- 15 hours ago
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00:04You
00:21The man is in his element, what's he doing?
00:23An age old ritual, meant to capitalize off the unknown origins of Westbridge's current state of affairs.
00:31Who ever guesses the reason they went code black wins a pot?
00:33Ah, interesting. We didn't do this at the VA.
00:36Game?
00:37Of course.
00:38Now, how's this look to you?
00:40My wager is on flooding. They're gonna be down for three hours and we're gonna get 20 of their patients.
00:44Put me down for flooding, four hours, and 30 patients.
00:49Okay, okay, okay. Hey, Dr. Robin, looks like you got some competition.
00:52Yes, it would appear that I do.
00:53All right, guys and gals, enough fun. We have people to take care of.
00:57You wanna bring Langdon back from triage for the extra hands?
01:00No, I do not. I don't think that's necessary. We're doing just fine without him.
01:03You're the boss, boss.
01:13Hi, uh, the doctor guy told me to put this mineral oil on my eye for 20 minutes. That was
01:20two hours ago.
01:22We're really busy, but we'll get to you.
01:24Oh, my God. Okay, hold on.
01:25I will check. Listen for your name to be called.
01:28Thanks.
01:29Next.
01:31Oh, excuse me.
01:32Uh, hi. I heard my brother was brought here. His name is Jackson Davis.
01:35Do you have ID?
01:36Yes, yes. Um, I am his sister, Jada Davis.
01:43I'm sorry. I just, uh, my friend told me that he was brought in by campus police.
01:48There was some sort of fight that broke out at his school. Is he okay? Is he here?
01:51Don't know, hon.
01:52Can you just tell me if he's a patient here?
01:53I'll check, take a seat, and I'll let you know.
01:57Okay.
01:58Next.
01:59Is Harlow feeling lightheaded or faint now?
02:05It's not as bad as it was before, but my head still hurts, and now my stomach does, too.
02:12What did she eat before she took her ibuprofen?
02:17Uh, it's not mine.
02:18Breakfast is my least favorite meal of the day.
02:25It's okay to look at me.
02:30I'm sorry. Um, we're gonna get started with some blood tests.
02:38Is that baby from the bathroom gonna be okay?
02:40She'll be fine.
02:41Uh, good news.
02:43Nose swab came back negative for COVID, influenza, and RSV, but a lot of other viruses can cause a cough.
02:51Lucky me.
02:52You can take off your mask.
02:54Pulse Ox is at 91.
02:57Your oxygen level is down since we checked you an hour ago, and your temp is up to 102.4.
03:03Let's get you some Tylenol.
03:05Have you been outside today? It's already stifling.
03:07Could be heat-related, but we're gonna take you back to the big ER for full evaluation.
03:13Can't you just write me a prescription for some medicine? I'm sure it's just a summer cold.
03:18You got somewhere to be?
03:19Work.
03:23I know, it's Saturday, but I don't think I've had a day off since...
03:27Well, your holiday weekend starts now.
03:31Hey, Javadi. What are you doing for your birthday?
03:34Who told you?
03:35Work gets around.
03:37Nothing. I hate celebrating my birthday.
03:40You only turned 21 once.
03:42It's your birthday?
03:43Oh, that makes you a...cancer, right?
03:47I didn't peg you for an astrology, girly.
03:50Yeah, I've been spending too much time around Santos.
03:53Yes, you have.
03:54I don't know how you guys do it. Live together and work together?
03:58It's my cross to bear.
04:00It can't be as bad as having to live with your parents.
04:03I don't know. I haven't lived at home in years. I kind of miss it.
04:06I can tell. You've been spending a lot of time on that farm. Farm?
04:10Remember the burned farmer who came in last year? Propane tank exploded. He died in the ICU.
04:14Yeah, that was sad.
04:15Well, this guy has been playing house with his widow and their baby.
04:20Oh, that's messy.
04:22No, it's not like that, okay?
04:25I've been helping Amy out on the farm after her husband died and she's a friend. She's just a friend.
04:30Sure, just a friend. With farm benefits.
04:34What are farm benefits?
04:35Oh, use your imagination.
04:38You ever see a milking machine?
04:39Oh, can we not talk about this, please?
04:41We're getting two runs rerouted from Westbridge already. Chest pain and belly pain.
04:45Robbie wants you three out back.
04:47Come on.
04:49Dr. Santos.
04:50Making progress in your charting, I hope.
04:52Getting there.
04:53Deficient charts leave a gap for the providers who give continuity of care.
04:57It delays hospital billing.
04:59Oh, I'd hate to delay billing.
05:03Timely documentation is essential.
05:06Let's fix this before end of shift.
05:08I'm on it, boss.
05:10Good.
05:11You wouldn't want to repeat your R2 year again because of this.
05:18Fuck.
05:20God, it's humid as shit out here.
05:24It is.
05:26What's going on at Westbridge?
05:27They're closed.
05:28Recovering their paramedic runs until they come back up.
05:31As if a holiday weekend wasn't enough.
05:33So, Dr. Al Hashimi.
05:36Yes?
05:37Do we like her?
05:40She seems pretty cool so far.
05:42You're trying to gossip about an attending with an attending?
05:45Dr. Robbie doesn't mind, do you?
05:50Oh, uh, it's a nice bike, by the way.
05:53Yeah.
05:57Pamela Perry, 48.
05:58Abdominal pain with vomiting after eating chilequiles with fried eggs.
06:02BP, 108 over 64.
06:04Pulse, 98.
06:05Good saps.
06:05Okay.
06:06Let's see how she feels with some Zofran and a liter wide open.
06:09Got it.
06:10Yo, Whitaker.
06:10How are you feeling, Miss Carrie?
06:11I'm so good.
06:18Who do we have here?
06:19Jean Samba, 54.
06:20Half an hour left-sided chest pain.
06:22History of hypertension on lisinoprol and Crestor.
06:25Some relief with two nitro.
06:26Decent vitals.
06:28No STEMI on 12 lead.
06:29Gave him 324 to a bull aspirin.
06:31Okay, we're going to give you a full evaluation, sir.
06:33Oh, I am to die.
06:35Not really.
06:36I will see his pearly gates.
06:39What's the plan?
06:40Repeat 12 lead.
06:41Check a troponin.
06:42Admit for new onset angina.
06:43Value A for P, aortic dissection.
06:44That goes without saying.
06:45Sounds good.
06:46I'm a minute behind you.
07:02And who do we have here?
07:04Vince Cole, 23.
07:05Fell through the skylight of a florist shop.
07:07Tend to be down to a bunch of ferns.
07:08Complained a headache, asking repetitive questions, and only response to pain.
07:12Multiple acts in the glass.
07:13VP, 118 over 72.
07:15Pulse, 98.
07:16Stats, 99 on 5 liters.
07:18No meds, no allergies.
07:19Hey, Vince.
07:19How did you fall through a skylight?
07:21Vince?
07:22Were you with him?
07:23Yeah.
07:24We were parkouring and he overshot a congol.
07:26What?
07:26Like jumping?
07:26Stepping off of buildings.
07:27People still do that?
07:28It's almost an Olympic sport.
07:29Now we know why it isn't.
07:35Tables are equal and reactive.
07:36What do you got?
07:37We got 10 foot fall altered.
07:38That's a long way down.
07:3910 feet is the threshold for trauma center activation.
07:4110 feet, 10% mortality.
07:420%.
07:43Anything over 0% is a concern.
07:45Somebody's annoying and it's not me.
07:48Hey, you said two.
07:48You missed one.
07:50I sent you back up tonight.
07:52One, two, three.
07:54Thanks, guys.
07:55Good to see you.
07:57Hit the E-Fast.
07:59Ogilvy, Joy, GCS, please.
08:01Open your eyes, sir.
08:03Two for eyes, two for verbal.
08:05Good lungs sliding bilaterally.
08:07Joy, finish GCS.
08:09Squeeze my hand.
08:12He gets a four for motor.
08:14Whole socks, 99.
08:15Heart rate, 102.
08:17Blood pressure, 114 over 78.
08:18And E-Fast is negative.
08:20Music to my ears.
08:22Is somebody shooting a documentary here?
08:23Whoa, whoa, whoa.
08:24You can't film in here.
08:25We've got patient privacy laws.
08:26What happened to your hand?
08:28Cut it.
08:29Uh, can somebody show Spielberg here out to the waiting room and get her registered at
08:33triage, please?
08:33He's my creative partner.
08:35I have his written consent to film everything for our TikTok page.
08:37Put the camera down.
08:39We have to drop this video for the fourth tonight.
08:40That literally means nothing to me.
08:42Sean, can you escort her out, please?
08:44Somebody will come and find you once he's stabilized.
08:46I'm gonna let her stay if she'd ask nicely.
08:49What is the, uh, story with surgery?
08:51You guys getting any Wesper's transfers yet?
08:52Not yet, but I'm sure it's coming.
08:54Pan scan, head through pelvis.
08:56Let's get him to CT ASAP.
08:57Absent gag.
08:58We need to intubate before CT.
09:01C-can I do it?
09:03I-I'm keeping a procedure log and I need more intubations on this rotation.
09:06If Dr. McKay wants to teach.
09:08Sure.
09:10Okay.
09:11Uh, I need suction, 802, etomidate, and sucks, and tidal CO2.
09:15Ambitious.
09:16Reminds me of someone I know very well.
09:21Can you knock?
09:23Yeah, I'm sorry.
09:24Hot off the press.
09:26Okay.
09:28No STEMI.
09:29Doesn't need to go right to the cath lab.
09:33Okay.
09:34Orders are in.
09:35Whitaker, try another nitro and let me know when the troponin's back.
09:38Yeah.
09:38Hey, hey, Jesse?
09:39Yeah?
09:40Do you think you could repeat this, but with the chest leads on his back?
09:45Why?
09:46T-waves are kinda high with ST depression anterior.
09:50We see ST depression all the time.
09:51Yeah, but it could be a posterior MI.
09:53All right, run it by the attending. If they agree, we'll do it.
09:59Uh, Victoria, if his CT's normal, he'll need an LP.
10:02Got it.
10:04Dr. El-Hashimi?
10:05This is Jada Davis, Jackson's sister.
10:08Oh, thank you. Hi.
10:09Is he okay? And why is he asleep?
10:11He was uncooperative when he first arrived and needed to be sedated.
10:16Uncooperative?
10:17That doesn't make any sense.
10:19What happened?
10:20We're still trying to piece the story together.
10:22He was brought in by a campus security guard who tased him after he was allegedly-
10:27Combative and violent.
10:28Wait, what do you mean tased him?
10:29We've treated his injury, and now we're trying to understand why he was so agitated.
10:34Okay, this doesn't sound like my brother.
10:36Well, his drug screen came back negative, so now we're taking Jackson to get a CT scan of his brain
10:40to look for any abnormalities.
10:41Can I go with him?
10:42You can't go into the CT, but you can wait for him to come back, and then we can discuss
10:47next steps.
10:50Okay.
10:52Just did my first ER intubation.
10:54That's great, man.
10:55Such a crack.
10:56You got a second?
10:56What's up?
10:57A 12 lead on my chest pain patient shows no STEMI, but the anterior leads might be suspicious for a
11:02posterior MI.
11:03Uh, agreed.
11:05Yeah, I was gonna repeat, but with the chest leads on the back.
11:08V-7 through V-9.
11:09Good idea.
11:14Hey, Dr. Ravi gave the go-ahead for the back leads.
11:16Sorry, man.
11:17I gotta call a report on a septic patient going to the ICU.
11:20Yeah.
11:20They see you today, huh?
11:22Uh, well, it's, uh, 10-15.
11:24We're actually just getting started.
11:26Oh.
11:27There she is.
11:28Dr. Mohan, uh, this is Lori Diaz, Orlando's wife.
11:32Thank you, Perla.
11:34Hi, Mrs. Diaz.
11:35Let me take you to your husband.
11:36Hi, mi amor.
11:38I'm sorry.
11:39You have to be here alone.
11:41I missed my first bus transfer in.
11:43Hi.
11:44Anyway.
11:47Father, get here.
11:49You fell at your construction site.
11:51A co-worker brought you in.
11:52He's a lot better, but doesn't remember anything.
11:55That's common after a concussion or DKA.
11:58DKA?
11:59It's a serious complication of your husband's diabetes.
12:03How serious?
12:04Can he go home?
12:05We still have to clear the ketones from his bloodstream.
12:08He'll need to be on an insulin drip for a while until things get back to normal.
12:12Best if he stays in the hospital.
12:16It's okay, Mom.
12:17Things are headed in the right direction, Mrs. Diaz.
12:20He's going to be better.
12:21Hmm.
12:24Sorry I gotta check his blood sugar.
12:27Oh, do you mind?
12:28Absolutely.
12:31So, the thing is, we don't have health insurance, so I don't think that we can avoid this.
12:41I'll have our case manager, Noel Hastings, come by.
12:45She's an expert in health insurance.
12:47She might have some options for you for coverage.
12:49Okay.
12:57Crap.
12:58What's wrong?
12:59Uh, some of the leads aren't sticking here.
13:01I lay down now.
13:03I'm tired.
13:04Yeah, as soon as we're done here.
13:05Whitaker, Louie's all numb.
13:07His tooth is ready for you.
13:08That's great.
13:09Hey, I'm having some trouble here with, um, adherence.
13:12Oh, of course you are.
13:14Uh, try this.
13:16Oh, yeah.
13:17That makes sense.
13:18Uh, you think you could...
13:22Do you mind if I paint some sticky stuff on you?
13:26If you must prolong the inevitable buffs, I'll be it.
13:29You'll get to lie down afterwards.
13:32No success with the mineral oil.
13:34That's what I said.
13:36So now what?
13:38You can wait one to two weeks for the superglue to break down on us all.
13:42I'm hosting a 4th of July party tonight.
13:44You want me to show up like this?
13:46The other option is I trim your eyelashes halfway down.
13:50That'll lower the strength of the glue holding them together.
13:53Let's do that.
13:55Lie back, please.
14:01I need you to hold your head perfectly still.
14:04Keep your eye closed.
14:05My eye can't open.
14:07That's why I'm here.
14:08No.
14:09I mean, your other eye, too.
14:15Okay.
14:16Here we go.
14:18Perfect, Mr. Samba.
14:19All good here.
14:21Hey, Ling.
14:23Do you see?
14:24We'll put you down in a second.
14:28Holy shit.
14:29The ST elevation V7, V8, V9.
14:33It's a posterior STEMI.
14:35What's that?
14:36It's the worst kind of heart attack.
14:38Mr. Samba?
14:40Mr. Samba?
14:42Hey, I could use a second set of hands here.
14:45Pulseless VTAC.
14:46Start compressions.
14:48Okay.
14:48Charging to 200.
14:52Okay, clear.
14:55Okay, resume compressions.
14:58Code STEMI.
14:58It was posterior.
15:00Yeah.
15:00Good call.
15:01You put the deep foot pads on?
15:02Yeah, just in case.
15:03Hold compressions.
15:08Normal sinus.
15:10All right.
15:11Got a strong pulse.
15:12Take a BP.
15:13All right.
15:13We'll prep him for cath lab.
15:16Hey, Mr. Samba.
15:18You're gonna be okay.
15:19No pearly gates today.
15:20Really good pickup, Whitaker.
15:26Has a patient ever flirted with you?
15:29Sure.
15:30Why?
15:30Well, there's this guy this morning.
15:32He turned out to be a criminal.
15:34But, yeah.
15:35It was a nice distraction from the deposition.
15:37Still worried about that?
15:39Yep.
15:39Yeah, counting down the hours.
15:40There are five left if you're wondering.
15:45Hi, Ms. Ronson.
15:47Felicia, please.
15:48Felicia.
15:48I'm Dr. King.
15:50This is my colleague, Dr. Santos.
15:51What brings you in today?
15:53I've had this pretty bad cough for a few days now.
15:56Do you smoke?
15:56Are you coughing up anything?
15:57Any chest pain?
15:58No, no, and no.
16:00I honestly think I picked it up at work.
16:02It was going around.
16:03Oh, where do you work?
16:04I'm in corporate at PNC Bank.
16:06Sit forward, please.
16:07It could be an office bug.
16:09Or I got it from the gym.
16:10I'm there all the time.
16:16Do you have anything to ask, Dr. Santos?
16:19What?
16:20Do you have any questions to ask our patient?
16:22Uh, no.
16:22I'm good.
16:24Okay.
16:24What did you hear?
16:26Maybe some crackles at the right base.
16:28Okay.
16:29Well, we're gonna need a chest x-ray to check your lungs.
16:33Will that take long?
16:34Maybe I can still make it to the office.
16:35Listen, I shouldn't.
16:39You can go put the orders in?
16:40Yep.
16:44How are we doing in here?
16:46Oh, this is thrilling.
16:47Definitely worth $200,000 worth of student debt.
16:51Superficial ones get a steristrip,
16:53full thickness tridermabond.
16:55How can you tell they need a suture Joy?
16:58If the edges are under significant tension?
17:00I didn't realize your name was Joy.
17:02I'm gonna have to tell my parents how trendy they were.
17:05CT, head, neck, chest, abdomen,
17:08pelvis all normal improvement.
17:09Lucky guy.
17:10A little bit of losing.
17:12Uh, pressure for two minutes,
17:14lidocaine and epi if that doesn't work.
17:16Are the admin orders in for surgical ICU?
17:18Fuck.
17:19What?
17:21This.
17:22Ah.
17:24Irrigation saline?
17:25It's just a small cut.
17:27It is a work-related blood exposure,
17:29which means you're a patient now.
17:30Are you serious?
17:31Needle stick?
17:32Piece of glass.
17:33Here you go.
17:34Thanks.
17:36No past records on this guy.
17:38We don't know HIV or hepatitis status.
17:40I'll put the orders in.
17:42HIV, antibody, hep B, surface, and hep C.
17:45She needs post-exposure medication.
17:47Maybe not.
17:48For occupational exposure,
17:50the rapid HIV test takes an hour or two.
17:53Subcutaneous puncture wound.
17:54No risk of joint or tendon involvement.
17:56Elevate pressure and then a band-aid.
17:59You can give yourself a dose of pep if you want while you're waiting for results.
18:02Uh, start a chart and I'll find another nurse for your blood draw.
18:06Great.
18:07Looks like we've got a couple more diverted from Westbridge.
18:10Any estimate on their downtime?
18:11Not yet.
18:14Time to pull Dr. Langdon from triage?
18:16No.
18:17No.
18:17First day back.
18:18I want to let him kind of ease into things.
18:21Understood.
18:22I'll keep an eye on it.
18:23Thank you very much.
18:25Thinking about changing your vet?
18:26I am just waiting my odds.
18:29Don't worry.
18:30I'll buy you a drink with my winnings.
18:38Your brother should be back shortly.
18:40There was little holdup at CT.
18:43Um, should I be worried?
18:46Let's wait and see what his test results say.
18:49This is just, um, this just doesn't make any sense.
18:53It doesn't sound like my brother at all.
18:55He's the friendliest guy I know.
18:58He never even gets angry.
19:00He barely yells.
19:01He's never had an episode like this in the past?
19:03No.
19:04Or not that I know of.
19:07He's in a great relationship and he's in law school because he wants to help people.
19:13He always tells me that I should, um, follow my dreams.
19:19Even if it means my parents may disown me.
19:24Should I call them?
19:25I think that's a good idea.
19:28This, this could be pretty serious.
19:35Thanks.
19:43The new radiologist is a hottie.
19:47Um, his head CT is normal, as are his blood and urine tests.
19:52Then what's wrong with him?
19:54We're not, um, sure yet.
19:56There is another test, a spinal tap.
19:59So this could be, um, an infection in the fluid that surrounds the brain, viral encephalitis.
20:03Um, it can also cause altered mental status and confusion.
20:08Can you treat it, if it is?
20:11Yes.
20:14Okay.
20:15Okay.
20:17I'll go find Dr. Al Hashimi and we'll do it together.
20:20Of course.
20:25Just what we thought, it's a, it's a fracture of your coccyx.
20:29It's your tailbone.
20:30You see, these pieces here should be lined up with that part here.
20:35Do I need surgery?
20:36No.
20:37No, no, no.
20:38These heal pretty well.
20:39But it'll take about six weeks.
20:43Six weeks?
20:45I have dinner dates every weekend.
20:48You can keep your, still keep your dinner plans.
20:52Dinner starts at Pino's, the best Italian in town.
20:56A nightcap at my place usually follows.
20:59And then, breakfast in bed.
21:02Okay.
21:04Well, in that case, you might, you might need to take a little break.
21:09My greatest joy in life is my social calendar.
21:18Is there something else you can do?
21:22Well, there, there is a procedure to push the fragments back in place.
21:27It could help it heal faster.
21:29Now we're talking.
21:31It'll hurt pretty bad.
21:32But only for a second.
21:33I can take it.
21:36Okay.
21:38Back in the gown.
21:50How's it going over here?
21:53Better now.
21:58Uh...
22:00Oh, the x-ray is back on your foot.
22:04And no fracture.
22:06So, um, ace wrap, ice, rest, and elevate.
22:10And you can take ibuprofen if you need it.
22:14So that's it?
22:15Well, if it's, if it's too painful to bear weight, we can give you crutches to use for a day
22:19or two.
22:21So I won't be seeing you again?
22:24Uh...
22:26As a patient, no, but...
22:28It was nice meeting you, Brian.
22:31It was nice meeting you too, Dr. McKay.
22:48You know, I was, I was gonna go check out a few of the art galleries in Lawrenceville tonight.
22:55Have you been to that one on 40th and Butler?
22:58No, I was, um, gonna go by. Maybe around 9?
23:03Okay.
23:05Cool.
23:06Cool.
23:09Dude, I resuscitated that part for a guy and intimated his demi. I think I can handle this.
23:14It's best if you watch the first one.
23:17How's that tooth feeling?
23:18The whole side of my face is numb.
23:21That's how we like it.
23:23Okay.
23:25We've got a fluctuant gum line at...
23:29Tooth number 23, lateral incisor.
23:31With an extension to an...
23:33Apical abscess.
23:35Right again.
23:36Ah, the kid's smart.
23:38Hook up the yank hour, get ready to retract the gum.
23:41Hey, Louie, this is a temporary fix, okay?
23:44You're gonna need to get that tooth pulled by a dentist.
23:46Hey, you gonna find me one?
23:48We can have you talk to Dylan.
23:50Is Dr. Collins around?
23:52My sister always helps me out.
23:55Well, uh, Dr. Collins finished her residency.
23:59Took up a job in Portland as an attending physician.
24:02Portland?
24:02Yeah, I think that's where she's from.
24:05She's adopting a baby. Wanted to be closer to her family.
24:08Wow, that's a beautiful thing.
24:11Okay, ready?
24:14Okay.
24:16Three cc syringe.
24:1820-gauge needle entering at the juiciest part.
24:22Aiming for the apex.
24:27Send that for culture?
24:28No.
24:29Pen VK for a few days.
24:30Books in the mouth are old school.
24:33Yeah.
24:33Just like me.
24:36Both parents work, but neither of them have health coverage?
24:39Orlando and his wife have multiple part-time jobs that don't offer insurance.
24:44Can they qualify for Medicaid?
24:47Unfortunately, no.
24:48Because their combined annual income is over the Medicaid threshold for a family of five.
24:52So they make too much money?
24:53And not enough at the same time.
24:55They live over the poverty line, and yet they are still living paycheck to paycheck.
25:01I think their best option would be to buy private insurance through the Affordable Care Act.
25:09My parents don't have insurance?
25:12I'm sorry, Anna.
25:14How much will it cost to keep my dad in the hospital?
25:17I don't know.
25:19But the ER visit alone will likely be in the thousands.
25:24We will figure something out.
25:27Okay?
25:33Purple top for the CBC, red top for chemistries and serologies.
25:37Okay.
25:40Ready?
25:41Uh, yeah.
25:42I can be a hard stick, so.
25:46None of them.
25:49Okay.
25:51One.
25:53Two.
25:54Three.
25:56Good blood return.
25:58Oh, thank God.
25:58Pop one on.
26:04You're supposed to release the tourniquet now.
26:06Right.
26:07Sorry.
26:11All right.
26:12Lab won't take it without your initials, time, and date drawn.
26:15How are you feeling?
26:16Peachy.
26:17Hopefully I get to do this several times every day.
26:20All set.
26:23Keep some pressure here for a minute.
26:26Initials, time, and date.
26:29Oh.
26:33Oh.
26:34Shit.
26:36Environmental to north.
26:38Sorry.
26:40How is he?
26:42He's stable.
26:43He's doing great.
26:45Doesn't look great.
26:46Doesn't look great.
26:48Is there brain damage?
26:50The head's CT showed no bleeding or skull fracture.
26:52It's most likely a bad concussion.
26:55It's hard to know when he'll regain consciousness.
26:57Did he break any bones?
26:59We don't think so.
27:00He should thank those ferns.
27:03Uh, chest and abdomen CT scans also showed no major internal injuries.
27:06Mm-hmm.
27:08What's that?
27:15We need respiratory therapy in here?
27:20Okay.
27:22One, two, three, over.
27:24Yes.
27:24You have a problem with the vent?
27:25No, he's bleeding from the back.
27:27Gotta prone him to take a look.
27:28Back away, Tanya.
27:29One, two, three, up.
27:31One, two, three, over.
27:33Good.
27:33Oh, shit.
27:34Left flank area.
27:35Careful, careful, everybody.
27:36There might be glass.
27:36Two-centimeter simple laceration.
27:39Open a suture kit, 4-O-Prolene.
27:40It wasn't bleeding when we flipped it on arrival.
27:42No, but when we moved him around for CT, it might have rubbed off a clot.
27:45Slow venous oozing.
27:47Might need a figure of eight.
27:54Yeah, little piece of glass in there.
27:57It's just under the skin.
27:58Is it a loose fragment?
27:59Yeah.
27:59Can we move it around?
28:00Here, I'll pull it out.
28:01No, don't.
28:02Shit.
28:03Okay.
28:03It's bigger than I thought it would be.
28:05That looks arterial.
28:06Can I get some four by fars over here, please?
28:08It's bigger than I thought it would be.
28:09Let me spend some pressure on this whole side.
28:11It's hard and deep, please.
28:12I can push it back in.
28:13No.
28:13No, no.
28:14You've done enough damage.
28:15Should I keep pulling it out, then?
28:16Absolutely not.
28:17The glass was tamponading a vessel.
28:19Not anymore.
28:20BP's down.
28:21Page surgery?
28:26Oh, I was looking for you.
28:27Well, you found me.
28:29The x-ray came back on the lady with the cough.
28:32Weird and filtrate.
28:33Have you seen it yet?
28:34I've been trying to catch up on my charting.
28:35Here.
28:37Yep.
28:38Stringy right lower lope.
28:40Yeah, it looks like aspiration pneumonia.
28:43Think about it.
28:43How do oral and gastric fluids end up in lungs?
28:47Um, dysphagia, swallowing disorders.
28:50But she's not an old person choking on their food.
28:53Right.
28:53And there's protracted vomiting.
28:55Okay.
28:55Maybe recent gastroenteritis, food poisoning.
28:58Yeah.
28:59Or.
29:00Or.
29:02An eating disorder.
29:04Think she's bulimic?
29:06I mean, she's fixated on working out.
29:09Check the enamel behind her front incisors.
29:13Um, oh, it's a, it's a, if it's not in the differential,
29:17it won't be in the diagnosis.
29:20You know the, yeah, you know, you know that.
29:29Nice job on the tap.
29:31Thanks.
29:32Hi.
29:33You called for a consult on Jackson Davis?
29:36Yes, we did.
29:37I'll let Victoria present the case.
29:41This is Jada, Jackson's sister.
29:43This is Dr. Jefferson from psychiatry.
29:46Psychiatry?
29:47Do you think this is a mental health problem?
29:49We thought it best to cover all our bases.
29:51We'll know more once I speak with your brother.
29:54Okay.
29:56Hi, Jackson.
29:59Jackson, can you wake up?
30:02Jackson.
30:03They said he's sedated.
30:07I'll come back a little later.
30:11Well, that was fast.
30:13Yeah.
30:13Next time, maybe wait until the patient wakes up before calling me down.
30:18Psychiatrists do best when we can actually talk to our patients.
30:22I got a little ahead of myself.
30:24Um, will do.
30:29Sorry.
30:31Pressure's up with one unit type specific.
30:36What the fuck, he was stable.
30:37Slight change in status.
30:38Okay.
30:39Get the clamp ready?
30:40Who's the genius who pulled that out?
30:43I thought it was a loose fragment.
30:45Next time, leave the decisions to the adults.
30:47Okay.
30:48Okay.
30:48Ready to go?
30:53Whoa.
30:55Looks like an icicle.
30:57Christmas in July.
30:58Hey, Sophie, can you answer that?
31:01Okay.
31:02I am injecting the X-step.
31:04Hello.
31:04What is that?
31:05It's a syringe full of tiny rapid expanding hemostatic sponges.
31:08Okay.
31:09Got it.
31:09Thanks.
31:10Radiology attending says a resident missed something.
31:13There's a radiopaque foreign body in the left paralumbar musculature.
31:16Not anymore.
31:17Not anymore.
31:18Sounds like first week in July syndrome.
31:20Mm-hmm.
31:22Okay.
31:24That looks pretty dry.
31:26On the surface.
31:27Okay, let's turn them back and down.
31:30Okay.
31:31One, two, three, over.
31:34One, two, three, flip.
31:36One, two, three, down.
31:39All right.
31:40CT is ready to rescan.
31:42Interventional radiology is holding a room.
31:43Look at you.
31:44So on top of things.
31:45Yeah.
31:46Hasta la proxima.
31:47What are you doing over here?
31:50Definitely not great.
31:52All right.
31:52Well, let's get you a ginger ale.
31:54So we never ever remove a deep foreign body in the ER.
31:57We always leave that to surgery.
31:59It won't happen again.
32:01I was just coming to find you.
32:04Sure you were.
32:05It's almost like you're avoiding me.
32:07Me?
32:07Never.
32:08No.
32:08Just having one of those busy days.
32:10You know, living the dream.
32:11Saving America's tired, poor, huddled masses yearning to breathe free.
32:14You're a saint.
32:15I tell myself that every day.
32:17I heard you had a motorcycle crash come through about an hour ago.
32:21Yeah.
32:23Couldn't save me.
32:25I know he was not wearing a helmet.
32:27Interesting.
32:28One motorcycle crash is not going to scare me off my trip.
32:31I didn't say it should.
32:33I hope he died doing what he loved.
32:37That's optimistic.
32:39Glass half full kind of guy.
32:43I am not on your couch.
32:45I'm aware.
32:46Conflict of interest here.
32:47Why?
32:47Because we're friends?
32:48Oh, look at you.
32:50Using the F word.
32:51It's growth.
32:53I use F words all the time.
32:54I guess this therapy must be working.
32:56Ah.
32:56I got somebody new for you.
32:58She takes no shit.
32:59You love her.
33:00I hope so.
33:02The last two have not exactly been my speed.
33:06Meaning what?
33:07Empathetic?
33:09Look, sometimes it just takes a little while.
33:12You know, find the right fit.
33:13Well, it's going to have to wait because I'm going on my sabbatical tomorrow.
33:15There's always Zoom therapy.
33:18Motorcycle trip is Zoom therapy.
33:22I'll bet somebody set off fireworks in the shitter.
33:27How dumb is that?
33:28You think people are smart.
33:30Yeah.
33:34What's up, man?
33:36You want to get on the books?
33:38Uh, yeah.
33:39Yeah, yeah.
33:40Maybe.
33:41Maybe.
33:41Yeah.
33:41Hey, look here.
33:42I only take real money.
33:44None of that I owe you bullshit.
33:47Okay, I have money.
33:49Okay?
33:49My first direct deposit finally hit, so.
33:52Nice.
33:54Put me down for $40 for power outage.
34:02Nice.
34:02We got a big ball on our hands.
34:05Oh, okay.
34:05Congrats, doctor.
34:07I like this side of you, man.
34:08Any improvement?
34:09No.
34:11What kind of super glue did you use?
34:13Does it matter?
34:13My eye is still fucking shut.
34:16Okay.
34:16There's one other thing I can try.
34:18No, I'm done.
34:18I asked for Dr. J earlier, and I would like to see her now.
34:22I haven't been in the hospital for a while.
34:24I don't know a Dr. J.
34:26She's one of the best doctors in Pittsburgh.
34:34Oh, Dr. J.
34:37Hmm.
34:37Do what you must be, lady.
34:39Mm-hmm.
34:41Okay.
34:41First, I need to get a good grip for the reduction.
34:44Uh-huh.
34:46Here we go.
34:48Try to relax.
34:50Deep breath with your mouth open.
34:53Not how I imagined our first intimate encounter.
34:57Okay.
34:58Got it.
34:59Now on three.
35:01Okay?
35:02One.
35:04Ah!
35:06Motherfucker!
35:08Oh, you shut up.
35:10I know.
35:12Sorry keeps you from tensing up.
35:14Okay, I think that worked.
35:16How does it feel?
35:17Can I sit up?
35:18Uh-huh.
35:19Oh.
35:21Oh.
35:25Oh, my God.
35:27Oh.
35:30It's definitely better.
35:33Oh, my God.
35:35Great.
35:37Can I give you a hug?
35:39Maybe, maybe later.
35:41Okay?
35:44Aspiration pneumonia.
35:46How does that happen?
35:47Uh, it's when bacteria from the mouth or stomach get into the breathing tube.
35:51Uh, when you're choking, if you're eating or vomiting.
35:56Oh.
35:58Do you ever drink a lot of alcohol?
36:00Maybe so much that you pass out?
36:02No, I'm not a big drinker.
36:04Have you had the stomach flu recently?
36:06Food poisoning?
36:08No, I know.
36:11Do you mind if we take a look inside your mouth?
36:20You can lean your head back.
36:23And look wide.
36:29What?
36:30Yeah.
36:31The enamel on the back of your teeth is worn away.
36:35What does that mean?
36:37Um, it can happen if someone makes themselves vomit repeatedly.
36:41All the stomach acid dissolves the enamel.
36:44What does that have to do with having pneumonia?
36:47It may have caused it.
36:51Can you just give me some medicine?
36:54Yeah, we can do that.
36:59Dr. J, finally.
37:02It is so nice to meet you, Dr. J.
37:05This is Willow, your new patient.
37:09I'm actually a student doctor.
37:11I, uh, watched all of your videos.
37:14The one about coping with difficult coworkers was super helpful.
37:17I gotta watch that.
37:19Um, so what is Willow's health issue?
37:22Uh, my eye, it's super glued shut.
37:26Halfway trim and mineral oil didn't work.
37:28No.
37:30Then I would suggest cutting the full lash down.
37:33I concur, Dr. J.
37:36As long as you're the one doing it.
37:39Oh.
37:41Okay.
37:42Yeah, sure.
37:43Um, yeah, sit back for me.
37:46Okay.
37:48I'll get you to close both your eyes and be as still as possible.
37:53Okay.
37:54All you, Doc.
37:55Thank you, Dr. Langdon.
37:58Okay.
37:59Here we go.
38:03How many followers do you have, Dr. J?
38:06More than you'd guess, Dr. Langdon.
38:08Yeah.
38:12There.
38:18He did it.
38:25Oh, my God.
38:26This looks terrible.
38:28I can still put a false lash on it, though.
38:31Right?
38:36How are you feeling, Mr. Diaz?
38:38Much better.
38:41We need to talk about how your diabetes progressed to this place.
38:46Is this doing Dr. Juan?
38:49What you say here remains between us.
38:54I'm taking a lower dose of insulin than I should be.
38:58How much of your prescribed dose are you using at a time?
39:01Half.
39:03I used to have insurance through work, but I lost that job when the pandemic hit.
39:08It was easy to keep up with my medication then.
39:10I had a great primary doctor, too.
39:13Now I'm kind of on my own.
39:16Do you have a glucose monitor?
39:18Oh, yes.
39:20But I can't afford the test strips every week.
39:22They're too expensive.
39:24Can we not talk about this in front of my family?
39:26Hi.
39:28They're my girls.
39:30Did you call your brothers?
39:31They're still a soccer.
39:32I have good news.
39:33I started a GoFundMe for Dad.
39:35A what?
39:36To help raise money for Dad's medical care since we don't have insurance.
39:40No.
39:41Take it down.
39:42Now.
39:42But why?
39:44I work hard.
39:45I don't need charity.
39:46But, Dad, we've already...
39:47Ana!
39:48You heard me.
39:49Take it down.
39:50Jesus, Orlando.
39:52I don't need that.
39:56Louis.
39:57Thought I'd sneak back in and check on you.
39:59How are we doing in here?
40:00Good.
40:01Two's feeling much better.
40:02Glad to hear it.
40:05Looks like you're stuck with us for the next three hours.
40:08Need to monitor your blood pressure.
40:09How about a drink while I wait?
40:12Water or orange juice?
40:15Uh...
40:15Never mind.
40:18So, uh...
40:19How's your kids doing?
40:22Oh, they're...
40:23Perfect little monsters.
40:25Tanner's five now.
40:27Penny's three.
40:28Uh-huh.
40:29Ain't that a blessing?
40:30It is, but they have zero interest in bedtime.
40:34And there's the dog always digging up the yard.
40:38How much sun does your lawn get?
40:41Plenty.
40:42Seated with perennial rye grass.
40:45And you want to lightly water it and put up a temporary fence so the dog can't get back to
40:51it.
40:52Color me impressed.
40:54What can I say?
40:55I like grass.
40:59No, seriously.
41:00How do you...
41:00How do you know all that?
41:03I was a groundskeeper.
41:05I worked with gardens and lawns back in the day.
41:10Robbie.
41:14Got a sec.
41:18Dr. Langdon.
41:20Dr. Alashimi.
41:21How's triage looking?
41:23Donny and I have it under control.
41:24Good.
41:25I want you to wrap up what you're doing out there and join us back here.
41:28We're expecting more diverted traffic from Westbridge.
41:31Will do.
41:32And I just want to say, I think it's great that you're in the physician's health program.
41:36I know it's a big commitment.
41:39Uh, yeah, it was hard at the beginning, but you know, I'm almost done with year one now.
41:45Only four more years to go.
41:48Penny for your thoughts.
41:50Oh, they're way more expensive than that.
41:52I'm on a budget. Take it and leave it.
41:55My day is not turning out the way that I expected.
41:58We had a call out. Langdon was available.
42:01I was sort of hoping to be on my sabbatical when he came back.
42:04You two were very close.
42:06Maybe this is the universe's way of telling you it's time to clear the air.
42:11Maybe it is.
42:13Maybe it isn't.
42:19Okay, so, um, we'll need to keep you for the day for your IV antibiotics and to monitor your oxygen
42:25level.
42:26Okay.
42:29Okay.
42:31Okay.
42:35What if...
42:39I have been making myself vomit.
42:45Well...
42:47Bulimia is treatable.
42:52I was gonna stop.
42:54I stopped before.
42:58My family gathers her own food.
43:02We eat when we're celebrating, we eat when we're mourning, we just eat.
43:06But then I got to college and it was all about how you looked.
43:10That's a lot of pressure.
43:17I started vomiting.
43:20Everyone said I looked great.
43:22So I went to the gym more.
43:24I didn't need to purge as much.
43:31Last year I went through a breakup, it all came back.
43:40You're doing long-term damage to your body.
43:45And it doesn't just go away on its own.
43:48It's okay to ask for help.
43:51We can set you up with our eating disorder program upstairs.
43:55It's here at the hospital.
43:56It's an outpatient program.
43:58You'd meet with a therapist for individual and group therapy once or twice a week.
44:05Would you be open to meeting with a therapist?
44:10I guess.
44:12Do you have any preference for type of therapist? Male, female?
44:17If there's a black woman, I'd like that.
44:21Yeah, we can arrange that.
44:30That was a good catch.
44:32Black women tend to go underdiagnosed when it comes to eating disorders.
44:36Really?
44:36Yeah, unfortunately.
44:38You know, I thought I had an eating disorder in high school and so I did a lot of research
44:42on the subject.
44:43I didn't. No, I just...
44:46My sister and I were really picky eaters growing up.
44:49You know?
44:51Color and texture.
44:53Vegetables and fish.
44:55Eggs.
44:57Slimy okra.
44:58Asparagus.
44:59Disgusting.
45:00Joe repair is crazy.
45:01Oh, eggs.
45:03Weird.
45:04It's not that weird.
45:05I gotta...
45:06catch up on my charting.
45:09You know, if you want to talk, I'm around.
45:13Talk about what?
45:15Being in R2.
45:16Way harder than an intern year.
45:17Yeah, um...
45:19Yeah, overseeing the med students, the interns, having no time to do my own charts.
45:24Just wait until you get into medical, surgical, and cardiac ICU.
45:28I stands for intense.
45:30Somehow that seems like an understatement.
45:33It does help you grow your clinical skills, you know, caring for the sickest patients.
45:38Tell that to these charts.
45:40Um, dictate.
45:42Helps you go faster.
45:46Oh, uh, what happened with our patient from Westbridge?
45:49You never grabbed me for his troponin.
45:51Mr. Samba, it was a posterior STEMI.
45:54What?
45:55Didn't show on the 12 lead?
45:56No, usually it doesn't.
45:57I think most clinicians would have missed it.
46:01But you didn't.
46:03Guess I got lucky.
46:07Whatever, fuckleberry.
46:10Okay, I'm sorry. Did I do something to bother you?
46:12Nope.
46:16Okay.
46:18Yo.
46:19What's up?
46:20I got a bounce back.
46:21You remember Debbie Cohen?
46:23Not really. I've seen 16 patients this morning.
46:26The restaurant worker with cellulitis on the dorsum of the foot?
46:29Yes, yes. She's on catflex. I'm marked the borders.
46:30Yeah, I got a hot pack on it, but, uh, you should take a look.
46:38Hi. Dr. Langdon.
46:40I wasn't expecting to see you back so soon. Meds upside your stomach?
46:44Uh, no. The pain got worse, and you said to come back if the redness spread outside the Sharpie line.
46:51Let's take a look.
47:02It looks like the infection isn't responding to the pills I prescribed you, so we need to get you on
47:07some IV antibiotics and get you back to the ED now.
47:10Uh, is it bad?
47:12Not if we can get a handle on it.
47:15Worse?
47:16Or maybe worse.
47:16No.
47:18No.
47:31No.
47:32No.
47:32No.
47:33No.
47:34No.
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