- 1 week ago
الطبيب الجيد 1 - Episode 6
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00:00¡Suscríbete al canal!
00:38¡Suscríbete al canal!
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03:26Let's go
03:28Trauma 3
03:43I can't stop the bleeding
03:48He's bleeding out
03:49Do something
03:58I need a urinary catheter
04:0014 gauge needle arterial
04:02Guidewire occlusion balloon
04:03And 20 cc's of saline
04:05Stat
04:29What's he doing?
04:30I have no idea
04:30We don't have one
04:31So I'm making a Reboa
04:34A what?
04:37A Reboa
04:39Is that even a word?
04:40A Reboa will occlude the damaged artery
04:42And stop the bleeding
05:02Release the pressure
05:10BP stabilizing
05:1290 over 60
05:17Nice work Dr. Murphy
05:19I made a Reboa
05:23Oxygen's dropping to 89
05:24Light light
05:26Don't mind for me
05:27Folks running from smoke annihilation
05:29The quake hit
05:30You see soot in her mouth or nose?
05:32No
05:33She doesn't need a quake
05:34She needs an escarotomy
05:46Sats are going back up
05:4890 twin rising
05:49Circumferential neck burns
05:50The shrinking charred skin
05:52Is acting like a noose
05:53Escarotomy relieves the constriction
05:56Get her out of this petri dish
06:01Get her out of this petri dish
06:01And into an isolation ward
06:02In the burn unit ASAP
06:03Sir
06:07Your heart's a bit awful
06:09Am I having a heart attack?
06:11No but it's not completely good news
06:12Cardiac tamponade
06:13Needs a pair of paracentesis
06:15Yes I'm aware of that
06:1618 gauge and 50 cc syringe please
06:19We need a fast ultrasound in here
06:21They're both in use
06:23If you don't have imaging
06:24You could puncture his heart
06:25Is the xiphoid in the same place
06:27As it was 20 years ago?
06:48Arraboa
06:49Ballsy
06:50Could have gone really wrong
06:51Yes well it didn't
06:54It's a cowboy move
06:55Something you would never even dream of trying
06:58How many times does Sean
07:00Going to have to prove himself
07:01Before you give him a shot?
07:13What happened in the ER?
07:15This one girl came in
07:16And you hesitated
07:16I wasn't hesitating
07:18I was thinking of the game plan
07:19Murphy was thinking of the game plan
07:21You got overwhelmed
07:22I wasn't
07:24First trauma
07:24What happens?
07:26You have to think clearly
07:27Quickly
07:28Methodically
07:28You need to think a little more like Sean
07:32A little more
07:34Not identically
07:53How you doing?
07:55How you doing?
07:56Sorry that's a stupid question
08:02You're maxed out on morphine
08:03You're maxed out on morphine
08:04I'll hold off until it hurts
08:11How bad is it?
08:13We're making good progress
08:14I'll have to, uh, debride any de-roof blisters
08:18Prevent a secondary nosocomial
08:19I need a mirror
08:21I guess it's the least you can do
08:22Since you can't even look me in the eye
08:52Do you know how many he-
08:54Hideous $300 bridesmaids dresses
08:56I've had to buy in the last two years
09:00I decided
09:02That when I got married
09:03My bridesmaids are gonna wear black cocktail dresses
09:07So they can use them again, you know
09:13But now
09:17Now I'm Freddy Krueger
09:21Who's gonna want to marry this?
09:27I'm gonna find a nurse
09:28Have her adjust your, uh, your morphine drip
09:38You hit your face
09:39Your jaw got stuck
09:40It hurts
09:41So the shot I just gave you
09:42Is gonna knock you out
09:43So that I can fix that
09:44Hang tight
09:45Crash patient status check
09:4623 people total
09:47One fatality on site
09:49Lost one in the ER
09:49Examine all the red tags
09:51Got 13 yellow and green
09:52Still in the waiting room
09:53I'll take whoever's up next
09:54Marco Magellanis
09:55Severed femoral artery
09:56Crushed femur
09:57I did the re-boa
09:58And then installed a temporary shunt
10:00Here are his CT and MRI results
10:07Find someone else
10:08Whoever's up next
10:12Oh, finally
10:31Excuse me, are you Marco's family?
10:33Yes
10:35We just found out that my cousin didn't survive the accident
10:38I'm sorry
10:41It's a bit much
10:42I'm so sorry
10:43Dr. Melendez
10:45This is Dr. Murphy
10:46Um, Ricardo
10:47I'm, uh, Marco's father
10:50This is, uh, his mother Lorena
10:52And this is Sonia
10:54They were getting married tonight
10:56How's my son?
10:57Marco's femur was completely shattered
10:59And his lower leg isn't getting enough blood
11:02Can you say this like
11:04Marco's suffered too much bone fragmentation
11:07We can't fix it
11:09Our only choice is to amputate
11:14Let me hear you
11:15Mikita
11:24So, they need a bed
11:28And we're a good ready for you
11:28Bay five needs a grade three hyphema
11:30Head CT page ophthalmology
11:32¡Suscríbete al canal!
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15:58¡Suscríbete al canal!
16:01¿Y?
16:02¿O o suerte?
16:11¿Quieres poner un femur en la pierna?
16:13No es verdad, es real.
16:15No es real.
16:16No es real, es real.
16:17No es real, es verdad.
16:17¡Vamos a hacerse un titán.
16:18Es increíble.
16:20Y Marco será capaz de ir, correr y correr.
16:23Y swim.
16:25Espero.
16:25¿Es posible?
16:28¿Por qué?
16:29¿Por qué?
16:30Vamos a hacer esta estrategia.
16:34¡Nos está intentando esta estrategia con la pierna más larga como la femur!
16:37Creo que es viable, pero hay riesgos.
16:40¿Ros riesgos?
16:41¿Para qué Marco muere?
16:43En mi estimation, hay una 10% chance que no le vaya.
16:46No, no.
16:47No me pierdas mi hijo.
16:48Si hay una oportunidad que pueda salvar Marco,
16:51debemos discutir esto más.
17:11No, no, no, no, no, no.
17:29Please, amputate our son's leg.
17:35Harvey.
17:44Why is the primary closure on the stump so vital in amputation surgery?
17:47For proper prosthetic fitting.
17:50Why are you marrying Jessica?
17:53Why does anyone get married?
17:56I don't know.
17:59I love her.
18:01I don't understand why having someone to love is so important to everyone.
18:07You have to stand down.
18:09You can't amputate Marco's leg.
18:10Why not?
18:11I filed an emergency injunction to stop the surgery.
18:18You were in a car accident.
18:20Your neck was punctured.
18:21The repair surgery went well.
18:23You're going to have to stay put for a week before we can release you.
18:27You were very lucky to be alive.
18:36My wife, Jenna Hensel.
18:40Is she okay?
18:41Can I see her?
18:48She's not listed.
18:50That's a good thing.
18:51She's probably still in the waiting room.
18:53I'll find her, bring her up.
18:55She'll be relieved to know you're okay.
18:58Okay.
19:00What the hell am I supposed to do with an unconscious patient whose leg is a ticking time bomb?
19:04Judge Singh is en route.
19:05She wants to hear from both parties and the doctors on the case.
19:08Do I have to testify?
19:10Hopefully not.
19:10I thought you would be happy.
19:12You thought you could save the leg.
19:14And I didn't want that not happening because the parents are afraid to make a tough call.
19:17It's their call to make.
19:19And if the accident happened an hour later, it would be the wife's.
19:22And she wants the fake leg.
19:23It's not fake.
19:25I thought you didn't believe in just blindly following protocol.
19:29He's their son.
19:30Nobody's going to love him more than them.
19:32Seriously?
19:32All parents love all children more than anybody else?
19:36People get divorced all the time.
19:38How often do they give up their kids?
19:39So this was us?
19:40You'd want your parents to decide over me.
19:42I didn't say that.
19:43You kind of did.
19:45I was saying there needs to be rules.
19:48There needs to be bright red lines telling us who gets to make these calls.
19:52It's the parents' call.
19:54Not anymore.
19:55Now the judges.
19:57How much time does Marco have left in the temporary shunt?
20:00Three hours.
20:02And then his leg will die.
20:06Okay.
20:07Okay.
20:17Dr. Torture returns.
20:19Thought I'd scared you off for good.
20:22Pick a movie.
20:24You deserve to get out of this room for a little while too.
20:29You think Groundhog Day is going to make a difference?
20:32I'm torturing you, but hey, you get to watch a funny movie.
20:36That is sort of what I was going for, yeah.
20:43I'm sorry.
20:47Also, there's something else I could do.
20:49How do you know there isn't?
20:51This is protocol.
20:52This is what they teach.
20:53I lucked out.
20:54I got the world's greatest expert on burn victims.
20:58You know everything that can be done.
21:03He loves to rock climb, scuba dive, bungee jump.
21:07This is insane.
21:09His leg is literally dying while we sit here reminiscing.
21:12Please.
21:13We're trying to figure out what your son would want.
21:15You want to live.
21:16I want that too, but if there's a way that we can save Marco's leg, he'd want me to do
21:22it.
21:22Dica, do you know what he wanted most of all?
21:28He wanted to marry you.
21:30He wanted to spend his life with you, have children with you.
21:34Now, he can do all that.
21:36He can be happy with the prosthetic leg.
21:41He's young.
21:42He's strong.
21:44Dica, he can get through this.
21:51When we met?
21:52I don't care about your stories.
21:54I don't care that you met rock climbing or kayaking or whatever.
22:01I just want...
22:02We met in rehab.
22:13Hey, are either of you Jenna Hensel?
22:15I haven't seen Jenna since we took pictures of the hotel.
22:19But she got on the bus.
22:21Yeah, she was sitting with Numi.
22:29I think she's still out there.
22:31Hey, guys, we've got to go back.
22:32Where?
22:33To the crash site, now.
22:35He never wanted you to know.
22:40He's an addict.
22:41He replaced one addiction for another one, a healthier one.
22:45But he needs...
22:47He needs to wakeboard or he'll drink himself to death.
22:52This is ridiculous.
22:53No, it's not.
22:54We talked about it a lot.
22:56It's pretty much all you do in rehab.
22:58Marco has clarity for the first time in his life.
23:01He knows what makes him happy.
23:03He knows his weaknesses.
23:06He's not as strong as you think.
23:09And that's okay.
23:11But...
23:12Marco cheated on you.
23:16It was about a month ago.
23:18He was overwhelmed with the wedding and the planning.
23:22He ran into an ex-girlfriend.
23:24It only happened once.
23:28You're lying.
23:30You're upset that he had secrets from you, so he...
23:33No, she's not lying.
23:38He was so upset.
23:40He does love you.
23:42Okay, maybe we're digressing here a little bit
23:44and we really don't have the time.
23:45It matters.
23:48She doesn't know him like...
23:52Maybe none of us do, but...
23:54But we are his parents.
23:57And you're not his wife.
23:59Yet.
24:16Okay, get the cops.
24:17Check everywhere.
24:18Other side of the road, bushes, trees.
24:20If she was ejected from the bus,
24:21she could be 40, 50 feet in any direction.
24:41She's got a brain bleed.
24:43We need to get her out of here now.
24:48Dr. Andrews, I think sellers may be eligible
24:51for experimental burn treatment.
24:53Sell it to me.
24:54Well, I've been doing some digging.
24:55San Diego Community Hospital's burn unit
24:58has been following a bazillion hospital's protocol
25:00to wrap burns in tilapia skins.
25:01Now, I know fish skins sound a bit crazy,
25:04but I was thinking we could do the same thing here.
25:07Dr. Kalu, I applaud your thinking, but...
25:11Tilapia skins contain more collagen proteins,
25:13both types one and three,
25:14than even human skin,
25:15which aids in tissue repair,
25:16negating the need for grass.
25:17Dr. Kalu...
25:18Accelerate healing, reduce risk of infection,
25:20and cut down on a patient's physical pain.
25:22Are you finished,
25:23or would you like to cut me off again?
25:25Okay, let's follow this through, shall we?
25:28You have to come up with a proposal
25:29for the experimental treatment,
25:30get it approved by our institutional review board,
25:33get your hands on medical-grade tilapia skins,
25:36and then we...
25:36Well, I thought you'd help expedite the process.
25:41You think I could bring it down
25:42from three months to two hours?
25:45You finished the debridement?
25:47Okay, I'll take over from here.
25:49Hey, keep thinking outside the box.
25:53Initiative is good.
26:04I'm in.
26:05Bagger.
26:06Did you get me the drill?
26:07The fire truck had one.
26:08What's going on?
26:09Her pupil's blown.
26:10She has a subdural hematoma,
26:11causing increased intraprenial pressure.
26:13If I don't alleviate it now,
26:14there is no way she makes it to the hospital alive.
26:18Okay.
26:41Unconscious female, flailed chest.
26:43I had to do a burr hole in field.
26:45Her sats are in the low 70s.
26:56She's good to go to the O.R.
26:59Sub girl, hematoma.
27:01She had the cervix posturing,
27:02a blown left pupil.
27:03When I passed the drill bit through her skull,
27:04a whole lot of blood pulled out.
27:06Good call.
27:13San Diego Community Hospital called.
27:15They're sending the tilapia skins.
27:16They're medevacinam in.
27:18Should be here within the hour.
27:20Celeste,
27:22you meet the criteria for an experimental treatment
27:24that I think will prevent you
27:26from having to undergo skin graft.
27:28Hold up.
27:28How did this even happen?
27:30Well, I found out San Diego's trial
27:31allows for multi-site collaborations.
27:34So there's no need for us to get her own IRB.
27:36They give us the skins.
27:37We provide the patient data.
27:39Fish skins?
27:40The tilapia skins have been cleaned and sterilized.
27:43They're perfectly safe.
27:53Well done, Dr. Kalou.
27:59Well done.
28:01So help you God?
28:02Yes.
28:05Dr. Melendez can tell you...
28:07He has.
28:08But the fake femur is yours, though, right?
28:10How confident are you in its design?
28:12It's not fake.
28:13Sean, she needs to know...
28:14I know what she needs to know.
28:15She needs to know, will it work?
28:17She needs to know how long it will last.
28:22Yes.
28:23Okay.
28:31He's this doctor...
28:32He's a surgical resident.
28:33He's very gifted.
28:34Is he going to answer my questions?
28:37Sean, I really need you to focus.
28:42Marco is running out of time.
28:44Just let him answer.
28:45No, we already know the answer.
28:46They don't know.
28:47If this thing has ever been done before...
28:49Be quiet!
28:58His toes are changing color.
29:08He's clotting.
29:09That's bad.
29:10Page Dr. Melendez stat!
29:15Murphy, what do we got?
29:16The shunt is clotting.
29:17It's restricting blood flow.
29:18It is failing.
29:19All right, we need a decision now.
29:20Are we cutting off the leg or replacing the bone?
29:22There's no doubt in my mind that Marco's parents and fiancé all love Marco.
29:26But it's become clear that...
29:27Now.
29:27I need a decision now.
29:30His parents know him as their child.
29:33Sonia knows him as a man.
29:35Replace the femur.
29:37Let's go.
29:40Thank you.
29:41Thank you.
29:51There's the bleed.
29:52See it?
29:53Yes, sir.
29:54You ever clipped an intracranial artery before?
29:57No, sir.
29:58Go for it.
30:07Just like every first time.
30:10You're a little excited, a little nauseous.
30:14Hopefully nobody gets hurt.
30:34Is it good to go?
30:36It's very good.
30:38Four sips.
30:43Are you ready?
30:46Yes.
30:48You ready?
30:49You ready?
30:58Yes.
30:59Yes.
31:00Yes.
31:03Yes.
31:19¡Suscríbete al canal!
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35:12Todos los amo sushi.
35:15Solo por seis meses.
35:17Tu cabello debería de estar completamente enganchado por entonces.
35:19Debería tener una pequeña escara.
35:22Gracias.
35:25Te lo juzgaste.
35:29Te lo juzgaste justo.
35:42¿Estás dormido? ¿Has dicho? ¿Has dicho?
35:49¿Quieres un momento, por favor?
35:51Claro.
35:59¿Has encontrado Jenna en el crash site? ¿Has encontrado ella?
36:04Almost immediately.
36:06I did a sternal rub.
36:08She had disturbed her posturing.
36:10Her left pupil was blown.
36:11I knew she had subdural hematomas,
36:13so I intubated the pearl hole.
36:16She also had a flail chest.
36:19Did you check her breathing after you intubated her?
36:22Yes.
36:25At least I think I did.
36:30Dr. Lim told me that when Jenna came into the ER,
36:34she wasn't ventilating properly,
36:36you inserted the tube too deep
36:37into her right main stem bronchus
36:41of her injured lung.
36:43We had no way of knowing
36:45how long she was hypoxic
36:46before we gave her the EEG.
36:59I drilled the perfect
37:01burr hole into her skull
37:03on the side of the road
37:04in the middle of the night
37:05and I screw up her intubation.
37:08Yes.
37:09It was tough conditions
37:10for anyone resident or not.
37:13Any one of us
37:13could have made the same mistake.
37:29I had a woman come into the ER once.
37:34A mother, 51 years old.
37:38Francine Parker.
37:40She had two boys.
37:42She had a cough.
37:44A bad one, but a cough.
37:49I checked her out, gave her some antibiotics,
37:51sent her home.
37:52Six hours later she was rolled into the ER.
37:55She had had a heart attack and I missed it.
37:57and she died.
38:03Though one day goes by
38:07when I don't think about her.
38:11She did your first.
38:14My fourth, actually.
38:19You're not gonna forget this.
38:22You never forget.
38:25But I don't know, maybe you were better off for it
38:27the next time around.
38:30You gotta find a way to keep going.
38:36Yeah.
38:38Go home, get some rest.
38:41I haven't even told her yet.
38:42And you're not going to.
38:45You made a mistake.
38:47You're too close to this.
38:48I'm not gonna allow you to talk to the family,
38:50to anyone else outside this hospital about this.
38:55Do we understand each other?
38:59Yes, sir.
39:05I don't have all the words to say.
39:12Still healing from my mistakes.
39:18I'll take the weight if it makes you stronger.
39:25I don't wanna leave you in this place.
39:34I called San Diego Community Hospital
39:36to thank them for including us in their study.
39:38They said they were happy to do it.
39:40And they asked that I pass along their thanks to you
39:44for your very generous donation to their burn unit.
39:52I know you come from a wealthy family.
39:54I don't begrudge that,
39:55but you can't open your wallet every time a patient's in need.
40:01The lines can get real blurry real fast.
40:06Yes, sir.
40:40What's this?
40:43My healthcare proxy.
40:44Jess, nothing's gonna happen.
40:46Really?
40:47That's good to know.
40:49Well, I won't let you down.
40:58I won't let you down.
40:59No, no, no.
41:01I won't let you down.
41:10Well, that was quite a night.
41:13Been a doctor for a long while.
41:16Don't remember a night.
41:17Quite like that one.
41:19Why did Nurse Farrar ask if I wanted love?
41:23Because she's a nosy...
41:28Sean, you really don't want love?
41:30I loved Steve and my rabbit.
41:34Not anymore.
41:36You don't love them anymore?
41:38No, I don't.
41:39They're dead.
41:41You can't love someone if they're dead.
41:45Well, I've lost people I love.
41:48I miss them.
41:49It hurts.
41:50But I still love them.
41:57I don't want love.
42:04Okay.
42:09You want breakfast?
42:12Can I have four pancakes instead of three?
42:15You can have five.
42:17I only want four.
42:19Okay.
42:21Okay.
42:52Sure.
42:52Yeah.
42:58Go.
42:59Anyway.
42:59Oh.
43:03Gracias por ver el video.
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