28:26We need to find those parents and call public health.
28:28Tell them we might have a measles outbreak.
28:32We get blood gas results back?
28:34I just got them.
28:36Met hemoglobin level of 42%, enough for cyanosis and lethargy.
28:40Party on, Wayne.
28:40Okay, let's go ahead and start methylene blue.
28:43One mig per kig, slow IV push over five minutes.
28:45On it.
28:46Don't need somebody to stay on bedside.
28:47Push it with a syringe.
28:49Santos, tag, you're it.
28:52How long until his cyanosis resolves?
28:55Five minutes, bright spark.
28:58Oh, you two definitely got beef.
29:07Hi, Georgia.
29:09This is Dr. Robbie.
29:10He's going to ask you some questions so we can help Flynn.
29:13Is that okay?
29:15Hi, Georgia.
29:16Can you tell me when your brother first got sick?
29:18A week ago, I was already getting better.
29:23You were sick too?
29:25Fever and rash like Flynn?
29:27Has your family traveled anywhere recently on an airplane or to another state?
29:33Orlando for a dance competition a couple of weeks ago.
29:36And where on your body did the rash start?
29:40On my face.
29:42Then it went down to my legs.
29:46Okay.
29:47Thank you, Georgia.
29:48Is Flynn going to be okay?
29:50Oh, well, yeah.
29:51We're going to do everything we can to help him.
29:57The story is consistent with measles.
29:59Plenty of opportunity for exposure in Orlando with all the international travelers.
30:02Isolation?
30:03No, because you're only infectious for four days after the rash starts.
30:06And we're past that point.
30:07But the altered ventral status.
30:10He's in the right time frame for ADM.
30:12ADM?
30:13Acute disseminated encephalomyelitis, a post-infection immune response.
30:17So a head CT and an LP?
30:19Afraid so.
30:20It has a 20% death rate.
30:22Dr. King, this is Morgan.
30:25Trish Gregory's daughter.
30:26Is my mom okay?
30:27Oh, yeah, um, she's fine.
30:29Uh, Dr. Robbie, do you mind if I show Morgan to a mom?
30:32No, go ahead.
30:32I'm going to send Flynn for a head CT and get Shen to prep the LP.
30:35Uh, what about the parents?
30:36I think he's still trying to find them.
30:38I can help.
30:39Go.
30:39We got this.
30:40Thanks, Lupe.
30:41Um, just this way.
30:42So she's going to need surgery.
30:46Take a seat.
30:48What?
30:50Why?
30:52Adrenaline crash after a big event?
30:56The juice box.
30:58Thanks.
31:00And what happened here today?
31:02It's not normal.
31:04But you, you're a rock star, Victoria.
31:14He knows my name.
31:19Got the IJ.
31:21Okay, back to business as usual, thank God.
31:24Guide wire and introducer.
31:26What the hell are you doing?
31:27Dr. Mohan is about to pull air from the right atrium and right ventricle.
31:31With what?
31:31By a French pigtail catheter.
31:33Inside his heart.
31:34Multiple side holes gives you a better shot at sucking out all the air.
31:38Dr. Abbott showed me a case report from South Korea.
31:40What the actual fuck?
31:41I just talked to cardiology.
31:42They want a CT scan.
31:43If it's showing air, then you need to dive him in the hyperbaric chamber.
31:46He'll be dead by then.
31:47Not if you kill him first with this banana pants procedure.
31:49We don't have time to wait for your fancy pants machine.
31:52You don't get the air out of his heart, he'll die.
31:54This is not the standard of care.
31:55Fuck standard of care.
31:56We want to save him.
31:57We go in now.
31:58Maybe I should...
32:00Thread in the pigtail.
32:01Excellent idea, Dr. Mohan.
32:11Put it under 24 centimeters, and then we'll confirm with x-ray.
32:15Good.
32:16I think I'll stick around in case you need another set of hands to resuscitate your patient when he crashes.
32:26Oh my god, you're bleeding.
32:28Are you okay?
32:29I'm fine.
32:32You gotta get me out of here.
32:34I just want to help you.
32:36I need help.
32:36I just want to go, okay?
32:37David, you haven't called me back or texted me all day.
32:44You didn't go to school.
32:47I saw the Instagram post you made.
32:51And I found the list about all the girls.
32:56You went through my stuff.
32:59I love you, and I don't...
33:00Those are my things.
33:01Can I just say that we all have scary thoughts?
33:03It does not make you a bad person.
33:06And dealing with those feelings can be hard.
33:10Talking to somebody can really help.
33:11Oh my god, just shut up.
33:13I'm not gonna fucking talk to anyone.
33:15Okay?
33:16You can't make me.
33:18Okay.
33:23David, I signed a petition.
33:27What the fuck?
33:30What, you signed some paper to get me locked up?
33:32I signed a petition to get you help.
33:36This is fucking bullshit.
33:38Seeing all those people come in here today.
33:41All those hurt people.
33:43And the death and the blood.
33:46I was so afraid of you being that sad and angry.
33:54I cannot bear to lose you.
33:58I would never do something like that.
34:01There's nothing wrong with me.
34:03It's me.
34:03Mom, you know I've never heard someone like that.
34:06Please, don't do this to me.
34:08Why are you doing this?
34:09All we're asking is that you speak with a professional.
34:14It's important to talk to somebody about how you're feeling.
34:18You think you might be open to that?
34:23Fuck you.
34:25Fuck all of you.
34:27Did you just get out?
34:30Get out!
34:37Hey, Perla.
34:38Can you take Teresa to go find a cup of tea?
34:41Yeah, of course.
34:44Jesus.
34:46What now?
34:48Well, I suggested a better way.
34:50But you had him taken down by the police, handcuffed and dragged in here?
34:55You made this fucking mess.
34:56You're going to have to fix it.
34:57Okay.
35:05Pigtails in the right atrium.
35:07Good position.
35:07Aspirate.
35:08See what you get.
35:09Pulling back blood from the heart.
35:15Along with the mare.
35:16How about that?
35:18BP's still only 85 systolic.
35:20No improvement.
35:21Advance slowly into the right ventricle.
35:23Oh, I know when I'm...
35:24That's how you know.
35:26Aspirate again.
35:27Run to three.
35:29More blood and air coming out.
35:31Run to five.
35:32Non-sustained B-tag.
35:33Charge to 200 for when he deteriorates.
35:34May need blood now.
35:35Pull the pigtail back to the RA.
35:37Step aside.
35:37Pull the pigtail.
35:38Dr. Mohan.
35:39Step aside.
35:39You got this.
35:43Normal sinus rhythm.
35:4592.
35:45Pulse ox is improving.
35:47BP's 112 over 84.
35:55Not too shabby, huh, Dr. Walsh?
35:57I think we can admit him to general surgery now.
36:00Hell no.
36:00He's a gunshot victim.
36:02Admit him to the cardiac ICU.
36:03We'll consult from there.
36:04Or you can admit him yourself with cardiology consulting.
36:08I thought you liked flying the plane.
36:10Not when it's going to crash.
36:17Solid work.
36:19That was your save, not mine.
36:21Take the win, Dr. Mohan.
36:24Thanks.
36:26Besides, it was a little too risky for me to do to myself.
36:30What?
36:31Suture.
36:36Whoa, this is so cool.
36:39Blue plus blue equals pink.
36:43Can you tell us your name?
36:45Max.
36:46Max, can you tell us what you took?
36:49Sleep.
36:51Yeah, he might need a second dose of amethylene blue if his methemoglobin level stays above 30.
36:56This definitely wasn't poppers.
36:57He would have had to have sniffed like a gallon of it.
37:00So what caused the overdose?
37:03Got to wait for him to wake up so he can get more answers.
37:10Trish, I have a special visitor for you.
37:12Mom, are you okay?
37:15Yeah, I'm fine.
37:19I'm so scared.
37:21I know.
37:22I'm dead.
37:32You okay?
37:35I just, my patient hasn't seen her daughter and it won't, it won't happen again.
37:40I've never apologized for feeling something for your patients.
37:44Today was chaos.
37:47You were awesome.
37:50I'm really glad you're with us, Dr. King.
37:53Robbie, some spans are here, the measles kit.
37:56You should go home.
38:02How did Flynn get measles?
38:04Uh, from his sister.
38:05Hi, I'm Dr. Robbie.
38:06Georgia is fine.
38:07She's in our staff room.
38:08She's the one who actually called 911 and probably saved her brother's life.
38:13Georgia was sick, but she got better on her own quickly.
38:15Yeah, many people get better on their own, like Georgia.
38:17However, as many as one in 20 kids that get measles get pneumonia like your son.
38:22Are your children vaccinated against measles?
38:24No.
38:26The MMR vaccine is perfectly safe.
38:29Measles is not.
38:30We're concerned about inflammation and possible damage to Flynn's brain and spinal cord.
38:35The measles got to his brain?
38:36Well, his head CT was normal, but the only way to find out if he's okay is to perform a
38:40lumbar puncture.
38:41A spinal tap?
38:43I've read about kids who've been paralyzed from a spinal tap.
38:46There is zero risk of paralysis.
38:48What about bleeding or infection?
38:50It's a perfectly safe procedure.
38:51We do it every day.
38:52We need spinal fluid to see if Flynn has acute disseminated encephalomyelitis.
38:56And if he does?
38:58We treat with high-dose steroids to decrease the risk of blindness, deafness, intellectual disability, even death.
39:04He could die from this?
39:06The death rate from Adem is high, one in five.
39:08Do the spinal tap.
39:10No!
39:12Can't you just give him steroids without the spinal tap?
39:15If there's no Adem, the steroids could suppress his immune system, making it harder to fight off the pneumonia.
39:20But it says here that...
39:21Can you put your damn phone away?
39:24Your son is critically ill.
39:25The longer that we wait, the higher the risk of permanent brain damage.
39:28What is not clear here?
39:31Hillary, he has a tube down his throat.
39:33They're not poking holes in my son's spine!
39:36Wow.
39:37Okay.
39:39Let's just wait and see if he gets better.
39:42Dr. King, could you please take Flynn's parents to see their daughter?
39:44No problem.
39:47They are going to see their daughter.
39:50Fucking Dr. Google bullshit.
39:51They want medical treatment, but they don't want medical advice.
39:53What the actual fuck are we doing?
39:54Yeah, I know, and we'll keep trying.
39:56Hey, you okay, buddy?
39:59Hey, Whitaker.
40:00Got a minute?
40:01Yeah, yeah.
40:03I just wanted to say thank you for earlier when I was, um...
40:10Oh, your brief moment of silent reflection?
40:13Yeah.
40:14You didn't mention that to anyone.
40:16No, no, God, no, no.
40:17I don't know what that was.
40:18I just felt like I was drowning.
40:22What was that you were reciting?
40:25It's called the Shema Prayer.
40:27It's a declaration of faith in God.
40:29I lived with my grandmother when I was little,
40:33and she and I used to recite it every morning.
40:36Even youths grow tired and weary,
40:38and young men stumble and fall.
40:41But those who hold hope in the Lord
40:44will renew their strength
40:46and soar on wings like eagles.
40:50That's Isaiah 40.
40:52I was an undergrad theology major.
40:55I don't know why I said that.
40:58I don't know if I actually believe in God,
41:01especially on days like today.
41:04A wise man once told me
41:06that you learn to live with it,
41:09learn to accept it,
41:11and find balance if you can.
41:16I hope we all do.
41:18Code orange, apply with the doctor.
41:19Fluid, blood, blood, and check travel.
41:22Code orange, apply with the doctor.
41:24Yeah, I agree.
41:25Paying spazole.
41:26Go ahead and put his last name on his pink.
41:29Yeah.
41:31Only one pink left.
41:32The rest all went up.
41:34Yeah.
41:35Hey, you guys need any help with the patient?
41:38No, no, no, no.
41:38We're good.
41:39It's quick and easy stuff.
41:40Go home.
41:40Yeah?
41:41Hey, you got a second?
41:42Yeah.
41:46What is up with Robbie?
41:47Oh, it's been better.
41:49I'm worried about him.
41:51Never seen him like this, have you?
41:55How about you, slugger?
41:57I'm better.
41:59Preach.
42:00Yeah.
42:03Sorry to interrupt.
42:05Oh, uh, if you guys are looking for Officer Stefano,
42:08he went up to surgery about an hour ago.
42:09We're looking for Dr. Cassie McKay?
42:13Uh, yeah, that's me.
42:15We were allergic about your ankle monitor being tampered with.
42:18Pending probation called to check in earlier,
42:19but you never responded.
42:20Yeah, yeah, it was, it was beeping
42:22and giving an error message.
42:24And we were in the middle of a mass casualty.
42:26Pit fest.
42:27Did you tamper with your ankle monitor?
42:33Yeah, I, um, I might have,
42:35I might have drilled a hole in it.
42:37Officers, look around.
42:38I ain't saving lives.
42:39Put your hands behind your head.
42:40Whoa, whoa, whoa.
42:41Hang on a second.
42:42Are you joking?
42:44Officer, wait a second.
42:45You're under arrest.
42:49Okay.
43:14You're under arrest.
43:15You're under arrest.
43:19You're under arrest.
43:21You're under arrest.
43:23You're under arrest.
43:25You're under arrest.
43:30You're under arrest.
43:31You're under arrest.
43:34You're under arrest.
43:35You're under arrest.
43:36You're under arrest.
43:38You're under arrest.
43:40You're under arrest.
43:41You're under arrest.
43:42You're under arrest.
43:42You're under arrest.
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