- 15 hours ago
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00:1527-1-1, get the fuck out!
00:17Is there a medic alert bracelet?
00:19You get an ID on him? Student ID.
00:21Name says Jackson Davis.
00:22That's the start.
00:23Jackson, what's going on?
00:24L-A-D! Title 6-1-1!
00:26Be with us.
00:27I love you, Mr. Davis. You're in a safe place.
00:30You're okay. I'm a one.
00:31Reasonable, miss. 2709.
00:33We're going to need you to calm down to get the taser barbs out of your neck.
00:36You need to jump on that?
00:37Mmm, covering falls for Dana.
00:40Stop talking to me!
00:41Hey! Title 27-1-6-1.
00:43Hard to assess pupils.
00:45Hard to assess anything.
00:46Yeah, yeah. Wait till after he's sedated.
00:48Can I have a lancepine?
00:49No, it'll take 15 minutes to kick in.
00:51500 peridol, put them down at five.
00:53No, you can't give it without knowing he's 15.
00:55Two beats of a rhythm strip before we take off the beats.
00:57Oh, no, no, no.
00:59This can't be in here. Get out!
01:01That looks good. I'll go with the Japeridol.
01:02The fuck out!
01:03Get off me! Get off me!
01:05Take potential barbs out!
01:072701!
01:07No, we gotta wait till the calm standards first.
01:10Get off me, man!
01:112901! Get out! Get out!
01:132710!
01:14Title 18, section 1938!
01:17Mr. Randall, happy 20th anniversary and a very happy 4th of July.
01:22Put no sex fireworks for you tonight. Give everything a chance to heal.
01:25Don't worry.
01:26I won't.
01:27Thanks, Doc.
01:28Ow.
01:29We're going right back through here, okay, man?
01:31Oh, thank you.
01:32Change the dressing twice a day.
01:34Doggy bag of the ointment and non-stick gauze.
01:37Cool. I know the drill.
01:38Come back if it starts to ache or stink.
01:40Exactly. Good luck. Stay safe.
01:42Shit, it's daddy. You're daddy.
01:44Lord, what'd they get up to now?
01:47Dreaming the street.
01:48Rose from Dover.
01:50I'm sorry, Ms. Graham.
01:52I just saw the ASO note in your chart.
01:55This is Lindsay.
01:55We'll bring you back as soon as possible.
01:59Stay with her.
02:02All right.
02:03Who here needs help?
02:05I'm just listening to see what you...
02:06You? You need help?
02:08Oh, no, no, no, ma'am.
02:09I've been on these since 1987.
02:11This one here, he got dizzy, fell down.
02:13I forgot my blood pressure medication.
02:15I left it back home in Georgia.
02:20And presto, we're back, Mr. Digby, with some IV antibiotics.
02:24First we scrub your outsides, then we clean your insides.
02:28What do you need to document in this chart?
02:30Uh, time started, time completed, and any adverse reactions.
02:33What else?
02:35Um, lot number on the antibiotic file.
02:40Excellent. Mr. Digby.
02:41Just Digby.
02:43Digby.
02:43Why'd you wait so long to come see us?
02:47I don't like going to doctors.
02:50Well, that makes two of us.
02:51We all need help from time to time.
02:53Think maybe we could arrange for some ongoing care?
02:55I just kind of want to get patched up, you know?
02:59I do know.
03:00But that's today.
03:01What's tomorrow?
03:03Sunday.
03:05It's the system.
03:07It's what it's there for.
03:08Buddy of mine, Dylan, knows all the angles.
03:11He even works the occasional miracle.
03:13You think maybe I could have him stop by?
03:17I guess, yeah.
03:19Right.
03:20How about a sandwich?
03:21Yeah.
03:22Yes, please.
03:27We always offer him two most important things.
03:30That they know we're here, and that we'll never stop offering.
03:33Thanks for covering, princess.
03:35Anytime.
03:37Yo, can I get some help over here?
03:38Yeah.
03:39What's going on, man?
03:40The crazy kid in there screaming.
03:42All right, have a seat.
03:42Yeah, it's him.
03:43Still going nuts.
03:45Probably meth.
03:47Fucking animal.
03:48What's your name, sir?
03:50Tony Cinchillo.
03:51Campus security.
03:52Yeah, I was at work when this happened, so I'm going to do everything documented.
03:56Okay.
03:57All right, heart rate's 89, pulse ox 97.
04:02Scott Black's tiny, five millimeters, should hold together with Dermabond.
04:06Kid threw a fucking chair at me.
04:08Work-related injury gets a full exam.
04:10Jesse here will take you.
04:11No, I'm going to stay here until the cops come, so I can give my statement, and so I can
04:15watch him.
04:17Yeah.
04:18Trust me, you do not want him getting out of there.
04:20Ow, fuck.
04:23Did she say anything?
04:25No more than she said to you.
04:27Nothing going on at home, nothing at school.
04:29And you believe her?
04:31There's some flags, raising in various stages of healing.
04:34She's a little withdrawn, doesn't engage much for girls her age.
04:38You could just be a little shy.
04:40Or scared of being in here.
04:41Or she's being abused.
04:44That too.
04:44We'll find out when my dad shows up.
04:46Yep.
04:47If he shows up.
04:55There's the first barb out.
04:57All right, Javadi, you're up.
05:01Okay, so you're going to want to clamp where the shaft meets the barb.
05:06Mm-hmm.
05:07Yep.
05:07Stabilize the skin.
05:09Not so close to us to stick yourself.
05:12I've seen that once or twice.
05:13Uh, pull up at 90 degrees.
05:16Harder?
05:17Yep.
05:17Harder.
05:19Oh.
05:20Do we suture those?
05:22Nope.
05:22Just a Band-Aid.
05:24Mel, we need orders.
05:25Right.
05:26I got a rainbow.
05:27Uh, CBC, CMP, UA, what alcohol and toxin?
05:33All the above.
05:34Cap, with this young man stable, can he go to Central 10 pronto?
05:37Double trauma at the back door.
05:38Okay, you heard the boss.
05:40Let's get going.
05:40Today is starting to heat up.
05:47Mark Yee, 32-year-old, restrained driver.
05:50Auto versus motorcycle.
05:51Altered with normal BP, setting 99 on 2 liters.
05:54We're at the hospital now, Mark.
05:56What's wrong with him?
05:56Why isn't he talking?
05:57His wife, Nancy.
05:58Front seat passenger declined transport.
06:00I'm fine.
06:01We were going all that fast.
06:02The motorcycle ran the light.
06:04I'm Dr. Robbie.
06:05This is Dr. Alashimi.
06:06Nice to meet you.
06:07And this is Nurse Dana.
06:08She's our charge nurse.
06:09We need to look over your husband.
06:10Hold on.
06:11Let's look over here for a minute and let him get to work, okay?
06:13Antoine, Larry, transfer out here.
06:15T1 will be open in a sec.
06:16Aye, aye, Cap.
06:18One, two, three.
06:21Incoming.
06:22Okay, Joy, you stay with me.
06:24Samira, you stay with Dr. Alashimi.
06:28Open skull fracture.
06:29Tubed in for agonal respirations.
06:31BP-60 palp initially started a liter of NS, but lost its pulse and root.
06:37Oh, boy.
06:38This doesn't look good.
06:39One, two, three.
06:41Joy, check his pupils.
06:42Somebody hand me a pair of scissors.
06:48Eight millimeters.
06:49Not reactive.
06:50A.K.A.
06:51Blum.
06:51She was fixed and dilated.
06:53Oh, gosh.
06:54Skull with tons of gray matter extravasation.
06:56At least it was quick.
06:57No helmet?
06:58Nope.
06:59Because he took the PennDOT motorcycle safety course.
07:01Isn't that what you took, Robbie?
07:02All compressions?
07:03Yes, but I still wear a helmet.
07:05Is he a donor?
07:07Also, nope.
07:08That is too bad.
07:08Hey, sister Lee, I think we are done here.
07:11What's next door?
07:12The guy who hit him.
07:13Joy, you're with me.
07:15What about a moment of reflection?
07:17I thought...
07:17He'll still be dead when we get back.
07:19Pulse hocks, 99.
07:20BP-108 over 72.
07:22E-fast negative.
07:23That was a lot better than the guy next door.
07:24How's the airway?
07:25Good volume, good sats, gag reflex.
07:30Present.
07:30Intubate?
07:31Maybe, maybe not.
07:32Mr. Yee.
07:33Joy, he's throwing a rub on his chest like this really hard, please.
07:36Mr. Yee.
07:38Spontaneous eye movement.
07:39Response to pain.
07:40GCS is 10.
07:41Borderline for intubation.
07:42No muscle tone.
07:43Flaccid paralysis in the left arm.
07:45Same on the right.
07:46And both legs.
07:47Add towels to both sides of the collar for more stability.
07:49Let's not make this worse.
07:51Pan scan with 3D reconstruction of the spine.
07:53He's quadriplegic?
07:55If so, it's a low cervical injury.
07:57Why is that, Joy?
07:59Uh...
08:00C-3, 4, and 5 helps you breathe to stay alive.
08:03Mr. Montrose, you can't just be wandering around talking to patients.
08:08That's what I do.
08:09I'm a greeter at Walmart.
08:11I get paid to wander and to talk to folks.
08:15Well, as a personal favor to me, can you at least stay in your general vicinity?
08:20I can get you a wheelchair while we wait for your x-rays, but it might take a minute.
08:24My dear, I cannot sit.
08:25My backside is killing me from where I fell on it, which is an embarrassing admission to make to such
08:30a lovely woman.
08:33Well, thank you for the compliment, but there's no need to be embarrassed.
08:36You took a very nasty fall.
08:38Well, then may I say that one look in your beautiful eyes and I think, I'm falling again!
08:46What a charmer!
08:47Just for that, I'm going to get you a foam donut.
08:50It's the eighth wonder of the world.
08:52Pretty great laugh you got there, Doc.
08:56Oh, God.
08:57My witch's cackle?
08:59Got CT results for Mr. Williams.
09:05Oh, wow.
09:08Okay.
09:12Right on time.
09:14Just getting full.
09:16Yeah, I'm ready for number five.
09:17That's impressive.
09:20Yeah, there's more where that came from.
09:22Although, uh, my intake is running low.
09:25Yeah, well, two more bottles ought to do it.
09:27Then we'll drain your tooth and we'll get you out of here before the fireworks tonight.
09:30Uh-huh.
09:32Okay, clamped.
09:33Ogilvy, make the change.
09:38All right, let her rip.
09:42Flowing like a river.
09:44I love me some fireworks.
09:47Oh, yeah?
09:49Shit, I met Mr. Zambelli.
09:52Lean forward?
09:54Many times on the field.
09:56Who's Mr. Zambelli?
09:59Son, you don't know fireworks if you don't know the name Zambelli.
10:02He helped Pittsburgh become the firework capital of America.
10:07You did know that, didn't you?
10:10No.
10:10Uh, y'all don't know nothing about pyrotechnics.
10:14Stick to doctrine.
10:16Yes, will do.
10:25I'm sure you have some questions.
10:28I know it's a lot to take in.
10:31It's a tumor.
10:34It's a brain tumor.
10:35Well, it's a mass.
10:37About four centimeters in the frontal lobe.
10:41Is it cancer?
10:43We can't say for sure right now.
10:46It could be many things.
10:49Infection, inflammation, a benign cyst.
10:53Is it what made me fall?
10:57Yeah, possibly.
11:01We'd like to keep you here and treat with dexamethasone,
11:04which is a steroid to take down the swelling.
11:06And then we'll need a brain biopsy to know exactly what it is.
11:11You're going to cut open my head.
11:14It's just a small hole.
11:16We'll do a CT-guided stereotactical biopsy with a blunt, thin needle.
11:22Which sounds crazy, but it's actually pretty amazing.
11:26I mean, most patients go home the next day.
11:32I don't know.
11:35What do you think I should do?
11:37I think this is a pretty good plan.
11:42Yeah.
11:44BP 95 over 67.
11:47This thing's a little on the low side.
11:49It is.
11:50Have you ever had low blood pressure in the past?
11:53No, sir.
11:54My blood pressure is always high.
11:56Hold still, sir.
11:57No talking while we do the EKG.
11:58The Hansons all run high.
12:00Except for money.
12:01He ran low, but he's dead.
12:03It's not helpful.
12:04You want to help?
12:05Quit playing family pharmacist.
12:07Pooling meds is how we've always done it.
12:09You put everything in a big pile in the middle of the table.
12:12Well, look where that got us now.
12:13No, I'm going to jump in here and echo that sharing meds,
12:15which haven't been prescribed to you,
12:16is actually a real big no-no.
12:18Well, how are we doing on remembering
12:19what your brother might have taken?
12:20We could call back to the house.
12:21Great idea.
12:23Okay.
12:24Whatever little round pill you took, sir,
12:26has caused your heart rate and blood pressure
12:28to drop so low,
12:29you're at risk of fainting, falling,
12:31or having a serious injury.
12:33Huh.
12:34We need to take him back to the ER
12:35so we can get a liter of fluids.
12:37We can check his blood tests
12:38and monitor his heart rate and blood pressure
12:39until he recovers.
12:41Pulse locks, holding steady at 99.
12:43Good tidal volume.
12:44How you doing there, Mr. Yee?
12:46Scanner can take him now.
12:47I'll check the results from upstairs.
12:49Why is he so altered?
12:50Could be concussion,
12:51maybe a small intracranial hemorrhage.
12:53All will be revealed by the donut of truth.
12:56Need a portable monitor?
12:57Joy, stay with him, please.
12:59See if the radiologist can give us a stab.
13:01How is he?
13:01Did I hear someone say he's paralyzed?
13:04There are signs of weakness in both arms and legs,
13:07but before we can make any prognosis,
13:09we'll need a full-body scan.
13:10Head CT will show us any brain injury,
13:12neck CT will show us any spinal cord injury,
13:15chest, abdomen, pelvis.
13:16We'll rule out any internal bleeding.
13:17Oh, my God.
13:18The scan should only take about 15 minutes.
13:21In the meantime,
13:22perhaps you'd let us look you over as well?
13:24I'm fine.
13:25The medics checked me.
13:26I just want to stay with my husband.
13:29Well, you can't go into the CT with him,
13:31but you can wait just outside if you like.
13:34Princess, this is Nancy.
13:35Mrs. Yee's going to go with her husband to CT.
13:36Will you show her where to go?
13:37Sure.
13:37Come on in.
13:42So what's the plan now?
13:44Keep observing me in my natural habitat?
13:46No telling what I might do next.
13:47I think I've got the gist.
13:49How about we each take a lap
13:50and meet here when Mr. Yee's back from CT?
13:53Splitting up so soon?
13:55You're free to see other people, Dr. Rabinovich.
13:58I'm looking for cooperation, not commitment.
14:05So you bandaged the burn yourself?
14:07Oh, no, no, no, no, no, no, no, no.
14:09Ma'am, you're making it difficult
14:11for me to see under this dressing.
14:12Is that a tablecloth?
14:14Part of a window curtain.
14:16Cleaner than tablecloth.
14:17I'll work for the doctor.
14:19But may I ask how this happened?
14:22For weeks on end, the kids with their hoochney firecrackers
14:25going all day and night.
14:26Oh, is this a firecracker burn?
14:29No, sweetie.
14:30This is from the full samovar I drop on the floor
14:33when the firecracker started going on again.
14:37I'm sorry, what's a samovar?
14:39It is a big metal urn for coffee or tea.
14:42It can get super-duper hot.
14:44And I was never allowed to touch ours.
14:47Hello, Mrs. Kovalenko.
14:48My name is Dr. Michael Rabinovich.
14:49Everybody calls me Dr. Rabi.
14:51Rabinovich, Jewish?
14:53You guessed it.
14:54And I see that you are here today for a burn.
14:57Why don't we take a look?
14:59Uh, not married?
15:00No, I'm not married.
15:03Do we attend synagogue?
15:05Uh, not for a while.
15:08I mean, high holidays, mostly.
15:12Where?
15:13Ooh, what did you put on this?
15:17Where?
15:18On your burn.
15:19Is this honey?
15:20Yes, honey.
15:21Where do you go on holidays?
15:23Uh, my grandparents, um...
15:26I grew up in the Rodef Shalom.
15:28You?
15:29Three of life.
15:32They're rebuilding.
15:34Yes, something new.
15:37Remember, rebuild, renew.
15:40That's a slogan.
15:44I'm sorry, did you say honey?
15:47You think honey's funny?
15:49I...
15:49Works like a charm.
15:51My father kept bees, I know.
15:54If the honey is medical grade and the burns are not too bad, honey actually does have some antibacterial and
15:59anti-inflammatory properties.
16:00However, these burns are very deep in some places.
16:03They're going to need debridement.
16:05I'm glad you came in.
16:08That's what I thought.
16:10I was hoping no, but figured as much.
16:14Not to worry.
16:15We are going to have you patched up and home in time for dinner and fireworks.
16:20No.
16:22No more fireworks.
16:24No.
16:24Yeah.
16:26Anyone here treating Kylie Connors?
16:30She's my daughter.
16:31She's nine.
16:32I'm Benny Connors.
16:33Mr. Connors, I'm Dr. Santos.
16:36I'm treating Kylie.
16:37Is she okay?
16:38Can I see her?
16:39My girlfriend Gina says she got a cut on her chin.
16:41Yeah, I can take you to her.
16:42She has a small laceration on her chin, but it was easily repaired with medical superglue,
16:46so no stitches necessary.
16:48Okay.
16:48She chipped her tooth, but it's a baby tooth, so it won't need dental work.
16:53All right.
16:53Well, that's a relief.
16:55Has Kylie had any previous injuries?
16:57Uh, yeah.
16:59She, um, she broke her wrist last year.
17:01She was skateboarding.
17:03Dana, if you could get Dylan to come to North One,
17:06and Ahmaud.
17:07You bet.
17:08Okay, I got it now.
17:09One, two, three.
17:10Daddy, you came.
17:11Oh, baby, what's going on, huh?
17:13My tooth broke and my chin got cut.
17:15Oh, no.
17:18What happened?
17:19She was running up the stairs.
17:22Dana was chasing me.
17:23We were playing.
17:24As I was saying, Mr. Connors, the laceration's pretty minor.
17:27On the stairs?
17:28It was an accident.
17:29Perhaps we can step up.
17:31An accident that wouldn't have happened if you weren't running up the stairs.
17:33Do you understand what I'm saying?
17:34We weren't running up the stairs.
17:34This is the last thing that I need.
17:36Right now is her mother finding out that she got hurt when she's with you.
17:39It was an accident.
17:40Yeah.
17:40And before you get all high and mighty, I've got questions of my own.
17:43Like what?
17:43Hey, Mr. Connors, I'm sorry.
17:45I meant to be here when you arrived.
17:47I'm Dylan Easton.
17:48I'm a social services.
17:49We have insurance.
17:50Perhaps we can step outside and chat for a second.
17:52I can fill you in where we are.
17:53Hey, Jesse, do you want to keep Kylie entertained for a few minutes?
17:56Absolutely.
17:57While I borrow her dad?
17:58We'll just head down to the family room.
17:59It's a little quieter there.
18:01Why do I got to talk to a social worker?
18:03Anytime a child is injured, we have some standard questions that we ask parents and caregivers.
18:07Good.
18:07That's fine.
18:08Great.
18:09Ask me here.
18:10Well, we noticed some bruising on Kylie's body, some old, some new on her back and legs.
18:17Any idea how she got those?
18:19Yeah, soccer.
18:19She plays for a club team.
18:21They're, you know, little girls, but they play like they're in the Hunger Games.
18:24Well, I understand that you and Kylie do a fair amount of roughhousing.
18:29What?
18:31I'm sorry.
18:32Are you fucking kidding me?
18:34Where are you going with this?
18:35Are you saying that I hurt my daughter?
18:36She kind of has nobody seen that.
18:37Oh, no, no, no, no, no, no, no.
18:38Gina!
18:39Mr. Connors?
18:40Just, just, Gina!
18:41Is there a take of a break?
18:42Gina, what did you say to them?
18:43Nothing.
18:44I said that you're a great dad.
18:45Okay, what else?
18:47That you guys like to wrestle.
18:48Jesus Christ.
18:49What?
18:49They wanted to know where all her bruises are from.
18:51Who the fuck are you to talk about me and my daughter?
18:53Who the fuck?
18:54Yeah, that's what I'm asking.
18:55Hey, big man, take one more fucking step.
18:57Hey, that's enough.
18:58You need to call this.
18:59Everybody, hey, everybody, back the fuck up!
19:01Stop, stop, stop, stop.
19:03Kylie's playlist is only 9,000.
19:06What does that mean?
19:07It's, it's not what we thought.
19:10It's probably ITP.
19:13What the hell is ITP?
19:15Something we can treat.
19:24You feel that?
19:25No.
19:27Excellent.
19:28This is looking very good.
19:30Ah, tell Mr. Kovalenko.
19:33Ha!
19:33Ha!
19:34Ha!
19:35Mrs. Kovalenko?
19:37Yes, Jana, please.
19:39Jana?
19:40You mentioned that you dropped the samovar when you heard firecrackers.
19:50I was on my way inside October 27th, 2018, to the synagogue when the shooting started.
20:05There's nothing I could do.
20:07I went in after the police arrived.
20:12I felt I had to.
20:16I'm better now.
20:18But...
20:21You see, 4th of July, when kids have their fireworks and firecrackers, I...
20:32There is no clock on how long it takes.
20:36Ha!
20:37No clock.
20:38You must be joking.
20:44Robbie?
20:44Yep?
20:45Marky is back from CT.
20:46Oh, okay.
20:47Um, Carla, why don't we go ahead and see if we can put a non-stick dressing on this?
20:50And I will come back, and we can discuss aftercare instructions.
20:54Yeah, you got it, boss.
20:55Thank you, doctor.
20:57Thank you, doctor.
21:10Vitus table, pulse ox holding at 99.
21:13Okay, heart and lungs look good.
21:16Dr. Mullen?
21:17Dr. Robbie?
21:19Yeah.
21:22Please make him be okay.
21:25I can assure you that we are going to do absolutely...
21:27Everything you can, I know.
21:29God, this is all my fault.
21:31Mrs. E?
21:32Oh, he's been so stressed.
21:34So I planned this weekend away as Seven Springs, but he didn't want to go because of work.
21:39So we fought this whole morning.
21:42And then I...
21:44I said awful things.
21:48Those can't be the last words we say to each other, doctor. Please.
21:51Good news.
21:53CT looks normal.
21:54No bleeding inside the skull, C-spine, no fracture scene.
21:59Huh.
21:59He didn't break his neck?
22:00Then why is he paralyzed?
22:01You can have spinal injuries without radiologic abnormalities.
22:05Sometimes he doesn't show up on CT, only on MRI.
22:08Dr. Mullen?
22:13Are you sure?
22:18Okay.
22:19Critical potassium level 1.2.
22:22Wow.
22:23Okay.
22:23That's crazy.
22:24Extremely low potassium with generalized weakness and no cervical injury.
22:28We may be looking at...
22:29Hypokalemic periodic paralysis.
22:31What is that?
22:32It's a rare condition where potassium gets shifted into the cells causing profound weakness,
22:36just like paralysis.
22:37Will he get better?
22:38Yes.
22:39Back to normal in a few hours.
22:40We can slowly tend to be cute, everything from PCL.
22:45Thank you so much.
22:46No.
22:47Did you hear that, Mark?
22:49Oh, baby.
22:50You're gonna get better.
22:54All right.
22:55Didi.
22:55Hey.
22:56Come on now, man.
22:56Oh, how you doing, DeWante?
22:59Fine.
22:59Great.
23:00If you're fine, you go home.
23:01Really?
23:02Yeah.
23:02Mm-mm.
23:03Hey.
23:04Tell him.
23:05Me and my sister were making bracelets, and I put beads up my nose.
23:12How many?
23:13One on each side.
23:15I gotta ask, why do you stick them up there?
23:18See how many will fit?
23:19To shoot them out like rockets.
23:21Mm.
23:22But I breathed in, and they went deeper, and now won't come out.
23:27Did you try anything at home?
23:29Yeah, I tried blowing in his mouth, but just got a little snot on my cheek.
23:32Hey, forever, Dad.
23:33Okay.
23:34We need to take a look with a little flashlight, okay?
23:37Okay.
23:38This is what I have to look forward to?
23:39This is so much more.
23:42Red bead below the inferior turbinate.
23:46I got a blue one.
23:49Afrin, benzocaine, cas extractor?
23:51Yup.
23:51Dad looks like we gotta go up and get him.
23:53No way.
23:53He's sitting still.
23:54Ugh.
23:54He'll be numbed up.
23:55You don't know this child.
23:57Okay.
23:57Hey, DeWante.
23:58You like video games?
24:00Everybody does.
24:01We have a 3D video game.
24:04Yeah.
24:05Cool.
24:10That's KCL and saline at 10 MEQ per hour.
24:14We avoid dextrose because the insulin response drops the cave in lower.
24:17If it's genetic, why didn't it happen when he was a kid?
24:20It usually starts after the teen years.
24:22And it can be intermittent.
24:23Sometimes it's triggered by intense exercise or stress.
24:27We've been married eight years.
24:28We've had fights.
24:29He's never collapsed.
24:31If a thyroid gets overactive, that brings it on later in life.
24:34I order TSH T3-T4.
24:37So now we just wait.
24:41Bag him.
24:41Starting compressions.
24:42Charge at 200.
24:43What is happening?
24:45Low potassium can harm electrical activity in the heart.
24:48Charge.
24:49Clear.
24:49Clear.
24:50Resuming compressions.
24:53So your little girl was ITP?
24:57Go figure.
24:58Nothing like a zebra to kickstart your morning.
25:00It's better than the alternative.
25:03True.
25:04ITP.
25:06So that's, uh, intra...
25:09Immune thrombocytopenia.
25:11Used to be called idiopathic thrombocytopenic purpura.
25:14Know what idiopathic means?
25:16That we don't know the exact cause.
25:18Means the patient is pathetic and the doctor is an idiot.
25:24Just checked on baby Jane Doe.
25:26Looking good.
25:27Taking formula well.
25:29We're here to take a statement.
25:30We're looking for a Tony Cianciolo.
25:33Yo!
25:34Right over here, boys.
25:37For officers.
25:39Heard you had some trouble over at the campus library.
25:41Shit.
25:42Let me just say.
25:43New appreciation for what you guys do every day.
25:46Freakin' junky jungle, right?
25:49At the campus library?
25:52Thumb and forefinger make a C.
25:53Bottom three fingers make an E for jar lift.
25:55One breath every five seconds.
25:56Come here.
25:57About two minutes since defibrillation.
25:59Holding compressions.
26:01Normal sinus.
26:02Karate.
26:03Strong karate.
26:03Okay.
26:03Let's try for BP.
26:05Why don't we check after the shock?
26:072024 ACLS guidelines.
26:08Patients can remain pulseless for a little bit even after successful defib.
26:11He came back with one shock.
26:13That's as good as it gets.
26:14104 over 68.
26:15Good squeeze.
26:16Good EF.
26:17Spontaneous respirations.
26:18Okay.
26:18He's breathing on his arm.
26:20Excellent sign.
26:22Can I touch him?
26:23Of course.
26:25Oh, Mark.
26:27Dang.
26:30Oh, shit.
26:31We need a gurney.
26:33Nancy.
26:35Mrs. Yee.
26:37Mrs. Yee.
26:38Weak, carotid, shallow breaths.
26:40Did she vasovagal from stress?
26:42Can't assume that.
26:42Positive seat belts.
26:44Oh, shit.
26:45Hang two units alone.
26:46They got the rabbit infuser.
26:46Somebody call Garcia.
26:47Shit.
26:48We really should have insisted on an examiner.
26:50Okay.
26:50I got the head.
26:51Platelets are these tiny things in the blood that help it clot.
26:55And thrombocytopenia is fancy for low platelets, which explains why your skin bruises so easily.
27:01And what causes it?
27:02It's actually her immune system that's causing the destruction of the platelets.
27:06Sometimes it's a triggered response to an environmental factor or a virus.
27:11And what's the treatment?
27:13What are you giving her?
27:14We'll be treating her with high-dose steroids to suppress the immune system and IV immunoglobulin,
27:20which reduces the destruction of the platelets in the spleen.
27:23Can I go home?
27:24You're gonna have to stay in the hospital for about three days to make sure that the treatment is working.
27:30Okay.
27:31Okay, so when can she get a room in the hospital?
27:34That is an excellent question.
27:35I'm going to see if I can make that happen sooner rather than later, but it might take a while.
27:40Okay.
27:40GPS says I should be there by 11.
27:42Do you have any other questions for me, ma'am?
27:45No.
27:45I'm sure I will.
27:46But I'll let you go for now.
27:48Thank you, Benny.
27:49All right.
27:49I'll see you when you get here.
27:50See you soon, baby.
27:51I love you.
27:52Bye, Mom.
27:52Love you, too.
27:56There you are.
27:58And there you are.
27:59Don't try to charm me.
28:01You promised to stay put.
28:02I was going to come right back.
28:04My backside is killing me.
28:06I need to keep moving or I get all achy and stiff.
28:09Well, I got you this foam donut to sit on while we wait for your x-rays.
28:14Hmm.
28:15Dr. Hazel Eyes, it says here that it's only supposed to take an hour or two for an x-ray.
28:22Well, the patient passport holiday edition would better reflect reality.
28:27It could be double that.
28:29There's no need for reality.
28:31We romantics prefer la rêve, the dream.
28:37We do, Joey.
28:39Oui.
28:50Hey, save a dance for me.
28:56Uh, yeah.
28:57Okay.
28:58I will.
28:59Dr. McKay.
29:00Yes.
29:00This is Gretchen Williams.
29:01Actually, it's Lambden.
29:03Ah.
29:03I called about my ex-husband, Michael.
29:05Yes.
29:06Yes, yes.
29:07Thank you for coming in.
29:08You were, um, listed as his emergency contact?
29:10I don't know why.
29:11We have been divorced for years.
29:14Is he all right?
29:16He's...
29:17He's going through a lot right now.
29:18Would you like to see him?
29:22Uh, okay.
29:23Leo, can you zoom in and please hold it a little steadier?
29:27Okay.
29:31Okay.
29:34Atorvastatin, Simvastatin, Ezetimibe.
29:37Those are all high cholesterol medications.
29:39Can you go to the right?
29:43Lisinopril, Losartan, Propranolol.
29:46Wait, wait.
29:47That's it.
29:48Wendy's pile.
29:49Yellowish bottle, little round blue pills.
29:51Just like I said.
29:52Propranolol?
29:53Bingo, little lady.
29:55Okay, yeah.
29:55Well, this makes a lot of sense now.
29:57Um, Propranolol is a high blood pressure medication.
30:01Those are, uh, 20 milligrams each.
30:04And the starting dose is 40 mg.
30:06How many pills did you take?
30:08No, ma'am.
30:08I went just before I came here.
30:11Dad.
30:12Um, pill...
30:13How many pills did you take?
30:15Oh, uh, I think four, maybe five.
30:20That is a lot.
30:21Okay.
30:22You got a full stomach, mind you.
30:24Well, um, the good news is it has a short half-life.
30:27So, um, we're gonna need to keep you for about four hours to monitor,
30:31but then you'll be able to rejoin for all the late afternoon festivities.
30:36All right.
30:37Woo!
30:38Unit three and four running in.
30:40BP 84 over 56, heart rate 112.
30:42Free fluids much bigger than before.
30:44She's not turning the corner.
30:45OR's holding a room.
30:46I'll let the husband know.
30:47Why'd you guys wait so long to check her?
30:48Good vitals in the field, no distress.
30:50She refused to sign in.
30:51You should've convinced her.
30:5320-20 hindsight.
30:54She was stable.
30:54Until she wasn't.
30:55Next time I'll use my x-ray vision goggles.
30:57Let's get her upstairs.
30:59Gotta do an accu-check on my DKA patient.
31:02Thanks for the backup.
31:04Anytime.
31:09Now, try and lift your arm, Mark.
31:14I'm trying.
31:15Can't do it.
31:16But you are getting stronger, and your speech is improving.
31:20Why did I lose so much potassium?
31:23You didn't lose it.
31:24It got shifted into cells.
31:26When it comes back, you'll return to normal.
31:28Where's Nancy?
31:29She had an injury to her spleen right about here with some internal bleeding.
31:34Oh, God.
31:35She passed out from blood loss.
31:36We were able to transfuse her, and she's now on her way to surgery to repair that damage.
31:40This is my fault.
31:43She's trying to...
31:46She fucked a trip for us.
31:48For me.
31:51I fought her the whole time.
31:53I've been...
31:58Please don't...
31:58Oh, my God.
31:59Please don't let her die.
32:01Please.
32:02I can assure you that she is in excellent hands.
32:07Is this how it works?
32:09How what works?
32:12You think things are important.
32:14That everything's so important.
32:18And then you end up here and see.
32:23Yeah, that is how it works.
32:27No, it's a small hole, like the size of a dime.
32:32Right, Doc?
32:32Mm-hmm.
32:33Yeah, even smaller.
32:35It's a minor enough procedure that most patients go home the next day.
32:39And then?
32:40And then they'll know what it is and how to treat it.
32:44Isn't that right?
32:45Yeah, exactly.
32:49I'm sorry that they called you.
32:52I never updated the form, I guess.
32:54No.
32:54No, it's okay.
32:56I'm...
32:57You know, they called and I was just kind of surprised.
33:03Well, you didn't have to come.
33:07But I did.
33:11I heard you get married.
33:14Congratulations.
33:19I hope he treats you well.
33:23And you deserve to be happy.
33:31I'm really sorry you're going through this, Michael.
33:35Yeah.
33:37Me too.
33:40But you know me.
33:42I'm a survivor.
33:47Why don't I leave you guys to talk for a few minutes?
33:52I have a patient to check on.
33:56Sure.
33:57Yeah.
33:59Mr. Diaz should be improving after two liters.
34:02Blood sugar?
34:03Down from 521 to 436.
34:06That's good, right?
34:07Moving in the right direction.
34:08Were you able to get a hold of your mom?
34:10Yes.
34:11She's on her way.
34:12She doesn't have a car.
34:13She takes buses, so it takes longer.
34:15I'm sorry.
34:16Don't be.
34:18Current insulin is 0.1 units per kilo per hour.
34:22Once the glucose is down to 250, reduce the insulin to 0.05 units per kilo per hour.
34:27Because you can normalize the blood sugar before you clear the ketones and you don't get hypoglycemia.
34:31But as treatment continues, you'll have to give IV dextrose to keep the blood glucose in between 150 and 200
34:36while the insulin clears the ketones.
34:38Obviously.
34:39I'm sorry, what?
34:43Got it.
34:44Duante, what are you doing in there, son?
34:46I'm a rabbit.
34:48Grabbing all the carrots before the farmer gets me.
34:50Keep going.
34:51This is a cat's extractor with a tiny balloon at the end.
34:55What we're gonna do is we're gonna slip it past the bead, inflate the balloon, try to pull out the
34:59bead.
34:59Is it painful?
35:00No, he's numbed up.
35:01Made it to level three.
35:03And pretty distracted.
35:04Dad's gonna hold your head still, okay?
35:06Look up.
35:06Okay.
35:09Now go back perpendicular below the turbinates.
35:16You guys ever hear of John O'Donohue?
35:19No.
35:20Been reading him a lot lately.
35:21He's got this book of, um, blessings.
35:24And there's this one about fatherhood.
35:27Really stuck with me.
35:30Voila.
35:30One red bead.
35:32Yeah?
35:33How's it go?
35:34The ending goes, may you be gentle and loving, clear and sure.
35:40May you trust in the unseen providence that has chosen you to be a family.
35:46May you stand sure on your ground and know that every grace you need will unfold before you like all
35:53the mornings of your life.
35:55Hmm.
35:56That's good.
35:58I'd add support your woman and pack good snacks.
36:02It's beautiful.
36:04And it turns out there's no handbook for fatherhood.
36:07So I will take all the wisdom I can.
36:12Blue bead out.
36:18Anything else?
36:20You tell me.
36:21I have my own report to do.
36:23Anything I left out.
36:24I have to back on that kid.
36:25We'll follow up with Mr. Davis.
36:27When Mr. Davis comes off the ceiling.
36:33Jackson Davis.
36:35Talk screen negative for cocaine, amphetamines, marijuana, PCP, benzos and opioids.
36:41So no drugs in his system?
36:43Nope.
36:44Taser barbs on the back of the victim's neck?
36:47Yep.
36:51Changes things, Tony.
36:53Hey, Louie.
36:54How we doing?
36:55Not so good.
36:57I can really use a drink.
37:00I'm feeling a little empty.
37:03Okay, well, empty is what we want.
37:04And it looks like we are there.
37:06Hey, well, if I can't get a drink, my tooth, you gotta do something.
37:11We're gonna go right to that.
37:12Let's hang some IV antibiotics.
37:15Three grams of unison.
37:16Excellent.
37:18He's gonna be right back.
37:20We're gonna numb it up and drain it.
37:21Ten minutes tops, okay?
37:23Hey, you said you met Mr. Zambelli, the fireworks guy on the field?
37:27What field was that?
37:28No more talking.
37:30You gotta fix my tooth.
37:32Deal.
37:39You're Muslim?
37:42I am.
37:46Oh, for what?
37:49After the shooting, it was the Muslims that came together for us in support and walked with us.
37:57You raised money.
37:59You paid for all the funerals.
38:03Anyway.
38:08Hello.
38:09How's it going in here?
38:11Did I miss all the gross stuff?
38:13Timed it perfectly.
38:14Excellent.
38:15My job's all about delegation and time management.
38:17Oh, not for much longer.
38:18That is very true.
38:19Why for not longer?
38:21Because tomorrow I am leaving to go on sabbatical.
38:24He's leaving us for three months on a motorcycle.
38:27Motorcycle?
38:28You're joking.
38:30Why would you do this?
38:31Why?
38:32Why?
38:33Why?
38:33Because, uh...
38:34You middle-aged man.
38:35Don't be stupid.
38:36Don't hold back.
38:37Tell me how you really feel.
38:39Forgive me for being blunt, Dr. Rabinovich, but how old are you, huh?
38:43Fifty...
38:44Ish?
38:45Ish.
38:45Fifty-ish-year-old man on a motorcycle.
38:49Very sad.
38:51Ha, ha, ha, ha.
39:02I, um...
39:05I-I don't know what to say.
39:08You ever heard of ITP?
39:10I never did.
39:13I really appreciate you bringing her here, okay?
39:15Of course.
39:16What do you think I am?
39:18Oh, that's right.
39:19You think I'm some kind of child.
39:20No, I never said that.
39:21No, fuck you didn't!
39:23In front of all those people, you made it sound like she might have been getting her while I was
39:26watching her.
39:26Like it was my fault.
39:27You basically said the same thing about me.
39:29No, I said that you guys roughhouse, that's all, because you do.
39:32You?
39:32No, I would never hurt my daughter.
39:35Actually, I don't.
39:37I've known you in six months.
39:39You could be anybody.
39:40Okay, well, I am sorry for what I said, okay?
39:42I was upset, and I was worried, and I just-I said something stupid, and I just-
39:46You just fucking let me finish!
39:47You are finished!
39:50We're finished.
39:53Well, happy fucking 4th of July.
39:55Yeah, happy Independence Day!
39:59Yeah, they did. They just did.
40:01Excuse me.
40:04Yes, what can I do for you?
40:06My wife and I were in an accident.
40:09She's in surgery right now.
40:11Would you mind holding my phone up for me so I could record a message for her?
40:15Of course I will.
40:17Happy to.
40:18Oh, good.
40:19I have the same one.
40:21I know how this works.
40:27Ready?
40:28Go.
40:31Hi, my love.
40:36So, I was listening to this couple argue, and they were yelling.
40:43Both so angry.
40:47And I just wanted you to know, that I was wrong.
40:54I was so wrong, and I'm sorry about all of it.
40:58Oh.
41:02Hey.
41:03How you doing?
41:05I haven't seen him in like four years.
41:08I can't imagine.
41:10That must have been-
41:11So crazy.
41:12You know, things were not good at the end.
41:15He was a really different person.
41:18Huge temper.
41:19Not like when we first got married.
41:21I'm so sorry.
41:25Could that mass have been there for a while, and only recently got worse?
41:30Yes.
41:31Could it be responsible for how much he changed?
41:34You know, his moods and tempers, he was-
41:37He was getting into fights with strangers.
41:41It's possible.
41:49Oh.
41:57Um, unless he's asked you to change it, would you please leave me as the emergency contact?
42:07Yeah, absolutely.
42:20Okay, I'm sending Mrs. Kovalenko home with burn dressing, but not before she turned my sabbatical into a midlife crisis.
42:27No comment.
42:28Moon check, two days.
42:29Got it.
42:30What about Kylie, this little girl? Has she gone up yet?
42:33Hopefully soon.
42:34Hey, we're starting to clear some space around here.
42:36Yep.
42:38PTMC charge nurse, go ahead, Medicare man.
42:43Is this a drill?
42:45Is this a joke?
42:46It's the fourth of fucking July.
42:52Got it. Thanks.
42:54What's up?
42:55Westbridge has a code black and is closing to internal disaster.
42:58Central's diverting all their ambulance traffic to us.
43:00What's the issue?
43:01Comstrike didn't say.
43:02Shit, it could be anything from a flooding toilet to a power arch. How long?
43:06Didn't know. A couple of doctors probably got the holiday flu and they're understaffed.
43:12How come? How long? How many?
43:17Sounds like a betting grid to me.
43:21We are back.
43:25Oh, I should have left last night.
43:40Oh my God.
43:43I mean that since the summer our next year.
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