- 6 hours ago
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00:15Next time, maybe inform the department chair before the shit hits the fan.
00:18I was on my way to tell you.
00:20Make sure you get everything you need.
00:21Okay, let's do this.
00:22IT called me up because I've trained in cyber attack prevention and response.
00:26You can tell everybody what to do.
00:28Well, thank you.
00:28Best if it comes from the department chair.
00:30Oh, you think?
00:34All right, everybody, circle up.
00:36What the fuck?
00:37We may have had a cyber attack.
00:39No, we shut down to prevent a cyber attack.
00:43Okay, everybody settle down.
00:45Listen up.
00:45As you can see, we're doing a little redecorating in the central work area.
00:49Our hospital computers are at risk for a cyber attack, so we are going old school, analog.
00:54For how long?
00:54Great question.
00:55Our IT department has shut everything down to give them time to bolster our cyber defenses.
01:00I believe the question was for how long?
01:02Hard to say.
01:03Could be up to 24 hours.
01:05Jesus.
01:06So, first order of business.
01:07We need to replicate the electronic patient boards on these dry erase boards, so please, somebody tell me they got
01:12a photo of the boards.
01:13Uh, yeah, yeah, yeah.
01:14Right here.
01:15Oh, kid.
01:15Oh, uh, it's a little blurry.
01:21Not more than a little blurry.
01:23Sorry.
01:24Oh, my God.
01:26I remember.
01:27Great.
01:28If everybody else can remember their patient names and their room numbers, that would be awesome.
01:31No, I mean, I can remember all of it.
01:33All of what?
01:34Names, doctors, room numbers.
01:37I kind of have a photographic memory.
01:39Seriously, the whole board?
01:41Central 12, Harlow-Graham, headache, abdominal pain, ASL only.
01:46Oh, shit.
01:46I have an interpreter waiting for me.
01:48Okay, for patient privacy, all chief complaints will be abbreviated, so HA for headache, AP for abdominal pain, and so
01:55forth.
01:55Central 10, Jackson Davis, new onset psychosis, Javadi, psych admission.
02:00Greek letter, Psy for psych.
02:02Heads is baby Jane Doe fever, Dr. Mohan awaiting admission orders.
02:06Nurses need to convert to a zone defense, north, central, south, trauma.
02:09Where's Dana?
02:10In with a sexual assault case.
02:11She can't leave until the exam is finished.
02:13Yeah, it can be a while.
02:14Princess has charged nurse experience.
02:16Not really.
02:16That's a great idea.
02:17Princess, it is.
02:18You can make the nursing assignments.
02:19Next.
02:20Central 9, Roxy Hamler, and Sage Long Cancer.
02:23Sorry, do we have to stand here while she recites a little board?
02:25No.
02:25In fact, go check on your patients, and then please come back here.
02:29How many hours a day are you on your laptop?
02:34At least eight hours.
02:36I work from home.
02:37And are you at a desk all day?
02:41No, no.
02:42I will either sit on the sofa, or sometimes I'll be in bed, kind of sitting up with the computer
02:48on my lap, that kind of thing.
02:50So you're always looking down at the screen?
02:52Yeah.
02:53Okay.
02:54I'm going to check the muscles in your neck.
03:03Oh.
03:04Ow, that hurts.
03:06All right, well, I think we can help.
03:09Come on over.
03:11Okay, gather up.
03:13Listen up, everybody.
03:13This is our chart rack.
03:15So as you can see, each slot and clipboard has a room number on it.
03:18When you pick up a new patient, you grab a fresh chart from the T system.
03:22Pick your chart by chief complaint.
03:25Use the cartoon to find it.
03:27Why are there two bodies?
03:29Trauma on the left, medical on the right.
03:31So head injury, you go left.
03:32Headache, go right.
03:34There's fish swimming in seaweed?
03:35No.
03:36That is bees and grass.
03:38That's the section for insect bites, skin rash, allergies.
03:41Okay, let's say, for example, Dr. Alashimi has a new patient with belly pain.
03:44For the history, circle the positives, like vomiting and diarrhea.
03:49Backslash the negatives, such as recent travel, sick contact, fever.
03:53For physical exam, checkmark normals on the left, and circle any abnormal findings on the right.
03:59Questions?
04:00Is your regenerative AI program still going to be working?
04:04Not for a while.
04:05And ditch your Spectralink phones as your voice over internet.
04:12PGMC emergency.
04:13Go ahead, medic command.
04:14That is how we will hear about incoming runs.
04:16Thanks.
04:17Two minutes out with abdominal pain and fever.
04:19Okay, has everybody got that so far?
04:20How do we write orders?
04:22Physician order form in triplicate labs, x-rays, IV, fluid, medication.
04:26Will the lab still be able to run blood tests?
04:28Yes.
04:29Are the CT scanners still working?
04:30Yes, but the results will come back on paper from the radiologist.
04:34This is the Dark Ages.
04:35So if you have orders with labs or x-rays, they go into the clerk file here.
04:39They will sign them off.
04:40They will add a downtime slip on them and make sure they go to the correct department.
04:44I'm sorry, who are the clerks?
04:45You're looking at them.
04:46Larry and Antoine are filling in until more help arrives.
04:48Got this.
04:49After the clerk orders, chart gets moved to the nursing order rack here for IVs, medications,
04:54procedures.
04:54Uh, medications are locked up in the PDS.
04:57The PDS is getting unlocked by a clinical pharmacist, Dr. Megan Nord.
05:00We've got your back.
05:01This is a lock.
05:02Any questions?
05:03Yes.
05:04Uh, no.
05:05What's up with the third rack?
05:07When your patient is ready to be discharged, chart goes here.
05:10This lets everybody know we're about to have an open bed.
05:12Now that your tuna melt is up.
05:14Jesse?
05:17What is that?
05:19That is a fax machine.
05:20They still make those?
05:21This is our lifeline to labs and x-rays.
05:23When the results come back, they will fax to us and the clerks will put them on the charts.
05:27Yes?
05:28If you say so.
05:29Incoming!
05:30Okay.
05:30Dr. McKay, Dr. Whitaker, Ogilvy with me.
05:34The rest of you, build your clipboards.
05:39I'm Howard Knox, 52, abdominal pain and fever, 152 over 90, tacky at 120, couldn't get 90.
05:45I wonder why.
05:46Hello, sir.
05:46My name is Dr. Robbie.
05:48Howard.
05:48This is a teaching hospital.
05:50I'll be supervising Drs. McKay and Dr. Whitaker and student Dr. Ogilvy.
05:53Hey.
05:53Hello.
05:54How are you feeling?
05:54Not so great.
05:55Okay.
05:56Princess, what's free?
05:57Problem one.
05:58Parla.
06:01Orders for Mylanta and Bupibokane Central 12.
06:04Wrong spot, Dr. Santos.
06:06And you need a sticker.
06:10Put it in the nursing orders rack and meet me over at PDS.
06:13How much does this suck?
06:14You didn't think today could get any worse.
06:16This is how we rolled when I was a resident.
06:18Was that in the 1900s?
06:20Yeah, when charts were written by candlelight.
06:22Hey, today will be an adventure.
06:24Think of it like back to the future.
06:28Or possibly Titanic.
06:31Here is your antacid.
06:32Cheers.
06:33And I marked the trigger point that is bringing out your headache.
06:37And a shot of local anesthetic in that area could really help.
06:42Yeah, let's do it.
06:43Great.
06:45You are going to feel a little pinprick and some burning.
06:57Oh, ow, ow.
06:59That really hurts.
07:00Temp 101.4.
07:02Tacky at 128.
07:03Pulse ox 92 on two liters.
07:04When did the pain start?
07:05It's been on and off for about a week.
07:07And where do you feel it?
07:08All over.
07:09It started on the left and now there's some on the right.
07:11How about that fever?
07:12Since last night, I was burning up and then I had chills pretty bad.
07:17Can't find a vein here.
07:18We'll try it for midlife.
07:19Let us know if this hurts.
07:21Uh, uh.
07:22Sorry.
07:22And on this side?
07:24Yeah, yeah, yeah.
07:24Sorry, sorry.
07:25Uh, guarding with no rigidity for pain 100 of Fenty M.
07:28Plan Dr. Whitaker.
07:30Blood cultures, lactate, Zosin.
07:33We're going to need a CT to figure out what's going on.
07:35Uh, uh.
07:37Yeah, it's not going to work.
07:38Yep, right, neatly.
07:39Tenmanship counts.
07:40Howard, for the scan, we're going to have to lay you flat on your back.
07:42Can you do that?
07:43I could ten years ago, but now it's too hard to breathe.
07:47If we can't lay you flat, then we're going to have to put a tube in your windpipe to help
07:50you breathe.
07:51Are you okay with that?
07:51Intubation with rapid sequence induction?
07:53Uh, no, we can't lay him down.
07:54No, the tube will go in your nose while you're awake, sir.
07:57Well, does it hurt?
07:58You'll be numbed up completely.
08:00You won't feel any discomfort.
08:01Do you happen to, um, know your weight?
08:04Uh, a little over 400.
08:06When was the last time you checked?
08:07It's been a while.
08:08Is it possible that you might be over 450?
08:11Possibly.
08:13Perla?
08:14Let's call for the Hoyer.
08:15So we're going to place the tube and get you ready for the scan.
08:18Is this something serious?
08:20It's hard to tell without a CT.
08:22You could just need antibiotics or you could require an operation.
08:25If surgery is necessary, then your weight could make things a little bit more complicated.
08:29I know.
08:29I'm sorry.
08:30Not to worry.
08:30We're going to take very good care of you.
08:32Team.
08:36Let's try for a midline.
08:38So it's been with ultrasound.
08:40Can ultrasound check for an app?
08:42He's a little too large for ultrasound.
08:43So this CT can only handle 450 pounds.
08:46And so if he's over that, we send him to the zoo?
08:49He's right there.
08:53I heard that there's a large animal CT.
08:55Because Presby's CT can handle 650.
08:58Yeah, if Presby's still up and running.
09:01What?
09:02That's not a jinx.
09:03It's...
09:04Have any of you ever done an awake nasal tracheal?
09:07Okay.
09:08Perla, can you also ask Dr. Alishima to come in?
09:10I'm going to need an assist.
09:11Yep.
09:11You got it.
09:12Uh, sorry.
09:14Signed.
09:16All about F.
09:17George Francis.
09:18Shortness of breath.
09:19Dr. Mohan awaiting D-dimer.
09:21Wow.
09:22She's still gone?
09:23Yeah.
09:23Remarkable relief.
09:25Dr. Al, Robbie's asking for you.
09:27Uh, okay.
09:28In trauma if you need me, princess.
09:29Got it.
09:32Who's supposed to run the downtime slips to X-ray and lab?
09:35Uh, the charge nurse.
09:37Don't look at me.
09:39My plate's full.
09:43Uh, parents of Roxy Hamlin?
09:46Essential nine.
09:46Oh, I got it, Donnie.
09:48Hi, I'm Victoria Givadi, one of the student doctors here.
09:51Um, I've been assisting with Roxy's care.
09:52Oh, thank you so much, Adam.
09:54I'm Lloyd.
09:55Cora.
09:56It's nice to meet you.
09:57She broke her leg?
09:58Um, yeah.
09:59There's a fracture down by the ankle.
10:01She's in a boot now, um, so there's not quite so much pain.
10:04But I'll take you.
10:05She's just in nine.
10:11The hospital Wi-Fi isn't working.
10:13Oh, it'll be down for a while.
10:14Sorry.
10:16Mom broke her leg, Grandpa.
10:18We heard.
10:21How are you, honey?
10:25You've got this, kiddo.
10:27Yeah.
10:29How long will she stay in the ER?
10:32Oh, until a bed opens up upstairs.
10:35Could be a while.
10:42You know, it's getting pretty crowded in here.
10:44Maybe we should take Tucker and Shane out for ice cream.
10:46Yes, please.
10:46No.
10:47No.
10:47I'm okay.
10:49Maybe your mom would like some time to rest.
10:52Yeah.
10:53Go.
10:56Can she have ice cream?
10:58She can have anything she wants.
11:01Come on.
11:02Let's go.
11:05Bye, Mom.
11:08All ice cream.
11:14Yep.
11:15Listen up.
11:17This is oxymetazolene, so open up the passage.
11:20What medication do you take?
11:22Uh, lisinopril and metformin.
11:26Ozempic, wagobeam.
11:27No.
11:28Kind of expensive.
11:29I'm going to squirt some numbing gel in your nose.
11:31If it drips back in your throat, that's okay.
11:34Here, in case you need it.
11:37Do you smoke alcohol?
11:39Never.
11:40Do you exercise?
11:42Moving from the bedroom to the kitchen.
11:44No, I'd walk more, but I'd need a bench to rest on every block.
11:48What about water aerobics?
11:49Let's focus on helping, Mr. Knox.
11:52Agreed.
11:53Took me 25 years to get this way.
11:55Car crash.
11:56Burn unit.
11:58Four leg surgeries over ten years.
12:01Laid me up so much, I lost my job.
12:03I need to numb the back of your tongue.
12:05This is going to taste pretty bad.
12:06Is there anyone you'd like us to call?
12:10Any family?
12:10All right.
12:12My parents passed.
12:13I'm single.
12:14Go figure.
12:16Siblings?
12:17Sister in Arizona.
12:19We don't talk much.
12:21Now that we've numbed up the back of your tongue, we can anesthetize a bit deeper.
12:27Sorry to interrupt.
12:28I have a middle-aged woman with sudden onset blindness.
12:30I can go.
12:31Okay.
12:32Will you see if Abbott's still right?
12:33Yeah.
12:34What's your sister's name?
12:36Lauren Milford.
12:37Where in Arizona?
12:39Flagstaff, I think.
12:40It's going to go over your tongue and numb your vocal cords.
12:43Ah.
12:44Ah-ha-ha.
12:45Ah-ha-ha.
12:46How many fingers?
12:47I don't see any fingers.
12:49And now?
12:51I can see a little bit of light.
12:54Um, Brooke, you've met Dr. King.
12:56This is Dr. Al Hashimi.
12:57Nice to meet you.
12:58And her wife, Wendy.
12:59Hello.
12:59Hello.
13:00Okay if we discuss your symptoms?
13:01As long as I can correct you if you get anything wrong.
13:04Trust me, she will.
13:05One hour of sudden painless vision loss in the left eye.
13:09No history of hypercoagulable state or vascular disease.
13:12Could you look straight ahead, please?
13:13Could be a central retinal artery occlusion.
13:16In English, please?
13:17A little blood clot can block the artery at the back of the eye and decrease your vision.
13:22Sometimes it's called an eye stroke.
13:24Stroke?
13:25Like she could be paralyzed?
13:26No, this would be limited to the eye.
13:28Is it permanent?
13:29First, we have to make the diagnosis.
13:32Retinal exam?
13:33Hard to get a good look.
13:34We need the FLP.
13:35The what?
13:39Oh, Princess.
13:41We need patient stickers on each of these order sheets or the pharmacy won't know who to give meds to.
13:45We're on it.
13:46Princess, smartphone front of scope.
13:49Corbin Corridor, iCart.
13:50Thanks.
13:51You seem a little confused.
13:53How do I figure out which new patient to pick up?
13:55Top of the board.
13:56They're listed in the order they arrive.
13:58You erase the first one and put your initials in the MD box.
14:00Okay, thanks.
14:02Caleb, Michael, you managing this chaos okay?
14:05Oh, it's all pretty easy when you're a short-timer.
14:08Any more comatose patients for me to have a chat with?
14:12I'm kidding.
14:13Okay.
14:14Victoria, this is Nicole Stedman.
14:17I run the parent support group for the psychiatric service.
14:20Yeah.
14:20Nicole's daughter was diagnosed sophomore year in college.
14:23You think, um, Jackson's parents might have a chat with her?
14:26Now we can certainly ask.
14:28Now we can see the whole retina without dilating the pupil.
14:32You're looking in the wrong eye.
14:34Uh, we start with the good eye for comparison.
14:38Retina looks great.
14:39Now for the bad eye.
14:41Eyes wide open.
14:44How's it look?
14:46Extremely pale, no blood flow.
14:47Digital massage, 10 seconds on, 5 seconds off.
14:49Order non-contrast head CT.
14:54Come in.
14:57Hi.
14:57Heard your patient took off.
14:59She's taking a little break.
15:01How long are you going to wait?
15:03You know about the cyber shutdown thing?
15:05Yeah.
15:06Wish I could help, but I'm going to stay here until all the evidence is collected, so.
15:09It's a hot mess out there.
15:11It's all day, yes.
15:14Sorry, I was just leaving.
15:16You okay?
15:18I'm good.
15:19I'm glad to hear it.
15:21You got something to eat?
15:22No.
15:25Let's keep going.
15:27Okay.
15:29Yeah.
15:37All right.
15:40Why don't we keep one in the ER?
15:43Because our intubated patients are usually sedated.
15:46Right.
15:48Maybe you could ease up with your comments about his weight.
15:52I was just wondering how he got so big and how we could help.
15:56We can help by finding out what's wrong with him and treating him with respect.
15:59What are you billing now?
16:00Second pain shot helped.
16:01Okay.
16:02There's more if you need it.
16:03Diminished balacons.
16:04Bye to talk from the ICU.
16:06Great.
16:07Howard, we need to open up that passageway now so we can pass the tube.
16:10I'm going to start with my pinky slowly over a few minutes.
16:12I'm going to go deeper all the way to the back of my knuckle.
16:15Once the tube's through your vocal cords, you won't be able to talk.
16:17But this is a communication device.
16:19Swipe through the screen for anything you want to say.
16:22Hit the icon and it talks to us.
16:24I would like some pain medicine.
16:27My pain is a nine.
16:29Can I get it to order a pizza?
16:32There is cell service in the ambulance bay.
16:34I found his sister's new number, left the voicemail.
16:37Okay, I'm going to start.
16:38You ready?
16:39Not really.
16:41Go ahead.
16:42Robbie, over here.
16:43Here we go.
16:43Head back.
16:44Wow.
16:47You thinking it's surgical?
16:48I'm hoping for a non-perfect abby.
16:50Can you do it with a scope?
16:51Possibly that he could be treated with antibiotics alone.
16:53If he needs surgery?
16:54With his size and emergency, open laparotomy, death rates, close to 50%.
17:00Okay, one step at a time.
17:02Let's keep trying his sister every 15 minutes.
17:04She'll get it.
17:09Half the downtime slips are blank.
17:12What are you talking about?
17:15Here and here.
17:17Larry, are you using a felt-tip pen?
17:19Maybe.
17:21It's not going through for the copies.
17:25Ballpoint pen only.
17:27Okay.
17:30Did we steal MIA?
17:32Is that the homeless guy?
17:33We need the bed if he eloped.
17:36What do you need?
17:37Fun attending.
17:38We're a senior resident?
17:39No, I'm good.
17:40Dr. Alashimi, can I present?
17:41Yes.
17:4232-year-old deaf woman with myofascial headache,
17:45ibuprofen-caused gastritis,
17:46and epigastric pain as she vasovagled.
17:48But now pain-free after myelanta,
17:50and a trigger point injection.
17:51Excellent.
17:52That can take care of the pain for several months.
17:54Yeah, it shouldn't recur.
17:55She keeps her screen at eye level.
17:57There was a delay in getting an ASL interpreter,
17:59and I almost gave up and ordered an unnecessary brain and abdominal CT.
18:03Good thing you didn't.
18:04Dr. Alashimi, for you.
18:07Nice job on the trigger point.
18:09Yeah, I know.
18:09How's the T-system going?
18:11Quick and easy.
18:13Yeah, and these MDMs, don't just circle your diagnosis.
18:16Also put a backslash through all the ones that you ruled out.
18:18Ain't no problem.
18:19Thank you very much.
18:21Princess, bum central 13 to the front of the CT line.
18:24What do you got?
18:24Sudden onset blindness patient has central retinal artery occlusion.
18:27I just spoke to an ophthalmologist at the BA,
18:29principal investigator for thrombolytics in cases like this.
18:32Not exactly standard of care.
18:34Kind of risky.
18:35Well, do informed consent.
18:36It's our best shot at saving some of her vision.
18:38You're patient.
18:39You're a call.
18:39I'm not going to be around longing for any complications.
18:44I'll be taking two swabs from the vagina,
18:48two swabs from the cervix.
18:53Let me know if you're feeling discomfort.
18:56Okay.
18:59Each swab gets labeled.
19:00First vaginal, second vaginal.
19:03Smear slide with both and let it air dry.
19:05Same for the cervix?
19:06Yeah.
19:07But no sliding either.
19:10How you doing, Alana?
19:12Hanging in there.
19:16Almost done.
19:20All these samples go in the vaginal contact envelope.
19:23I can help with that.
19:24No.
19:24It's got to be me.
19:26I'm going to pull this out.
19:29Okay.
19:31All good here.
19:32Legs can come down.
19:37Are we done?
19:39One last thing.
19:41Four more swabs inside your mouth.
19:43Didn't you do that already?
19:45Next one's different.
19:46Inside your cheek for your DNA.
19:48No pants.
19:53So, it could be bipolar or schizophrenia.
19:58Those are the two most likely possibilities.
20:00How do they know which it is?
20:01Based on response to medicine.
20:03But also with therapy and observation on award.
20:06They'll monitor his mood and interactions with others.
20:11Is there a blood test or a brain scan that'll tell us for sure?
20:16Unfortunately not.
20:17When properly medicated, people with bipolar disorder can have successful careers.
20:23So we hope for bipolar.
20:25You can hope for your son's happiness.
20:27With early treatment, 20% of people with schizophrenia have a complete recovery.
20:32So 80% don't?
20:34This is a new version of Jackson.
20:39How old was your daughter?
20:4120.
20:42Studying architecture at Georgetown.
20:46Schizophrenia.
20:48I'm sorry.
20:50Oh, she's good.
20:51Living at home, working as a cashier at Giant Eagle.
20:56Employee of the month.
20:59Well, we still have struggles.
21:01But there's also laughter and love.
21:11Good to go.
21:13How'd that feel?
21:14Very weird.
21:15No pain.
21:16It's just weird.
21:17Okay, the next step is we're going to take this tube and pass it through your nose,
21:22stopping at the back of your tongue.
21:24Best not to talk for that.
21:25Tube soaking in warm water to make it more flexible.
21:29Do you want to try it?
21:32What day and time is it?
21:34Fourth of July, 2.31 p.m.
21:37When is my tube coming out?
21:39You know, we have to put it in first.
21:42I know.
21:43Just practicing.
21:44Sounds like you're an expert already.
21:47Before I can't talk, I just want to say thank you for everything.
21:57You're very welcome.
22:04Here we go.
22:11STI prevention.
22:12One shot treats gonorrhea, then pills for chlamydia and trichomonas.
22:17We also have morning after contraception.
22:19She has an IUD.
22:21Over 99% effective, not 100.
22:23We still offer.
22:25I'll pass.
22:26For HIV, we got PEP, post-exposure prophylaxis.
22:3028 days.
22:31As soon as you start, the more effective.
22:34I'm pretty sure they could use an extra set of hands out there.
22:39It's nice to meet you, Alana.
22:42You're a very brave woman.
22:43Yeah.
22:51She's a good nurse.
22:53She's still learning, but she will be.
22:58After this, we're done?
22:59Yeah.
23:04I'm glad you were here today.
23:10Me too.
23:13We have a decision to make.
23:16Studies have shown that some vision can be restored with a clot-busting medication.
23:21So give it.
23:22But there are possible risks.
23:25For eye stroke, only 17% get better without any treatment.
23:30Only 17%?
23:31Yes.
23:31But with the medicine, another 20% can improve.
23:36But there can be complications.
23:392% of patients who receive the medication get worse.
23:42And 1% have severe disability or death.
23:47Okay.
23:52I mean, this one has to be your call.
23:57No, it's our call.
24:00What would you do without me?
24:02Figure out how to get by.
24:06And I'd probably cry for two years solid.
24:10Two years, that's all.
24:13I want the medication.
24:15Okay.
24:20Hey, we need your full name to make a chart.
24:23Jackie Liddell.
24:24Jackie Liddell.
24:26And you are?
24:27Her friend Jackie.
24:28You have the same name?
24:29No, no.
24:30She's Jackie with a CK.
24:31I'm Jackie with a Q.
24:32You can call me CK.
24:35Best not to talk CK, okay?
24:37Just chill.
24:37No.
24:38I bit off half my tongue.
24:41What?
24:41She said I bit off half my tongue.
24:43You can understand that?
24:44Oh, you should hit her when she's had two pitchers of margaritas fucked up and slurring.
24:48Oh, my God, I'm so sorry.
24:51Princess, what's open?
24:52South 15's clean.
24:54Deep tongue laceration.
24:56I can jump on this.
24:58Robbie and Alice Schumer are both with critical patients.
25:01Hello.
25:02I'm Dr. Langdon.
25:04I'll be supervising your care.
25:08Jesus, CK, your doctor's fucking hot.
25:10What?
25:13Tubes at 14 centimeters just above the airway.
25:16Okay, Howard.
25:17I'm going to start.
25:18If you want me to stop, you just put your hand up, okay?
25:23Blue mark tells me I'm in the tube.
25:28Looks like you cleared it.
25:30If he inhales, we should see cords.
25:33Okay.
25:34Deep breath for me, Howard.
25:38Come on.
25:39Very beautiful.
25:40Chords are sensitive, so we spray lidocaine in the scope.
25:43Okay.
25:45One cc going in now.
25:48We'll just give that a second to work.
25:50Hey, how you doing, Howard?
25:54Once the tube's in, you'll have to breathe through your nose.
25:57Okay, Howard, hold still.
25:58Well, I am now going in past your vocal cords until we see the carina.
26:06Ogilvy?
26:07Uh, there.
26:08Right and left main stem.
26:10And the tube slides in.
26:16And the scope comes out.
26:21Great.
26:23Okay, inflate the balloon.
26:25Deep breath through your nose.
26:26Amazing.
26:27You good?
26:29Great, entitled waveform.
26:31Does he need a pen?
26:32He's breathing on his own, but a little CPAP wouldn't hurt.
26:34Starting at five, titrate to ten.
26:37Okay, that went really well, Howard.
26:39Now we're going to check your weight.
26:43So the nurse examiner is supposed to lock up the rape kit in this fridge where it stays
26:47until it gets turned over to law enforcement.
26:49It's called preserving the chain of evidence.
26:52Are you fucking kidding me?
26:54Is there a problem?
26:57Jesus Christ.
26:58The police are supposed to pick up the rape kits within 72 hours.
27:01This one I did two weeks ago.
27:04God damn it.
27:08So how exactly did this happen?
27:10We were in between pubs taking a selfie.
27:13Very nice.
27:14Until she jerked her head up.
27:18Ouch.
27:19Okay, topical epi did the trick.
27:21No more bleeding.
27:22Sweet.
27:23I can go home now?
27:24I don't think so.
27:26It looks like the Grand Canyon across the back of your tongue.
27:28We need to put in some stitches.
27:29I don't want stitches.
27:31Listen to the doctor.
27:33Don't tell me what to do.
27:35This is all your fault.
27:36No, it's not.
27:37Yes, it is.
27:38Princess?
27:39Oh, it's Princess.
27:40Hey, why don't you show Q where she can wait while we patch up her friend?
27:43Of course.
27:44Okay, this is a numbing shot for the tip.
27:47The tip?
27:48That's not where I bid it.
27:50One step at a time.
27:58That's 20 makes it, TNK.
28:01In 1439.
28:04Failing anything?
28:06Not yet.
28:07Could take an hour or two.
28:10We're going to move you to another room for better monitoring.
28:14Dr. King?
28:18I'd like you to stay with her.
28:21Why?
28:22In case there are complications.
28:24You'll be there to respond quickly to a blown pupil, a seizure, altered mental status.
28:29Or I could catch up on my charts.
28:31And my deposition's coming up.
28:33Think of this as a great way to steal some quiet time and get mentally prepared.
28:37Jesse, Mel's with you.
28:41Excuse me, Dr. Mohan.
28:43Excuse me.
28:44Dr. Mohan.
28:45In a minute, George.
28:46I've got this.
28:49Oh, I, um...
28:51D-dimer's back.
28:52Um, normal.
28:54I'm ready to go.
28:55Are you feeling better?
28:57I really wasn't short of breath this time.
29:02Then why'd you come in?
29:05When I found out about the blood clot in my leg, I just kept thinking it's going to go to
29:09my lung and kill me.
29:10We've talked before about how the eloquist would prevent that.
29:13I know.
29:16Well, I finally took your advice.
29:18I got out of the house.
29:20And I joined the Frick Park Lawn Bowling Club.
29:24Wonderful.
29:25I mean, you're right, you know?
29:27We all need a community.
29:33You're going to do what?
29:35In order to fix your tongue, we need to move it forward to access the laceration.
29:39You're just going to feel some pulling, okay?
29:40I guess so.
29:44Go for it.
29:46What size suture is that?
29:48Oh, silk.
29:49The biggest one we got.
29:52As soon as I cut the needle, you're on traction, Joy.
30:03Oh, that is pretty deep.
30:07And now we can numb up the cut.
30:09It's best to start with...
30:10Proximal side first so she doesn't feel the distal injection.
30:15Give it ten minutes.
30:16I'll be back for the repair.
30:21I got a rape kit sitting here for two weeks that was supposed to be picked up within 72 hours.
30:26I don't care.
30:27Get someone out of here now.
30:28No.
30:29You expect us to treat your officers?
30:31As soon as they come in, you get a detective to pick these kits up ASAP.
30:34I got to go.
30:35Dana, your South 19 got their head CT before it went down.
30:38No results yet.
30:39All right.
30:39Let's send the reminder.
30:40Hey, Dana.
30:41Dana, hang on.
30:44What's up?
30:44We put in an order for more pain meds for Roxy.
30:47All right.
30:48So put it in the nursing racks.
30:49Oh, I did.
30:50A long time ago.
30:53All right.
30:53I'll bump it to the front.
30:55What's that noise?
30:57UFO landed.
30:58The aliens are invading.
30:59Hey, Dana.
31:01Chem 7's not back on trauma to you yet.
31:03Let me see the chart.
31:05Ah, Jesus.
31:06Bet your Chem 7 wreck went to radiology.
31:08Larry, Antoine.
31:09You put labs and chest X-ray on the same downtime for me.
31:12You need two slips.
31:13One for labs, one for radiology.
31:15What happened again?
31:16I'll run it down myself.
31:17Use the ice to add a bedside.
31:19They won't take them to CT without a creatinine.
31:21Oh, perfect.
31:22Nice to have you back.
31:23Thrilled to be here.
31:24You trying to text?
31:25I am just composing.
31:27I'm going to send it from the bay.
31:29My mechanic friend, Duke, never showed up.
31:31I thought he was coming in this morning.
31:32That was the plan.
31:33I guess he got busy.
31:36What if he's a no-show?
31:37Tell me what he needs.
31:38I'll pass it on in a night shift.
31:39That won't be necessary.
31:43Well, princess, asking you shall receive normal hot seat.
31:47Thanks.
31:48I'll get him discharged.
31:50How's your day going?
31:51I think I'm getting writer's cramp.
31:54You with the big guy?
31:55Yeah.
31:57It's sad.
31:58Bad car accident, multiple operations, tons of stress.
32:03The lidocaine shot to its sensitive area.
32:06I'm going to have binge drinking party go with a tongue lack.
32:08Sounds like she needs some help.
32:10More ways than one.
32:13How's your first shift back going?
32:16One day at a time.
32:18First year sober as the hardest.
32:20That's what they keep telling me.
32:22I'm nine years and counting.
32:26Oh.
32:28Special delivery for my guy.
32:31If you need anything, call me.
32:34Thanks.
32:41Where are you going?
32:43Blister's North 3.
32:44That's where I'm going.
32:46Did you sign up for the patient?
32:47I pulled the chart from the rack.
32:49You're supposed to sign up on the dry erase board.
32:50You're supposed to have a clipboard for the patient.
32:53I thought the nurse had that.
32:55Whatever.
32:57Hi, I'm student Dr. Ogilvie, and this is...
33:00Wow.
33:01That is some rash.
33:03Tell me about it.
33:04Student Dr. Javadi, when did this start?
33:07Last night.
33:08And have you been on any hikes recently around poison ivy?
33:10Nope.
33:11Haven't left the house.
33:12What about new medications?
33:14Lotions, soaps, detergents even?
33:16I don't take medicine.
33:17Nothing new with all that other stuff.
33:19And where did this start?
33:20Everywhere, all at once.
33:21Just a lot of pain.
33:23Um, really itchy.
33:25What is it?
33:26Not sure yet.
33:28Um, be back in a second.
33:31Okay.
33:32You...
33:36What are you thinking?
33:38I have no idea.
33:40Agreed.
33:46Well, it's just what we call it when we write down things to describe a clinical disease.
34:10Of course.
34:13Any changes?
34:15Not so far.
34:16It's time for the next neuro check.
34:19Excuse me, Dr. King.
34:20Do you have a minute?
34:22Um, no.
34:23I'm observing a patient right now.
34:2560 seconds, tops.
34:28I'll check pupils.
34:29We're good here.
34:38I just finished my deposition.
34:41Oh, um, should I go up now?
34:44Yeah, just wait until you get a call.
34:45Okay.
34:46Well, I'd ask how it went, but we're not supposed to discuss the case.
34:49This isn't a discussion.
34:51It's a monologue, so shut up and listen.
34:55The malpractice case is frivolous.
34:57The mother of the measles kid claims we caused intellectual decline by performing a spinal tap.
35:02But the tap was perfect with no complications.
35:05Her son presented with altered mental status due to low oxygen from measles pneumonia.
35:10Any change in intellect was due to hypoxic brain injury.
35:13It had nothing to do with your spinal tap.
35:16End of monologue.
35:17Look, we never discussed the case.
35:21I gotta get some sleep.
35:23Okay.
35:23Thanks.
35:25I guess.
35:28Okay, are you ready to lay down?
35:30I got your head.
35:32Nice and slow.
35:33One, two, three.
35:37Okay, how's that feel?
35:41Lifting up now.
35:52All right, keep going.
35:58And then I'll do it right about there.
36:02215?
36:04That's in kilos.
36:08Okay.
36:09Team.
36:15It's not that much over 450.
36:17No, we can't.
36:18We just break our CT on a holiday weekend.
36:20And the medics take him while he's intubated?
36:22If I go along for the ride, I could still get a nap in before my night shift.
36:30Uh, 474.
36:33Our CT can't handle your weight, but we're going to take you over to Presbyterian Hospital.
36:38Road trip.
36:40I'll keep you company the whole time.
36:44Sorry for all this trouble.
36:47It's okay.
36:48This is what we do.
36:55So, sub-Q starts deep.
36:56You want to bury the knot.
36:58Yeah, I've done these before.
36:59Joy, how do we cut the ends?
37:02Short slide to the knot.
37:03Turn 45 degrees.
37:04Excellent.
37:06Um, Dr. Langston, we have a case.
37:08It'll have to wait.
37:09It could be urgent.
37:10Fine, Robbie or Alice Shemmy.
37:14This girl is wasted.
37:16Drunk as a skunk.
37:18Should we check a blood alcohol level?
37:20No, it won't change what we do.
37:22She can go home when she has a steady gig.
37:23I already set one off.
37:25Joy, do you want to guess her blood alcohol?
37:28Why would I want to do that?
37:30I don't know, because it's fun.
37:38When will you have a bit?
37:39I'm not sure she needs a bit.
37:41She's a fat-brow infant.
37:43Well, it's clearly over a month old and looks amazing.
37:45Every marker is normal.
37:46She has a cold virus.
37:47Infants with rhinovirus can still have a serious bacterial infection.
37:50Not this one.
37:51We send kids like this home all the time.
37:52Except this one doesn't have a home.
37:55Or a parent.
37:57All right.
37:58I can't put a kid with a virus in the nursery,
38:01and I can't waste a private room on a healthy baby.
38:03Then what do you propose?
38:05CYF can place her in emergency foster care by tomorrow morning.
38:08You want to leave her down here overnight?
38:10Seems to be the standard care these days.
38:13Have your attending give me a call.
38:14Will do.
38:15I can't believe this.
38:16Let's CYF know it's very urgent.
38:18Got it.
38:19This is turning into quite the day.
38:22You know, I've been thinking about applying for a fellowship.
38:26I thought you had a job lined up in New Jersey.
38:28I did, to be close to my mom.
38:30But she sold our house to travel the world with her new boyfriend.
38:35So what's the point of New Jersey?
38:37Yeah, good question.
38:38Which fellowship?
38:40I've narrowed it down to ultrasound, toxicology, and sports medicine.
38:47Those are very disparate fields leading to very different careers.
38:50I know.
38:51I'm a little undecided.
38:53Do you have research experience?
38:55I was a part of a study on racial disparities in health care until the White House cut the funding
39:00last year.
39:01Yeah.
39:02You are not alone.
39:03Have you considered a geriatrics fellowship?
39:06I have not.
39:08I've seen your skills with the elderly, and there are a lot of openings.
39:12It might be your best shot.
39:14Think about it.
39:17Last stitch.
39:18You want me to cut?
39:19I got it.
39:22It looks good.
39:24Okay.
39:24Let's pull the traction suture.
39:26With pleasure.
39:29Okay, Jackie.
39:31Jackie.
39:32Sell it.
39:33All done.
39:35All done with what?
39:36It's sewing up your tongue.
39:38What happened to my tongue?
39:40You bit it.
39:41Huh.
39:42No, I didn't.
39:43That is called a blackout.
39:45How much did you drink?
39:47A couple Bloody Marys.
39:49Only a couple?
39:51I don't know.
39:52Maybe more.
39:53It's a holiday.
39:54A pub crawl.
39:55Do you usually have a couple cocktails every day?
39:58Only on weekends.
40:00How about during the week?
40:01Nothing much.
40:02Just wine with dinner or a few beers.
40:07Maybe we should recommend rehab?
40:10Yeah.
40:11We could try.
40:18Ready to roll.
40:20How are you feeling?
40:22My pain is a two.
40:23You got meds if you need them.
40:24Scan will be quicker than the ride to Presby.
40:26We'll keep trying to reach your system.
40:27You guys are the best.
40:28See you later.
40:29Can I put a new patient in T1?
40:31Uh, no.
40:32I kind of want to leave one trauma room open.
40:33Why don't you double up the north if you have to?
40:37Mr. Digby?
40:40It's just Digby.
40:41Right.
40:42You've been looking all over.
40:43Where you been?
40:44With Louie.
40:46You been in there for an hour?
40:47He was my friend.
40:49I had a lot to say.
40:51Well, let's get you back to your bed.
40:56Louie got his wings.
40:58Dr. Robbie, we picked up a patient together.
41:02Teamwork.
41:02It's a concerning bullous rash.
41:03We might need a biopsy for pemphigus vulcare.
41:06It's phytophotodermatitis.
41:07What?
41:08I asked.
41:09He was making three gallons of margaritas for a party,
41:11squeezing fresh limes out in the sun.
41:13Let's go take a peek.
41:15I don't need to see it again.
41:19How's it going out there?
41:21Standing room only.
41:22If I call the fire department,
41:23will they clear that waiting room?
41:25Wish, what's up?
41:26Twelve patients need med refills.
41:28Shouldn't they see their doctors?
41:29With the Medicaid cuts, we are their doctor.
41:31No, I can't be prescribed to their pharmacies.
41:33Looking at your pen.
41:34Go old school.
41:35Dana, on what?
41:37Lord, you got the security pads?
41:40Sure do.
41:41Just need a patient sticker.
41:42Any other questions?
41:44Yeah.
41:45What would have happened if you weren't here today?
41:48You don't be curled up in the fetal position,
41:51crying like babies.
41:53Were you wearing flip-flops?
41:54I was.
41:56What is it?
41:57Phytophotodermatitis.
41:57Otherwise known as margarita burn.
42:00For some people, limes plus sunshine can cause a horrible rash.
42:03This is all because of limes?
42:05Have you ever squeezed limes outside in the sun before?
42:08I don't think so.
42:09You will feel better after a day of steroid pills,
42:12but once these heal, you gotta wear sunscreen,
42:14because these blisters can turn into dark scars
42:16and stay a while if you don't.
42:18I'll be right back with your aftercare instructions.
42:22Hey, Robbie?
42:23Yep.
42:24My, uh, my hospice patient, Roxy, is still in a ton of pain.
42:28Where are we with the morphine?
42:2910 milligrams an hour.
42:32Okay, you can both, uh, another two and go up to 12.
42:34I will let Princess know.
42:3512 an hour is a lot.
42:37Yeah, on top of the MS cotton, she could stop breathing.
42:41Are you familiar with the doctrine of double effect?
42:44Not really.
42:46It is an ethical principle in palliative care.
42:49We treat pain.
42:50And if in doing so there's a negative side effect, we accept it.
42:54Even if the negative side effect is death?
42:57In some cases, that could be the best outcome.
43:08Emma, Emma, would the chart of the paper?
43:11No, there is enough paper.
43:18How are we going to get through this mess?
43:19I was about to ask you.
43:22I don't know.
43:23Ask the puns.
43:24You can't leave the video.
43:26Nothing's getting done here.
43:27Good, good.
43:27Good.
43:27I'll do it.
43:28You've got a lot of beer.
43:29You've got a lot of beer.
43:29You've got the one that really sounds good.
43:30It's the jazz.
43:31Let's make the wall.
43:32I'm not listening.
43:33You're not breathing for it.
43:34I'm not breathing for it.
43:35I've kept it.
43:35I can't.
43:40You're not breathing for it.
43:51I've kept it.
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