- 13 hours ago
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00:01.
00:15Drug show collapse at the waterpark.
00:17Two victims coming in via helicopter.
00:19ETA, five minutes.
00:20Time to rally the troops.
00:21I'll get environmental to clear and drop the trauma rooms.
00:23I'm gonna restock the crash carts with McKay
00:25to take the latest scripts to the drug cage.
00:27It would be a fun one.
00:28Fun one? What's up?
00:29Slide broke at the waterpark.
00:30Two victims.
00:31Five minutes to touchdown.
00:32No information on extended injuries.
00:33I can jump in with that.
00:34Ogilvy, grab some goggles, gloves, gown,
00:38go up to the roof.
00:38First patient that lands, bring him down.
00:41Hey, we've got two choppers.
00:42Then you wanna grab some bodies and meet me?
00:43What injuries are we expecting?
00:44Structural collapse.
00:45Could be anything.
00:46I can increase the morphine drip to manage the pain,
00:49but that could also slow down your breathing.
00:53You will likely feel very drowsy.
00:55You may lose consciousness,
00:57and it could cause you to stop breathing altogether.
01:10I'll be right back.
01:19Hey, you okay?
01:21Yeah.
01:22Sorry.
01:24Look, it's hard seeing your patients die.
01:27But as professionals, we have to create emotional boundaries for ourselves.
01:31It's not about us.
01:32It's about them.
01:35Yeah, she's so calm.
01:37I just...
01:40She had a long time to prepare for this moment.
01:43What she's doing for her sons.
01:46Managing this with so much grace.
01:49The real gift of love.
01:50I feel like an asshole.
01:53All they want is more time with their mother.
01:55All I want is less time with mine.
01:57Don't feel guilty.
01:59I mean, you can be grateful and gracious from a distance.
02:03Just talk to her.
02:04Tell her what you want.
02:05She'll understand.
02:08I doubt that.
02:11Give her a chance.
02:13You know?
02:14She may surprise you.
02:17Hey.
02:18Two birds headed our way.
02:20Need a hand?
02:20That's the rumor.
02:22Santos.
02:23Trauma incoming.
02:24Grab a gown.
02:25You can assist Dr. Langdon.
02:30Fuck me.
02:31Jesus.
02:32I got blood tubes growing moss over here.
02:34Tick tock, people.
02:36Hey, Olive.
02:37Give me a solid.
02:37Run these to the lab.
02:38No problem.
02:39I got more lab results.
02:41Start putting them on the patient clipboards.
02:43PTMC emergency.
02:45Go ahead, medic man.
02:46Do cyber attacks happen often?
02:47More than you realize.
02:48I blame the riskies.
02:49Dr. Mohan.
02:51It's your mother?
02:52She sounds pretty upset.
02:54She says she really needs to talk to you?
02:57You're shitting me.
02:58Tell her I'm not available.
03:10How's your ship going?
03:12It's been a lot already.
03:15You know, I worked in an ER before up in Vermont.
03:18And we had MBAs and ODs, MIs.
03:21But this place...
03:23This place is relentless.
03:26Holiday weekend.
03:27We're not normally offline.
03:29I think we have a very different idea of normal.
03:33It's not for everyone.
03:34I'm not sure it's healthy for anybody.
03:36Here's your leg.
03:38Jesus.
03:47I need more runners.
03:48Well, you could shut down the gift shop.
03:50They always have a couple of volunteers there.
03:52Everyone says volunteers use walkers.
03:54Beggars can't be choosers.
03:56Go get them.
03:57Okay.
03:57I'm gonna grab a smoke first.
03:59No time.
03:59Nicotine gum.
04:00Take the edge off.
04:01You two.
04:02Head to triage.
04:03Help out the front of the house.
04:04They're running out of space and there's a line out the door.
04:06Okay.
04:07Let's go.
04:07Hang on, Moham.
04:11Sign this.
04:14Nicotine patch, 21 milligrams.
04:16Who's it for?
04:17Monica.
04:18This nicotine gum shit.
04:19She'll never survive the shift that I need her so I don't lose my goddamn mind.
04:25Thanks.
04:26Is Dr. Abbott still around?
04:28He'll wait to get some sleep before his night shift starts in a couple hours.
04:30Shit.
04:31Okay.
04:31I should have planned this better.
04:33I was hoping he'd write me a letter of rec for an elective so I could have a shot at
04:37a fellowship next year.
04:38Which one?
04:41Whichever will take me.
04:42Did the electives fill up a while ago?
04:44Don't remind me.
04:45I'm gonna throw myself at the mercy of the court.
04:47Beg for them to take me anyway.
04:48Just kill me now.
04:50Be less painful.
04:52You know, I can't read this handwriting.
04:54It has...
04:551,000 milligrams of acetaminophen orale,
04:584 milligrams of dengetron under the tongue,
05:00and trial of clear fluids.
05:02Seriously?
05:03It says all that?
05:04It's not in the text with emojis.
05:06You kids can't read for shit.
05:11Rehab?
05:11Fall from 10 feet onto a metal fence.
05:13Right below the knee.
05:15Good vitals.
05:16Oh, it hurts.
05:17Oh, my God.
05:18What's she had so far?
05:1950 of vent.
05:19Repeated 25.
05:20No meds.
05:21No allergies.
05:21Where should I put this?
05:22Just hang onto it for now.
05:24On my count.
05:251, 2, 3.
05:29Hey, Whitaker.
05:30Eat fast.
05:30Donnie, primary survey, please.
05:32Pupils equal and reactive.
05:35What's your name?
05:36My leg hurts really bad.
05:38Did I break it?
05:39Um, I wouldn't say that it's broken exactly.
05:41We're gonna get an x-ray to determine that.
05:43Put that on the gurney.
05:45Line it up for x-ray.
05:45Keep your fucking mouth shut.
05:47Good.
05:47Long sliding right and left.
05:49Airway patent.
05:49Breath sounds bilaterally.
05:51My head hurts.
05:52BP, 100 over 60.
05:54Pulse, 118.
05:55Pulse lock, 98%.
05:56Does your belly hurt?
05:58No, asshole.
05:59It's my leg.
06:01Okay, she's really moving here.
06:02Andriticetamine?
06:03Yeah, we can't evaluate like this.
06:06Hey, Ogilvy.
06:08Deep breaths, yeah?
06:09Yeah, okay.
06:10What a girl, what's next?
06:11Uh, once she's sedated, finish the e-fast.
06:14Playing x-ray, check her back straight to CT.
06:16What if the ketamine wears off?
06:18Right.
06:18Uh, we should do a popliteal nerve block before the CT.
06:22Anesthetize from the knee down.
06:24Two of you.
06:25Tip, pushing ketamine now.
06:26What's the bullet?
06:26Forty-two-year-old male with 20 foot fall.
06:29I want chest trauma with hand injury.
06:31Where's my son?
06:32Where's my son?
06:33Saki to 108, SAS 98 on two liters.
06:36BP, 122 over 84.
06:37Or pan scan due to mechanism, you?
06:39Tim fib amputation.
06:41Hoping ortho can give us a little hope for replantation.
06:43Derek, where are you hurting?
06:44Chest.
06:45In my finger.
06:46Did they find my son?
06:47Did you hit your head?
06:48Don't think so.
06:49I need to find my son!
06:51We'll find him for you, but we need to take care of you first.
06:53Pericardium's clear, no fluid in Morrison's.
06:56Move both arms, wiggle your feet.
06:58Good.
06:59Any pain in your neck?
07:00No.
07:01Spleen looks good.
07:02Start with his chest, that's where he hurts.
07:04No hemotemp in him?
07:05Normal sliding.
07:07Best to start with the side he's complaining about first.
07:10Uh, I don't see much sliding there.
07:12His name is Jack.
07:14He's seven.
07:15Pneumothorax?
07:15Set up for a chest tube.
07:16Not yet.
07:17Uh, let's go posterior lateral, look for fluid first.
07:21Traumatic pneumothorax, we should prep the chest.
07:23Not necessarily, he's hemodynamically stable.
07:26Okay.
07:27Does that look like some fluid there?
07:29Hard to say for sure.
07:31Okay, he's tachycardic pneumothorax, he needs a chest tube.
07:34BP and SATs are fine, we can wait for CT.
07:36If it's small, it'll resolve on its own.
07:37We observe and reimage.
07:38I agree.
07:39He's stable for now, let's wait for the scan, Dr. Santos.
07:41Okay, let's order CT chest, abdomen, pelvis, and x-ray left hand.
07:47Whoa, major degloving.
07:49Focus on the primary.
07:50Dr. Langdon's correct, we need to log roll him.
07:54Okay, how about another four more feet?
07:56Put it in.
07:57Hang in there, Derek, we got you.
08:01Fuck off already.
08:03Boyfriend?
08:04Wish.
08:05My mom.
08:06Every time I get a second of service, another dozen types of men.
08:09Hey!
08:09How much longer do I have to wait?
08:11I've got a broken leg here.
08:12Someone will be with you shortly, sir.
08:14Am I allowed to use the bathroom?
08:16I really have to go.
08:17I don't know, ma'am.
08:18I am not your doctor.
08:19It says right there, doctor.
08:21Yes, but I'm not your doctor, but if you go back to your room, a nurse will come find you.
08:24I wasn't in a room.
08:26I had to be parked in the hall.
08:28Are either of you treating my mother?
08:29Nope!
08:37Take a seat.
08:38It's gonna be a while.
08:43Helen Torres, come on down.
08:48Helen Torres.
08:48Yes, yes.
08:49I'm going to go.
08:53Pass the door to this side.
08:55Oh, thank you.
09:10I'm Dr. Mullen.
09:11This is Dr. Kwan.
09:12Helen.
09:13How long has your leg been swollen, Helen?
09:15It's been getting worse over the past week.
09:19Dr. Mullen, your mom called again.
09:21She said you don't need to go back.
09:22Not now.
09:23With a patient.
09:27Sorry about that.
09:29Did you fall or hit your leg?
09:32No.
09:34Have you ever had a blood clot before?
09:37No.
09:41Are you all right?
09:42Excuse me?
09:43Do you need to sit down?
09:45Oh, no.
09:45I'm fine.
09:47You don't look too good.
09:48What?
09:50No, it's just, um...
09:52It's really hot in here.
09:54And, uh...
09:55And, uh...
09:56You need to sit down.
09:57I'm good.
10:00I just...
10:01I need some hair.
10:02Excuse me a second.
10:03No.
10:21I can't help.
10:30Look out, McWay.
10:32get in
10:35I'm okay
10:36I'm okay
10:37get in the fucking chair
10:43leave me
10:43coming through
10:45out of my way
10:47we were going down the water slide and the bottom just
10:49fell off
10:50I grabbed Zach's arm and I tried to hold on to the sides
10:53but my hand slipped and my ring got stuck
10:55my finger was ripping off and I just
10:58and I lost him
11:00we can numb up your finger as soon as we gauge the extent of the injury
11:03you can cut the damn thing off for all I care
11:05I just need to find Zach
11:07okay do you feel anything
11:09here? yeah sharp
11:10how about here? sharp again
11:12a little late for the show yo yo
11:13I am the show Dr. Langdon you're the warm up act
11:16I didn't know if somebody missed me
11:18Mr. Foster suffered a deke loving injury of the ring finger
11:20stable pneumothorax awaiting imaging
11:23hello sir I'm Dr. Garcia from the trauma service
11:26need the ring cutter
11:27that's why they pay the surgeons a big bucks
11:29possible flexor tendon injury
11:31try to bend up your ring finger
11:38let's go with the block
11:40you want to feel a pinprick and some burning?
11:43which tendon did we test Dr. Santos?
11:46seriously that's a med student question
11:48we're teaching hospital
11:50it's always good to review
11:53flexor digitorum superficialis is intact
11:55as it inserts on the middle phalanx
11:58correct
11:59gee thanks
12:01no sign of tension
12:03at least not tension you know
12:05let's wait for the CT
12:06I'll be next door
12:07Langdon
12:09Mel's sister's been asking for you
12:10she's getting antsy and we could really use the room
12:12CT's ready
12:13okay let Becca know I'll be there soon
12:15and Mr. Foster got separated from his son Zach
12:18at the water park
12:19I don't know if we could call for you
12:21my wife Angela
12:22Dr. Santos will you escort Mr. Foster to CT?
12:30help
12:30you need a hand here?
12:33what the hell happened?
12:34I think I'm having an MI
12:36my chest is so tight I can barely breathe
12:38okay I gotta get a swab lead
12:39Perla
12:40can I get an assist here?
12:42yeah I'm on it
12:44CT's normal
12:45why do we take down the tourniquet Whitaker?
12:47to give the residual limb blood slope
12:50two little pumpers
12:51a little figure eights
12:52how to take care of those
12:54park
12:56park the shark
12:56orthopedic surgeon
12:58is this a favorable amputation?
13:00pretty clean cut
13:01then sliced through like a guillotine
13:02x-ray
13:06not too bad
13:10stop
13:11tying off a couple materials
13:13I'm not blind
13:16where's the amputated leg?
13:17double bag, none ice
13:19sterile saline on the inner bag
13:21ice water
13:22in the outer bag
13:23no direct ice on skin contact
13:26we've spent a lot of time
13:27he still needs to look
13:33get Robbie
13:44antibiotics
13:44cefazolin and gent
13:46we've cleared her chest
13:47abdomen and pelvis
13:48clean wound
13:49no crush injury
13:51rapid transport time
13:54replantation is a go
13:55I'll book an OR
13:56irrigate the hell out of this
13:57three liters
13:58three liters?
13:59of saline
14:00genius
14:02thanks shark
14:07I knew he meant saline
14:10Dr. Robbie
14:11we need you in central sex
14:13Dr. Mohan may be having a heart attack
14:14what?
14:18EKG is normal
14:19you sure?
14:20check it out
14:21you can be here on second opinion
14:22what's going on?
14:23it's okay
14:23I'm okay
14:24you don't look okay
14:25you look like shit
14:27I feel like shit
14:28what happened?
14:29I don't know
14:30I just got really hot
14:32and I started having trouble breathing
14:35we should send up some labs
14:36just to be safe
14:38any chance you're pregnant?
14:40not sure I feel comfortable
14:41answering that
14:44no
14:44she was tacky
14:46but it's resolved now
14:47have you eaten anything?
14:48yeah
14:49you staying hydrated?
14:50100%
14:51I'm doing everything right
14:53it's everything around me
14:53that's all fucked up
14:54it's just my mom moving
14:56and calling me over
14:57and over again
14:58and now me scrambling
14:59to find a job next year
15:00I had it all planned out
15:01and now everything's
15:02just out the window
15:03wait a minute
15:03is this a panic attack
15:04because of your mommy issues?
15:06what? no
15:07Jesus
15:08do you need to go home?
15:09you should go home
15:10no I'm fine
15:10I don't need the fucking liability
15:12go home
15:12and the rest of you
15:14the last time I checked
15:14the ED is a shit show
15:16so let's all get back to work
15:17huh?
15:25sorry for taking so long Becca
15:27nurse Dana said you'll be back
15:29in a few minutes
15:30but it's definitely been more
15:31than a few minutes
15:32you're right
15:32my apologies
15:34I brought some drink options
15:36okay
15:36we've got apple juice
15:39cranberry juice
15:40OJ
15:42and Pittsburgh's finest
15:43what's that?
15:45water
15:46OJ please
15:47okay
15:49let's see
15:54all right
15:57now I am going to give you two pills
15:59the first is an antibiotic
16:01that will get rid of the infection
16:03the second should take care of the burning
16:05you want to take both pills
16:07for three days
16:08and drink lots of water
16:09I'll write it all down
16:11I hate pills
16:13could you mash those up
16:14and put them in the OJ for me?
16:16coming right up
16:19okay
16:22Mel's going to be super worried
16:23when you tell her
16:25you are going to be just fine
16:26but um
16:27as far as telling your sister
16:29what's going on with you
16:30that is your decision
16:31not mine
16:34so
16:35you're not going to tell Mel?
16:38I can't
16:39not unless you
16:40my patient
16:41tell me to
16:45do you know when
16:46Mel's going to be done
16:47with her important meeting?
16:50hopefully soon
16:52Dr. Langdon
16:54you need to buy control
16:55of the two
16:59that guy I gotta go
17:00I will be
17:01don't say in a few minutes
17:02unless you actually mean
17:03in a few minutes
17:05I would never
17:11and I need you
17:12to be kind
17:12to each other
17:14I'm kind
17:15she's just a butthead
17:16sometimes
17:19he's your brother
17:21and he loves you
17:25don't go
17:27I don't want to go
17:29but it's
17:30it's not up to me
17:33okay
17:34we'll always be connected
17:37no matter what
17:42invisible string
17:47invisible string
18:01hey
18:04you gonna go in
18:05and see your mom
18:07cancer sucks
18:10yeah
18:11yeah it's us
18:16it's not fair
18:18no it's not
18:24I don't want to go in there
18:28nobody's gonna make you
18:36she didn't used to look like that
18:41yeah I get that
18:46but if you don't go in there
18:48and say goodbye
18:50and tell your mom you love her
18:53I think you might wish you had
18:55for a very long time
19:01it's your call
19:06D5 half normal saline
19:0828k
19:08run it at 125 an hour
19:11one of the most common reasons
19:12for traumatic replantation
19:14failure is infection
19:15so we do what Whitaker
19:16rinse and repeat
19:17until surgery calls for us
19:21is everything okay
19:22with Dr. Mohan
19:23she's fine
19:24focus
19:30I don't know
19:32Kenamine's wearing off
19:33I can't feel my leg
19:39I'm Dr. Michael Rabinovich
19:41you're at a hospital
19:41and we gave you a nerve block
19:43so that you can't feel any pain
19:44why
19:45you were on a water slide
19:47that collapsed
19:47and did serious injury
19:48to your leg
19:50okay
19:54fuck
19:55is that my leg
19:56is that my
19:57did you cut my fucking leg off
19:58your leg was cut off
19:59in the accident
20:00our surgeons are going to
20:01try for replantation
20:02I
20:03no
20:03she needs more catamere
20:05just wrap up the leg
20:05Emily I know that this is
20:06really hard
20:06I need you to focus on me
20:08right now
20:08because we need to get
20:09your consent to proceed
20:10with the surgery
20:11why
20:11there are risks
20:12with the surgery
20:13there's anesthesia
20:14no
20:14and there's no guarantee
20:15Emily
20:17can you just
20:17just put it back on
20:19can you just
20:20put it back on
20:21so as I can send to me
20:22now can she have sedation
20:23okay load it up
20:24ketamine and rock
20:24it's gonna be okay
20:25it's gonna be okay
20:26we're gonna intubate
20:27before the OR
20:27it's gonna be okay
20:30finishing second cut
20:32success
20:33can that be saved
20:34the finger or the ring
20:36the wedding ring
20:37uh yes sir
20:38a jeweler can weld it
20:39back together
20:40good as new
20:41stop
20:42irrigate
20:43the ring shavings off
20:44first
20:46what did I miss
20:47finishing irrigation
20:49okay
20:50doesn't look like
20:51you lost any skin
20:52it's a little dusky
20:53might not be viable
20:54there's intact skin
20:55on the dorsum
20:56more irrigation
20:57then tack it down
20:58with one suture
20:58okay thanks
21:00radiologist reports
21:01a 25% in the thorax
21:03is that bad?
21:04that is a partially
21:05collapsed lung
21:06that needs treatment
21:07I can put in a chest tube
21:08he doesn't need a chest tube
21:10okay
21:10what do you want
21:11a pigtail catheter
21:12I was thinking a thore event
21:14what why
21:15it's not a bad idea
21:16no need for wall suction
21:18the pan can operate today
21:19he can go home tomorrow
21:20with a thorvent
21:20you can learn a lot
21:22from your senior residents
21:23I'm happy to teach
21:24Dr. Santos
21:26thank you Dr. Langdon
21:32Janelle
21:32I need you to take
21:33the samples
21:34to the lab
21:34and come back
21:35with any results
21:36that are ready
21:37Joffrey
21:37head to CT
21:38to see if any new results
21:39are printed
21:40and bring those back
21:40Pam
21:41check in with whoever's
21:42running the PDS
21:43to see if any orders
21:45need to go to the pharmacy
21:46and bring back any meds
21:47that are ready for pickup
21:48rinse and repeat
21:49every 15 minutes
21:50double tie those shoelaces
21:51and hydrate
21:52it's not a sprint
21:53it's a marathon
21:55fine my pretties
21:58okay
21:58any word I'm finding
21:59on water slide dad's kid
22:00not yet
22:01called the wife
22:02went straight to voicemail
22:04at least dispatch said
22:05that there were a couple
22:06of fatalities on site
22:07when adult one kid
22:08sweet Jesus
22:09who the fuck did this
22:11no sign up on orders
22:12for labs
22:13or x-rays
22:14and it's in the wrong
22:15freaking wreck
22:15you guys trying to kill
22:16me and the patient
22:17I'll take care of it
22:18thanks
22:19Dana
22:20this gum is
22:21absolutely
22:21shit I know
22:23Pam, she said
22:24you needed this right away
22:25just in time
22:25slap one on
22:26and give it an hour
22:27to kick in
22:27you're welcome
22:29what?
22:31the prescription
22:31is for you
22:32my insurance will cover it
22:33hers won't
22:34is that insurance fraud?
22:37tell me in jail
22:38I could use a vacation
22:43mom
22:49I'm
22:49I'm really glad
22:50to see you mom
22:51I
22:51Garcia told me
22:52about the sigmoid
22:53volvulus you missed
22:53it was an oversight
22:55that could have killed her
22:57without electronic records
22:58it's been kind of a challenge
22:59to figure out
22:59chaos is the status quo
23:00in the ED
23:01even when the computers
23:01are working properly
23:02you have to be hyper vigilant
23:03and double check everything
23:04I can handle it
23:05why would you want to?
23:07don't hear you're learning
23:08street level medicine
23:09all the seat of your pants
23:11oh well
23:11I made a mistake
23:12but the more talented
23:13practitioners upstairs
23:14will fix it
23:17you are better than this
23:22love you
23:28well
23:29that is one way
23:30to do a debrief
23:31you should talk to her
23:32which one?
23:33honestly
23:33both of them
23:34can you call in
23:35some extra doctors?
23:37sure
23:37everyone's dying
23:38to work on the 4th of July
23:39why?
23:40Dr. Mohan went down
23:41yeah
23:42I saw your pep talk
23:45she's taking a little break
23:46until her labs are back
23:47she's going to be fine
23:48but I'm not sure
23:49her head is in the game
23:51I'm on it Cap
23:52small stab incision
23:54with the 11 blade
23:55midclavicular line
23:56second intercostal space
23:58she's going to stab me
23:59it's just a medical term
24:01stay superior to the rib
24:07is there a problem?
24:09nope
24:09everything's going well
24:11place the trocar
24:13hold back the adhesive wings
24:16and advance until you see
24:18the red diaphragm move
24:20that means you're in
24:21the pleural space
24:23now remove the trocar
24:28perfect
24:29okay
24:30now we can either
24:32hook up to wall suction
24:33or we can use this
24:34one way valve
24:35to repeatedly aspirate
24:36with a syringe
24:37now with all your
24:38vast experience
24:38Dr. Langdon
24:39you should probably decide
24:43we can avoid wall suction
24:45if I pump manually
24:46have at it doc
24:47enough
24:48apparently decency and decorum
24:50need to be reintroduced
24:50to our R2 curriculum
24:52nice work Dr. Langdon
24:54we'll go check in a no R
24:55for Mr. Foster
25:02hey
25:02I'm going to need you to pick up your face
25:05get a sec Dr. Mullen
25:07just almost died on me
25:08not even close
25:09she's tougher than she looks
25:11propane hero
25:11and north four
25:12hey any word from surgery
25:14on how our big patient
25:15Howard's perforated diverticulitis
25:17is going
25:17still in the OR
25:18what about our drunk firework kid
25:20waiting this turn
25:20in the surgical conga line
25:22what about social services
25:24that they found
25:25a temporary foster home
25:26for our baby Jane Doe
25:27still working on it
25:29kid's going to be old enough
25:30to drive
25:30by the time she gets out of here
25:31you joke
25:34oh for fuck's sake
25:36go
25:37quickly
25:37before I change my mind
25:39hey
25:40did the county pick up
25:41Louie's body yet
25:42no he's still in the viewing room
25:43Jesus
25:44he's just laying in there
25:45yeah
25:45another couple minutes
25:46I'm wheeling him down
25:47to the morgue myself
25:50what's the bullet
25:50eight year old boy
25:51part of the water park accident
25:52thrown off the water side
25:54how far did he fall
25:54maybe six or seven feet
25:56landed in a tree
25:57had to wait for a ladder
25:58check to get him down
25:59major neck trauma
26:00must have taken all the impact there
26:01couldn't two roam
26:02hard to bag
26:02sats in the 80s
26:03BP 85 over 60
26:05pulse 50
26:08okay one
26:09two and three
26:12possible laryngeal fracture
26:13hypoxic bradycardic
26:15kid needs an airway
26:16before your wrist
26:16brazil tape
26:18peens cart
26:18set up suction
26:19oh my god
26:20is that Zach
26:22hey
26:22hey kid
26:23can you look at me
26:25no response
26:26no purposeful movement
26:27to pain
26:29oh my god
26:30is this your kid
26:32no
26:32circle back to your room
26:33now
26:33brazil says 25 kilograms
26:35jesse
26:35five and a half
26:36et2
26:36okay uh
26:38a 30 of rock
26:3950 can be
26:39you're gonna paralyze
26:40yep
26:41if we can't intubate
26:42we crack
26:43he's too young
26:44for a crack
26:44needle crack
26:45you can't ventilate
26:46through that
26:46sats down to 78
26:4711 blade kelly
26:48and a peds bougie
26:49one quick look
26:50and then we cut
26:51i can't tell
26:52if there's lung sliding
26:52no movement
26:53no air entry
26:54way too edematous
26:55i can't see the cores
26:56better with cricoid pressure
26:59nothing
26:59fuck
27:00okay
27:00tall world between
27:01the shoulder weights
27:02down to 49
27:03headed to cardiac arrest
27:04the trach's gonna take
27:0520 minutes
27:05this kid's not gonna last
27:0660 seconds
27:06that's why we're doing
27:07a slash trach
27:08don't know it
27:08me neither
27:10boss
27:10she'll get what you got
27:20pull up the trachea
27:22between your thumb
27:23and middle finger
27:24vertical incision
27:25right over the trachea
27:27vertical not horizontal
27:29or you transect the trachea
27:31and cut the jugular veins
27:33that's a lot of blood
27:34now it's a tactile procedure
27:37two centimeter incision
27:38through the tracheal rings
27:40finger in the trachea
27:44bougie into the airway
27:47thoughts on what's next
27:48dr. Whittaker
27:49insert the et tube
27:50into the trachea
27:52suction
27:52lots of blood in the airway
28:01okay back in
28:03check the co2
28:06sounds coming up
28:07in the 80s
28:07bilateral breath sounds
28:09and tidal co2 is 70
28:11that's crazy high
28:11it'll come down
28:12tie down the tube
28:13control all the bleeders
28:14spray an amp of epi
28:15on a stack of 4x4s
28:17okay
28:18sats are up to the 90s
28:20good co2's in the 50s
28:22good heart rate
28:22you forgot the last step
28:23change your underwear
28:25how many of these
28:26you done
28:27first one
28:28you serious
28:29what about you
28:30none
28:31i practiced in the sim lab
28:33when i was at stanford
28:34what'd i miss
28:34all the fun
28:35slash trach
28:36seriously
28:38fractured larynx
28:39couldn't oxygenate
28:39couldn't ventilate
28:40he was a meat cleaver
28:41on this kid
28:42e and t can revise
28:43the trach in the or
28:45they'll be thrilled
28:46to clean up your mess
28:47or maybe they'll thank us
28:49for not letting him die
28:56so we're still waiting
28:57on your prescription
28:57and the pharmacy's a little
28:59backed up
29:00but i'm glad to see
29:01you're doing good
29:02well
29:04i'm well
29:06glad to see you're well
29:08can't you expedite
29:09my medication
29:11sure
29:12but it may still be
29:13a little while
29:13before dr mohan
29:14can sign off
29:14on the discharge
29:15so
29:16sit tight
29:19and do what
29:24you just keep this handy
29:25for occasions like this
29:28uh i thought that i might
29:29not have that much
29:29to do today
29:31but
29:33man i was wrong
29:41thank you
29:47what brings you in today
29:48a friend made me come in
29:50name's robbie
29:52he said i should
29:52ah you're duke
29:54donnie
29:56robbie's vip is here
30:01hi i'm donnie
30:03nurse practitioner
30:04robbie's already put in
30:05orders for a numbing spray
30:07for your nostril
30:08nostril
30:09it's my throat
30:11it's not my nose
30:11okay let's get you uh
30:13set up in a room
30:18that was the most unprofessional
30:20deposition i've ever witnessed
30:22they were nowhere near that
30:23aggressive with dr ellis
30:26okay
30:29it didn't go as badly as you think
30:31they suggested i was incompetent
30:33they're posturing to set the stage
30:35for a ridiculous settlement request
30:38this isn't about those parents
30:39or that kid
30:40it's only about trying to make
30:41a lot of money
30:42well
30:43i don't have a lot of money
30:45not your money dr king
30:46it's an insurance game
30:48you're protected by the hospital
30:49this won't affect your career
30:57hey how was your deposition
30:58uh
30:59have you seen dr langdon
31:00uh no
31:02why
31:04okay okay
31:05how is becca
31:06oh she's fine
31:07yeah
31:07okay i should go see her then
31:09how was your deposition
31:10i'm sure i was stressful
31:12uh
31:15what's going on with becca
31:16what's her diagnosis
31:17i can't tell you
31:19why
31:20hipaa
31:21seriously
31:21if you want to know
31:23what's going on with becca
31:23you're gonna have to ask yourself
31:25okay you survived your deposition
31:27welcome back to the seventh circle of hell
31:28what uh what's this
31:29you're welcome for covering your patients
31:32they are yours again
31:33might want to check on the pancreatitis
31:34in our three first
31:36oh okay
31:37langdon
31:38i got some intel on louie
31:40they move him out of the viewing room
31:41no but can he's promised
31:42they're on the way to come get him
31:43can i get the county coroner's number
31:46what for
31:47i just want to make sure
31:48if no family shows up
31:49louie gets a proper burial
31:50that's expensive
31:51you may want to rent it
31:52by the missus first
31:53uh
31:54maybe i started go fund me
31:55i bet people around here
31:56would pitch in
31:57hey kid
31:58you can't do this for a ran house guy
32:00that dies around here
32:02better but for the grace of god
32:03no the success of your sobriety
32:05is a testament to your support system
32:08louie didn't have that
32:09still
32:10louie was a good man
32:11he deserves to be put to rest
32:13with dignity
32:14okay
32:15i'll dig it up
32:19you heard all that
32:22robbie
32:23your vip's here
32:24got him in central 11
32:26finally
32:30about fucking time
32:31if i knew you were going to make me wear a dress
32:33i wouldn't have come at all
32:35dennis whitaker
32:35meet my buddy duke
32:37nice to meet you
32:38any friend of dr robbie's
32:39friend of mine
32:40friend is a vast overstatement
32:42he's more just a pain in my ass
32:44don't let his surly exterior fool you
32:46deep down inside he's just as grumpy
32:48how did you two meet
32:50tinder
32:52jeez
32:52duke is a motorcycle engineer
32:54you should have seen his bonnieville
32:56when he first brought it in six months ago
32:58someone left it for dead
33:00he helped me bring it back to life
33:01today we're going to return the favor
33:03dr whitaker is one of our most trusted physicians
33:05and today he's going to help me oversee your care
33:07uh
33:07what seems to be troubling you
33:09ask him
33:11he's the one who made me come in
33:12he's had some hoarseness
33:13on and off for a couple months
33:14okay
33:15any history of tobacco
33:16or alcohol use
33:18two of my oldest and closest friends
33:20former two-pack-a-day smoker
33:22and lover of the drink
33:23okay
33:23you got any medication
33:24uh
33:25blood pressure meds
33:26mm-hmm
33:27which he forgets to take
33:29he's all numbed up and ready to go
33:30okay
33:31thank you donnie
33:33my man
33:34i'm going to take this scope
33:36and i'm going to stick it in your nose
33:38and we're going to check out
33:39your upper airway
33:41that seems like a lot of fuss for a sore throat
33:43dr whitaker
33:44you want to explain to duke
33:45why this procedure is absolutely necessary
33:47the scope is going to give us a better view
33:50of your voice box
33:50and your vocal cords
33:53here we go
33:54yeah
33:59i feel a little pressure between your eyes
34:01i am sorry about that
34:03okay
34:03just breathe through your nose
34:05this is going to help us see if there are any abnormalities
34:08like inflammation
34:09tumors
34:10nodules
34:11that all looks pretty normal
34:13i don't see too much drainage
34:14stick your tongue out for me all the way
34:16all the way out
34:17good
34:18now say eee
34:20eee
34:20good
34:21now again say eee
34:23eee
34:23good
34:23removing the scope
34:27dr whitaker what do you think
34:29looks normal
34:29no abnormalities
34:30told you it was nothing
34:32with your history of smoking
34:33i'd like to do a chest x-ray
34:35if there are growths
34:37they can push against the recurrent laryngeal nerve
34:40intermittently
34:40that can paralyze one of the vocal cords
34:42and cause the hoarseness
34:45that sounds like a lot of bullshit
34:47doctors speak to charge me more
34:49you've got medicare
34:50besides i finally got you into my ed
34:52you're going to get the golden workup before i leave town tonight
34:55only an idiot would ride all night after working a 12-hour day
34:59that does sound pretty dangerous
35:01stay put or do i have to tie you down
35:03fine so long as you keep your hands where i can see them
35:06no promises
35:06let me know when his chest x-rays back
35:08yeah
35:13hey
35:15are we okay
35:18uh yeah
35:19why
35:21i don't know
35:21you kind of ripped me a new one in front of langdon
35:25whose side are you on
35:26this isn't middle school
35:28langdon made a mistake and owned up to it
35:30let it go
35:31he should
35:34he should have been fired
35:36but instead he waltzes back in here
35:38no big deal
35:39meanwhile i've been a goddamn pariah for the last 10 months
35:42for doing the right thing
35:43or maybe you're a pariah because you don't play well with others
35:48if you still got beef with langdon
35:49go tell him
35:50he's here to stay so put on your big girl panties and work it out
35:54no
35:55you want to have sex and eat ramen in bed i'm your girl
35:58but if you want to talk about this langdon shit
36:13how's it hanging dr j
36:15never call me that again
36:17it was a joke
36:18relax he's clueless about your tiktoks
36:22but you're not
36:24props on the side hustle
36:25there is no hustle there's some stupid videos
36:27wait are you an influencer
36:29no
36:29yep
36:32yo pre-docs it's not happy hour yet
36:34there's still shit ton of patients to be seen
36:40oh ben our slash trade kid from the water park
36:43had some purposeful movement in pre-op
36:46that's a good sign
36:47take the win
36:51we need to talk
36:54we are talking
36:55in private
37:05what the hell was that with samira earlier
37:08that was tough love
37:09you are her superior
37:11she was obviously struggling and your advice was go home
37:14essentially yeah
37:15this is the ed it's not for the faint of heart
37:18it's not for the unempathetic either
37:21samira's not having a panic attack because of her patient
37:24she's having one because of personal baggage
37:25what she needs to do is pull her head out of her ass and focus on the work
37:28what about you
37:29what do you need to get some basic human empathy back
37:34i don't know
37:36something that gives me a little hope this place won't fall to shit when i'm gone
37:40found him
37:42found who
37:43the water slide dad's kid
37:44how'd you manage that
37:45i went outside stalked the dad's ig
37:47found a pic of his son sent it to pittsburgh pd
37:49now they're on the way over
37:50well maybe gen z should be working for the fbi
37:57hi
37:58hi
37:58mal
38:01you uh you doing all right
38:03i'm a little bored
38:06um how are you feeling
38:07a lot better dr langdon gave me some medicine and oj
38:10he's super nice
38:12i see why you like him
38:15did he tell you what the medicine was for
38:17yes
38:18um did you tell her
38:20i did not
38:22uh i explained to becca that due to doctor patient confidentiality everything she told me was private
38:28and that it was her decision if she wanted to share anything with you or not
38:34um do you want to share
38:35yes
38:46i have a urinary tract infection
38:52oh
38:54okay
38:54yeah
38:55those um
38:56those can happen if you you know hold your pee in for too long or you accidentally wipe from back
39:01to front
39:02mel i know i know mel he told me
39:03oh
39:04good
39:05you know he also told me it can happen from having sex
39:10uh yeah it can
39:11uh it's not like you're having sex
39:14yes i am
39:19what i'm having sex
39:22with who
39:25my boyfriend
39:26you have a boyfriend
39:27yes
39:28his name is adam and
39:31we're having sex
39:33lots of sex
39:36okay
39:40um
39:41mel
39:42are you okay
39:46mm-hmm
39:49got a sec
39:51sure
39:51how you feeling
39:53i'm fine
39:55are you sure
39:55yeah
39:56troponin d-dimer and tsh all normal
39:59listen i'm sorry about earlier i think i was being
40:02a dick
40:04i was gonna say i'm professional but probably that too
40:08i'm sorry
40:10thanks
40:12but now i kind of need you to stop feeling sorry for yourself and focus back on your patients
40:16i think you can do that
40:19sure
40:19great
40:24with this extra dose
40:25and increased morphine from the pump
40:28your pain should subside
40:29your breathing will slow down
40:32you may get very sleepy
40:36i'll go be with the boys
40:39they need you more than i do now
40:43later
40:45right now i'm exactly where i'm supposed to be
40:55yeah
40:56okay
40:58here we go
41:00summer me
41:026 jv
41:02i love you
41:24to me
41:28ready to be
41:32Down from the storm
41:39Brought me over on
41:47Juniper over
41:55Can't be done
42:01Down from the storm
42:09Brought me over on
42:17Juniper over
42:24Juniper over
42:28Juniper over
42:28Juniper over
42:29Juniper over
42:29Juniper over
42:30Juniper over
42:30Juniper over
42:30Juniper over
42:31Juniper over
42:32Juniper over
42:32Juniper over
42:32Juniper over
42:32Juniper over
42:32Juniper over
42:34Juniper over
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