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00:12Dr. L?
00:16Dr. L?
00:19Trauma's at the back door.
00:27Let me know when the rest of her labs are back.
00:31The girlfriend hasn't been much help.
00:33Is she being uncooperative?
00:36No, not really.
00:37Apparently she's only been going out with the little girl Kylie's father for a few months.
00:41Where's he now?
00:42She's in Newcastle for work.
00:44I left him a message to come in.
00:46Okay, come find me when he gets here.
00:47Have you talked to the trauma counselor this week?
00:49I'm going to.
00:51Promise.
00:52Okay, good.
00:53Medics are rolling in.
00:53I'll be right there.
00:54How's our little girl who took a stair tumble?
00:57I'm going to check for internal hemorrhage with an ultrasound.
00:59What is your gut telling you?
01:00Her gut?
01:02Yeah.
01:03It's this thing that AI will never have.
01:05I don't want to think about what my gut is saying right now.
01:09Come find me when you know more.
01:11Us, if you don't mind.
01:12I don't mind us.
01:13Come find us when you know more.
01:14Do you want to jump on this trauma?
01:15I've got my hands full.
01:17I don't want this one getting away from me.
01:19We don't know what this is yet.
01:20Don't go jump into conclusions.
01:21I'm not jumping to anything.
01:22I'm just looking out for my patient.
01:28Something I should know about scientists?
01:30Very confident.
01:31Not afraid to get her hands dirty.
01:33Strong patient advocate.
01:34Fearless.
01:35Seems like you were suggesting she jumps to conclusions.
01:37No, no, no, no, no.
01:37I was merely suggesting or reminding you not to.
01:39Yeah.
01:40A 58-year-old guy, trip with a scaphoid fracture, epistaxis, non-focal neural, but it's nice head trauma.
01:47But every time I check on him his affect has drastically changed.
01:50My gut is telling me something's not right.
01:57What?
01:57Nothing.
01:58Your plan.
02:00So with the head CT, if normal, LP, ruled encephalitis.
02:03Put in your orders.
02:04Has he been here before?
02:05Hmm?
02:06Have you called the family to rule out any psychiatric history?
02:08No, but I will.
02:09Do you want to jump on this trauma in the meantime?
02:11What is that?
02:12It's a surprise.
02:13Wonderful.
02:17Mel, you want to jump on this?
02:18What is it?
02:19It's a surprise.
02:21What do you got for it, Sam Boy?
02:22Alan Billings, pallet of roofing tiles.
02:25Fell eight feet.
02:25Hit his upper arm with an open dislocation.
02:28Ouch.
02:29Two rounds of Fent.
02:30One, then 0.5 per kilo.
02:32A and O with good vitals.
02:33Mel, hold the arm steady.
02:35Sure.
02:36Uno, dos, tres.
02:39Mr. Billings, I'm Dr. McKay.
02:41And I'm Dr. Garcia from surgery.
02:43And this is Dr. King.
02:44Hi.
02:44Oh, it really hurts.
02:46Give us a minute and we're going to take care of that, okay?
02:48Any headache?
02:48Chest or belly pain?
02:49Oh, just the arm.
02:50Satz 99.
02:51Pulse 104.
02:52BP 116 over 78.
02:53What do you think, Dr. King?
02:54Oh, um, it is an open dislocation.
02:57Can you be more specific?
02:59I think it's inferior, yeah.
03:02Do you remember the name for that?
03:07Sounds like a Harry Potter spell.
03:12Luxatio erecta.
03:13Correct.
03:13Check the neurosurgeon.
03:14Sir, can you feel me touching you?
03:17Okay.
03:18Can you wiggle your fingers?
03:19Yeah.
03:21Good radial pulse.
03:23E-fast is negative.
03:24Hey, what's the next thing for McKay?
03:25Uh, Ansef and Genomycin.
03:28Sedate for traction.
03:30Retraction.
03:30Then you need a CT angiogram to rule out vascular injury.
03:33That sounds like a plan.
03:34But with an open joint, you need to wash out in the OR with Ortho.
03:37Agreed.
03:38Instead of wasting time down here, it should be easier to reduce undergenital anesthesia with fewer risks.
03:43Possibly.
03:44Let's get an opinion from Ortho.
03:47You're definitely new, Dr. Wishful Thinking.
03:49Ortho would like to take their sweet time.
03:51Okay, sedation orders, Dr. McKay.
03:52100 of Propofol titrate to effects.
03:54Be back with that.
03:56Excuse me.
04:01How's the day going, doc?
04:03Yeah, pretty good.
04:04Looks like your albumin's infusing.
04:09Oh, uh, medical students Ogilvy and Quan are gonna be working with me.
04:13Hello.
04:14Student doctors.
04:15You want them to try it?
04:16They gotta learn sometime.
04:18It's best if they watch the first one.
04:21I can prep and drape?
04:22Yeah.
04:23After your albumin's in.
04:25That's correct.
04:26To prevent hypotension, we introduce albumin if we anticipate more than five liters.
04:31Last time, it was six.
04:33That's like a gallon and a half.
04:35Of high octane premium.
04:37Okay, you need anything else, Mr. Louie?
04:40No, ma'am.
04:40Okay.
04:41Grab me when you're ready.
04:42Yeah.
04:44Whitaker, wife of your DNR this morning's in Central A.
04:47Did she know her husband died?
04:49Not that you tell her.
04:51I'll be right there.
04:53Uh, yeah.
04:54Uh, always make sure your entry point is safe by identifying the pocket of fluid.
05:00That's not a pocket.
05:01That's a leg.
05:02Yeah, but you do not want to hit a vein or artery on the way in, so make sure you
05:05check with color Doppler.
05:06Oh, oh.
05:09Joey?
05:10I can't see.
05:11I can't see anything.
05:13It's because your eye is shut.
05:13I can't open it.
05:14It's glued shut.
05:15I was trying to put on lashes.
05:17Oh, my God.
05:19Oh, my God.
05:20Am I going to go blind?
05:21No, no.
05:21I'm pretty sure this is something we can fix.
05:23Just take a deep breath.
05:27Okay.
05:28So you, uh, glued your eyes shut with what exactly?
05:31Superglue.
05:32Okay.
05:32Well, is it something you typically use to apply your lashes?
05:34No, it's typically something you use to glue shit.
05:37You break, like, coffee mugs and stuff.
05:39You know what I'm talking about.
05:40It's, it's, it's superglue.
05:41Okay, okay.
05:42Yeah, got it.
05:44Can I just talk to Dr. J?
05:45She'll know what to do.
05:47Is that an ophthalmologist?
05:49No, she works here in the ER.
05:52Yeah, I don't think so, but I know what I'm doing.
05:55Most of the time.
05:59For a Z-track, we pull up the skin before advancing into the peritoneal space.
06:06Looks good.
06:07Fluid's clear.
06:08Does that hurt as much as it looks?
06:11Oh, it's not too bad.
06:13Hey, Ogilvy, spike the bottle from you?
06:15What tests do we want on these fluids?
06:17Uh, cell count to rule out spontaneous bacterial peritonitis.
06:20Ding!
06:20What would make that diagnosis, Joy?
06:23Um.
06:24Absolute neutrophil count over 250.
06:27How are we doing in here?
06:29They are doing great.
06:31I think they got this.
06:37Hey, Dana, can you get Chiara down here for me?
06:39She isn't answering her spectral link.
06:40She's not working today.
06:41It's, uh, I forget.
06:44I'll find out and get them down here.
06:45What else do you need?
06:46How about a double espresso martini?
06:49I like the way you think.
06:52Hey, Trudy, it's Dana.
06:53What's going on up there?
06:54What's up, Crash?
06:56You mean besides my mother driving me insane?
06:58I just tell her that her efforts would be better suited to endorsing someone like myself.
07:05If you're seriously thinking of a double residency, let me save you the trouble.
07:09You can't do it.
07:11Why?
07:12Just because you couldn't do it?
07:16Honestly, yes.
07:17Because you're a genius.
07:19Yes.
07:20What's the square root of 841?
07:22I'm not a human calculator.
07:24Social worker Dylan Easton is covering for Chiara this weekend.
07:27They're on their way down.
07:29Yep.
07:31Oh, shit.
07:32I have a nun with conjunctivitis.
07:35Her swab is showing gram-negative intracellular diplococci.
07:38Thonorrhea?
07:39Come to Jesus.
07:41Well, a lab must have made a mistake.
07:44Maybe it's an immaculate infection.
07:46We'll call the lab soon.
07:47Clear this up.
07:47Trade carefully, Missy.
07:49There's a nun with gonorrhea.
07:51Okay.
07:52In her eye.
07:55Seriously, you guys are going to take this away from me?
07:58Disappointed in you two.
07:59Twenty-nine.
08:01What?
08:02Square root of 841.
08:05How we doing with Mr. Digby?
08:07He's in a gown in South 21.
08:09Is there someplace we can get this laundered?
08:10Does it go in right in the incinerator?
08:12We'll get him a whole new wardrobe.
08:14You ever use a cast saw before?
08:16Oh.
08:16Of course you haven't.
08:17Well, today's your lucky day.
08:18Follow me.
08:20Dr. Mohan, you got a minute?
08:22Yeah.
08:22Have you met Emma?
08:24First day, new grad RM?
08:25Hi.
08:26Nice to meet you.
08:27Emma needs to learn cast removal.
08:29How long's the cast been on?
08:30Months.
08:31Maybe years.
08:32Probably going to want to breathe through your mouth.
08:37All right, Mr. Digby.
08:39Dr. Mohan can cut your cast off now.
08:41How long's the cast been on?
08:43I don't know, but it's really getting itchy.
08:47Okay, this cuts the cast.
08:49Not the skin.
08:51This should relieve the itch him.
09:05Okay.
09:06So we can cast the spread.
09:07Okay.
09:15There you are.
09:16One more.
09:17Okay.
09:23Okay.
09:29Oh, I see you brought some friends.
09:31Oh, my God, are those maggots?
09:39I'll need ethyl chloride spray to freeze them off.
09:42Never saw that in nursing school, am I right?
09:50Now irrigate like hell, Mel.
09:53Okay.
09:58Okay, on my count.
10:01One, two, three.
10:04Come on, motherfucker.
10:07Humoral head is not reducing.
10:08Should be done in the OR.
10:09I am the OR.
10:11Okay, we're gonna get this back in
10:12before Ortho even answers the page.
10:14Mel, stick four fingers under that humoral head.
10:17Really?
10:17Yeah, get in there really, really deep.
10:19And when you feel the traction and lift it above the glenoid,
10:23that will convert this to an anterior dislocation
10:25and should pop right back in.
10:27Okay.
10:28Okay.
10:29Ready to go?
10:30One, two, three.
10:34Okay.
10:35Oh.
10:37Very cool.
10:38Sterile saline.
10:40Shoulder immobilizer and CT.
10:42I guess you guys don't need me anymore.
10:47You all right, Dr. King?
10:48Yeah.
10:50You don't seem all right.
10:52Well, my deposition is today.
10:55Ah, do you want to talk about it?
10:57I'm not allowed to.
10:58No, we don't have to talk about the deposition,
11:00but we can talk about how it is affecting you.
11:03Average emergency physician catches a med mal case
11:06every seven years.
11:06Nine times out of ten, the doctor wins.
11:08I've been sued four times myself.
11:10Dr. Al.
11:12I've never been named in a lawsuit.
11:19Um, but sometime...
11:25Sister Grace?
11:27This is one of my residents, Dr. Mohan.
11:29Nice to meet you.
11:31You as well.
11:31I wish we could recruit as dedicated
11:33and talented young women as you two.
11:36I imagine it's a calling, much like medicine.
11:38Yes, very much so.
11:41Sister Grace, under the microscope,
11:44we're seeing something called a gram-negative bacteria.
11:47Is that serious?
11:49It can be, if left untreated.
11:52But fortunately, we can give you a shot of antibiotics,
11:54irrigate your eye with a liter of saline,
11:56and give you drops to use at home every few hours.
11:58How did I get it?
12:02So, the appearance of the bacteria in your eye
12:05suggests that it's gonorrhea.
12:09Traditionally, that's the sexually...
12:10I know what gonorrhea is, Dr. Javadi.
12:13I'm a nun, not a numbskull.
12:15I do a lot of work in an unhoused shelter.
12:19Are you handling dirty sheets, pillowcases, soiled clothes?
12:24Yes.
12:25Part of my day is spent doing laundry,
12:28making beds, disposing of old clothes.
12:31Do you wear gloves?
12:33When they're available.
12:34Okay, well, let's get you your shot
12:37and set up for irrigating your eye.
12:40I bet we can scrounge up a couple boxes of gloves
12:42while you're here.
12:43It's important to protect yourself.
12:46We'll be back.
12:49Why am I here?
12:51I'm not sick.
12:53We took care of your husband, Ethan, earlier today.
12:57Is Ethan sick?
13:00Well, he was very ill.
13:03And, um, we did everything we could to treat him,
13:06but his heart stopped beating,
13:09and I'm so sorry to say that he died.
13:14He died?
13:17Ethan?
13:18No.
13:20No.
13:22Are you sure?
13:26Yes.
13:28No.
13:29No, no, no, no, no, no.
13:31Ethan isn't sick.
13:33No.
13:34I know how difficult this must be for you.
13:44Uh, kidneys look good on ultrasound.
13:46No intra-abdominal injury.
13:48Hey, Dylan.
13:49Hmm, Robbie.
13:50Is this the tumble down on stairs kid, Kylie?
13:52Yeah.
13:53And?
13:53I'd like to talk to the girlfriend first,
13:55away from the little girl.
13:56We can arrange that.
13:57Okay.
13:57Keep us informed.
13:59Yes, keep us informed.
14:01More labs are back on our abandoned baby Jane Doe.
14:05Well, everything looks normal so far,
14:08but you seemed really concerned earlier.
14:11She still needs a catheteran.
14:13Or not.
14:15You can't trust a bag-deran.
14:18Agreed, but we can avoid the trauma of a catheter.
14:20With a suprapubic tap?
14:21Oh, I may have a trick or two up my sleeve, Dr. Alashimi.
14:28Hey.
14:29Princess, hold up.
14:31Hi.
14:31How you feeling, Mr. Williams?
14:33Okay.
14:34A little nervous about going in the machine.
14:36I can get a tad claustrophobic.
14:38Yeah.
14:39Well, um, we're sending you for a CT, not an MRI,
14:42so it's like a open donut.
14:44Oh, good.
14:45I like donuts.
14:48There you are.
14:49Thought you forgot about me.
14:51Oh, no, I was just with other patients.
14:55So, what do you do for fun?
14:57I mainly do what my sister likes.
14:59Um, she loves Kennywood and the zoo.
15:01No, what about you?
15:04What do you like to do?
15:09Um, you still like, um, the Renaissance Fair?
15:14Really?
15:14Yeah.
15:15Isn't that kind of dorky, though, where everybody dresses up like somebody they're not?
15:19Yeah, but that's the fun, you know?
15:20You can be anyone or anything you want.
15:22I, um, I actually had this alter ego that was a 17th century French woman culture.
15:27Stop!
15:32You okay, kid?
15:33It was a doozy.
15:36Okay, we ready?
15:38Cleaned and dried with sterile gauze.
15:40Is that water cold?
15:41Right out the fridge.
15:42Okay, Jessie, you can take the armpits.
15:43I'm gonna take the legs.
15:45One, two, three, up.
15:47Dr. Alashima, you're gonna be our catcher.
15:50And Samir, you're gonna do suprapubic circles with that gauze.
15:53And the cold should stimulate waiting.
15:56Even if she pees, it's likely to be contaminated.
15:59Not.
15:59According to the British Medical Journal, they did the research.
16:02Any lukes or nitrites and we can't.
16:05Oh, oh, Dr. Alashima, get it?
16:08I was gonna invite you to join the softball team, but now I'm not so sure.
16:12There we go.
16:13Looks like you got a good midstream sample.
16:16Here's a fresh blanket.
16:17Okay, plan.
16:20Ceftriaxone, two-day admit till blood culture is negative.
16:23Next steps.
16:24Foster care.
16:26Oh, yeah.
16:29Someone must have been in a bad way.
16:31To walk away from you, little one.
16:34We need to call the police.
16:37Let me know what the urine dip shows.
16:42We will let you know what the urine dip shows.
16:46You must be Dr. Alashima.
16:49And you must be Dr. Langdon.
16:51I've heard all about you.
16:53Welcome back.
16:54And this is?
16:56Uh, Linda Stevens.
16:57One episode of substernal chest pressure resolved with rest.
17:0012 lead negative for stemming heading for north four.
17:04Hello.
17:05I'm Dr. Alashima.
17:07Nice to meet you.
17:08Nice to meet you.
17:10Ma'am, this is a teaching hospital.
17:12Is it okay if some of our trainees join me?
17:14Not a problem.
17:16Dr. Whitaker, Javadi, Ogilvy, Joy.
17:20Gather around.
17:22Dr. Langdon, you are more than welcome to stay too.
17:25Uh, maybe for a minute.
17:26We're pretty busy in triage.
17:28Okay.
17:30Stevens.
17:32I have an app on my phone that can listen to our conversation and the details of my physical exam
17:37and write it all up in your medical record.
17:39Wow.
17:41Cool.
17:42It's protected.
17:44Confidential.
17:44Doesn't even stay on my phone.
17:46What's going on?
17:47Somebody helped her took off when I saw the cops locked her backwards off a stool.
17:51Oh, Jesus.
17:52Head trauma.
17:52No LLC.
17:53Okay, you need to get checked out.
17:54I'm fine.
17:55No choice.
17:56It's work-related.
17:57Let's, uh, let's find her a room and prep for a burr hole.
18:00What?
18:02Oh.
18:04I forgot how much you like to joke.
18:06Captain Scurvy.
18:08Yeah.
18:08Who the hell's Captain Scurvy?
18:10It's an inside thing.
18:12How's our shoulder guy?
18:14Oh, he slept like a baby.
18:16CT angio shows no vascular injury.
18:18What about your slip and fall guy with the labile affect?
18:22Oh, Michael Williams.
18:24He's still in the scanner.
18:25He seems to have settled down so he doesn't need babysitting.
18:28Good, maybe he's coming around.
18:29Ortho can take Mr. Billings here for surgery.
18:31Play that order, sailor.
18:33Dr. Ravinovich.
18:35Nurse Hastings.
18:36You can call me Robbie.
18:37You can call me Noel.
18:42Oh, you could just tell me what the hell's going on here.
18:45This is Noel.
18:46She's our, um...
18:47Med control manager.
18:48No, we met.
18:49Case manager.
18:50And this guy will be staying.
18:51Oh, he needs surgery.
18:53Which his insurance will pay for at Westbridge Memorial, not here.
18:58Wait, so we have to transfer?
19:00If...
19:00If he's stable?
19:02I believe that he is.
19:04Look on the bright side.
19:05We're gonna free up a bed and discharge a patient.
19:07I mean, that's great for us.
19:08Not so good for him.
19:09He will get great care at Westbridge.
19:12Don't you agree?
19:13Robbie?
19:14I'm sure that he will.
19:17What am I missing?
19:19Is there something else happening with Alan Billings that I don't know about?
19:23Not medically.
19:24This is just a simple insurance transfer.
19:28Hmm, yeah, okay.
19:34What's that about?
19:36Nothing.
19:38Didn't feel like nothing.
19:39Dr. McKay has a very heightened sense of empathy.
19:42Meaning?
19:42Meaning she's good at picking up on stuff.
19:46You didn't say anything, did you?
19:47Nope.
19:48I subscribe to the Falstaff advice.
19:51Discretion is the bitter part of Ballard.
19:52Oh.
19:54You're still planning on leaving tonight?
19:56Yep.
19:58I don't understand why you can't leave in the morning.
20:02Will you excuse me for a second?
20:03I gotta go talk to a patient while she's separated from her caregiver.
20:06Oh.
20:06Yep.
20:06That doesn't sound ideal.
20:08It's not ideal.
20:08I gotta figure out what's going on, and I'll go find you before I leave.
20:13Okay.
20:17Okay, you're gonna start this.
20:21Hey, Stinks.
20:23Evans.
20:24Hope you know what you're doing.
20:25What is that supposed to mean?
20:29I'm a big girl.
20:31Okay, big girl.
20:34I'm fine.
20:36That's good.
20:36Follow my finger?
20:39How's the head?
20:41It's a little sore.
20:43Lean forward.
20:43Let me take that one.
20:46Yeah, you're gonna have a pretty good goose egg.
20:49Heavy?
20:50A little.
20:51I can get you some Tylenol unless you need something stronger.
20:54Oh no, that's okay.
20:55I'm not very drug tolerant.
20:57Lucky you.
21:02I'm glad you're back.
21:04Thanks.
21:05Yeah, I'm glad to be back.
21:08You know why I was gone?
21:09Did you see my patient?
21:10Um, no.
21:11Not really.
21:13I mean, I've heard rumors, but I learned a long time ago not to listen.
21:16I was in rehab.
21:16Oh.
21:17For an addiction to benzos.
21:20Oh.
21:21Yeah.
21:22But I'm clean now and it never affected my work.
21:26I just need to get it all out of my system once and for all.
21:32But yeah, I didn't handle things the way I should have.
21:36I thought I could treat myself and I let a lot of people down.
21:40I'm sorry, Mel.
21:43You never let me down.
21:46Yeah.
21:47Yeah.
21:48Yeah, I did.
21:49We should be setting an example, not a cautionary tale.
21:52Hey.
21:55How you doing?
21:57I'm okay.
21:58Listen, I'm really sorry about all of that.
22:01The guy robbed the liquor store last night.
22:03He tried to get away on a bicycle, but wiped out and took off on foot.
22:06He must have hobbled in here more so to hide out than he gets stitched up, I think.
22:10You catch him?
22:11We will.
22:12Anything you could tell us about him will help.
22:14You think he gave legit information?
22:16Probably not, but it's all we have at the moment.
22:19If we do find him, you may have to testify in court, Dr. King.
22:24In court?
22:25As a material witness.
22:27Attest to his injuries, his treatments.
22:30Simple stuff.
22:31Yeah, but we'll cross that bridge when you come to it, right?
22:34Mel?
22:37Rest here a minute.
22:38I'll be right back.
22:42You know, I'm fine, really.
22:44I should just...
22:44Ten minutes, please.
22:45Doctor's orders.
22:49ER can be a little bright and noisy.
22:57Dorsalis pedis and posterior tibial pulses two plus and equal.
23:02Your exam is perfect, ma'am.
23:04Oh, that's really good to hear.
23:06I will be back when your blood tests are ready.
23:09Let us know if the chest pain returns.
23:11You are so welcome.
23:15What do you think?
23:16Well, I don't think it's cardiac.
23:18I mean, what do you think of the app?
23:20I mean, it's hard to say without seeing the full thing.
23:22Take a look.
23:25Oh, my God.
23:26Do you know how much time this will save?
23:28Studies show you can spend 80% less time charting.
23:32You'll get out of here sooner, improving both patient and physician satisfaction.
23:36Oh, excuse me.
23:37It says here she takes Risperdal, an antipsychotic.
23:40She takes Restoril when needed for sleep.
23:42So is that, um...
23:43Huh, AI.
23:44Almost intelligent.
23:46Generative AI is 98% accurate at present.
23:49You must always carefully proofread and correct the minor errors.
23:53It's excellent, but not perfect.
23:54This is amazing.
24:00You speak Farsi?
24:02Oh, I did my undergrad at UCLA.
24:05A lot of my friends are Persian.
24:06So you learned the language?
24:08Enough to break the eyes.
24:10I am impressed.
24:13Me too.
24:15That you had friends.
24:17Dr. Whitaker, I said hello to your widow with Alzheimer's,
24:20but she only must talk to a doctor.
24:21She was also very overdue for a diaper change.
24:23Okay.
24:24Yeah.
24:25Uh, Ogilvy, you're with me?
24:29Come on.
24:31Mrs. Bostic?
24:35Takotsuba? Broken heart syndrome?
24:36Uh, no.
24:37Ah!
24:38Gigi.
24:38Hello?
24:39Hey.
24:41Um, you wanted to see me?
24:43No.
24:44Who are you?
24:47I'm Dr. Whitaker.
24:49We talked about your husband.
24:51Oh, Ethan.
24:54Oh.
24:55Can you please come see me?
24:59Um...
25:01No.
25:03Unfortunately, he was very sick.
25:07And...
25:08He died.
25:11Ethan?
25:13Died?
25:15No!
25:17No!
25:18No!
25:19That's impossible!
25:21No!
25:22No!
25:24No!
25:25No!
25:25No!
25:27What do you like to do for fun?
25:29I love voice back riding.
25:31Does your dad take you?
25:31Yep.
25:33Sometimes he even rides, but most of the time he just watches me.
25:37Have you ever fallen off?
25:38Have you ever been thrown?
25:39Nope.
25:40I'm a very good rider.
25:42Do you have your own horse?
25:44I wish.
25:44I live in an apartment.
25:47Okay, Kylie.
25:48We need to take some blood now.
25:49Do you have to do that?
25:51Yeah, but I promise it'll go super fast and only hurt for like a moment, okay?
25:56So, I'm just gonna put this rubber band around your arm to help me find your vein better.
26:03And then this, make sure no germs get in your body when we do it.
26:08Okay.
26:09Now, you're just gonna feel this teeny little prick, but you can look away, okay?
26:17Worst part's over.
26:20Tough little girl.
26:22Yeah, well, little girls can be just as tough as little boys, even tougher.
26:26Yes.
26:27I just hope it's not because she's become accustomed to pain.
26:31At the very least, she's gonna need a visual exam of external genitalia to live for signs of trauma.
26:35I can have Dr. Elshidney come out.
26:37No, she's my patient.
26:38I can do it.
26:47Nice and clear.
26:49Uh, with an infection, it'd be kinda cloudy.
26:54Joey, get ready to spike the third bottle here after I clamp.
26:58Oh, good in here?
26:59Yes.
26:59Uh, Dr. Whitaker was just explaining that with SPP we would see a turbid appearance.
27:04However, he failed to mention that bloody fluid indicates either a traumatic tap or the likelihood of hepatocytic carcinoma, in
27:11which case we would send for cytology.
27:13That is correct.
27:15Kid knows his shit.
27:17He's so smart.
27:22Oh, hey.
27:23Hey.
27:24How's it feel to officially be a doctor?
27:26It's pretty cool, actually.
27:29Uh, I didn't get my first paycheck today.
27:30It's only for the first week, but I will take it.
27:33How are the men's students?
27:35Uh, Joy's pretty peculiar.
27:37And the other guy, Ogilvy, is really smart and likes to show people.
27:42He's obnoxious.
27:44Well.
27:45What he is is your competition.
27:47He's a gunner.
27:49Yeah, right.
27:53He's not my competition.
27:55He's from out of state for a four-week sub-internship.
27:58You don't think he's angling for an emergency residency spot here next year?
28:03I mean, even if he was, I...
28:05What?
28:06He couldn't possibly compete with your gigantic brain?
28:14I'd step it up if I were you, Crash.
28:19Oh, she's still calling you that, huh?
28:22I don't really even care anymore.
28:24I mean, she still calls you Huckleberry.
28:25Yeah, but, you know, we're friends now, so...
28:29Friends don't give each other shitty nicknames.
28:32You think Huckleberry's a shitty nickname?
28:36No.
28:38No, Huckleberry's cute.
28:40Oh.
28:41It's cool.
28:42It's not like Crash.
28:43Oh, come on, man. Crash's pretty cool.
28:46It's like, you know...
28:47Crash, it's got momentum.
28:50Dr. Javadi?
28:52Dr. Whitaker?
28:53Oh, I'm... I'm still a student doctor.
28:55Whitaker's the real deal now.
28:57Right.
28:59Welcome back.
29:01Thanks.
29:02Yeah, thank you.
29:03It's good to be back.
29:06Okay.
29:07I will be in exile on Triage Island
29:11and with the rest of the drug addicts if anyone needs me.
29:15It was weird.
29:16It was very...
29:17Saan yung party ni Javadi?
29:19Bula pa itong plano.
29:20What?
29:21Eh, di kailangan mag-plano tayo.
29:25Mukha bang 21 si Javadi sa'yo?
29:28Ngayon, oo naman.
29:30Nakakakanda itong bugar na to.
29:32Ay, ano ka?
29:35Hindi ikaw.
29:37Hindi ako.
29:37Oh.
29:38Pero yung yi bang dao.
29:40Mm-hmm.
29:43Woo!
29:44That's gonna hurt.
29:45Dr. Langdon, Clint Hansen, his cousin Mona.
29:48How'd this happen?
29:50Mm-hmm.
29:51Bacon grease from a big riddle.
29:53Oh.
29:53Looks like more than a splatter.
29:55Yeah, some fool put it in a sink while I was washing dishes.
29:57I was so far away.
29:58You reached for the soap without even looking.
30:00You couldn't hear me.
30:00No, not with the water running.
30:02Who the hell pours bacon grease down the drain?
30:04There's a jar under the sink.
30:05Well, you could have told me that.
30:06You're a guest in my house and now you've totally fucked up my plumbing.
30:09Okay, how about we focus on treating this burn?
30:11I'll grab the let.
30:12We're gonna need to trim off some of the dead skin so it doesn't get infected.
30:14I'm in charge of the brunch buffet.
30:16Can you make it fast?
30:18Sure.
30:19This one came in by car.
30:20All I got is the name Orlando Diaz.
30:22What's the story?
30:23He tripped over some rebar.
30:24Tripped or fainting?
30:25I don't know.
30:26Orlando, open your eyes.
30:28Hit his head?
30:29I guess.
30:29Why didn't you call 911?
30:30He wouldn't let me.
30:31He was talking.
30:32Not so much now.
30:33Orlando.
30:34Mr. Diaz.
30:35Jesus.
30:37He drunk?
30:37No.
30:38Ketone's on his breath.
30:38He diabetic?
30:39I don't know.
30:40Altered head trauma.
30:41Possible DKA.
30:42Call it overhead.
30:48Dr. Whitaker, your assessment was spot on.
30:51Your Alzheimer's widow definitely needs placement.
30:54Do you have a nursing home that can take her today?
30:55I wish.
30:57Medicare requires a three-day hospitalization before they'll approve that.
31:00I don't really have a reason to admit her.
31:02But I do.
31:04She's gravely disabled.
31:05I'll put her on a cycle.
31:07We'll make it work.
31:08Thank you, Caleb.
31:11Yeah, you have a few moments, Michael?
31:13Actually, I do not.
31:14But once I get things settled here, I will come and find you.
31:18Okay.
31:21Dr. Robbie?
31:23Dillon just talked to the girlfriend.
31:25You'll have to fill me in in a minute.
31:26What do you got?
31:27AMS.
31:27Can't tell if he fell because he was altered or he's altered because he fell.
31:30There's ketones on his breath.
31:31Okay, I got this.
31:35All right.
31:36I guess it's just us.
31:37Um, what did the girlfriend have to say?
31:39Well, Gina seems a little confused and on edge by this, but I'm not suspicious about abuse on her part.
31:43What about Kylie's father?
31:44Well, I'm a social worker, not a mind reader.
31:46I need to speak with him.
31:47Yeah, he's supposed to come in.
31:49If he doesn't, looks pretty guilty.
31:51Let's not jump to any conclusions just yet.
31:53I'm not jumping.
31:54I'm just saying if this dude doesn't show up, hell, I'll go find him myself.
32:01Kidding.
32:02I will speak to Kylie before her dad gets here.
32:05If he shows up.
32:07Yes.
32:09That's definitely ketones.
32:10We need to do an acu-check.
32:11I'm on it.
32:12He's tacky at 124, pulse ox 97, BP's 106 over 72.
32:16Lung sliding bilaterally.
32:17Good bowel sounds.
32:19Abdomen is soft, non-tender.
32:21How do you know it's non-tender?
32:23Because I didn't see any grimacing.
32:25He's altered.
32:26He didn't even flinch for the IV start.
32:27I meant to say non-rigid.
32:30Huh.
32:31Toes down and going bilaterally.
32:32No evidence of upper motor neuron deficit.
32:33Good.
32:35EVOS negative.
32:36How can I assist?
32:37You can check in with Dr. McKay or Dr. Tantos.
32:40If you don't mind, I'd like to observe.
32:41Learn how you handle things.
32:42Whoa.
32:43Blood sugar's critical high.
32:44It's over 500.
32:44Ding, ding, ding, ding, ding.
32:46Sounds like diabetic ketoacidosis.
32:47We need to start treating that.
32:49Then write to CT to rule out an intracranial bleed.
32:51Severe respiratory distress coming in.
32:53ATI three minutes.
32:54I'll stick him in trauma one.
32:55Yep.
32:55Would you like me to take that?
32:56Yes, please.
32:58This guy needs an insulin drip, right?
32:590.1 units per kilo?
33:00No.
33:01Not without knowing his potassium.
33:03Insulin causes an intracellular shift, and if the potassium is under 3.5, the drip would
33:07kill him.
33:07That is very true.
33:08We can start with lactated ringers one liter per hour until we get the results from the
33:12Chem 7 and the VBG.
33:14Why is he in decay?
33:15Maybe he's not taking enough insulin.
33:17More frequently, a precipitating event can be identified, such as pneumonia, urinary tract
33:20infection, stroke, myocardial infarction, pancreatitis.
33:23Yeah, we always check for those.
33:24They're part of a standard order set.
33:26Right?
33:27Dr. Mohan?
33:35He's from Crazy Grandpa Jimmy's side.
33:38He's from my grandfather's brother's side.
33:39Grandpa Ricky is still a psycho.
33:42Clearly runs in the family.
33:43Hold on.
33:44Your grandparents are Ricky and Jimmy Hanson?
33:47From the racing family?
33:49Unfortunately.
33:50I got something that needs attention.
33:52Not another baby.
33:56Sorry.
33:57Excuse me.
34:00This is Mr. Randall.
34:02He's been erect for the last eight hours.
34:05Should have gone down by now, right?
34:07It happens.
34:08It's a good thing he came in, Mr. Randall.
34:10I'll take him right back.
34:11Do you mind finishing up with the Bakersons?
34:12I'd rather not.
34:15So, Mr. Randall.
34:16Ian.
34:17Ian.
34:17Did you take anything that might have left you this condition?
34:21I used an ED injection.
34:23Two, actually.
34:24I gave myself a second shot.
34:27One on each side.
34:28So, double the recommended dosage?
34:33It's our wedding anniversary.
34:35Oh.
34:35Is this a big one?
34:38The anniversary.
34:39Is it important?
34:40Like, significant?
34:41Like a milestone?
34:42It's our 20th.
34:44Oh, nice.
34:44Well done.
34:45Congratulations.
34:48Glucose, 521.
34:49Sodium, 129.
34:51Potassium is 3.7.
34:52Chlorides, 97.
34:54Bicarbs, 8.
34:55Meaning?
34:56We can start the insulin drip and add 20 of K to each liter.
34:59Big anion gap of 24.
35:02It should be under 10.
35:03We follow it to assess progress.
35:05Actually, the 2024 and the national guidelines state that anion gap should not be used,
35:09just as they can be misleading and the presence of hyperglycemia and metabolic acidosis.
35:15I recently had a case in the ICU.
35:17BBG is back.
35:18pH of 6.97.
35:19Normal, 7.4.
35:21What causes the acidemia?
35:22Without insulin, the body can't use glucose, so it breaks down fat-producing ketones, leading
35:26to severe acidosis, which can cause cardiac arrest.
35:28But the hyperglycemia causes the body to excrete more water and electrolytes, leading to severe
35:32dehydration, cardiac and renal dysfunction.
35:34Insulin drip, fluids with KCL, capillary glucose every hour, CHEM 7 every four hours.
35:39ICU is going to want a double lumen midline, too.
35:41I can do it.
35:42Seven and a half quads.
35:43Can I just say we evaluate our students not only on their fund of knowledge and on their
35:47procedural mastery, but also maybe more importantly on their skills as team players.
35:52He can do it.
35:53She can do it.
35:55Otero, will you update everyone?
35:56Barry Mitchell, eating breakfast at Pamela's, sudden onset respiratory distress, some strider,
36:01decent pulse locks with trouble speaking.
36:03Have they tried the highlights?
36:04Three times.
36:07Any history of asthma?
36:10Sit up for intubation.
36:11Agreed.
36:13Okay, sir, scoot across.
36:15Always a good sign when they slide over on their own.
36:18Came from a diner with an upper airway obstruction.
36:20Didn't clear with abdominal thrusts, so we gotta take a look.
36:23Heart rates 118, pulse locks 96.
36:25Mr. Mitchell, we're gonna sedate you to look down this road, okay?
36:29Draw a ketamine and rocuronium.
36:31What about ketamine only?
36:33Well, we need full paralysis for a successful first-pass intubation.
36:37Might not need an intubation if it's just a forebody.
36:39We can't assume that.
36:41It could be subglottic stenosis, epiglottitis.
36:43I got ketamine and roc.
36:47Ketamine only.
36:4880 milligrams.
36:50In that case, I'll leave this in your capable hands.
36:55Cetacane spray and a yank hour, please.
36:58Thirty minutes ago, I told you I'd never been sued.
37:00I'd like to keep it that way.
37:05Instead of showing up here, you'd think you'd put an eight-hour heart on to good use.
37:10Well, it is a medical emergency.
37:12If left untreated, priapism can cause permanent damage to the penis and erectile dysfunction forever.
37:17Thanks for the PSA.
37:19Pharmacist mixed up phenylephrine, 10 cc's of 100 mics per cc.
37:24Great, that's the maximum dose.
37:25Steril bowl of saline.
37:26You might need to refill since they'll be flushing over and over again.
37:29Hold out the empty basin to catch whatever they pull out.
37:32Got it?
37:33I think so.
37:34Holler if you need me.
37:35What are we doing?
37:37He's out from Versed.
37:38Did a lidocaine block to the dorsal penile nerves at 10 and 2.
37:42Yeah, he's ready.
37:43Excellent.
37:44Enter the dorsal side to hit the corpus cavernosum.
37:47I'll hold the glands.
37:49How deep?
37:50Two centimeters.
37:52Ah, now aspirate.
37:56Will you guys do this, like, every day?
38:00If we're lucky.
38:06Okay, let's lay him down and take a look.
38:10Okay.
38:18Good view of the epiglottis.
38:21And mystery solved.
38:24This is what you get for eating broccoli for breakfast.
38:27Got a good grip on it.
38:29Okay.
38:32Okay.
38:39I can see why the Heimlich didn't work.
38:43Rotate a little bit.
38:47Voila!
38:49That is why you give ketamine alone.
38:52Because if we gave a paralytic, we would have to intubate and ventilate for an hour.
38:58All right.
38:59This guy's going to Westbridge for surgery.
39:02Trauma one.
39:02We'll move out shortly.
39:04Our Alzheimer's widow, Evelyn Bostick, can see her husband in the viewing room.
39:08Oh, bless her.
39:10My CT results back on Michael Williams?
39:12Not yet.
39:13Neither are the labs on our little girl, Kylie.
39:14That's not me.
39:15I did, however, get a few things back on our abandoned baby chain dome.
39:19Still not me.
39:20I'll take those.
39:22Just keeping you informed.
39:26Okay.
39:28We're just trying to get her upstairs.
39:32Okay.
39:33All right.
39:33Got it.
39:35Superbabies urine dipped negative.
39:36Zero WBCs.
39:38Respiratory panels positive for rhinovirus.
39:39Give me a super benign sores.
39:41Procalcitonis.
39:42Here, Pierre Penny.
39:42Now, Peds is saying they want a urine tox screen and an HIV antigen before they'll
39:46take her.
39:46That sounds excessive.
39:49Feel like they're just trying to keep her down here.
39:50Can you blame them?
39:52I've never met a Peds nurse yet that wasn't a little wacky.
39:54You know what 12 hours of crying babies does to a person's psyche?
39:57I almost went into Peds.
39:59Good thing you didn't trust me.
40:00Too long up there, you cuckoo for cocoa puffs.
40:02You are very punchy today.
40:04Punchy's my new baseline.
40:05No one even looks at me funny.
40:07I'm taking him out.
40:08Going right for the eyes.
40:09Oh, I gotcha.
40:10Bet you never knew that about me.
40:12I did not.
40:12Where is Dr. Alashimi?
40:14In North Five with the priapism.
40:15Ha!
40:16Better her than me.
40:18I did not intend for that to come off as sexual in any way.
40:22And on that note, I'm gonna go check on Louie and then I'm gonna get some air in the ambulance
40:25bay so if anybody needs me, that's where I'll be.
40:27Water, Captain.
40:29Ah!
40:30Ah!
40:31Ah!
40:31It looks like some pus at the base of the lateral incisor.
40:35We can drain that for you.
40:36Sounds like it's gonna hurt.
40:38Nah, we'll numb you up.
40:40Make sure you use the good stuff.
40:43It'll be top shelf, Louie, I promise.
40:45How are we doing in here?
40:47Good.
40:48Almost four liters out.
40:50I already feel like a million bucks.
40:52I just needed an oil change.
40:55And I'm just about to drain an apical abscess.
40:57That's what I'm talking about.
40:59I feel like I'm having a spa day.
41:03Keep it up, Whitaker.
41:08How long does this take?
41:10Up to an hour, sometimes two.
41:13Mel, any suggestions?
41:17Mel, you did these at the VA.
41:19How can we facilitate detumescence?
41:21Oh, um, sometimes massaging the shafts can help.
41:26That's what she said.
41:27You can break up the clots with massage or compression.
41:31Got it.
41:33You okay, Mel?
41:35She's thinking about her deposition.
41:38Just stick with the facts of the case, and it always goes well.
41:41I thought you said you hadn't been sued.
41:43I haven't, but I know many colleagues who have.
41:46I also know your work, Dr. King.
41:49Your medical decision-making in the chart is always extremely thorough.
41:52Well, we're getting somewhere.
41:54First signs of flaccidity.
42:00I don't know how I could ever thank you.
42:02Well, Mel, I think you just did.
42:04You saved my life.
42:06I didn't do anything.
42:08Well, this is what happens when your wife starts being a Nazi about your diet.
42:12She's got me keeping a food journal.
42:14It's a good way to count calories.
42:16What calories?
42:18She insists I eat five servings of vegetables a day.
42:21A rabbit don't even eat that many vegetables.
42:23I ain't never choked on a sausage-egg McMuffin.
42:27I feel like I've been here all day.
42:29It's actually only been a couple of hours, Mrs. Bostic.
42:33Well, where are we going now?
42:34Um, I thought you might like to see your husband.
42:42Is Ethan still here?
42:45Yeah.
42:46Oh, yes, yes, please.
42:55Oh, this has been such a long day.
43:01I'm so glad to see you rest here.
43:05But I think it's time.
43:07We should be going home.
43:09If we stop at the store on the way, I could pick up what I need to make your shepherd's
43:13pie.
43:14But not if it's hot out.
43:16You know how I hate using the oven in the heat.
43:21We're ready to leave now.
43:30Dr. Robbie, is this a good time?
43:33That depends on what you have in mind, Dr. Alashimi.
43:36I'd hoped you would have reviewed my ideas for improving the department.
43:41I was looking forward to getting some feedback from you.
43:43Okay.
43:44Well, I think the department functions pretty well, all things considered.
43:47I mean, we face the same challenges that most emergency departments face.
43:49Let's take generative AI, for instance.
43:51ER doctors spend 40% of their time charting, only 28% of their time at the bedside.
43:58That doesn't sound accurate.
44:00I've included the study in my packet.
44:02Wait.
44:03And patient passports have been shown to increase satisfaction
44:05because they show the time required for each phase of the visit.
44:10Yeah, I get it.
44:10What do you got?
44:10Combative college kid.
44:12Flipped down the library, tased in the neck by campus security.
44:14Five mid-dazzling didn't touch him.
44:16Will you get the fuck off me, 29-01?
44:1829-01, motherfucker!
44:20Get up!
44:21Fuck you!
44:22Tell me some more about your ideas.
44:25Maybe later.
44:25Let me out!
44:26Let me the fuck out!
44:27Let me out!
44:28Let me out!
44:59Let me out!
45:01Let me out!
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