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00:09Sous-titrage Société Radio-Canada
00:32Sous-titrage Société Radio-Canada
01:26Sous-titrage Société Radio-Canada
01:29Sous-titrage Société Radio-Canada
01:34Sous-titrage Société Radio-Canada
01:37Sous-titrage Société Radio-Canada
02:09Sous-titrage Société Radio-Canada
02:13Sous-titrage Société Radio-Canada
02:22Alan Billings, pallet of roofing tiles
02:24fell eight feet, hit his upper arm with an
02:26open dislocation. Ouch!
02:29Two rounds of Fent, one
02:30then .5 per kilo, A&O with good vitals.
02:33Mal, hold the arm steady.
02:35Sure. Uno dos tres.
02:39Mr. Billings, I'm Dr. McKay.
02:41And I'm Dr. Garcia from surgery.
02:43And this is Dr. King. Hi.
02:44Oh, it really hurts.
02:46Give us a minute and we're gonna take care of that, okay?
02:48Any headache? Chest or belly pain?
02:49Oh, just the arm.
02:50Sats 99, pulse 104, BP 116 over 78.
02:53What do you think, Dr. King?
02:54Oh, um, it is an open dislocation.
02:56Can you be more specific?
02:59I think it's inferior, yeah.
03:02Do you remember the name for that?
03:07Sounds like a Harry Potter spell.
03:12Luxatio Erecta.
03:13Correct. Check the neurocirc.
03:14Sir, can you feel me touching you?
03:17Can you wiggle your fingers?
03:19Yeah.
03:21Good radial pulse.
03:23E-fast is negative.
03:24Hey, what's next, Dr. McKay?
03:25Uh, Ansef and genomicin, sedate for traction.
03:30Then you need a CT angiogram to rule out vascular injury.
03:33That sounds like a plan.
03:34But with an open joint, you need to wash out in the OR with Ortho.
03:37Agreed.
03:38Instead of wasting time down here, it should be easier to reduce endogenal anesthesia with fewer risks.
03:43Possibly.
03:44Let's get an opinion from Ortho.
03:47You're definitely new, Dr. Wishful thinking.
03:49Ortho would like to take their sweet time.
03:51Okay, sedation orders, Dr. McKay.
03:52A hundred of propofol titrate to effects.
03:55Oh.
03:55Be back with that.
03:56Excuse me.
04:01How's your day going, Doc?
04:03Yeah, pretty good.
04:04Looks like your albumin's infusing.
04:09Oh, uh, medical students Ogilvy and Quan are gonna be working with me.
04:14Hello.
04:14Student doctors.
04:15You want them to try it?
04:16They gotta learn sometime.
04:18It's best if they watch the first one.
04:21I can prep and drape?
04:22Yeah.
04:23After your albumin's in.
04:24That's correct.
04:26To prevent hypotension, we introduce albumin if we anticipate more than five liters.
04:31Last time it was six.
04:33That's like a gallon and a half.
04:35Of high octane premium.
04:38Okay, you need anything else, Mr. Louie?
04:40No, ma'am.
04:41Okay.
04:41Grab me when you're ready.
04:42Yeah.
04:44Whitaker.
04:44Wife of your DNR this morning's in Central A.
04:47Did she know her husband died?
04:49Not till you tell him.
04:51I'll be right there.
04:53Uh, yeah.
04:54Uh, always make sure your entry point is safe by identifying the pocket of fluid.
05:00That's not a pocket.
05:01That's a leg.
05:02Yeah, but you do not want to hit a vein or artery on the way in, so make sure you
05:05check
05:05with color Doppler.
05:07Oh.
05:07Mm-hmm.
05:09Joey?
05:10I can't see.
05:11I can't see anything.
05:13It's because your eye is shut.
05:13I can't open it.
05:14It's glued shut.
05:15I was trying to put on lashes.
05:17Oh, my God.
05:19Oh, my God.
05:20Am I gonna go blind?
05:21No, no.
05:21I'm pretty sure this is something we can fix.
05:23Just take a deep breath.
05:27Okay.
05:28So, you, uh, glued your eyes shut with what, exactly?
05:31Super glue.
05:32Okay.
05:32Well, is it something you typically use to apply your lashes?
05:35No, it's typically something you use to glue shit.
05:37You break, like, coffee mugs and stuff.
05:39You know what I'm talking about.
05:40It's-it's-it's super glue.
05:41Okay.
05:42Okay.
05:42Yeah, got it.
05:43Can I just talk to Dr. J?
05:45She'll know what to do.
05:47Is that an ophthalmologist?
05:48Uh, no.
05:50She works here in the ER.
05:51Yeah, I don't think so.
05:53But I know what I'm doing most of the time.
05:59For a Z-track, we pull up the skin before advancing into the peritoneal space.
06:06Looks good.
06:07Fluid's clear.
06:08Does that hurt as much as it looks?
06:10Oh, it's not too bad.
06:13Hey, Ogilvie spiked the bottle for you?
06:15What tests do we want on these fluids?
06:17Uh, cell count to rule out spontaneous bacterial peritonitis.
06:20Ding!
06:20What would make that diagnosis, Joy?
06:24Um...
06:24Absolute neutrophil count over 250.
06:27How are we doing in here?
06:29They are doing great.
06:31I think they got this.
06:37Hey, Dana, can you get Chiara down here for me?
06:39She isn't answering her spectral link.
06:40She's not working today.
06:41It's, uh...
06:43I forget.
06:44I'll find out and get them down here.
06:45What else do you need?
06:46How about a double espresso martini?
06:49I like the way you think.
06:52Hey, Trudy, it's Dana.
06:53What's going on up there?
06:54What's up, Crash?
06:56You mean besides my mother driving me insane?
06:59I'd just tell her that her efforts would be better suited
07:02endorsing someone like myself.
07:05If you're seriously thinking of a double residency,
07:08let me save you the trouble.
07:09You can't do it.
07:11Why?
07:12Just because you couldn't do it?
07:16Honestly, yes.
07:17Because you're a genius.
07:19Yes.
07:20What's the square root of 841?
07:22I'm not a human calculator.
07:24Social worker Dylan Easton is coming for Chiara this weekend.
07:28They're on their way down.
07:28Thank you.
07:29Yep.
07:31Oh, shit.
07:32I have a nun with conjunctivitis.
07:35Her swab is showing gram-negative intracellular diplococci.
07:38Gonorrhea?
07:39Come to Jesus.
07:41Well, a lab must have made a mistake.
07:44Maybe it's an immaculate infection.
07:46We'll call the lab soup.
07:47Clear this up.
07:47Try carefully, Missy.
07:49There's a nun with gonorrhea.
07:52In her eye.
07:55Seriously, you guys are gonna take this away from me?
07:57Just point it at you two.
08:0029.
08:01What?
08:02Square root of 841.
08:05How we doing with Mr. Digby?
08:07He's in a gown in South 21.
08:09Is there someplace we can get this laundered?
08:10Those are going right in the incinerator.
08:12We'll get him a whole new wardrobe.
08:14You ever used a cast saw before?
08:16Oh.
08:16Of course you haven't.
08:17Well, today's your lucky day.
08:18Follow me.
08:20Dr. Mohan, you got a minute?
08:22Yeah.
08:22Have you met Emma?
08:24First day, new grad RM?
08:25Hi.
08:26Nice to meet you.
08:27Emma needs to learn cast removal.
08:29How long's the cast been on?
08:30Months.
08:31Maybe years.
08:32Probably gonna wanna breathe through your mouth.
08:37All right, Mr. Digby.
08:39Dr. Mohan can cut your cast off now.
08:41How long's the cast been on?
08:43I-I don't know, but-but it's really getting itchy.
08:47Okay, this cuts the cast.
08:49Not the scam.
09:07Thank you.
09:11Okay.
09:17Okay.
09:24Oh, je sais que tu trouves des amis.
09:26Oh mon Dieu, ce sont des maggots.
09:34Je vais en servir d'éthylchloride pour freer les offre.
09:37Je ne sais pas ça dans la classe de la nurse, am I right?
09:45Maintenant, irrigate comme un peu, Mel.
09:48OK.
09:53OK, on my count, one, two, three.
09:59Come on, motherfucker.
10:02Humoral head is not reducing.
10:03Should be done in the OR.
10:04I am the OR.
10:06OK, we're going to get this back in before ortho even answers the page.
10:09Mel, stick four fingers under that humoral head.
10:12Really?
10:12Yeah, get in there really, really deep.
10:14And when you feel the traction and lift it above the glenoid,
10:18that will convert this to an anterior dislocation and should pop right back in.
10:22OK.
10:23OK.
10:24Ready to go?
10:25One, two, three.
10:28All right.
10:30OK.
10:30Oh.
10:32Very cool.
10:33Sterile ceiling, Dixie.
10:34A shoulder immobilizer and CT.
10:37I guess you guys don't need me anymore.
10:42You all right, Dr. King?
10:43Yeah.
10:45You don't seem all right.
10:47Well, my deposition is today.
10:50Ah, do you want to talk about it?
10:52I'm not allowed to.
10:53No, we don't have to talk about the deposition, but we can talk about how it is affecting you.
10:58Average emergency physician catches a med mal case every seven years.
11:01Nine times out of ten, the doctor wins.
11:03I've been sued four times myself.
11:05Dr. Al?
11:07I've never been named in a lawsuit.
11:14Um, but some time.
11:20Sister Grace, this is one of my residents, Dr. Mohan.
11:24Nice to meet you.
11:26You as well.
11:26I wish we could recruit as dedicated and talented young women as you two.
11:31I imagine it's a calling, much like medicine.
11:33Yes, very much so.
11:36Sister Grace, under the microscope, we're seeing something called a gram-negative bacteria.
11:43Is that serious?
11:44It can be, if left untreated.
11:47But fortunately, we can give you a shot of antibiotics, irrigate your eye with a liter of saline,
11:51and give you drops to use at home every few hours.
11:53How did I get it?
11:57So, the appearance of the bacteria in your eye suggests that it's gonorrhea.
12:04Traditionally, that's the sexually...
12:06I know what gonorrhea is, Dr. Javadi.
12:08I'm a nun, not a numbskull.
12:10I do a lot of work at an unhoused shelter.
12:14Are you handling dirty sheets, pillowcases, soiled clothes?
12:19Yes.
12:20A part of my day is spent doing laundry, making beds, disposing of old clothes.
12:26Do you wear gloves?
12:28When they're available.
12:29Okay, well, let's get you your shot and set up for irrigating your eye.
12:35I bet we can scrounge up a couple boxes of gloves while you're here.
12:38It's important to protect yourself.
12:41We'll be back.
12:44Why am I here?
12:46I'm not sick.
12:48Hey, we took care of your husband, Ethan, earlier today.
12:52Is Ethan sick?
12:55Well, he was very ill.
12:58And, um, we did everything we could to treat him,
13:01but his heart stopped beating,
13:04and I'm so sorry to say that he died.
13:09He died?
13:12Ethan?
13:13No, no, no.
13:17Are you sure?
13:21Yes.
13:23No, no, no, no, no, no.
13:26Ethan isn't sick.
13:28No.
13:29I know how difficult this must be for you.
13:40Kidneys look good on ultrasound.
13:41No intra-abdominal injury.
13:43Hey, Doug.
13:44Hmm, Robbie.
13:45Is this the tumble down the stairs kid, Kylie?
13:47Yeah.
13:48And?
13:48I'd like to talk to the girlfriend first,
13:50away from the little girl.
13:51We can arrange that.
13:52Keep us informed.
13:54Yes, keep us informed.
13:57More labs are back on our abandoned baby Jane Doe.
14:00Everything looks normal so far,
14:02but you seemed really concerned earlier.
14:05She still needs a catheterin.
14:08Or not.
14:10You can't trust a bag-derin.
14:13Agreed, but we can avoid the trauma of a catheter.
14:15With a suprapubic tap?
14:16Oh, I may have a trick or two up my sleeve, Dr. Alashimi.
14:23Hey.
14:24Princess, hold up.
14:26Hi.
14:27Hi.
14:27How you feeling, Mr. Williams?
14:28Okay.
14:29A little nervous about going to the machine.
14:31I can get a tad claustrophobic.
14:33Yeah.
14:34Well, um, we're sending you for a CT, not an MRI,
14:37so it's like a open donut.
14:39Oh, good.
14:41Oh, no, I was just with other patients.
14:45So, what do you do for fun?
14:47I mainly do what my sister likes.
14:49Um, she loves Kennywood and the zoo.
14:52No, what about you?
14:54What do you like to do?
14:59Um, you still like, um, the Renaissance Fair?
15:04Really?
15:05Yeah.
15:05Isn't that kind of dorky, though,
15:07where everybody dresses up like somebody they're not?
15:09Yeah, but that's the fun, you know?
15:10You can be anyone or anything you want.
15:12I, um, I actually had this alter ego that was a 17th century French woman culture.
15:17Stop!
15:22You okay, kid?
15:23It was a doozy.
15:26Okay, are we ready?
15:28Cleaned and dried with sterile gauze.
15:30Is that water cold?
15:31Right out the fresh.
15:32Okay, Jessie, you can take the armpits.
15:33I'm going to take the legs.
15:35One, two, three, up.
15:37Dr. Alashimi, you're going to be our catcher.
15:40And Samira, you're going to do superpubic circles with that gauze.
15:43And the cold should stimulate voiding.
15:46Even if she pees, it's likely to be contaminated.
15:49Not.
15:49According to the British Medical Journal, they did the research.
15:52Any lukes or nitrites and we calf.
15:55Oh, oh, Dr. Alashimi, get it?
15:58I was going to invite you to join the softball team, but now I'm not so sure.
16:03There we go.
16:03Looks like you've got a good midstream sample.
16:06Here's a fresh blanket.
16:07Okay, plan.
16:10Softriaxone, two-day admit till blood culture is negative.
16:13Next steps.
16:14Foster care.
16:16Oh, yeah.
16:19Someone must have been in a bad way to walk away from you, little one.
16:24We need to call the police.
16:27Let me know what the urine dip shows.
16:32We will let you know what the urine dip shows.
16:36You must be Dr. Alashimi.
16:39And you must be Dr. Langdon.
16:41I've heard all about you.
16:43Welcome back.
16:44And this is?
16:46Uh, Linda Stevens.
16:47One episode of substernal chest pressure resolved with rest.
16:50Twelve lead negative for STEMI.
16:51Heading for north four.
16:54Hello.
16:55I'm Dr. Alashimi.
16:57Nice to meet you.
16:58Nice to meet you.
17:00Ma'am, this is a teaching hospital.
17:02Is it okay if some of our trainees join me?
17:04Not a problem.
17:06Dr. Whitaker, Javadi, Ogilvy, Joy.
17:10Gather around.
17:12Dr. Langdon, you are more than welcome to stay, too.
17:15Uh, maybe for a minute.
17:16We're pretty busy in triage.
17:18Okay.
17:20Stevens.
17:22I have an app on my phone that can listen to our conversation and the details of my physical exam
17:27and write it all up in your medical record.
17:30Wow.
17:31Who?
17:32It's protected.
17:34Confidential.
17:34Doesn't even stay on my phone.
17:36What's going on?
17:37Somebody helped her up to golf and assault the cops.
17:39Locked her backwards off a stool.
17:41Oh, Jesus.
17:42Head trauma.
17:42No LLC.
17:43Okay, you need to get checked out.
17:45I'm fine.
17:45No choice.
17:46It's work-related.
17:47Let's, uh, let's find her a room and prep her burr hole.
17:50What?
17:52Oh.
17:54I forgot how much you like to joke.
17:56Captain Scurvy.
17:58Who the hell's Captain Scurvy?
18:00It's an inside thing.
18:02How's our shoulder guy?
18:04Oh, he slept like a baby.
18:06CT angio shows no vascular injury.
18:08What about your slip and fall guy with the labile affect?
18:12Oh, Michael Williams.
18:14He's still in the scanner.
18:15He seems to have settled down so he doesn't need babysitting.
18:18Good.
18:18Maybe he's coming around.
18:19Ortho can take Mr. Billings here up for surgery.
18:21Lay that order, sailor.
18:23Dr. Ravinovich.
18:25Nurse Hastings.
18:26You can call me Robbie.
18:27You can call me Noel.
18:32Oh, you could just tell me what the hell's going on here.
18:35This is Noel.
18:36She's our, um...
18:37Med control manager.
18:38No, we met.
18:39Case manager.
18:40And this guy will be staying.
18:41Oh, he needs surgery.
18:43Which his insurance will pay for at Westbridge Memorial, not here.
18:48Wait, so we have to transfer?
18:49If he's stable?
18:52I believe that he is.
18:54Look on the bright side.
18:55We're going to free up a bin.
18:56Discharge the patient.
18:57I mean, that's great for us.
18:58Not so good for him.
18:59He will get great care at Westbridge.
19:02Don't you agree, Robbie?
19:04I'm sure that he will.
19:06Okay.
19:07What am I missing?
19:09Is there something else happening with Alan Billions that I don't know about?
19:13Not medically.
19:14This is just a simple insurance transfer.
19:18Yeah, okay.
19:24What's that about?
19:26Nothing.
19:28Didn't feel like nothing.
19:30Dr. McKay has a very heightened sense of empathy.
19:32Meaning?
19:32Meaning she's good at picking up on stuff.
19:36You didn't say anything, did you?
19:38Nope.
19:38I subscribe to the Falstaff advice.
19:41Discretion is the bitter part of valor.
19:42Oh.
19:44You're still planning on leaving tonight?
19:46Yep.
19:48I don't understand why you can't leave in the morning.
19:52Will you excuse me for a second?
19:53I've got to go talk to a patient while she said break from my caregiver.
19:56Yep, that doesn't sound ideal.
19:58It's not ideal.
19:58I've got to figure out what's going on, and I'll find you before I leave.
20:03Okay.
20:07Hey, you're just doing this.
20:10Hey, Stinks.
20:13Evans.
20:14Hope you know what you're doing.
20:15What is that supposed to mean?
20:18I'm a big girl.
20:21Okay, big girl.
20:24I'm fine.
20:26That's good.
20:26Follow my finger?
20:29How's the head?
20:31It's a little sore.
20:33Lean forward.
20:33Let me take a look.
20:36Yeah, you're going to have a pretty good goose egg.
20:39Headache?
20:40No.
20:41I can get you some Tylenol unless you need something stronger.
20:44Oh, no, that's okay.
20:45I'm not very drug tolerant.
20:47Lucky you.
20:52I'm glad you're back.
20:54Thanks.
20:55Yeah, I'm glad to be back.
20:58You know why I was gone?
20:59I was just in a patient.
21:00Um, no.
21:01Not really.
21:03I mean, I've heard rumors, but I learned a long time ago not to listen.
21:06I was in rehab.
21:07Oh.
21:07For an addiction to benzos.
21:10Oh.
21:11Yeah.
21:13But I'm clean now, and it never affected my work.
21:16I just need to get it all out of my system once and for all.
21:22But yeah, I didn't handle things the way I should have.
21:25I thought I could treat myself, and I let a lot of people down.
21:30I'm sorry, Mel.
21:33You never let me down.
21:36Yeah.
21:37Yeah, I did.
21:39I should be setting an example, not a cautionary tale.
21:43Hey.
21:45How you doing?
21:47I'm okay.
21:48I'm really sorry about all that.
21:51The guy robbed the liquor store last night.
21:53He tried to get away on a bicycle, but wiped out and took off on foot.
21:56He must have hobbled in here more so to hide out than to get stitched up, I think.
22:00You catch him?
22:01We will.
22:02Anything you could tell us about him will help.
22:04You think he gave legit information?
22:06Probably not, but it's all we have at the moment.
22:09If we do find him, you may have to testify in court, Dr. King.
22:14In court?
22:15As a material witness.
22:17Attest to his injuries, his treatments.
22:20Simple stuff.
22:21Yeah, but we'll cross that bridge when we come to it, right?
22:24Mel?
22:25Oh, yeah.
22:27Rest here a minute.
22:28I'll be right back.
22:32You know, I'm fine, really.
22:34I should just...
22:34Ten minutes, please.
22:35Doctor's orders.
22:39ER can be a little bright and noisy.
22:47Dorsalis pedis and posterior tibial pulses, two plus and equal.
22:52Your exam is perfect, ma'am.
22:54Oh, that's really good to hear.
22:56I will be back when your blood tests are ready.
22:59Let us know if the chest pain returns.
23:01Thank you.
23:01You are so welcome.
23:05What do you think?
23:06Well, I don't think it's a cardiac.
23:08I mean, what do you think of the app?
23:10I mean, it's hard to say without seeing the full thing.
23:12Take a look.
23:15Oh, my God.
23:17Do you know how much time this will save?
23:18Studies show you can spend 80% less time charting.
23:22You'll get out of here sooner, improving both patient and physician satisfaction.
23:26Well, excuse me.
23:27It says here she takes Risperdal, an antipsychotic.
23:30She takes Restoril when needed for sleep.
23:32So is that, um...
23:33Huh, AI, almost intelligent.
23:36Generative AI is 98% accurate at present.
23:39You must always carefully proofread and correct the minor errors.
23:43It's excellent, but not perfect.
23:45This is amazing.
23:51You speak Farsi?
23:52Well, I did my undergrad at UCLA.
23:55A lot of my friends are Persian.
23:56So you learned the language?
23:58Enough to break the eyes.
24:00I am impressed.
24:03Me too.
24:05That you had friends.
24:07Dr. Whitaker, I said hello to your widow with Alzheimer's,
24:10but she only wants to talk to a doctor.
24:11She was also very overdue for a diaper change.
24:13Okay, yeah.
24:14Thank you.
24:15Thank you. Ogilvy, you're with me.
24:18Come on.
24:21Mrs. Bostick?
24:25Dr. Tsubo, broken heart syndrome?
24:26Uh, no.
24:28Hello?
24:30Hey.
24:31Um, do you want it to see me?
24:33No.
24:35Who are you?
24:37I'm Dr. Whitaker.
24:39We talked about your husband.
24:42Oh, Ethan.
24:44Oh.
24:44Can't he please come see me?
24:49Um...
24:50No.
24:53Unfortunately, he was very sick.
24:56And he died.
25:01He's there?
25:03Died?
25:17What do you like to do for fun?
25:19I love horseback riding.
25:21Does your dad take you?
25:22Yep.
25:23Sometimes he rides, but most of the time he just watches me.
25:27Have you ever fallen off?
25:28Have you ever been thrown?
25:29Nope.
25:30I'm a very good rider.
25:32Do you have your own horse?
25:34I wish.
25:34We live in an apartment.
25:37Okay, Kylie.
25:38We need to take some blood now.
25:39Do you have to do that?
25:41Yeah, but I promise it'll go super fast and only for, like, a moment, okay?
25:46So, I'm just gonna put this rubber band around your arm to help me find your vein better.
25:53And then this, make sure no germs get in your body when we do it.
25:59Okay, now, you're just gonna feel this teeny little prick, but you can look away, okay?
26:07Worst part's over.
26:10Tough little girl.
26:12Yeah, well, little girls can be just as tough as little boys, even tougher.
26:16Yes, I just hope it's not because she's become accustomed to pain.
26:21At the very least, she's gonna need a visual exam of external genitalia to live for signs of trauma.
26:25I can have Dr. Elshidmi come home.
26:27No, she's my patient.
26:28I can do it.
26:37Nice and clear.
26:39With an infection, it'd be kind of cloudy.
26:44Joy, get ready to spike the third bottle here after I clamp.
26:48All good in here?
26:49Yes.
26:50Dr. Whitaker was just explaining that with SPP, we would see a turbid appearance.
26:54However, he failed to mention that bloody fluid indicates either a traumatic tap or the likelihood of hepatocellular carcinoma, in
27:01which case we would send for cytology.
27:03That is correct.
27:05Kid knows his shit.
27:07Kid knows his shit.
27:07He's so smart.
27:12Oh, hey.
27:13Hey.
27:14How's it feel to officially be a doctor?
27:17It's pretty cool, actually.
27:19I didn't get my first paycheck today.
27:20It's only for the first week, but I will take it.
27:23How are the men's students?
27:25Uh, Joy's pretty peculiar, and the other guy, Ogilvy, is really smart and likes to show people.
27:32He's obnoxious.
27:34Well, what he is is your competition.
27:37He's a gunner.
27:39Yeah, right.
27:43He's not my competition.
27:45He's from out-of-state for a four-week sub-internship.
27:49You don't think he's angling for an emergency residency spot here next year?
27:53I mean, even if he was, I...
27:55What?
27:56He couldn't possibly compete with your gigantic brain?
28:04I'd step it up if I were you, Crash.
28:09Uh, she's still calling you that, huh?
28:12I don't really even care anymore.
28:14I mean, she still calls you Huckleberry.
28:16Yeah, but, you know, we're friends now, so...
28:19Friends don't give each other shitty nicknames.
28:22You think Huckleberry's a shitty nickname?
28:26No.
28:27No.
28:27No.
28:28Huckleberry's cute.
28:30Oh.
28:31It's cool.
28:32Uh, it's not like Crash.
28:34Oh, come on, man.
28:35Crash's pretty cool.
28:36It's like, you know...
28:37Crash.
28:38It's got momentum.
28:41Dr. Javadi?
28:42Dr. Whitaker?
28:43Oh, I'm...
28:44I'm still a student doctor.
28:45Whitaker's the real deal now.
28:47Right.
28:49Welcome back.
28:51Thanks.
28:52Yeah, thank you.
28:53It's good to be back.
28:57Okay.
28:57I will be in exile on Triage Island with the rest of the drug addicts if anyone needs me.
29:05That was weird.
29:06Very.
29:08Where's Javadi's party?
29:09Where's Javadi's party?
29:10There's no plan.
29:10What?
29:11Eh, we need to do a plan.
29:15Is Javadi's like Javadi's 21?
29:17Ah, right now.
29:19Yes.
29:20This place is so beautiful.
29:22What?
29:25Not you.
29:27Not me.
29:28Not me.
29:29Mm-hmm.
29:31Mm-hmm.
29:33Woo!
29:34That's gonna hurt.
29:35Dr. Langdon, Clint Hanson, his cousin Mona.
29:38How'd this happen?
29:40Mm-hmm.
29:41Bacon grease from a big griddle.
29:43Oh, looks like more than a splatter.
29:45Yeah, some fool put it in his sink while I was washing dishes.
29:47I was so far away.
29:48You reached for the soap without even looking.
29:50You couldn't hear me.
29:50No, not with the water running.
29:52Who the hell pours bacon grease down the drain?
29:54There's a jar under the sink.
29:55Well, you could have told me that.
29:57You're a guest in my house and now you've totally fucked up my plumbing.
29:59Okay, how about we focus on treating the sperm?
30:01I'll grab the let.
30:02We're gonna need to trim off some of the dead skin so it doesn't get infected.
30:04I'm in charge of the brunch buffet.
30:06Can you make it fast?
30:08Sure.
30:09This one came in by car.
30:10All I got is the name Orlando Diaz.
30:12What's the story?
30:13He tripped over some rebar.
30:14Tripped or fainted?
30:15I don't know.
30:16Orlando, open your eyes.
30:18Hit his head?
30:19Yes.
30:19Why didn't you call 911?
30:20He wouldn't let me.
30:21He was talking and not so much now.
30:23Orlando, Mr. Diaz.
30:26Jesus.
30:26He drunk?
30:27No, ketones on his breath.
30:28He diabetic?
30:29I don't know.
30:30Altered head trauma.
30:31Possible DKA.
30:32Call it overhead.
30:38Dr. Whitaker.
30:40Your assessment was spot on.
30:41Your Alzheimer's widow definitely needs placement.
30:44Do you have a nursing home that can take her today?
30:46I wish.
30:47Medicare requires a three-day hospitalization before they'll approve that.
30:50I don't really have a reason to admit her.
30:53But I do.
30:54She's gravely disabled.
30:55I'll put her on a psych hole.
30:57We'll make it work.
30:58Thank you, Caleb.
31:01Yeah, you have a few moments, Michael?
31:03Actually, I do not.
31:04But once I get things settled here, I will come and find you.
31:08Okay.
31:11Dr. Robbie, Dylan just talked to the girlfriend.
31:15Robbie!
31:15You'll have to fill me in in a minute.
31:16What do you got?
31:17AMS.
31:17Can't tell if he fell because he was altered or he's altered because he fell.
31:20There's ketones on his breath.
31:21Okay, I got this.
31:21Thank you.
31:25All right, I guess it's just us.
31:27Um, what did the girlfriend have to say?
31:29Well, Gina seems a little confused and on edge by this, but I'm not suspicious about abuse on her part.
31:33What about Kylie's father?
31:34Well, I'm a social worker, not a mind reader. I need to speak with him.
31:37Yeah, he's supposed to come in.
31:39Yeah, he doesn't.
31:40Looks pretty guilty.
31:41Let's not jump to any conclusions just yet.
31:43I'm not jumping.
31:44I'm just saying if this dude doesn't show up, hell, I'll go find him myself.
31:51Kidding.
31:52I will speak to Kylie before her dad gets here.
31:55If he shows up.
31:57Yes.
31:59That's definitely ketones. We need to do an accurate check.
32:01I'm on it. He's tacky at 124, pulse ox 97, BP's 106 over 72.
32:06Lung sliding bilaterally, good bowel sounds, abdomen is soft, non-tender.
32:10How do you know it's non-tender?
32:13Because I didn't see any grimacing.
32:15He's altered. He didn't even flinch for the IV start.
32:17I meant to say non-rigid.
32:20Huh.
32:21Toes down and going bilaterally, no evidence of upper motor neuron deficit.
32:23Good.
32:25EFOS negative. How can I assist?
32:27You can check in with Dr. McKay or Dr. Santos.
32:30If you don't mind, I'd like to observe, learn how you handle things.
32:32Whoa, blood sugar's critical high, it's over 500.
32:34Ding, ding, ding, ding, ding.
32:36Sounds like diabetic ketoacidosis.
32:37We need to start treating that, then write to CT to rule out an intracranial bleed.
32:41Severe respiratory distress coming in.
32:43ATI three minutes, I'll stick them in trauma.
32:45Yep.
32:45Would you like me to take that?
32:46Yes, please, thank you.
32:48This guy needs an insulin drip, right?
32:490.1 units per kilo?
32:50No.
32:51Not without knowing his potassium.
32:53Insulin causes an intracellular shift, and if the potassium is under 3.5, the drip would kill him.
32:57That is very true.
32:58We can start with lactated ringers one liter per hour until we get the results from the Chem 7 and
33:03the VBG.
33:04Why is he in decay?
33:05Maybe he's not taking enough insulin.
33:07More frequently, a precipitating event can be identified, such as pneumonia, urinary tract infection, stroke, myocardial infarction, pancreatitis.
33:13Yeah, we always check for those. They're part of a standard order set.
33:16Right, Dr. Mohan?
33:26He's from crazy grandpa Jimmy's side.
33:28She's from my grandfather's brother's side. Grandpa Ricky is still a psycho. Clearly runs in the family.
33:33Hold on, your grandparents are Ricky and Jimmy Hanson? From the racing family?
33:39Unfortunately.
33:40I got something that needs attention.
33:42Not another baby.
33:46Sorry.
33:47Excuse me.
33:50This is Mr. Randall.
33:52He's been erect for the last eight hours.
33:55Should have gone down by now, right?
33:57It happens. It's a good thing he came in, Mr. Randall. I'll take him right back.
34:01Do you mind finishing up with the Bakersons?
34:02I'd rather not.
34:05So, Mr. Randall.
34:06Ian.
34:06Ian, did you take anything that might have led to this condition?
34:11I used an ED injection. Two, actually. I gave myself a second shot. One on each side.
34:18So, double the recommended dosage?
34:23It's our wedding anniversary.
34:25Oh, is this a big one? The anniversary. Is it important? Like, significant? Like a milestone? Or...
34:33It's our 20th.
34:34Oh, nice. Well done. Congratulations.
34:38Glucose, 521. Sodium, 129. Potassium's 3.7. Chloride's 97. Bicarb's 8.
34:45Meaning?
34:46We can start the insulin drip and add 20 of K to each liter.
34:49Big anion gap of 24. It should be under 10. We follow it to assess progress.
34:55Actually, the 2024 and the national guidelines state that anion gaps should not be used,
34:59just as they can be misleading and the presence of hyperglycerinic anabolic acidosis.
35:05I recently had a case in the ICU.
35:07BBG is back. pH of 6.97.
35:09Normal, 7.4.
35:10What causes the acidemia?
35:12Without insulin, the body can't use glucose, so it breaks down fat-producing ketones,
35:16leading to severe acidosis, which can cause cardiac arrest.
35:18But the hyperglycemia causes the body to excrete more water and electrolytes,
35:21leading to severe dehydration, cardiac, and renal dysfunction.
35:24Insulin drip, fluids with KCL, capillary glucose every hour, chem 7 every four hours.
35:29ICU's gonna want a double lumen midline, too.
35:31I can do it.
35:32I can do it. 7 1⁄2.
35:33Can I just say we evaluate our students not only on their fund of knowledge and on their procedural mastery,
35:38but also, maybe more importantly, on their skills as team players.
35:42He can do it.
35:43She can do it.
35:45Otero, will you update everyone?
35:46Barry Mitchell, eating breakfast at Pamela's.
35:49Sudden onset respiratory distress.
35:51Some strider.
35:52Decent pulse locks with trouble speaking.
35:53And they tried the highlights?
35:54Three times.
35:57Any history of asthma?
36:00Set up for intubation. Agreed.
36:02Okay, sir, scoot across.
36:05Always a good sign when they slide over on their own.
36:07Came from a diner with an upper airway obstruction.
36:10Didn't clear with abdominal thrusts.
36:12We gotta take a look.
36:13Heart rate's 118, pulse ox 96.
36:16Mr. Mitchell, we're gonna sedate you to look down this road, okay?
36:19Draw up ketamine and rocuronium.
36:21What about ketamine only?
36:23No, we need full paralysis for a successful first-pass intubation.
36:27Might not need an intubation if it's just a forebody.
36:29We can't assume that.
36:31It could be subglottic stenosis, epiglottitis.
36:33I got ketamine and roc.
36:37Ketamine only, 80 milligrams.
36:40In that case, I'll leave this in your capable hands.
36:45Cetacane spray and a yank hour, please.
36:48Thirty minutes ago, I told you I'd never been sued.
36:50I'd like to keep it that way.
36:55Instead of showing up here, you'd think you'd put an eight-hour heart on to good use.
37:00Well, it is a medical emergency.
37:02If left untreated, priapism can cause permanent damage to the penis and erectile dysfunction forever.
37:07Thanks for the PSA.
37:09Pharmacist mixed up phenylephrine, 10 cc's of 100 mics per cc.
37:14Great, that's the maximum dose.
37:15Sterile bowl of saline.
37:16You might need to refill since they'll be flushing over and over again.
37:19Hold out the empty basin to catch whatever they pull out.
37:22Got it?
37:23I think so.
37:24Holler if you need me.
37:25What are we doing?
37:27Uh, he's out from Versed.
37:28Did a lidocaine block to the dorsal penile nerves at 10 and 2.
37:32Yeah, he's ready.
37:33Excellent.
37:34Enter the dorsal side to hit the corpus cavernosum.
37:38I'll hold the glands.
37:39So deep?
37:40Two centimeters.
37:42Ah, now aspirate.
37:46Will you guys do this, like, every day?
37:50If we're lucky.
37:56Okay.
37:57Okay.
37:58Let's lay him down and take a look.
38:00Okay.
38:08Good view of the Epiglottis.
38:10Yes.
38:11And mystery solved.
38:14This is what you get for eating broccoli for breakfast.
38:17Got a good grip on it.
38:19Okay.
38:22Okay.
38:29I can see why the Heimlich didn't work.
38:33Rotate a little bit.
38:37And voila.
38:40That is why you give ketamine alone.
38:42Because if we gave a paralytic, we would have to intubate and ventilate for an hour.
38:48All right.
38:49This guy's going to Westbridge for surgery.
38:52Trauma one.
38:53We'll move out shortly.
38:54And our Alzheimer's widow, Evelyn Bostick, can see her husband in the viewing room.
38:58God bless her.
39:00My CT results back on Michael Williams?
39:02Not yet.
39:03Neither of the labs and our little girl Kylie.
39:04That's not me.
39:05I did, however, get a few things back on our abandoned baby chain dome.
39:09Still not me.
39:10I'll take those.
39:12Just keeping you informed.
39:16Okay.
39:18We're just trying to get her upstairs.
39:22Okay.
39:23All right.
39:23Got it.
39:25Super baby's urine dipped negative.
39:26Zero WBCs.
39:28Respiratory panels positive for rhinovirus.
39:29Giving us a benign source.
39:31Pro-calcitonis to your peer opinion.
39:32Now Peds is saying they want a urine tox screen and an HIV antigen before they'll take her.
39:36That sounds excessive.
39:38Feel like they're just trying to keep her down here.
39:40Can you blame them?
39:42Never met a Peds nurse yet that wasn't a little wacky.
39:44You know what 12 hours of crying babies does to a person's psyche?
39:47I almost went into Peds.
39:49Good thing you didn't trust me.
39:50Too long up there, you cuckoo for Cocoa Puffs.
39:52You are very punchy today.
39:54Punchy's my new baseline.
39:56No one even looks at me funny.
39:57I'm taking him out.
39:58Going right for the eyes.
39:59Well, I gotcha.
40:00Bet you never knew that about me.
40:02I did not.
40:02Where is Dr. Alashini?
40:04In North Five with the priapism.
40:06Ha!
40:06Better her than me.
40:08I did not intend for that to come off as sexual in any way.
40:12And on that note, I'm gonna go check on Louie, and then I'm gonna get some air in the ambulance
40:15base,
40:15so if anybody needs me, that's where I'll be.
40:17A lot of cats.
40:19Ah!
40:20Ah!
40:21Ah!
40:21Ah!
40:22It looks like some pus at the base of the lateral incisor.
40:25We can drain that for you.
40:27Sounds like it's gonna hurt.
40:28No, we'll numb you up.
40:30Make sure you use the good stuff.
40:33It'll be top shelf, Louie, I promise.
40:35How are we doing in here?
40:37Good.
40:38Almost four liters out.
40:39I already feel like a million bucks.
40:42I just needed an oil change.
40:45And I'm just about to drain an apical abscess.
40:47That's what I'm talking about.
40:49I feel like I'm having a spa day.
40:53Keep it up, would you go?
40:58How long does this take?
41:00Up to an hour, sometimes two.
41:03Mel, any suggestions?
41:07Mel, you did these at the VA.
41:09How can we facilitate detumescence?
41:12Oh, um, sometimes massaging the shafts can help.
41:16That's what she said.
41:18You okay, Mel?
41:20She's thinking about her deposition.
41:23Just stick with the facts of the case, and it always goes well.
41:26I thought you said you hadn't been sued.
41:28I haven't, but I know many colleagues who have.
41:31I also know your work, Dr. King.
41:34Your medical decision making in the chart is always extremely thorough.
41:37Well, we're getting somewhere.
41:39First signs of flaccidity.
41:45I don't know how I could ever thank you.
41:47Well, Mel, I think you just did.
41:49You saved my life.
41:51I didn't do anything.
41:53Well, this is what happens when your wife starts being a Nazi about your diet.
41:57She's got me keeping a food journal.
41:59It's a good way to count calories.
42:01What calories?
42:03She insists I eat five servings of vegetables a day.
42:06A rabbit don't even eat that many vegetables.
42:08I ain't never choked on a sausage egg McMuffin.
42:12I feel like I've been here all day.
42:14It's actually only been a couple of hours, Mrs. Bostick.
42:18Well, where are we going now?
42:20Um, I thought you might like to see your husband.
42:27Is Ethan still here?
42:30Yeah.
42:31Oh, yes, yes, please.
42:42Oh, this has been such a long day.
42:46I'm so glad to see you resting.
42:50But I think it's time.
42:52We should be going home.
42:54If we stop at the store on the way, I could pick up what I need to make your shepherd's
42:58pie.
42:59But not if it's hot out.
43:01You know how I hate using the oven in the heat.
43:06We're ready to leave now.
43:15Dr. Robbie, is this a good time?
43:18That depends on what you have in mind, Dr. Alashimi.
43:21I'd hoped you would have reviewed my ideas for improving the department.
43:26I was looking forward to getting some feedback from you.
43:28Okay.
43:29Well, I think the department functions pretty well, all things considered.
43:32I mean, we face the same challenges that most emergency departments face.
43:34Let's take generative AI, for instance.
43:36ER doctors...
43:38That doesn't sound accurate.
43:40I've included the study in my packet.
43:42Wait.
43:43And patient passports have been shown to increase satisfaction
43:46because they show the time required for each phase of the visit.
43:50Yeah, I get it.
43:50We got a bat of college, kid.
43:52Flipped down the library, tased in the neck by campus security.
43:54Five mid-dazzling didn't touch him.
43:56Will you get the fuck off me, 29-01?
43:5829-01, motherfucker!
44:01Fuck you!
44:02Tell me some more about your ideas?
44:05Maybe later.
44:05Let me out!
44:06Let me the fuck out!
44:07Let me out!
44:08Let me out!
44:08Let me out!
44:08Let me out!
44:09Let me out!
44:10Let me out!letter
45:08...
45:38...
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