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The.Pitt.S02E08.540p.X265.AAC [Full Movie] [Must See]Full EP - Full
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00:11Next time, maybe inform the department chair before the shit hits the fan.
00:14I was on my way to tell you.
00:16Make sure you get everything you need.
00:17Okay, let's do this.
00:18IT called me up because I've trained in cyber attack prevention and response.
00:22And you can tell everybody what to do.
00:23No, thank you. Best if it comes from the department chair.
00:26Oh, you think?
00:30All right, everybody, circle up.
00:31What the fuck?
00:33We may have had a cyber attack.
00:35No, we shut down to prevent a cyber attack.
00:39Okay, everybody settle down.
00:41Listen up.
00:41As you can see, we're doing a little redecorating in the central work area.
00:45Our hospital computers are at risk for a cyber attack.
00:48So we are going old school, analog.
00:50For how long?
00:50Great question.
00:51Our IT department has shut everything down to give them time to bolster our cyber defenses.
00:55I believe the question was for how long?
00:58Hard to say.
00:59It could be up to 24 hours.
01:01Jesus Christ.
01:02So, first order of business.
01:03We need to replicate the electronic patient boards on these dry erase boards.
01:07So please, somebody tell me they got a photo of the boards.
01:09Uh, yeah, yeah, yeah.
01:10Right here.
01:10Oh, cute.
01:11Oh, uh...
01:14It's a little blurry.
01:16Not more than a little blurry.
01:19Sorry.
01:20Oh, my God.
01:22I remember.
01:23Great.
01:24If everybody else can remember their patient names and their room numbers, that would be awesome.
01:27No, I mean I can remember all of it.
01:29All of what?
01:30Names, doctors, room numbers.
01:33I kind of have a photographic memory.
01:35Seriously, the whole board?
01:37Central 12, Harlow-Graham, headache, abdominal pain, ASL only.
01:41Oh, shit.
01:42I have an interpreter waiting for me.
01:45Okay.
01:45For patient privacy, all chief complaints will be abbreviated.
01:48So, HA for headache, AP for abdominal pain, and so forth.
01:51Central 10, Jackson Davis, new onset psychosis, Javadi, psych admission.
01:56Greek letter, psi for psych.
01:58Heads is baby Jane.
01:59Doe fever.
02:00Dr. Mohan awaiting admission orders.
02:02Nurses need to convert to a zone defense.
02:04North, central, south, trauma.
02:05Where's Dana?
02:06In with a sexual assault case.
02:07She can't leave until the exam is finished.
02:09Yeah, it can be a while.
02:10Princess has charge nurse experience.
02:12Not really.
02:12That's a great idea.
02:13Princess it is.
02:14You can make the nursing assignments.
02:15Next.
02:16Central 9, Roxy Hamler, NSA's on cancer.
02:19Sorry, do we have to stand here while she recites on board?
02:21No.
02:21In fact, go check on your patients and then please come back here.
02:25How many hours a day are you on your laptop?
02:30At least eight hours.
02:32I work from home.
02:33And are you at a desk all day?
02:37No, no.
02:38I will either sit on the sofa or sometimes I'll be in bed kind of sitting up with the computer
02:44on my lap, that kind of thing.
02:45So you're always looking down at the screen?
02:48Yeah.
02:49Okay.
02:50I'm going to check the muscles in your neck.
02:59Oh, ow, that hurts.
03:02Hi.
03:03Well, I think we can help.
03:05Come on over.
03:07Okay.
03:08Gather up.
03:08Listen up, everybody.
03:09This is our chart rack.
03:11So as you can see, each slot and clipboard has a room number on it.
03:14When you pick up a new patient, you grab a fresh chart from the T system.
03:18Pick your chart by chief complaint.
03:21Use the cartoon to find it.
03:23Why are there two bodies?
03:25Trauma on the left, medical on the right.
03:27So head injury, you go left.
03:28Headache, go right.
03:29That's fish swimming in seaweed?
03:31No.
03:32That is bees and grass.
03:34That's the section for insect bites, skin rash, allergies.
03:36Okay.
03:37Let's say, for example, Dr. Alishimi has a new patient with belly pain.
03:40For the history, circle the positives, like vomiting and diarrhea.
03:45Backslash the negatives, such as recent travels, sick contacts, fever.
03:49For physical exam, checkmark normals on the left and circle any abnormal findings on the
03:55right.
03:55Questions?
03:56Is your regenerative AI program still going to be working?
04:00Not for a while.
04:01And ditch your Spectralink phones.
04:03There's your voice over internet.
04:07P.T.M.C. Emergency.
04:08Go ahead, medical man.
04:10That is how we will hear about incoming runs.
04:12Thanks.
04:13Two minutes out with abdominal pain and fever.
04:14Okay, has everybody got that so far?
04:16How do we write orders?
04:18Physician order form in triplicate labs, x-rays, IV fluid, medication.
04:22Will the labs still be able to run blood tests?
04:24Yes.
04:25Are the CT scatters still working?
04:26Yes, but the results will come back on paper from the radiologist.
04:30This is the dark ages.
04:31So if you have orders with labs or x-rays, they go into the clerk file here.
04:35They will sign them off.
04:36They will add a downtime slip on them, make sure they go to the correct department.
04:40I'm sorry, who are the clerks?
04:41You're looking at them.
04:42Larry and Antoine are filling in until more help arrives.
04:44Got this.
04:45After the clerk orders, chart gets moved to the nursing order rack here for IVs, medications,
04:50procedures.
04:51Medications are locked up in the PDS.
04:53The PDS is getting unlocked by a clinical pharmacist, Dr. Megan Nord.
04:56Look at your back.
04:57This is the lock.
04:58Any questions?
04:59Yes.
05:00No.
05:01What's up with the third rack?
05:03When your patient is ready to be discharged, chart goes here.
05:06This lets everybody know we're about to have an open bed.
05:08Your tuna melt is up.
05:10Jesse?
05:13What is that?
05:14That is a fax machine.
05:16They still make those?
05:17This is our lifeline to labs and x-rays.
05:19When the results come back, they will fax to us and the clerks will put them on the charts.
05:23Yes?
05:24Would you say so?
05:25Incoming!
05:26Okay.
05:26Dr. McKay, Dr. Whitaker, Ogilvy with me.
05:29The rest of you, build your clipboards.
05:35Howard Knox, 52, abdominal pain and fever, 152 over 90, tacky at 120, couldn't get 90.
05:41I wonder why.
05:42Hello, sir.
05:42My name is Dr. Robbie.
05:44Howard.
05:44This is a teaching hospital.
05:46I'll be supervising Drs. McKay and Dr. Whitaker and student Dr. Ogilvy.
05:49Hey.
05:49Hello.
05:50How are you feeling?
05:50That's so great.
05:51Okay.
05:52Princess, what's free?
05:53Trouble one.
05:53Her left.
05:57Orders for Mylanta and the Pibokane Central Club.
06:00Wrong spot, Dr. Santos.
06:02And you need a sticker.
06:06Put it in the nursing orders rack and meet me over at PDS.
06:09How much does this suck?
06:10You didn't think today could get any worse.
06:12This is how we rolled when I was a resident.
06:14Was that in the 1900s?
06:16Yeah, when charts were written by candlelight.
06:18Hey, today will be an adventure.
06:20Think of it like back to the future.
06:24Or possibly Titanic.
06:27Here is your antacid.
06:28Cheers.
06:29And I marked the trigger point that is bringing out your headache.
06:33And a shot of local anesthetic in that area could really help.
06:38Yeah, let's do it.
06:39Great.
06:41You are going to feel a little pinprick and some burning.
06:53Oh, ow, ow.
06:54That really hurts.
06:56Temp 101.4.
06:58Tacky at 128.
06:59Full socks 92 on two liters.
07:00When did the pain start?
07:01It's been on and off for about a week.
07:03And where do you feel it?
07:04All over.
07:05Started on the left and now there's some on the right.
07:07How about that fever?
07:09Since last night, I was burning up and then I had chills pretty bad.
07:13Can't find a vein here.
07:14We'll try it for midlife.
07:15Let us know if this hurts.
07:17Uh, uh.
07:17Sorry.
07:18And on this side?
07:20Yeah, yeah.
07:20Sorry, sorry.
07:21Uh, guarding with no rigidity for pain 100 of Fentim.
07:24I have a plan, Dr. Whitaker.
07:26Blood cultures, lactate, Zosin.
07:29We're going to need a CT to figure out what's going on.
07:31Uh, uh.
07:32Yeah.
07:33It's not going to work.
07:34Yeah, that's right.
07:35Neatly, penmanship counts.
07:36Howard, for the scan, we're going to have to lay you flat on your back.
07:38Can you do that?
07:39I could 10 years ago, but now it's too hard to breathe.
07:43See, if we can't lay you flat, then we're going to have to put a tube in your windpipe
07:46to help you breathe.
07:46Are you okay with that?
07:47Intubation with rapid sequence induction?
07:49Uh, no, we can't lay him down.
07:50No, the tube will go in your nose while you're awake, sir.
07:52Well, it doesn't hurt.
07:54You'll be numbed up completely.
07:56You won't feel any discomfort.
07:57Do you happen to, um, know your weight?
07:59Uh, a little over 400.
08:02When was the last time you checked?
08:03It's been a while.
08:04Is it possible that you might be over 450?
08:07Possibly.
08:09Carla, let's call for the Hoyer.
08:11So we're going to place the tube and get you ready for the scan.
08:14Is this something serious?
08:16It's hard to tell without a CT.
08:18You could just need antibiotics or you could require an operation.
08:21If surgery is necessary, then your weight could make things a little bit more complicated.
08:25I know.
08:25I'm sorry.
08:26Not to worry.
08:26We're going to take very good care of you.
08:28Team.
08:32Let's try for a midline.
08:34So advantage with ultrasound guides.
08:36Can ultrasound check for an app?
08:37He's a little too large for ultrasound.
08:39So Mr. CT can only handle 450 pounds.
08:42And so if he's over that, we send him to the zoo?
08:45He's right there.
08:49I heard that there's a large animal CT in the zoo.
08:52Presby's CT can handle 650.
08:54Yeah, if Presby's still up and running.
08:56What?
08:58That's not a jinx.
08:59Have any of you ever done an awake nasal tracheal?
09:03Perla, can you also ask Dr. L?
09:05Is she going to come in?
09:06I'm going to need an assist.
09:07Yep.
09:07You got it.
09:08Uh, sorry.
09:09Signed.
09:12All about F.
09:13For a transis.
09:14Shortness of breath.
09:15Dr. Mohan awaiting D-dimer.
09:17Wow.
09:18She's still going?
09:19Yeah.
09:19Remarkable, really.
09:21Dr. L, Robbie's asking for you.
09:23Uh, okay.
09:24In trauma if you need me, princess.
09:25Got it.
09:28Who's supposed to run the downtime slips to X-ray and lab?
09:31Uh, the charge nurse.
09:33Don't look at me.
09:35My plate's full.
09:39Uh, parents of Roxy Hamlin?
09:42Central 9.
09:42Oh, I got it, Donnie.
09:44Hi, I'm Victoria Givadi, one of the student doctors here.
09:47I've been assisting with Roxy's care.
09:48Oh, thank you so much, Adam.
09:50I'm Lloyd.
09:51Cora.
09:52It's nice to meet you.
09:53She broke her leg?
09:54Um, yeah, there's a fracture down by the ankle.
09:57She's in a boot now, um, so there's not quite so much pain.
10:00But I'll take you.
10:00She's just at 9.
10:07The hospital Wi-Fi isn't working.
10:09Oh, it'll be down for a while.
10:10Sorry.
10:12Mom broke her leg, Grandpa.
10:14We heard.
10:17How are you, honey?
10:21You've got this, kiddo.
10:23Yeah.
10:25How long will she stay in the ER?
10:28Oh, until a bed opens up upstairs.
10:31Could be a while.
10:38You know, it's getting pretty crowded in here.
10:39Maybe we should take Tucker and Shane out for ice cream.
10:41Yes, please.
10:42No, no, I'm okay.
10:45Maybe your mom would like some time to rest.
10:48Yeah.
10:49Go.
10:51Can she have ice cream?
10:54She can have anything she wants.
10:57Come on.
10:58Let's go.
11:01Bye, Mom.
11:04Almond's cream.
11:10Yep.
11:11Listen up.
11:13This is oxymetazolene to open up the passage.
11:16What medication do you take?
11:19Lisinopril and metformin.
11:21Ozempec, Wigobi.
11:23They're all kind of expensive.
11:25I'm going to squirt some numbing gel in your nose.
11:27If it drips back in your throat, that's okay.
11:30Here, in case you need it.
11:32Do you smoke alcohol?
11:35Never.
11:36Do you exercise?
11:37Moving from the bedroom to the kitchen?
11:40No, I'd walk more, but I'd need a bench to rest on every block.
11:44What about water aerobics?
11:45Let's focus on helping, Mr. Knox.
11:48Agreed.
11:49Took me 25 years to get this way.
11:51Car crash.
11:52Burn unit.
11:54Four leg surgeries over ten years.
11:57Laid me up so much, I lost my job.
11:59I need to numb the back of your tongue.
12:01This is going to taste pretty bad.
12:02Is there anyone you'd like us to call?
12:05Any family?
12:07My parents passed.
12:09I'm single.
12:10Go figure.
12:12Siblings?
12:13Sister in Arizona.
12:15We don't talk much.
12:17Now that we've numbed up the back of your tongue,
12:19we can anesthetize a bit deeper.
12:23Sorry to interrupt.
12:24I have a middle-aged woman with sudden onset blindness.
12:26I can go.
12:27Will you see if Abbott's still around?
12:29Yeah.
12:30What's your sister's name?
12:32Lauren Milford.
12:33Where in Arizona?
12:35Flagstaff, I think.
12:36It's going to go over your tongue and numb your vocal cords.
12:42How many fingers?
12:43I don't see any fingers.
12:45And now?
12:47I can see a little bit of light.
12:50Brooke, you've met Dr. King.
12:52This is Dr. Al Hashimi.
12:53Nice to meet you.
12:54And her wife, Wendy.
12:55Hello.
12:55Hello.
12:55Okay if we discuss your symptoms?
12:57As long as I can correct you if you get anything wrong.
13:00Trust me.
13:01She will.
13:01One hour of sudden painless vision loss in the left eye.
13:05No history of hypercoagulable state or vascular disease.
13:08Could you look straight ahead, please?
13:09Could be a central retinal artery occlusion.
13:12In English, please?
13:13A little blood clot can block the artery at the back of the eye and decrease your vision.
13:18Sometimes it's called an eye stroke.
13:20Stroke?
13:21Like she could be paralyzed?
13:22No, this would be limited to the eye.
13:24Is it permanent?
13:25First, we have to make the diagnosis.
13:28Retinal exam?
13:29Hard to get a good look.
13:30We need the FLP.
13:31The what?
13:35Oh, Princess, we need patient stickers on each of these order sheets or the pharmacy won't
13:40know who to give meds to.
13:41We're on it.
13:42Princess, smartphone frontoscope.
13:45Equipment corridor eye cart.
13:46Thanks.
13:46You seem a little confused.
13:49How do I figure out which new patient to pick up?
13:51Top of the board.
13:52They're listed in the order they arrive.
13:54You erase the first one and put your initials in the MD box.
13:56Okay.
13:57Thanks.
13:58Caleb, Michael, you managing this chaos okay?
14:01Oh, it's all pretty easy when you're a short timer.
14:04Any more comatose patients for me to have a chat with?
14:08I'm kidding.
14:09Okay.
14:10Victoria, this is Nicole Stedman.
14:13I run the parent support group for the psychiatric service.
14:15Yeah, Nicole's daughter was diagnosed sophomore year in college.
14:19You think Jackson's parents might have a chat with her?
14:22Yeah, we can certainly ask.
14:24Now we can see the whole retina without dilating the pupil.
14:28You're looking in the wrong eye.
14:30We start with a good eye for comparison.
14:34Retina looks great.
14:35Now for the bad eye.
14:37Eyes wide open.
14:40How's it look?
14:42Extremely pale, no blood flow.
14:43Digital massage, ten seconds on, five seconds off.
14:45Order non-contrast head seat.
14:50Come in.
14:53Hi.
14:53Heard your patient took off.
14:55She's taking a little break.
14:56How long are you going to wait?
14:59You know about the cyber shutdown thing?
15:01Yeah.
15:02Wish I could help, but I'm going to stay here until all the evidence is collected, so.
15:05It's a hot mess out there.
15:07It's all day, yes.
15:10Sorry, I was just leaving.
15:12You okay?
15:14I'm good.
15:15I'm glad to hear it.
15:17You got something to eat?
15:18No.
15:21Let's keep going.
15:23Okay.
15:25Yeah.
15:36Why don't we keep one in the ER?
15:38Because our intubated patients are usually sedated.
15:42Right.
15:44Maybe you could ease up with your comments about his weight.
15:48I was just wondering how he got so big and how we could help.
15:52We can help by finding out what's wrong with him and treating him with respect.
15:55What are you billing now?
15:56Second pain shot helped.
15:57Okay.
15:58There's more if you need it.
15:59Diminished balance.
16:00Bye to talk from the ICU.
16:02Great.
16:03Howard, we need to open up that passageway now so we can pass the tube.
16:06I'm going to start with my pinky slowly over a few minutes.
16:08I'm going to go deeper, all the way to the back of my knuckle.
16:10Once the tube's through your vocal cords, you won't be able to talk.
16:13This is a communication device.
16:15Swipe through the screen for anything you want to say.
16:18Hit the icon and it talks to us.
16:21I would like some pain medicine.
16:23My pain is a nine.
16:25Can I get it to order a pizza?
16:28There's cell service in the ambulance bay.
16:30I found his sister's new number, left the voicemail.
16:33Okay, I'm going to start.
16:34You ready?
16:35Not really.
16:37Go ahead.
16:38Robbie, over here.
16:39Here we go.
16:39Head back.
16:40Oh.
16:43You thinking it's surgical?
16:44I'm hoping for a non-perfect appy.
16:46Can you do it with this girl?
16:47Possibly, but he could be treated with antibiotics alone.
16:49If he needs surgery?
16:51With his size, an emergency, open leperotomy, death rates, close to 50%.
16:56Okay, one step at a time.
16:57Let's keep trying your sister every 15 minutes.
17:00She'll get it.
17:05Half the downtime slips are blank.
17:08What are you talking about?
17:11Here and here.
17:13Larry, are you using a felt-tip pen?
17:15Maybe.
17:17It's not going through for the copies.
17:21Ballpoint pen only.
17:23Okay.
17:26Did we steal MIA?
17:28Is that the homeless guy?
17:29We need the bed if he eloped.
17:32What do you need?
17:33Fun attending.
17:34We're a senior resident?
17:35No, I'm good.
17:35Dr. Al-Hashimi, can I present?
17:37Yes.
17:3832-year-old deaf woman with myofascial headache, ibuprofen-caused gastritis, and epigastric pain.
17:43And she vasovagled.
17:44But now pain-free after my lanza and a trigger point injection.
17:47Excellent.
17:48That can take care of the pain for several months.
17:50Yeah, it shouldn't recur.
17:50She keeps her screen at eye level.
17:52There was a delay in getting an ASL interpreter, and I almost gave up and ordered an unnecessary brain and
17:58abdominal CT.
17:59Good thing you didn't.
18:00Dr. Al-Hashimi, for you.
18:03Nice job on the trigger point.
18:05Yeah, I know.
18:05How's the T-system going?
18:07Quick and easy.
18:09Yeah, and these MDMs, don't just circle your diagnosis.
18:12Also put a backslash through all the ones that you ruled out.
18:14Ain't no problem.
18:15Thank you very much.
18:17Princess, bump central 13 to the front of the CT line.
18:20What do you got?
18:20Sudden onset blindness patient has central retinal artery occlusion.
18:23I just spoke to an ophthalmologist at the BA, principal investigator for thrombolytics in cases like this.
18:28Not exactly the standard of care.
18:30Kind of risky.
18:31Well, due informed consent.
18:32It's our best shot at saving some of her vision.
18:34You're patient.
18:35You're a call.
18:35You're not going to be running long enough for any complications.
18:40I'll be taking two swabs from the vagina, two swabs from the cervix.
18:49Let me know if you're feeling discomfort.
18:52Okay.
18:54Each swab gets labeled.
18:56First vaginal, second vaginal.
18:59Smear slide with both and let it air dry.
19:01Same for the cervix?
19:02Yeah.
19:03But no sliding either.
19:06How you doing, Lana?
19:08Hanging in there.
19:12Almost done.
19:16All these samples go in the vaginal contact envelope.
19:19I can help with that.
19:20No.
19:20It's got to be me.
19:22I'm going to pull this out.
19:25Okay.
19:27All good here.
19:28Legs can come down.
19:33Are we done?
19:35One last thing.
19:36Four more swabs inside your mouth.
19:39Didn't you do that already?
19:41Next one's different.
19:42Inside your cheek for your DNA.
19:44No pears.
19:49So, it could be bipolar or schizophrenia.
19:54Those are the two most likely possibilities.
19:56How do they know which it is?
19:57Based on response to medicine.
19:59But also with therapy and observation on a ward.
20:02They'll monitor his mood and interactions with others.
20:07Is there a blood test or a brain scan that'll tell us for sure?
20:12Unfortunately not.
20:13When properly medicated, people with bipolar disorder can have successful careers.
20:19So, we hope for bipolar.
20:21It can help for your son's happiness.
20:23With early treatment, 20% of people with schizophrenia have a complete recovery.
20:28So, 80% don't?
20:30This is a new version of Jackson.
20:35How old was your daughter?
20:3720.
20:38Studying architecture at Georgetown.
20:42Schizophrenia.
20:44I'm sorry.
20:46Oh, she's good.
20:47Living at home, working as a cashier at Giant Eagle.
20:52Employee of the month.
20:55We still have struggles.
20:57But there's also laughter and love.
21:07Good to go.
21:08How'd that feel?
21:10Very weird.
21:11No pain.
21:12Just weird.
21:13Okay, the next step is we're going to take this tube and pass it through your nose,
21:17stopping at the back of your tongue.
21:20Best not to talk for that.
21:21Tube soaking in warm water to make it more flexible.
21:25Do you want to try it?
21:28What day and time is it?
21:30Fourth of July, 2.31 p.m.
21:33When is my tube coming out?
21:35We have to put it in first.
21:37I know.
21:38Just practicing.
21:40Sounds like you're an expert already.
21:43Before I can't talk, I just want to say thank you for everything.
21:53You're very welcome.
22:00Here we go.
22:02Here we go.
22:07STI prevention.
22:08One shot treats gonorrhea, then pills for chlamydia and trichomonas.
22:13We also have morning and after contraception.
22:15She has an IUD.
22:16Over 99% effective, not 100.
22:19We still offer.
22:20I'll pass.
22:22For HIV, we got PEP.
22:24Post-exposure prophylaxis.
22:2628 days.
22:27The sooner you start, the more effective.
22:30I'm pretty sure they could use an extra set of hands out there.
22:35It's nice to meet you, Alana.
22:38You're a very brave woman.
22:39Yeah.
22:47She's a good nurse.
22:49She's still learning, but she won't be.
22:54After this, we're done?
22:55Yeah.
23:00I'm glad you were here today.
23:06Me too.
23:09We have a decision to make.
23:12Studies have shown that some vision can be restored with a clot-busting medication.
23:17So give it.
23:18But there are possible risks.
23:21For eye stroke, only 17% get better without any treatment.
23:25Only 17%?
23:27Yes.
23:27But with the medicine, another 20% can improve.
23:31But there can be complications.
23:342% of patients who receive the medication get worse.
23:38And 1% have severe disability or death.
23:48I mean, this one has to be your call.
23:53No, it's our call.
23:56What would you do without me?
23:58Figure out how to get by.
24:02And I'd probably cry for two years solid.
24:05Two years, that's all.
24:09I'm with the medication.
24:11Okay.
24:16Hey, we need your full name to make a chart.
24:19Jackie Liddell.
24:20Jackie Liddell.
24:21And you are?
24:23Her friend Jackie.
24:24You have the same name?
24:25No, no.
24:26She's Jackie with a CK.
24:27I'm Jackie with a Q.
24:28You can call me CK.
24:31Best not to talk CK, okay?
24:33Just chill.
24:33No.
24:34I bit off half my tongue.
24:37What?
24:37She said I bit off half my tongue.
24:39You can understand that?
24:41Oh, you should hear her when she's had two pictures of margaritas fucked up and slurring.
24:44Oh, no, I'm so sorry.
24:47Princess, what's open?
24:48South 15's clean.
24:50Deep tongue laceration.
24:52I can jump on this?
24:54Robbie and Alan Shimmer are both with critical patients.
24:57Hello.
24:58I'm Dr. Langdon.
25:00I'll be supervising your care.
25:04Jesus, CK, your doctor's fucking hot.
25:06What?
25:09Tubes at 14 centimeters, just above the airway.
25:12Okay, Howard, I'm going to start.
25:14If you want me to stop, you just put your hand up, okay?
25:18Blue Mart tells me I'm in the tube.
25:24Looks like you cleared it.
25:26If he inhales, we should see cords.
25:29Okay, deep breath for me, Howard.
25:34Wow.
25:34Very beautiful.
25:36Chords are sensitive, so we spray lidocan in the scope.
25:39Okay.
25:41One cc going in now.
25:44We'll just give that a second to work.
25:46Hey, how you doing, Howard?
25:50Once the tube's in, you'll have to breathe through your nose.
25:53Okay, Howard, hold still.
25:54Well, I am now going in past your vocal cords until we see the carina.
26:02Ogilvy?
26:03Uh, there.
26:04Right and left main stone.
26:06And the tube slides in.
26:12And the scope comes out.
26:17Great.
26:19Okay, inflate the balloon.
26:20Deep breath through your nose.
26:22Amazing.
26:23You good?
26:25Great.
26:26Intidal waveform.
26:27Does he need a pen?
26:28He's breathing on his own.
26:29A little CPAP wouldn't hurt.
26:30Starting at five, type three to ten.
26:33Okay, that went really well, Howard.
26:35Now we're going to check your weight.
26:38So the nurse examiner is supposed to lock up the rape kit in this fridge where it stays
26:43until it gets turned over to law enforcement.
26:45It's called preserving the chain of evidence.
26:48Are you fucking kidding me?
26:50Is there a problem?
26:53Jesus Christ.
26:54The police are supposed to pick up the rape kits within 72 hours.
26:57This is what I did two weeks ago.
27:00God damn it.
27:04So, how exactly did this happen?
27:06We were in between pubs taking a selfie.
27:09Very nice.
27:10Until she jerked her head up.
27:13Oof.
27:14Ouch.
27:15Okay, the topical epi did the trick.
27:17No more bleeding.
27:18Sweet.
27:19I can go home now?
27:20I don't think so.
27:22It looks like the Grand Canyon across the back of your tongue.
27:24We need to put in some stitches.
27:25I don't want stitches.
27:27Listen to the doctor.
27:29Don't tell me what to do.
27:30This is all your fault.
27:32No, it's not.
27:33Yes, it is.
27:34Princess?
27:35Oh, it's Princess.
27:36Hey, why don't you show Q where she can wait while we patch up her friend?
27:39Of course.
27:40Okay, this is a numbing shot for the tip.
27:43The tip?
27:44That's not where I bit it.
27:46One step at a time.
27:54That's 20 mgs, TNK.
27:57In 1439.
28:00Failing anything?
28:02Not yet.
28:03Could take an hour or two.
28:06We're going to move you to another room for better monitoring.
28:10Dr. King?
28:14I'd like you to stay with her.
28:17Why?
28:18In case there are complications.
28:20You'll be there to respond quickly to a blown pupil, a seizure, altered mental status.
28:25Or I could catch up on my charts.
28:27And my deposition's coming up.
28:29Think of this as a great way to steal some quiet time and get mentally prepared.
28:33Jesse, Mel's with you.
28:36Oh, uh, excuse me, Dr. Mohan.
28:39Excuse me, Dr. Mohan.
28:41Uh, in a minute, George.
28:42I've got this.
28:45Oh, uh, I, um...
28:47D-dimer's back.
28:48Um, normal.
28:50I'm ready to go.
28:51Are you feeling better?
28:53I really wasn't short of breath this time.
28:58Then why'd you come in?
29:01I found out about the blood clot in my leg.
29:03I just kept thinking it's going to go to my lung and kill me.
29:06We've talked before about how the eloquence would prevent that.
29:09I know.
29:12Well, I finally took your advice.
29:14I got out of the house.
29:16I joined the Frick Park Lawn Bowling Club.
29:20Wonderful.
29:21I mean, you're right, you know.
29:23We all need a community.
29:29You're going to do what?
29:30In order to fix your tongue, we need to move it forward to access the laceration.
29:35You're just going to feel some pulling, okay?
29:36I guess so.
29:40Go for it.
29:42What size suture is that?
29:44I'm silk.
29:45The biggest one we got.
29:48As soon as I cut the needle, you're on traction, Joy.
29:51Okay.
30:00That is pretty deep.
30:03And now we can numb up the cut.
30:05It's best to start with...
30:06Proximal side first so she doesn't feel the distal injection.
30:11Give it ten minutes.
30:12I'll be back for the repair.
30:17I got a rape kit sitting here for two weeks.
30:19It was supposed to be picked up within 72 hours.
30:22I don't care.
30:23Get someone to have a hand now.
30:24No.
30:25You expect us to treat your officers?
30:26As soon as they come in, you get a detective to pick these kits up.
30:29ASAP.
30:30I got to go.
30:31Dana, your South 19 got their head CT before he went down.
30:34No results yet.
30:34All right.
30:35Let's send a reminder.
30:36Hey, Dana.
30:37Dana, hang on.
30:40What's up?
30:40We put in an order for more pain meds for Roxy.
30:43All right.
30:44So, put it in the nursing racks.
30:45Oh, I did.
30:46A long time ago.
30:48All right.
30:49I'll bump it to the front.
30:51What's that noise?
30:53You up all landed.
30:54Aliens are invading.
30:55Hey, Dana.
30:57Chem 7's not back on trauma too yet.
30:59Let me see the chart.
31:01Oh, Jesus.
31:02I bet your Chem 7 wreck went to radiology.
31:04Larry, Antoine.
31:05You put labs and chest X-ray on the same downtime form.
31:08You need two slips.
31:09One for labs.
31:10One for radiology.
31:11What happened again?
31:12I'll run it down myself.
31:13Use the ice set at bedside.
31:15They won't take them at CT without a creatinine.
31:16Oh, perfect.
31:18Nice to have you back.
31:19Thrilled to be here.
31:20You trying to text?
31:21I am just composing.
31:23I'm going to send it from the bay.
31:24My mechanic friend, Duke, never showed up.
31:27Larry's coming in this morning.
31:28That was the plan.
31:29I guess he got busy.
31:31What if he's a no-shot?
31:33Tell me what he needs.
31:34I'll pass it on in a night shift.
31:35That won't be necessary.
31:39Oh, princess.
31:41I'm asking you shall receive no mahat sitte.
31:43Thanks.
31:44I'll get him discharged you.
31:46How's your day going?
31:47I think I'm getting writer's cramp.
31:50You with the big guy?
31:51Yeah.
31:52It's sad.
31:54Bad car accident, multiple operations, tons of stress.
31:59The lidocaine shot into a sensitive area.
32:01I'm going to binge drinking party go with a tongue lack.
32:04Seems like she needs some help.
32:06More ways than one.
32:09How's your first shift back going?
32:12One day at a time.
32:14First year sober as a artist.
32:16That's what they keep telling me.
32:18I'm nine years and counting.
32:23Oh, special delivery for my guy.
32:27If you need anything, call me.
32:30Thanks.
32:37Where are you going?
32:39Blisters of North 3.
32:40That's where I'm going.
32:42Did you sign up for the patient?
32:43I pulled the chart from the rack.
32:45You're supposed to sign up on the dry erase board.
32:46You're supposed to have a clipboard for the patient.
32:49I thought the nurse had that.
32:51Whatever.
32:53Hi, I'm student Dr. Ogilvie, and this is...
32:56Wow.
32:57That is some rash.
32:58Yeah.
32:59Tell me about it.
33:00Student Dr. Javadi, when did this start?
33:02Last night.
33:04And have you been on any hikes recently around poison ivy?
33:06Nope.
33:07Haven't left the house.
33:08What about new medications?
33:09Hotions, lotions, soaps, detergents, even?
33:12I don't take medicine.
33:13Nothing new with all that other stuff.
33:15And where did this start?
33:16Everywhere, all at once.
33:17Just a lot of pain.
33:19Um, really itchy.
33:21What is it?
33:22Not sure yet.
33:24Um, be back in a second.
33:28You...
33:32What are you thinking?
33:35I have no idea.
33:36Agreed.
33:39Well, it's pemphigoid?
33:41Autoimmune severe pruritus?
33:42Yeah, but not as deadly as pemphigus vulgaris.
33:44Untreated, the death rate is over 90%.
33:46We need to check for pustules, mucous membrane involvement, and...
33:48And the Nikolsky sign.
33:52Here you go.
33:55What?
33:56For your progress now.
33:59Did I hear we're making progress?
34:02Oh, um...
34:03It's just what we call it when we write down things to describe a clinical course.
34:09Any changes?
34:11Not so far.
34:12It's time for the next neurocheck.
34:15Excuse me, Dr. King, do you have a minute?
34:18Um, no.
34:18I'm observing a patient right now.
34:2060 seconds, Tops.
34:24I'll check pupils.
34:25We're good here.
34:32Hey.
34:34I just finished my deposition.
34:38Oh, um...
34:38Should I go up now?
34:39Yeah, just wait until you get a call.
34:41Okay.
34:42Well, I'd ask how it went, but we're not supposed to discuss the case.
34:46This isn't a discussion.
34:47It's a monologue, so shut up and listen.
34:51The malpractice case is frivolous.
34:53The mother of the measles kid claims we caused intellectual decline by performing a spinal tap.
34:58But the tap was perfect with no complications.
35:01Her son presented with altered mental status due to low oxygen from measles pneumonia.
35:06Any change in intellect was due to hypoxic brain injury.
35:09It had nothing to do with your spinal tap.
35:12End of monologue.
35:14We never discussed the case.
35:17I gotta get some sleep.
35:19Thanks.
35:21I guess.
35:24Okay, are you ready to lay down?
35:26I got your head.
35:28Nice and slow.
35:29One, two, three.
35:32Okay.
35:33How does that feel?
35:37Lifting up now.
35:48Keep going.
35:54And...
35:55Then I'll do it right about there.
35:58215?
36:00That's in kilos.
36:04Okay.
36:05Team.
36:11It's not that much over 450.
36:13No, we can't.
36:14We're just breaking our CT on a holiday weekend.
36:16Can the medics take him while he's intubated?
36:18If I go along for the ride, I could still get a nap in before my night shift.
36:26Uh, 474.
36:28Our CT can't handle your weight, but we're gonna take you over to Presbyterian Hospital.
36:34Road trip.
36:36I'll keep you company the whole time.
36:40Sorry for all this trouble.
36:42It's okay.
36:44This is what we do.
36:51So, sub-Q starts deep.
36:52You want to bury the knot?
36:53Yeah, I've done these before.
36:55Joy, how do we cut the ends?
36:58Short slide to the knot, turn 45 degrees.
37:00Excellent.
37:02Um, Dr. Langston, we have a case.
37:04It'll have to wait.
37:05It could be urgent.
37:06Fine, Robbie, or Alice Shemmy.
37:10This girl is wasted.
37:12Drunk as a skunk.
37:14Should we check her blood alcohol level?
37:16No, it won't change what we do.
37:18She can go home when she has a steady heat.
37:19I already set one off.
37:21Joy, do you want to guess her blood alcohol?
37:24Why would I want to do that?
37:26I don't know, because it's fun.
37:34When will you have a bit?
37:35I'm not sure she needs a bit.
37:37She's a febrile infant.
37:39Oh, it's clearly over a month old and looks amazing.
37:41Every marker is normal.
37:42She has a cold virus.
37:43Infants with rhinovirus can still have a serious bacterial infection.
37:46Not this one.
37:47We send kids like this home all the time.
37:48Except this one doesn't have a home.
37:51Or a parent.
37:54I can't put a kid with a virus in the nursery and I can't waste the private room on a
37:58healthy baby.
37:59Then what do you propose?
38:01CYF can place her in emergency foster care by tomorrow morning.
38:03You want to leave her down here overnight?
38:06Seems to be the standard of care these days.
38:09Have your attending give me a call.
38:10Will do.
38:11I can't believe this.
38:12Let CYF know it's very urgent.
38:14Got it.
38:14This is turning into quite the day.
38:18You know, I've been thinking about applying for a fellowship.
38:21I thought you had a job lined up in New Jersey.
38:23I did to be close to my mom.
38:26But she sold our house to travel the world with her new boyfriend.
38:31So what's the point of New Jersey?
38:33Yeah, good question.
38:34Which fellowship?
38:36I've narrowed it down to ultrasound, toxicology, and sports medicine.
38:43Those are very disparate fields leading to very different careers.
38:46I know.
38:47I'm a little undecided.
38:49Do you have research experience?
38:51I was a part of a study on racial disparities in health care until the White House cut the funding
38:56last year.
38:57Yeah, you are not alone.
38:59Have you considered a geriatrics fellowship?
39:02I have not.
39:04I've seen your skills with the elderly, and there are a lot of openings.
39:08It might be your best shot.
39:10Think about it.
39:13Last stitch.
39:14You want me to cut?
39:15I got it.
39:18Looks good.
39:19Okay.
39:20Let's pull the traction, too, Jay.
39:21With pleasure.
39:25Okay, Jackie.
39:27Jackie.
39:28What's up?
39:29What's up?
39:29All done.
39:31All done with what?
39:32Sewing up your tongue.
39:34What happened to my tongue?
39:35You bit it.
39:37Huh.
39:38No, I didn't.
39:39That is called a blackout.
39:41How much did you drink?
39:43A couple Bloody Marys.
39:45Only a couple?
39:46I don't know.
39:47Maybe more.
39:49It's a holiday.
39:50A pub crawl.
39:51Do you usually have a couple cocktails every day?
39:54Only on weekends.
39:56How about during the week?
39:57Nothing much.
39:58Just wine with dinner or a few beers.
40:03Maybe we should recommend rehab?
40:06Yeah.
40:08We could try.
40:14Ready to roll.
40:16How are you feeling?
40:17My pain is a two.
40:19We got meds if you need them.
40:20Scan will be quicker than the ride to Presby.
40:22We'll keep trying to reach your system.
40:23You guys are the best.
40:24See you later.
40:25Can I put a new patient in T1?
40:27No, I kind of want to leave one trauma room open.
40:29Why don't you double up the north if you have to?
40:33Mr. Digby?
40:36It's just Digby.
40:37Right.
40:38You've been looking all over.
40:39Where you been?
40:40With Louie.
40:42Been there for an hour?
40:43He was my friend.
40:45I had a lot to say.
40:47Well, let's get you back to your bed.
40:52Louie got his wings.
40:54Dr. Robbie, we picked up a patient together.
40:58Teamwork.
40:58It's a concerning bullet rash.
41:00We might need a biopsy for pemphigus vulcare.
41:02It's phytophotodermatitis.
41:03What?
41:04I asked.
41:05He was making three gallons of margaritas for a party,
41:07squeezing fresh slimes out in the sun.
41:09Let's go take a peek.
41:11I don't need to see it again.
41:15How's it going out there?
41:17Standing room only.
41:18If I call the fire department,
41:19will they clear that waiting room?
41:20Wish.
41:21What's up?
41:2212 patients need med refills.
41:24Shouldn't they see their doctors?
41:25With the Medicaid cuts, we are their doctor.
41:27No, I can't be prescribed to their pharmacies.
41:29Look at your pen.
41:30Go old school.
41:31Right now, on what?
41:33Lord, you got the security pads?
41:35Sure do.
41:37Just need a patient sticker.
41:38Any other questions?
41:40Yeah.
41:41What would have happened if you weren't here today?
41:44You don't be curled up in the fetal position,
41:46crying like babies.
41:49What, are you wearing flip-flops?
41:50I was.
41:51What is it?
41:53Phytophotodermatitis.
41:54Otherwise known as margarita burn.
41:56For some people,
41:57limes plus sunshine can cause a horrible rash.
41:59This is all because of limes?
42:01Have you ever squeezed limes outside in the sun before?
42:04I don't think so.
42:05You will feel better after a day of steroid pills,
42:08but once these heal,
42:09you gotta wear sunscreen,
42:10because these blisters can turn into dark scars
42:12and stay a while if you don't.
42:14I'll be right back with your aftercare instructions.
42:18Hey, Robbie?
42:19Yep.
42:20My, uh, my hospice patient, Roxy,
42:22is still in a ton of pain.
42:24Where are we with the morphine?
42:2510 million grams an hour.
42:27Okay, you can both, uh, another two,
42:29go up to 12.
42:30I will let Princess know.
42:3112 an hour is a lot.
42:33Yeah, on top of the MS cotton,
42:34she could stop breathing.
42:37Are you familiar with the doctrine of double effect?
42:40Not really.
42:42It is an ethical principle in palliative care.
42:45We treat pain.
42:46And if in doing so there's a negative side effect,
42:48we accept it.
42:50Even if the negative side effect is death?
42:53In some cases, that could be the best outcome.
43:03Emma.
43:04Emma.
43:14How are we going to get through this mess?
43:15I was about to ask you.
43:18I don't ask the fence.
43:20You can't leave the video.
43:21Nothing's getting down here.
43:23No.
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