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The.Pitt.S01E01.540p.x265.AAC [Full Movie] [Full Series]Full EP - Full
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00:13Baby, it's all right
00:21Maybe you'll stay here tonight
00:28Baby, it's all right
00:34Maybe you'll stay here tonight
00:40Out on the street, a lot of music might get done
00:45It's over my woman, one of those old fans of God
00:53She said, hey boy, why don't you get on in
00:59For tonight, I'll be your lover
01:03And your friend, baby, it's all right
01:17You last name?
01:18Uh, it's, uh, J-A, uh, I mean, Jess
01:21Is it true?
01:39Nope, Simi told Hector that Dr. Durangian said the hospital was up for sale
01:42They might turn into an ortho center with no ER
01:45Oh, they're always threatening to shut us down, but they never do
01:56Gloria is looking for you
01:57No guts, no Gloria
01:59Must be time for my weekly spanking
02:01It'd be nice for all our sakes
02:03You sure you're cool being here today?
02:06Yeah
02:06Where wouldn't I be?
02:09Well, if you need to talk
02:10Yeah, I won't, but thanks
02:14Where's Abbott?
02:17Getting some air
02:29Hey
02:30You okay in there?
02:35Uh, awesome
02:39I like to say it goes away, but I had morning sickness for six months with my second daughter
02:44Hell, who am I kidding?
02:46No one still worries me sick
02:50Thanks
02:50It was worth it
02:52You tell anybody yet?
02:55Oh, no
02:57Not until I pass 12 weeks
02:59Not this time
03:00Nothing but good vibes
03:02But just so you know, Robbie's working today
03:05Today's the day Doc Adamson thought he hasn't worked at him four years
03:11So why is he here?
03:13All I know is he still blames himself for Adamson's death
03:16So if he's a little prickly today, give him a pass, okay?
03:21Great
03:21Thank you
03:23Hang in there, kid
03:31Morning, Jack
03:40What are you doing here?
03:42I'm working
03:44And you?
03:47Well, I don't know
03:49Had a guy come in
03:52Hit by a drunk driver in a crosswalk
03:5439-year-old vet
03:57Survived three tours without a scratch
04:02I spent the last two hours coding it
04:07That's always a rough way to end the night
04:09Must have had a reason at one time to keep coming back
04:12But
04:14I can't think of it right now
04:18Because this is the job that keeps on giving
04:21Nightmares
04:23Ulcers
04:25Suicidal tendencies
04:29Besides, if you jump on my shift
04:32That's just rude, man
04:42Hope I'm never one of your patients
04:45That makes two of us, my friend
04:49I got a pregnant teen coming back today
04:51For a mifepristone
04:53And a small bowel obstruction waiting on surgery
04:55For the last three hours
04:57Oh
04:59And unfortunately, the kraken is still boarding at VA
05:02Still?
05:03Guy's been here for a week waiting on a psych bed
05:05Yep
05:06He's only getting worse
05:08He's catching some Zyprex disease at the moment
05:11But when he wakes up, God help you all
05:16I wrote a note for the family of my dead vet
05:18If you don't want drugs
05:21Oh, and you got the med students
05:23And new interns starting today
05:24So, good luck with that
05:26Leggy, leggy me
05:28Sir, come back here
05:29No more needles
05:30Sir
05:31No more needles
05:32Stop
05:34Sure you want to work today, huh?
05:35They're gonna hurt me
05:36Sir, I promise nobody's going to hurt you
05:41Sir
05:45You left this mess
05:47They had a rough night
05:50Good morning, sunshine
05:52You obviously haven't seen this board
05:54Ah, we've seen worse
05:56Nothing like a little challenge every now and then
05:58To keep everybody on their toes
05:59Dr. Rubinovich?
06:01Melissa King
06:02I will be joining you today
06:03I just came from two months in the VA
06:05Hey, welcome to the pit
06:06This is Dr. Jack Abbott
06:08Nice to meet you
06:09I can't take how excited I am to be here today, so
06:13Talk to me at the end of the day
06:15Ignore him
06:16He had a rough night
06:17And is having an ongoing existential crisis
06:20Don't worry
06:21You'll get there soon enough
06:22I married my second husband, Everett, in 1964
06:27He unfortunately passed in 1976
06:30From a heart attack while we were vacationing in Consummi, Florida
06:34It was awful
06:36Good morning
06:36We're gonna round Dr. Morhan
06:39Excuse me, Estelle
06:40We'll be right back
06:44So, you know we track every resident's patients seen for an hour
06:47I was just taking her history
06:48It's a brief backstory about what brought them in, not an autobiography
06:51I was almost done
06:51You hadn't even made it to this century
06:55Patients, they check in for registration here
06:58A nurse eyeballs them, makes sure they're not dying
07:01If not, they're moved to one of two triage rooms for vitals and a quick chair exam
07:05Where you can do your labs and your x-rays
07:07And then they come back to...
07:09Waiting room
07:09Until the bed opens up
07:11For how long?
07:12Eight hours, if they're lucky
07:14A lot of times, 12
07:15Uh, is it always this busy?
07:18Uh, no
07:19Well, it gets a lot busier
07:24I'll take this
07:25Hey, Mateo
07:27Good morning, Cass
07:28This is Sherry
07:30Hi
07:32Sherry, I'm Dr. McKay
07:33I have some student doctors with me today
07:35Do you mind if they observe?
07:37Sure
07:37Okay
07:39What's going on, Sherry?
07:41I'm...
07:41Ah
07:43I burned my hand on a sterno
07:46What are you doing with a sterno?
07:48Uh, cooking
07:49You were cooking with a sterno?
07:51Yeah
07:51We were making s'mores
07:54Sweet
07:55This one loves spores
07:56Uh, we've been here for hours
08:00And I have to get them to school
08:02Do you know how much longer this will take?
08:05Uh, yeah
08:06Let's see
08:07You taking anything for the pain?
08:09Not yet
08:10A thousand of Tylenol, 400 ibuprofen, and the saline dressing?
08:13Yes, please
08:14Okay
08:15We'll go around
08:16And the fun begins
08:19All right, Sherry
08:19We're gonna patch you up and get you out of here as soon as possible, okay?
08:23I'll be back
08:27As you can see
08:29We have some new faces with us this morning
08:31Good morning, good morning
08:32Come on over
08:33Starting with second year resident Dr. Melissa King
08:36Fresh from the VA
08:37Everyone calls me Mel
08:39I'm so happy to be here
08:41Trinity Santos, intern
08:43Victoria Javadi
08:44Ms. 3
08:45Uh, Dennis Whitaker
08:46Ms. 4
08:48Welcome to the pit
08:49We got two traumas from the T
08:50Five minutes out
08:51Okay, copy that
08:52Uh, actually
08:52This is the most important person
08:54That you're gonna meet today
08:55This is Dana
08:55She's our charge nurse
08:56She is the ringleader of our circus
08:59Do what she says when she says it
09:01As you can see
09:02Our house is always packed
09:04And our department is mostly clogged up with borders
09:07Those are admitted patients waiting for a room upstairs
09:09Sometimes for days
09:11Beds are a very precious commodity around here
09:13So please be quick and efficient with your workups
09:15What else?
09:17We treat the sicker patients back here
09:18But please keep your eye on that waiting room
09:20Make sure nobody's gonna die out there
09:23Your senior residents are Dr. Collins and Dr. Langdon
09:27You report to them
09:28And they report to me
09:30Okay
09:30Great
09:31Senior residents
09:32You got your sign-outs?
09:33Yep
09:33Yep
09:34Okay
09:34Let's do this
09:38Virgil Straker
09:39Nine millimeter GSW to the left shoulder
09:42CT angiogram negative
09:44Surgery wants to admit for overnight observation
09:46Good vitals
09:47They repeat a crit?
09:49Stable crits every two hours times three
09:50Discharge on Sefton
09:51Recheck tomorrow
09:52You'll get way more rest at home
09:53Good morning, Mr. Straker
09:55You wanna go home?
09:56Hell yeah
09:57Okay
09:58Hey, hey, Rob
09:59Hey, Rob
10:04Murphy Rodenstein
10:0548-year-old woman
10:06With cirrhosis and upper GI
10:08Bleed, intubated, and stable after one unit
10:11Awaiting ICU bed
10:12Hey, Doc
10:15And we all know Louis Cloverfield
10:17Blood alcohol of 420
10:20At 11pm
10:21I've been cutting back
10:22How is he still breathing?
10:24That's a lethal dose for you and me
10:25That's happy hour for Louis
10:26Sobered up, had two rounds of lorazepam
10:28Hold out your hands for me, Louis
10:31Another tool of lorazepam
10:32On it
10:33And a script for Librium
10:34It's good to see you, Louis
10:35It's always a pleasure, Doc
10:37Bar fight
10:38With complete avulsion of tooth number eight
10:42Smile, Charlie
10:43Oh
10:44Where's your tooth, Charlie?
10:46If I can find out
10:48Cancel the discharge
10:49Order a chest x-ray
10:50Gotta rule out aspiration
10:52Incoming
10:5542-year-old male
10:56Sam Wallace
10:57Blunt head with agonal respirations
10:58Dropped down on the T-tracks
11:00Couldn't tube him
11:00LMA in place
11:01Suicide attempt
11:02Rescue
11:02He's a good Samaritan
11:03Took a spill
11:04Helping a woman who fell off the track
11:06She's right behind us
11:07Okay, trauma one
11:07Go ahead
11:10Come on
11:11Woman falls on T-platforms
11:13Good vitals
11:13No head injuries
11:14D-gloving injury
11:15Right lower leg
11:16With open fracture
11:16Dysmocation of the ankle
11:19Okay, trauma two, trauma two
11:21Let's go
11:28How we doing, ready?
11:31Here we go, ready?
11:32One, two, three
11:35Good breath sounds bilaterally
11:37But we need to protect his
11:38Apparently he jumped down
11:39To save the lady
11:39When he climbed back up
11:40He slipped
11:41Fell back and hit his head
11:42Okay, thanks
11:42It's more of an R2 procedure
11:43Mel, right?
11:44I need you on the 8 fast
11:46Pupils, 4 millimeters
11:47And reactive
11:48Okay, that's encouraging
11:49What do you want for meds?
11:50120 ketamine, 80 of rock
11:52A-tip on a monitor
11:53Morrison's clear
11:54That's a lot more blood than expected
11:56Um, he's probably
11:58Anti-coagulated for 8-bits
11:59Check his medical records
12:01CV's on a DOAC
12:01Standby with 4 factor PCC
12:03There's a brain bleed
12:04What's with the PCC?
12:05Mel
12:06Uh, clotting factors
12:072, 7, 9, and 10
12:09Okay, be right back
12:10Yeah
12:1150 of fat, didn't touch it
12:13Did she faint or did she trip off the clapboard?
12:14No one knows
12:15The other guy jumped down
12:16Pulled her out the tracks
12:17Just as the train was rolling in
12:18Isolated engine to the foot
12:20The train ran over her foot
12:21Got caught between the platform
12:22And the incoming train
12:23Ma'am?
12:24Ma'am, what's your name?
12:262 grams
12:27Do you speak any English?
12:29Airway and breathing are perfect
12:31As is circulation
12:33BP 140 over 85
12:35Students
12:37What might have made her faint on the platform?
12:39TIA, CVH
12:40Oh, she needs
12:41EKG and a
12:42Troponin
12:43Okay, good, good
12:4330 people
12:44Subway train de-gloved her foot
12:46With an open fracture dislocation
12:47Ooh, and I thought my heels were painful
12:49These are dynamically stable
12:50D-Fast negative
12:51Ma'am, I'm Dr. Yolanda Garcia
12:52Any pain in your chest or belly?
12:56Can we please push the morphine?
12:58No
12:58It could cloud her mental status
13:00I can't do an exam like this
13:01Push the damn morphine
13:03We're doing a popliteal block
13:04Numbs the lower leg
13:06No side effects
13:07Wonderful
13:07Where's the other guy?
13:08Next door
13:08He's a bit worse
13:09Pan scanner
13:10Let me know when she stops screaming
13:15The cords are very anterior
13:17Yeah, that's because we can't flex the neck
13:19Keep the hockey stick straight up
13:22I'm in
13:23Good, well done
13:24Bring me up to speed
13:25Intubated for agonal respirations
13:27GCS5
13:28Probably anticoagulated
13:30With what?
13:31First time here
13:32There's no medical records
13:33Call for FFP?
13:34No, we got four-factor PCC
13:36AD of mannitol to reduce brain swelling
13:38Then right up to CT
13:41Do me if I'm swap out with Jessie for me
13:43Of course
13:44Dr. Rabinovich
13:45Can you have a moment?
13:46I'm just a little busy right now, Gloria
13:48One sec
13:51Nerve block complete
13:52Seems like it's starting to work
13:53Swapping out, Jessie
13:54Takes ten minutes for the full effect
13:56And the mark can last a good four hours
13:58She's next for CT
13:59Do you have any idea what language that is?
14:01Definitely not Tagalog
14:03Maybe Hindi or Urdu
14:04I'm gonna go get language services
14:06Don't you speak like five languages?
14:07Six, but that's not one of them
14:09Six, and I thought Collins was smart
14:11Oh, that's right
14:12Way too early for you to start being an ass, London
14:14Open hostility in front of a patient
14:16She doesn't speak English
14:18Judgmental and dismissive
14:19How we doing?
14:20Vital stable
14:21Unlike these two
14:22Ooh, good for you
14:24Princess made a joke
14:25And I thank you for that beautiful blessing
14:28Namaste
14:29Okay, do we have a phone or anything with the relative's name on it?
14:32Uh, EMT said the purse got obliterated when the subway ran over it
14:36Any way I can speak with her?
14:38Highly doubt it
14:39We don't know what language she speaks
14:40Hey, um
14:41Hi, what's up?
14:42It's fucked up
14:42Any chance she jumped?
14:44She may have been pushed
14:46Jesus
14:46Yeah
14:47She'll be looking at a pause by Ikram
14:49I take it you're free now?
14:55We need to talk about your numbers
14:57Uh, people we've saved?
14:59Metrics
14:59Our door-to-balloon times beat federal standards
15:02I'm talking about press-gaining scores
15:04Patient satisfaction?
15:06If you're still alive, you should be satisfied
15:08Our goal is 36% very satisfied with their care
15:12Your department is at eight
15:13Do you know how likely patients are to recommend this hospital?
15:17Um, this is an emergency department, not a Taco Bell
15:2011%
15:20Well, if you want people to be happier, don't make them wait for 12 hours
15:23There's a nursing shortage across the country
15:26Most of our patients are boarders who are waiting for a bed upstairs
15:31We don't have the beds
15:32That's bullshit, the beds are up there
15:34You just don't want to hire the staff you need to care for
15:37Oh, Doc, Doc, it ain't working
15:40I mean, whatever they're giving me, it's not working
15:42No response from exit to it
15:44Should I send in the fleet?
15:46Okay, sir, we're gonna try an enema
15:49Like I said, there's a nursing shortage
15:51Well, if you paid them a living wage, they'd be lying enough to work here
15:54Our budget can't support that
15:55Oh, here's a dirty little secret
15:57The hospital saves money keeping patients down here in the pit
16:00It's way cheaper than staffing upstairs
16:02I have asked you repeatedly to stop referring to the emergency department as the pit
16:07It is derogatory and incompatible to the institution's image
16:10You know what's incompatible to the institution's image?
16:12Me speaking to the media about people who code in our waiting rooms
16:15And people who get shitty care in our hallways waiting for an ICU bed for days
16:19I've heard about doctors who have tried that and find themselves out of work
16:24I know today is difficult for you
16:26Every day is difficult down here
16:27Boarding is a nationwide problem
16:29Your predecessor, Adamson, sure as hell knew that
16:32Or wasn't that something he taught you?
16:33Fuck!
16:34Wow, really?
16:36Yes, really
16:37Other hospitals are managing this crisis much more effectively
16:40So you can either step up your game or you can step aside
16:55Good Samaritan dude has a small left temporal intraparenchymal bleed
16:59No epidural, no subdural, no midline shift in the brain
17:01That's good news
17:02You can recover
17:03CT can take her in five, let's have a look
17:05Bandage scissors
17:06All right
17:07If an artery is totally transected
17:10The smooth muscle in the tunica media contracts with hemostasis
17:13But if it's a partial cut, get out your umbrella
17:16Grab a culture from the open fibula before you reduce
17:19You're up
17:22I'll stabilize the need for the reduction
17:24Dr. Langdon will be distracting distally before moving medially to clear the tibia
17:29Good
17:31Ready?
17:45Med student down
17:48Good catch on bar fight Billy
17:50He has an aspirated tooth on chest x-ray
17:52Would have been dead in a week from a lung abscess that you let him be discharged
17:55You're calling the pulmonary cardiac arrest TTA ten minutes where should we put it anywhere?
18:00We'll have to put somebody in the hall
18:02Dr. Robbie she took a fall
18:05I tripped on the gurney I'm fine
18:10Why don't you go get a cool drink in the staff lounge
18:15I'm fine, really, I swear
18:16Oh, I know, but it's hospital policy
18:18Anytime someone gets a paper cut around here, we have to fill out a workers' comp report
18:27Another way
18:30I was fine until about two weeks ago after the Rochester Marathon
18:34Okay, any falls or injuries?
18:37Just tired, sore muscles
18:38Yeah, I'd be in bed for a month
18:40Was this your first triathlon?
18:42God, no, no, I do one every few months
18:46Have you seen a doctor yet?
18:48Uh, no
18:49I went for a run this morning
18:51Had to quit after a minute
18:52Pretty short of breath
18:54This goes under your tongue
18:56Thank you
18:56No current meds, no allergies?
18:58We're gonna check a few labs in an EKG
19:01Draw a red and purple top
19:02Yep
19:06Attempt 98.2
19:08Take a deep breath for me, Otis
19:11A little pimp right now, okay?
19:17Otis?
19:19Otis?
19:21You didn't take him for a lightweight, huh?
19:25Oh shit
19:26No pulse
19:27Crash card, lay him flat
19:31Let's check a rhythm
19:32Saline pads
19:35Quick look paddles
19:41V-Tech
19:42Charging at 200
19:44Charged
19:45Clear
19:47All right, he's back to normal sinus
19:49Need a gurney in here
19:53So what's the plan?
19:55ICU
19:56When we can get a bed
19:57And admit for supportive care
19:59Repeat head CT
20:00In three hours
20:02Or sooner
20:03If he blows a pupil
20:04Want a Kepler load?
20:05Order's already in
20:08Nice job
20:11Do you think he'll wake up?
20:13Maybe
20:15Maybe not
20:18No good deed goes unpunished
20:22Oh, has anyone, um, notified the family?
20:29I could try
20:31Otis Williams
20:32Healthy 31-year-old
20:34V-Tech arrest
20:34Two weeks after triathlon
20:36NSR with one shock
20:37Pulse 98
20:39BP 110 over 60
20:40He's a little young son of mine, huh?
20:42Exactly, right?
20:42What's the differential, Dr. Collins?
20:44Uh, drug overdose
20:45Electrolytes
20:46On QT
20:46Oh, regatta syndrome
20:48WPW
20:49How you doing there, Otis?
20:50Okay
20:51What happened?
20:53V-Tech again?
20:54200 joules
20:56Charged
20:57And clear
20:59Back in sinus
21:01Otis?
21:04Otis?
21:06Oh, groaning's good
21:07Five of nasal
21:08O2CBC
21:09CMP
21:10Tonin
21:10And D-dimer
21:11What are you doing?
21:131-gram calcium glutinate
21:14IV push
21:14We don't have the labs back
21:16Lick them on her
21:17YNQRS and peak T waves
21:18Hypokalemia
21:19How'd he get that?
21:20Tense exercise
21:21Caused muscle breakdown
21:21Rhabdomyolysis
21:22Knocked out his kidneys
21:23Now he's not clearing potassium
21:24I bet it's over 7.5
21:25Wait two minutes for the ice time
21:27If you're resting
21:27You might not get him back
21:28Calcini, you could kill him
21:29Wait
21:30It's my ass
21:31Not yours
21:43Hand scan is negative
21:44Hand scan is negative
21:44That means you can admit to orthopedics
21:46But there may have been a medical etiology
21:48If she fainted
21:49That's not surgical
21:50Get an internal medicine consult
21:51Or admit to medicine with ortho consulting
21:53Either way, I'm off the case
21:55Okay, thanks for nothing
21:57Andsef's in
21:58I'll grab the chance
22:00Did we figure out what she's speaking?
22:02Last interpreter thought she might be from Pakistan
22:04There are 77 languages in Pakistan
22:07Okay, well I will buy lunch for whoever figures it out
22:10Good luck
22:11If you need me, I'll be saving lives
22:14That was wicked
22:17That was gross
22:19Yeah, too much for little Miss Crash and Burn
22:21What'd you do with her?
22:23Nothing, I think she'll be fine
22:24Are you kidding?
22:26If that took her out, she'll be lucky to make it through this rotation
22:28I got 50 bucks so she doesn't last through this shift
22:32Come on
22:33Put your money where your mouth is
22:35Uh, no, I didn't say anything, okay?
22:38I sure as hell don't have 50 bucks
22:40I'll be this lady's age by the time I pay off my student loans
22:43Not that you
22:46Hey
22:47You wanna sell a kidney?
22:50I could get you 30k as soon as this weekend
22:53If that's just between you and me
22:56Think about it
22:58Okay
23:02How you doing?
23:04Yeah
23:06QRS is narrowed
23:08Much better
23:09Potassium is 7.7
23:11Creatinine 5.6
23:13High potassium and renal failure
23:15Just what you thought
23:16Must be my lucky day
23:18Ordering 10 units of regular insulin
23:20And 25 grams of glucose
23:23Why insulin and glucose?
23:25Shift the potassium intracellularly?
23:27Exactly
23:27But the definitive treatment is
23:29Hemodialysis
23:30I'll call renal and get a tech down with the machine
23:32Have you ever seen a dialysis catheter inserted?
23:35Dr. Collins is gonna place ephemeral Quentin under ultrasound guidance
23:38It's an excellent way to learn
23:39Oh my chest
23:41Yeah, we had to shock you
23:43You're gonna be sore for a while
23:45It shocked my heart?
23:46Long story
23:47Dr. Collins will fill you in
23:57You got a sec?
24:01You okay?
24:03Why wouldn't I be?
24:04Are you okay?
24:06Why wouldn't I be?
24:08You seem annoyed with me already and I just got here
24:13It's not always about you, Robbie
24:17Am I gonna be okay?
24:19Yeah
24:20You just need to take it easy on yourself
24:23Muscle breakdown and myoglobin damage your kidneys
24:26Why did you shock my heart?
24:28When your kidneys don't work potassium builds up and messes with the electrical activity in your heart
24:35Can it happen again?
24:37We gave you medicine to lower your potassium and you'll need dialysis to clear it all out
24:42Then I'll be okay
24:44Yeah
24:45You might need a week or two for your kidneys to recover, but yeah
24:49You really need to hydrate like crazy before and after a triathlon
24:54Trust me
24:56I won't let this happen again
24:58Good
25:00Be kind to yourself, okay?
25:14Oh, hey, Abbott's told me that he's got a pregnant teen coming back today from Mifepriston
25:18Let me know when she gets here
25:19Yep
25:20Bile obstruction, still waiting on a surgery consult
25:22What about Garcia? She was just here for the traumas
25:24I think she was waiting for her attending to sign off
25:29Okay
25:32Oh, one of the med students took a header
25:34I parked her in the lounge under the guise of a work comp report
25:37Will you just go in there eyeballing and make sure she's alright?
25:40She's gonna miss the morning arrival of the living dead
25:42How many are we expecting?
25:43We're getting three, but one died en route
25:46Who knows luckier? Us or them?
25:48What's open?
25:49Fourteen?
25:49Eighty-nine-year-old woman from a SNP
25:51History of emphysema, CHF, MS, B-fib, unresponsive to three shocks, two rounds of epi
25:56What is that?
25:57Lucas' chest compression system
25:59Robotic CPR
26:03Anybody get a hold?
26:04One, two, three
26:11Students are dropping like flies
26:12Take a break, ice the finger
26:14You can count on getting a couple elderly patients every day around 7.30
26:18After the nursing homes and assisted living facilities do their morning bed checks
26:22You can practically set your watch
26:24Was there an advanced directive?
26:25No, full coat for the nursing home
26:27Seriously?
26:29Lucas off
26:32Still V-fib
26:33Lucas on
26:34One more round of epi
26:36One more shock
26:37And then we call it
26:43Joseph Spencer, 79, fever and cough from assisted living
26:47He has a history of mild Alzheimer's
26:49One, two, three
26:52Heart rate 130, BP 90 over 60
26:54Gating 500 cc's, normal saline
26:56Hi, Mr. Spencer
26:57I'm Dr. King
26:58This is Dr. Collins
26:59How are you feeling today?
27:01Is it dinner time?
27:03I'm not really hungry
27:04Do we have any paperwork from the facility?
27:06He has a pulse
27:07IV fluids and medications are fine, but no intubation and no chest compressions
27:11That's helpful
27:12Course ronchi here
27:13Right middle load infiltrate
27:16Temp 102
27:18Call a code sepsis
27:19Mm-hmm
27:20Code?
27:20To make sure we check all of our boxes
27:22The federal government audits our sepsis bundle performance and publishes the data online
27:26Today it better be perfect
27:28Two sets of blood cultures
27:30Lactic acid
27:3130 cc's per kilo NS
27:33A gram of ceftriaxone
27:34500 of azithromycin
27:36Repeat lactic
27:38Then three hours
27:38Nice
27:41Charging
27:42And
27:45Stop
27:46Call it
27:47Nursing home just fax us the DNR
27:49Are you kidding?
27:51Power out the defibrillator and the lucas
27:53Complete waste of time and money
27:54Who the hell works at that place?
27:55A nurse taking care of 60 patients who couldn't find the form
27:58She called 911 so she could take care of the others
28:00Okay, let's move her to the viewing room and notify the family
28:03Yeah
28:04One of the things we do here is to take a moment of silence when we lose a patient
28:10To respect their humanity and also to remember that this was somebody's child
28:14Or sibling or parent
28:17Friend
28:25I like the sound of fucking music
28:32I'm so sorry
28:34Maybe leave it on vibrate while you're working?
28:39Say the doc
28:40You behave yourself now
28:42Always
28:42Please
28:45Your med student's back on her feet
28:48How old's that kid?
28:49I don't know, I didn't ask
28:50Is she some sort of savant?
28:52I don't know, maybe
28:53Dr. Benavich, I just wanted to apologize for any trouble my clumsiness might have caused
28:57I feel ridiculous
28:58Oh, I can't tell many times I've hit my head on an overhead lamp twice
29:01I needed to get staples
29:03Why don't you go work with Dr. McKay in triage? That would help both of us
29:07Oh, I don't need special treatment
29:10Good, because I don't give it
29:14Look, I know I might look too young, but I studied my ass off to get here
29:17Probably harder than the others
29:20I earned this
29:20Okay, look, I respect your dedication and your determination
29:24But while you're here, you're my responsibility
29:26And when one of my responsibilities takes a header
29:29Wow! Abbott called for a surgical consult on the SBO three hours ago
29:32You're very lucky they didn't perf
29:33I'm here to see my daughter
29:35I'm sorry, is that a patient?
29:37You were talking to her
29:41Am I interrupting?
29:42No
29:44No, we're done
29:45We're good
29:46Come find me when you're ready to present your next case
29:48Thank you
29:51So, how's your first day going?
29:53It's great
29:54Yeah?
29:54Yeah, really great
29:55Hey Crash, they're doing a dialysis catheter insertion in North One if you want to check it out
29:59Mm-hmm
30:01Did she say Crash?
30:02No?
30:04No, no, it's not crash
30:05Um, she said crush
30:07Because I'm always crushing it
30:11Thanks for coming down, Mom
30:12But I've got a patient
30:14Bye
30:25Bye
30:26What do you want?
30:26Um, I, I just wanted to make sure you're comfortable
30:30I am taking a dump and dustpan
30:34So what's that fucking tell ya?
30:36Um, I'm, I'm clearly, I'm clearly in the wrong room
30:39Yeah
30:40I'm sorry
30:40Mm-hmm
30:46So, it would have been nice if someone had told me that Eileen Shamsie's daughter was one of our med
30:52students
30:52Well, and we're on the surprise
30:54Was it as awkward as I hoped to have been?
30:56You have a mean streak in you, you know that?
30:59What's the deal with the body in 19?
31:01Let's have its NBC vet from last night, still waiting on next to Ken, supposedly on their way
31:05Okay, can we move him to the viewing room at least?
31:07Nursing home DNR's heading there, joining last night's Jane Doe, coroner's office is backed up
31:11Well, then our Mort needs to take her then
31:15Perla
31:18Triathlete, Otis
31:19Uh, he's stable, repeat potassium is 6.1
31:22Renal wrote the dialysis order, text should be down 15 minutes
31:25Good, thank you
31:28Language mystery solved yet?
31:30No
31:30Hey, what's your take on dogs?
31:35In what context?
31:36For kids
31:38Kids and puppies go together like fish and chips
31:40Man's best friend, you know?
31:42Well, you don't have dog
31:43I don't have a best friend
31:44What am I?
31:46You're my best resident, big difference
31:47Yeah, but we're still friends
31:49Not if this conversation goes on, my smugger
31:52I have a lethargic four-year-old
31:55No PMH, no innocent illness, no fever, vomiting
31:58Parents just couldn't wake him up this morning
32:00What, Ren?
32:01Oh, self routine
32:03There's no nuchal rigidity
32:05No skin lesions
32:07No focal neuro
32:10He looks well fed and cared for
32:13DKA from new onset diabetes?
32:15No, BG85
32:17CDC, PRP, UA9
32:28Can you wake up for me Tyler?
32:31He's not usually this sleepy?
32:33No, and he barely flinched for the blood test
32:35He wakes up at 90 miles an hour and doesn't stop until he passes out at night
32:38He passes out?
32:40No, he just means he goes all day
32:42Any chance he could have ingested something?
32:44Any pills, vitamins, any prescriptions that may have been left around?
32:49No, that's all kept locked in the medicine cabinet
32:51The whole house is child proof
32:53What about alcohol? Anything left out?
32:56No
32:56What about pets?
32:58No
33:00Usually they're quite active
33:01Very
33:03Any injuries lately?
33:04No
33:05Bumped his head recently
33:07Not that I'm aware of, but he does the rough housing with Drew
33:10But he never gets hurt
33:11Oxygen level is normal
33:13Good pulse and blood pressure
33:15No signs of infection
33:17We're gonna start with blood and urine tests
33:18Check for any metabolic abnormalities
33:25It's really throbbing
33:26Yeah, the blood's under pressure
33:28Gotta drain it
33:31No anesthesia or?
33:32Stop before I hit the nail bed
33:35I hope
33:39Hey, eyes down here
33:41Watch and learn
33:42I'm just looking who to see next
33:43We're supposed to take them in the order they arrive
33:47Yeah, I know how it works
33:48Okay, no need to cry about it
33:50Do you want me to choose for you?
33:52No
33:55Wow
33:56The pain's gone, thank you
33:59Alright, how about a 20-year-old cough and eight?
34:03Should be easy, probably viral
34:04I don't need an easy one
34:07Suit yourself, Huckleberry
34:08I'm gonna take the splitting headache
34:10Maybe I'll catch a subarachnoid hemorrhage or something cool
34:13Hey, why do you keep calling me that?
34:15Huckleberry?
34:16It's a term of endurement
34:18It sounds like sarcasm
34:19You think?
34:20Ordering on harassment
34:23Where are you from?
34:25Broken bone, Nebraska
34:27Jesus, where the hell is that?
34:29It's about three and a half hours west of Omaha
34:31Oh yeah, just a little south of nowhere
34:33What the hell do you do there?
34:35My parents have a farm, so...
34:37You're a farm boy?
34:38Hey
34:40Yeah, I guess
34:41I rest my case, Huckleberry
34:50I'm so sorry ma'am, we don't understand you
34:54I'm so sorry ma'am, we don't understand you
35:02I'm so sorry ma'am, we don't understand you
35:08Oregon
35:09You
35:11Where are you from?
35:14Uh huh
35:17China?
35:18India?
35:19I can't tell where you're pointing, Tajikistan?
35:23Nepal
35:26You're from Nepal
35:27Nepali
35:34Mom's got a bad burn, needs womb checks and hand therapy
35:36And I got a sneaky suspicion she may be unhoused
35:40I'll talk to her, we can offer some help
35:42Thank you, I appreciate it
35:43Ah, you're back!
35:45Dr. Robbie suggested I might be of assistance?
35:47Yeah, I can use the company
35:49Victoria Javadi, this is Chiara Alfaro
35:52She's a department social worker, which pretty much makes her an angel
35:55Welcome
35:56Thanks
35:57Thank you
35:58So, what rotation is this for you?
36:00Third, I've done OBGYN and peds
36:02Are you any favorites?
36:04Not really
36:05Well, what are you leaning towards?
36:07I'm not really sure yet
36:09Okay, well you have time
36:10Can I actually ask you a personal question?
36:14I'm 20, and I've earned the right to be here
36:18Oh, yeah, I don't doubt that for a minute
36:21I was actually wondering if Dr. Eileen Shamsie from surgery is a friend or relative of yours?
36:27I saw you talking to her in the hall
36:29Yeah, she's my mother
36:33Oh, oh wow
36:35Oh, that's cool
36:38Are you really only 20?
36:40Yeah, and for the record, my father also works here, he's an endocrinologist
36:44Oh, so it's like a family business
36:48I'm sorry, that was a joke, that was a joke, and I'm sure that comes with a lot of pressure
36:52And as for the age thing, I'm a 42-year-old R2, so I have my own haters, trust me
36:59Okay, um, sometimes when it gets busy, we'll help the nurses bring back patients
37:03Okay
37:04Okay, next to come back is Fred Saida, knee pain after a fall
37:08Great, Fred Saida
37:09Doug, hey Doug, hi, hi, Doug Driscoll
37:10Any chance someone can see me now? I've been here for like two hours
37:13Unfortunately, Mr. Driscoll, there's a lot of patients still ahead of you, some of whom are severely ill
37:16Yeah, and I got chest pains that woke me up in the middle of the night
37:19Chest pain?
37:20Yeah
37:20No, it's not plural, it's just chest pain, not chest pains
37:24Yeah, and if I have more than one, it's chest pains
37:27Are you even a real doctor?
37:28She's a student doctor
37:29Yeah, well, keep her the hell away from me
37:30I just need to see someone, okay? Not her
37:33Isn't chest pain an emergency? I don't...
37:35It looks here like you get an EKG five minutes after arrival, so it's not a heart attack
37:39Yeah, but I'm supposed to get a chest x-ray and blood tests
37:43And you are next in line for lab tech, okay? So listen for your name, excuse me
37:47Fred...
37:49Actually, can you get me a wheelchair, please?
37:52Uh, hi, I'm Dr. McKay, what's going on?
37:55Uh, I found her on the floor in the bathroom, she can't start puking
37:58What's her name?
37:59Teresa, she's my mom
38:01Teresa? Teresa, are you taking any medication?
38:04No
38:04Any previous stomach problems?
38:06No
38:07When did the vomiting begin?
38:09Last night, last night
38:12Do you have any dizziness or fatigue?
38:15Mystery solved
38:17Our lady with the degloved foot is Nepali
38:19Oh, hey!
38:21Congratulations
38:22Otis' BP is crashing, 70 over 50, still waiting for dialysis
38:29How you doing there, Otis?
38:31Not good, not so good
38:3215 liters, non-rebreather, please
38:40Oh, crap
38:41Diastolic collapse at the right atrium and right ventricle
38:44Tampa now from your remake infusion
38:45That's why his BP is low?
38:46Too much fluid and pressure around the heart chambers can't fill
38:49Otis, you've got some fluid around your heart, we need to get it off
38:53What's the problem?
38:5325 in propupol
38:5410 cc's of lidocaine with epi-pericardiocentesis strength
38:57I have to get that from central
38:58No, no, just open a central line kit
39:00Dr. Santos, take the head of the bed
39:01And bag him if he stops breathing, compressions if he lose the carotid
39:04Prep a drip to sub-xifluid, please
39:0610 cc's of 1% weight
39:08Chlorhexidine here, 25 with 27 gauge
39:10No, no, long 25, long 25
39:11Thank you
39:14Ejecting lidocaine
39:17Compressure down, 60 over 40
39:19Great
39:22Wait, you can't ultrasound on place
39:24I know, that's why I'm taking the probe
39:2518 gauge thin wall on a 60 cc syringe
39:28Please, Dr. Collins, let's go
39:31You're going in right over the center of my probe
39:35Advancing very slowly
39:37Looking for the hyper-coated tip
39:39Very, very slowly
39:40Do not hit that hard
39:42Dr. Santos, you see that sea of black?
39:44That's the effusion
39:44We're looking for a little white dot
39:47There it is
39:48Got it
39:50Aspirating
39:513 cc should be enough
39:57Good, next we'll place the guide wire and then the triple lumen catheter
40:01Pulse ox is 99, pressure's up, 124 over 78
40:05Looks like things are back to normal
40:09That was cool
40:10Four Zofrans on board
40:12That should stop the nausea
40:13Yeah
40:15David, have you had any vomiting?
40:17No
40:18Anyone else sick at home?
40:21No, it's just us
40:23My husband passed away a few years ago
40:25From COVID
40:27I'm so sorry
40:29Potassium, 3.1
40:33Is that bad?
40:34It can cause heart problems, but we're going to correct it
40:3710 in the bag
40:3810 in the bag, 20 P.O.
40:40Trotty, any questions?
40:44Um...
40:44David, have you two traveled out of the country recently?
40:48No, I never go anywhere
40:50Is she enough to stay here?
40:54If the rest of the tests are good and she responds to treatment, she can go home
41:06Mr. Milton, my name is Dennis Whittaker, I'm one of the student doctors here, I'll be seeing you first
41:11Nice to meet you
41:13BP's 150 over 90
41:14Okay, let's just a touch high
41:17I forgot to take my damn Inalapro this morning
41:19No, we'll get that for you
41:20Tell me about this belly pain
41:23It started about here
41:26Um, woke me up at like 2 a.m.
41:30Pretty intense
41:32Lasted about an hour
41:34Now it's gone
41:34Any fever? Vomiting?
41:37Nah, I never get sick
41:38Okay, what did you eat last night?
41:41Oh, it was my wife's birthday
41:43Took her out to Sullivan's for a steak
41:46Well, the exam is pretty benign
41:49I'm gonna test for gallstones
41:50If there is a stone
41:52And you eat fatty food
41:56There can be pain when the gallbladder contracts
42:00Oh!
42:01Uh, bingo!
42:02One stone, there it is
42:05Do I need surgery?
42:07Uh, you should be able to manage with a low-fat diet
42:10But we'll send off labs for liver and pancreas
42:13Just let us know if you have any more pain
42:16Okay
42:17Thanks
42:19Uh, yeah, you bet
42:21Great
42:23You want any kg?
42:26For?
42:27Heart attacks can present us upper abdominal pain
42:30Um, yeah
42:32No, yeah, that's a great idea, thank you
42:48I'm going as fast as I can
42:50I'm picking up two patients
42:51I didn't say anything
42:54I, uh, I need a fresh set of eyes
42:56From what?
42:5754-year-old woman brought in with intractable vomiting by your 18-year-old son
43:01I'm, um, I'm getting a weird vibe
43:06How so?
43:08I don't know, maybe she was given something
43:10Some sort of elder abuse
43:12It's just a strange dynamic I can't quite figure out
43:14And you're really good at sussing out that sort of thing
43:16I don't know about that
43:21Uh, excuse me, Dr Langdon?
43:25Almost all of our labs are back on sleeping boy Tyler
43:28All 100% normal
43:30What are we missing?
43:35Is he waking up?
43:37No, he's still fast asleep
43:39Most of the lab results are in and they look great
43:42No abnormal blood count, no, uh, electrolyte abnormalities
43:45No diabetes, no, um, kidney disease, so
43:50Good, so, so what's wrong with him?
43:52We're still trying to figure that out
43:54Did he have a play date yesterday by chance?
43:57No, he had preschool, but he was fine when I picked him up
44:00Any kids in his class, Bill?
44:02No, my phone tree would have lit up if someone else was sick
44:05He eat anything this morning?
44:07No
44:08Why?
44:10It looks like some sort of gelatin
44:13Any chance he could have gotten into some, uh, bath beads or laundry pods?
44:17No, and there's no such thing in our house
44:19What about gummies?
44:20No, we're very strict about candy
44:23Right?
44:27Oh, shit
44:29Danny
44:30What about Danny?
44:32Your brother, he...
44:34He gave me some gummies he got in Cleveland
44:36They were in my coat pocket
44:39Are you fucking serious?
44:41Pot gummies?
44:42Yes, I'm so sorry
44:44Let me call the lab, maybe the tox cream is back
44:47Hey, this is Dr. Langdon from the ED
44:49Can I fast track a lab on a little boy
44:51Last name Jones, first name Tyler, tox cream
44:53Fuck out, I mean it!
44:54Why don't we step outside and maybe you can help me figure out how much you may have taken
44:59Thanks, I appreciate that quick turnaround
45:04Labs confirm it, your son tested positive for cannabis
45:08It's a fucking nightmare
45:14Theresa, David, this is my attending, Dr. Rabinovich
45:18Hi, Dr. Robbie, we need to do a pelvic exam
45:21And David, I don't think you want to be in here for that
45:24Definitely not
45:25Can you have Nurse Perla come join me please?
45:29You want a coffee or a soda or something?
45:32Why do I need a pelvic exam?
45:33Uh, you don't
45:36Your son seems like a nice kid, he's clearly worried about you
45:40But your exam and your labs are not matching any of the usual diagnoses, so I'm not really sure what's
45:45going on
45:47I'm not here for me
45:49I'm here for David
45:50I don't understand, he said that you've had persistent vomiting, some dehydration
45:54I made myself sick
45:56With Ipecac
45:57To induce vomiting, why would you do that?
46:00So David would bring me here
46:02My son has some problems, he needs professional help
46:07Okay, what kind of problems? Drugs, alcohol?
46:11I found some of his writing
46:15I thought it was school work, but it wasn't
46:20It was lists of girls he wanted to hurt
46:37Hurt them out
46:38He said
46:40They should all be eliminated
46:44Has David seen a therapist?
46:46No
46:49He's not a bad kid, but I'm afraid he's troubled
46:52And I didn't want to call the police because I was afraid they'd overreact
46:55He's just a kid
46:56How old is David?
46:58He just turned 18 last month
47:01Then he's considered an adult and he would have to consent to treatment
47:06Do you have any guns in the house?
47:08No
47:09My husband did, but I got rid of all of them after he passed
47:14He's a good soul
47:15I just don't want to see him hurt anyone, or himself
47:21How you feeling Crash?
47:23I'd really appreciate it if you didn't call me that
47:25Why not? It's a cool nickname, you earned it, you should own it
47:31I don't like it
47:33Well, it's just a joke
47:39You know, if it makes you feel any better
47:43I sharted the first time I saw an emergency c-section
47:48Really?
47:50Of course not
48:02Excuse me, I'll be right back
48:05I got a situation
48:07Eighteen-year-old kid brings in his dehydrated mom
48:09Dad died during the pandemic
48:11Mom's vomiting is self-induced for the sole purpose of getting him here
48:14After she finds his death list for classmates
48:18I...
48:19Okay?
48:20What does she want us to do?
48:22Help him, protect him, save him
48:24Where is he now?
48:25Talking to McKay
48:28How are you doing?
48:29Me?
48:30I'm good
48:31I'm always good, you know that
48:32Do I? Does anybody?
48:34I'm an open book
48:35Not even close
48:36You do know you can always come talk to me, right?
48:43How's it going over here?
48:45Good, good
48:46We're just going over aftercare instructions, prescription medications, special diet for the next few days
48:51Dr. McKay, can you check with the statics on mom?
48:53I can
48:53David, I wanted you to meet Kiara, she's a social worker here who helps in situations like this
48:59We heard about your father's passing
49:01We're really sorry
49:03And we know that can put a lot of pressure on somebody your age
49:06Which combined with school, and now having to take care of your mom, that's a lot
49:11It's fine
49:12We just want to make sure that when your mom goes home you can handle it
49:15We want to make sure you have someone you can talk to if you need to
49:18I'm okay
49:20I don't need to talk to anybody
49:23After a parent dies, the sadness can last a long time
49:27How's that going for you?
49:29It's not a problem
49:30What about school?
49:32What about it?
49:34Anything you enjoy there?
49:36Not really
49:39A lot of people have thoughts that can disturb them
49:43If you've had any, it's okay to talk about it
49:45What's that have to do with my mom?
49:47Is she gonna be okay?
49:49Yeah, she's gonna be fine
49:50She's probably got a stomach virus, maybe food poisoning
49:52I think she's more worried about you
49:55She always worries about me
49:56Does she have a reason to?
49:59No
50:00It's almost 8, I gotta go
50:04You sure you wouldn't prefer to wait with your mom?
50:06I'm late for school, she can just call me when she's ready
50:10It would actually be kind of helpful to talk to you some more
50:13Hey David
50:15David
50:17Hey, just give me five minutes
50:18Leave me alone
50:28Hey David
50:34Robby
50:36Robby
50:38Got a college kid, respiratory rest, coming in hot
51:11Come on
51:12Robby, we need a pen today here
51:15Dr. Adamson just went down with a full tox of 65
51:19Big dog
51:20It's just the first one
51:24We are on the street
51:25This is not a nice word
51:26Oh my god
51:27Love a pen
51:31We have no idea
51:33The second one is sleeping
51:57guitar solo
52:30guitar solo
52:53guitar solo
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