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The.Pitt.S01E02.540p.x265.AAC [Full Movie] [Full Episodes]Full EP - Full
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00:07You
00:30Collar skin, respiratory distress is here.
00:32Right.
00:33You okay?
00:33Yep.
00:34I wanted to talk to the patient in Central 12th Summer, but he took off.
00:38Is there a problem?
00:40According to Mom, she found a list of high school girls that he'd like to eliminate.
00:44What the hell is wrong with kids these days?
00:47You mean besides social media and the worldwide pandemic and the environmental crisis?
00:52Yeah, yeah, you're about to help today, aren't you?
00:55Nick Bradley, 19, found unresponsive by parents.
00:58No meds, no allergies.
00:59On arrival, he was barely breathing with pinpoint pupils bradycardic at 38.
01:03Pupils responded to Narcan, but we tubed him when his respirations didn't pick up.
01:07Any drugs for alcohol on the scene?
01:09No.
01:10Signs of trauma?
01:11Nothing.
01:12Okay, open your eyes, Nick.
01:14On three.
01:14One, two, three.
01:18Where was he found?
01:19In bed by his mom.
01:21Pupils are six millimeters, non-reactive.
01:26Heart rate 64, BP is cycling.
01:29No response to pain, GCS-3.
01:31Does that fit any Toxidrome?
01:33No.
01:34If it was just opiates with Narcan, he'd be breathing on his own.
01:39A beta blocker shouldn't give pinpoint pupils.
01:41Maybe parents had some prescription meds in their bathroom.
01:43They're on their way.
01:44ETA five minutes.
01:45Close trauma tier one.
01:46ETA five minutes.
01:47That's a stand-up scooter rider versus car door.
01:50No helmet.
01:50No blood in the belly.
01:52No pericardial effusion.
01:54And lungs are up.
01:57Hema Q's good, 15.
01:59BP 84 over 58.
02:01Okay.
02:02What's your plan, Dr. Collins?
02:03Um, push dose epi, 0.1 milligram.
02:08Foley for urine, stabilized for CT, and throw a wide net.
02:17Where, where are we going now?
02:19We need the room for someone else, but you can rest in the hall till we get your labs back.
02:25Your parents must be proud.
02:27Having a son who's a doctor.
02:30Yeah, I guess.
02:34You know, I was the first one in my family to go to college.
02:36And, uh, no, they sacrificed a lot to get me here.
02:42How's your pain, Mr. Milton?
02:44Uh, I'm fine.
02:45Could use a latte, though.
02:47That could bring back the gallstone pain.
02:49How about a bourbon?
02:50It's barely eight o'clock.
02:52Uh, how about some ice chips?
02:55No, thanks.
02:56I prefer my whiskey neat.
02:58Yeah, that's not happening.
03:05Systolic back down to 90.
03:07Another 0.1 of epi.
03:09Flaccid paralysis of all four extremities.
03:14No eye movement with ice water.
03:16So no brainstem function.
03:18Due to?
03:19Hypoxic injury, massive hemorrhage.
03:21Samira, escort him to CT.
03:23Take the drug box with you.
03:25Call me if you need me.
03:27Hey, are you okay?
03:30Yep.
03:30You sure?
03:31Have you ever had to worry about me?
03:34No, but never hurts to check in.
03:36It's part of my job.
03:38Consider yourself checked in.
03:40Okay.
03:42Uh, uh, uh, uh, uh.
03:45Got something?
03:46Oh, I had a case for Dr. Collins.
03:48May I see it?
03:49Yeah.
03:51Uh, 68-year-old male, history of hypertension,
03:53one hour of right upper quadrant pain after eating a fatty meal now resolved.
03:57A febrile, non-tender, there was a gallstone present on POCUS.
04:01EKG shows no acute ischemic changes, but I'm still waiting on LFTs and lipase.
04:06Why did you order the EKG?
04:09The nurse suggested it to rule out any cardiac issues.
04:12Well, good call on both your parts.
04:14Nurses know what they're doing.
04:15Never hesitate to listen to them.
04:17Come find me when those labs are back.
04:18Yeah.
04:19Hey, how's that figure?
04:20Oh, it's nothing.
04:20Dr. Robbie.
04:21Yep.
04:21The son and daughter of Mr. Spencer from Assisted Living.
04:24They're here.
04:24Okay.
04:25I'll be right there.
04:33Your father has pneumonia and a condition called sepsis.
04:37Uh, what is that exactly?
04:38It means that the bacteria has spread from his lung to his bloodstream.
04:42So far, he's been responding well to treatment.
04:45Hey, Pop.
04:47It's Helen and Jeremy.
04:51Jeremy.
04:52Jeremy.
04:53Jeremy.
04:56Jeremy.
04:57Jeremy.
04:58Jeremy.
04:58Jeremy.
04:58Jeremy.
04:59Jeremy.
05:00Jeremy.
05:01Jeremy.
05:03Jeremy.
05:04Jeremy.
05:06Jeremy.
05:08Jeremy.
05:11Jeremy.
05:18Jeremy.
05:22can he go back to assisted living eventually we hope so your dad has an advanced directive
05:27expressing his wishes which says that iv fluids and medications are okay but no artificial life
05:32support no cpu he doesn't want a bunch of machines keeping him alive okay then we will continue with
05:39oxygen and iv fluids and antibiotics but if his lungs stop working we're not going to place a
05:45tube in his windpipe for breathing machine but pneumonia is treatable most of the time it is
05:52but if he can get better in a week then put him on a machine that's not what he wanted
05:56do either of you have durable power of attorney for health care yes okay well this is a decision
06:03that does not need to be made right now why don't you think about it talk about it if things
06:10get
06:10worse sometimes allowing for a comfortable natural death can be the most humane path
06:18no routine cases until we assess the tier one thanks dr langdon so uh how's the va
06:27yeah it was uh good uh you know challenging i learned a ton i just think it maybe it should
06:34be mandatory
06:34that all doctors spend time there like on a regular basis because of all they've sacrificed for us
06:39that's a nice thought how'd you choose the pit oh i have a sister with special needs and she got
06:44into this really great facility here in pittsburgh and ptmc has such a great reputation i thought
06:49you know i'd be good can i present my headache to you uh yeah what do you got a 36
06:53year old woman
06:54with severe headache due to paracervical trigger point her pain went from 11 to zero after two cc's
06:59of imr cane wait wait you did a trigger point injection before presenting the case
07:03yeah interns always present first i spent a month at the pain no it's not coming very comfortable
07:09it's definitely not okay 23 year old ben kemper no helmet got doored riding an e-scooter neck
07:14versus handlebar then face planted to the pavement obvious facial fractures but alert and oriented with
07:19good vitals here we go one two three
07:29how we doing ben one back in my throat that's probably from the nose bleed short rapid rhino please
07:37tacky at 120 pull socks borderline at 90. we'll buy it 15 liters for now neck contusion larynx shifted to
07:44the right no crepitans morphine i'm gonna stick something in your nose to stop the bleeding
07:52no hemotympanum inflate the balloon how about now ben
07:59better what's up uh good vitals a and o let's have a look
08:08oh ouch ah floating face before three fracture you don't see that every day okay let's prep for
08:14an airway double setup just in case
08:30nice work thanks all right mr tigari you are good to go oh thank you remember 10 off for doctors
08:40and nurses i'm a student doctor all right sorry i hit my head remember well my son loves pizza so
08:48i
08:48will take you up on it for sure thank you okay thank you wait for a nurse okay thanks
08:52i just realized it sounds like i always feed my kid junk food oh no pizza s'mores no no please
09:00i i like
09:01pizza pizza s'mores who doesn't how many kids do you have just one harrison he's 11 now what does your
09:12husband do no husband just being my son i take it you don't have kids i i don't mean on
09:17account of your
09:17age or i don't know maybe i do i mean most medical students don't have kids oh yeah no no
09:24um no kids
09:25just i'm not even a boyfriend just just it's just school for now yeah that'll keep you pretty busy
09:31i do not miss it must have been difficult as a young mother it had its moments but my life
09:37has
09:38been full of challenges med school was not one of the hardest by far it was one of the most
09:43rewarding
09:43though other than having my son hey facial act with a possible foreign object in the eye which is
09:51always a solid seven on the wmb scale what makes mateo vomits you okay yeah yeah um he's funny the
10:05nurse oh mateo you can say his name um yeah uh a foreign object in the eye could be really
10:13serious
10:22hey fruitcake hey i'm talking to you fruitcake myrna i've told you a hundred times my name is dr robbie
10:30you want to see my vagina i have already seen it and once was enough thank you robbie parents of
10:39nick bradley the odt are here okay parkerman trauma one he's not back from ct yet but i'll
10:45be right there in a minute behaving yourself myrna oh yes ma'am
10:53how we doing ketamine sucks on board pole socks holding at 94 prepping the neck just in case let's
10:58have a look a little deeper lots of swelling i can't see the cords to the right the left yeah
11:08really distorted from the trauma and the demon is only going to get worse which is why we should
11:11crike you don't crike a laryngeal fracture don't listen to edwina scissor hands here if they can't
11:15cut it surgery doesn't know how to fix it the contusion is high at the thyroid cartilage so you just
11:19stand there looking pretty er ken and let me fix this we're down to 85. all right pull out eye
11:25gel
11:25bag and crike eye gel please i've never done a crike before no mel will do the crike you've already
11:31had a busy morning glove up mel no i'm doing the crike doctor you would be doing it doctor if
11:36it
11:36wasn't an odd day surgery gets even days ed gets odd days you know this for quite sake it's because
11:40you're all odd down here okay teamwork please let's focus on the patient i so appreciate your gracious
11:45understanding i'll assist in case she screws up through london plain nice stats are up with the
11:50eye gel you ready hello oh uh hello you've done this yes in the cadaver lab let's hope that's not
12:01where
12:01this poor soul ends up we'll do an open technique since we have a minute okay okay you're gonna be
12:08making a vertical incision to avoid the jugulars the carotids good if this was a crack that needed
12:16to happen in seconds you could use a 10 blade your finger and a bougie
12:23this is called a wheat laner and this is your tray cook c-spine head ct omf start a propofol
12:31drip
12:31okay now we're gonna make a horizontal decision across the crack growth library membrane
12:394-0 shiley next get ready bag the craic
12:45yeah yeah yeah good
12:54oh excuse me no worries end title co2 is yellow yellow is yes nicely done sew it in okay i
13:02will be
13:02next door does your resident know how to suture or do i need to teach you're all class yo-yo
13:09i know
13:09thanks that means a lot of nothing coming from you no you okay if you're done fighting we're not
13:16fighting this is playing langdon's too soft to fight oh yeah i have nothing but respect for dr
13:21garcia in fact i think she would make a wonderful hostess at applebee's later odds
13:28let's go okay thanks just receive word your son's head ct is normal and he's maintaining a good heart
13:35rate you got him back blood pressure thank you thank god right now he's unconscious with a tube in
13:40his throat for oxygen why don't we step out for a minute while they get him settled then you can
13:45come back you can sit with him as long as you want nikki it's mama i'm here babe you're doing
13:51great son
13:53blown
13:56okay let's step outside
14:06so we don't know how long he was at home without breathing he's breathing now not on his own but
14:13he's gonna wake up we certainly hope so we're gonna know better after we get some more test results back
14:19are you sure that he didn't take anything that could have caused this no no he's a good kid he's
14:24in
14:25college he has a part-time job he even chose to live at home so he can focus on school
14:29dr robbie from the
14:31urn with that it's a drug test and it is positive for fentanyl no that is impossible nick doesn't do
14:40drugs there are a lot of pills that are sold illegally that have fentanyl not just painkillers
14:45xanax had a van you know not our son well maybe he didn't know that he took something with fentanyl
14:52i
14:52don't know the hows and the whys don't really matter what matters is spending time with nick we've got
14:57some more tests to run we'll know our options after that but in the meantime why don't you take
15:01a seat talk to him
15:05can he hear us you know we're never really sure so you should just assume that he can
15:09and we'll come find you as soon as we know more okay
15:19can we move nick bradley to a private room like you're gonna make it
15:24do you respond to narcan i think his pinpoint pupils just grew into blown pupils from great
15:29stem death shit yeah not much older than jake don't go there hard not to sometimes
15:41mr spencer's room hey robbie teresa the mother of the young man david who bolted
15:47she's asking for her son okay i'll be there in a minute what is happening uh his oxygen levels are
15:53dropping mr spencer how are you feeling i don't remember where i parked mr spencer do you know where
16:01you are it's so loud in here dad do you know where you are dad look at me what's my
16:08name i don't know
16:09where my car is ipad 15 over 5. step out
16:20what's five pap it is a pressurized air mask that can improve his oxygen
16:25either his pneumonia is getting worse or his heart couldn't handle the fluids that we gave him to
16:29treat the sepsis his lungs are filling up with fluid can't you take the fluid away not without his
16:34blood pressure crashing with very bad consequences so let's just hope the bipap works and if it doesn't
16:41then i would need to know your decision about using a breathing machine we're still talking
16:45about it well we know he expressed his wishes in writing do not intubate we're thinking try it for a
16:52week that would be a very painful week he wouldn't get a lot of rest with all the monitors and
17:00all the
17:00blood tests he might need to be sedated he might need to be restrained because he'd be in an
17:04unfamiliar place with a very uncomfortable tube down his throat and he wouldn't really know what
17:09was happening elderly patients can often develop psychosis but he might get better or he might get
17:16worse what would you do i really can't answer that for you this is your father that's your decision to
17:23make i can guarantee you that we will keep him as comfortable as possible if a natural death is what
17:28you
17:28choose but he's not your father and he can recover from us what my sister means is that we're still
17:34deciding the best thing to do well the sooner you decide the better i'm really sorry i wish there was
17:42more than i could do i'm not sure that he has that much time left dr robbie
18:01we're right she can't say whether she was bumped by accident or shoved on purpose no other witnesses
18:06no not really pull security footage maybe we'll find something hopefully she tripped
18:13i don't mean i hope she tripped i mean i hope she wasn't pushed on purpose
18:17that would make this a hate crime yes ma'am
18:22ma'am doctor sorry i'm i'm sorry no harm no foul will you let me know if she says anything
18:31else
18:31that could be important to your investigation
18:41no trust me how do you know i just know i just wanted i know look i'll let you know
18:50if she says
18:50anything else that could be important to your investigation thank you you know for the record no
19:12any luck getting our uh seg boarders upstairs yeah right at least the kraken's still sleeping
19:20is it me or was that no what you don't even know what you were gonna say
19:26maybe you do you seem nice absolutely not
19:33there's no possible scenario in which you and i have this conversation you of all people should
19:38know better i was new just walk away best possible scenario just keep on walking
19:48you gotta lay off mixing adderall and energy drinks trust me i will all right thanks
19:56it's the thing about emergency medicine you never know what you're gonna get
19:59and we get everything is that why you chose it ah maybe a little i also get to pick my
20:05shifts
20:05which for a single mother is amazing but mostly i just like the people you know they're always
20:11there when you need them you wouldn't want to be a part of that you know
20:25this is the monitoring center we see that you're not in your inclusion zone do you have permission to
20:30be outside this area yes i am at work just like last time and the time before that
20:38i'll be right back
20:42what is the point of this thing if it doesn't even work
20:54sorry you're doing great take your time you okay i am i get frustrated when i can't do things or
21:01at
21:02least it looks like it yeah you and me both thanks but um my frustration manifests itself emotionally
21:08and then uh i get upset and then it looks like i can't handle things and you know then i
21:13can't
21:13cry in front of the patient because no one wants to see their doctor cry that's just a big red
21:16flag
21:17you you just did a perfect craic you're doing great
21:23hey you pasty white how about a sandwich uh what brings you here today sir i'm here for a
21:32fucking sandwich okay okay uh excuse me perla perla can this patient get a sandwich i already gave
21:42you a sandwich bro i ain't ate this whole week sure give him another sandwich they're on the food cart
21:49just make sure it's not egg salad or he'll throw it on the floor okay good to know thanks
22:08any quick ones up here it's only 8 30 and robbie's already on my case for being too slow
22:13i can usually at least make it a lunch before he starts hounding me
22:16cut a little slack today okay it's the anniversary of dr adamson's death that's sad
22:23there's still no reason to take it out on me i'm just saying dr mohan samira please i just
22:31wanted to apologize when my phone went off earlier that was really unprofessional don't sweat it trust
22:37me we'd need to laugh otherwise we'd never stop crying thank you besides with all the craziness that
22:42comes through here every hour nobody cares and notices got an unresponsive unhoused man coming in
22:48might be a good teaching case funky music
22:54let's go caucasian male approximately 60 to 70 years old found unresponsive no signs of trauma no id
23:03i'm on three on three one two three
23:10oh did you take anything smelly alcohol from here this guy's wearing the spring summer and fall
23:15collection
23:22what's wrong what's going on patient tested positive for rats
23:28no if it matters i only counted three oh there goes one
23:38because your son tested positive for thc the psychoactive ingredient in cannabis we're gonna have
23:44to admit him for overnight observation and monitoring what about his brain is there a chance
23:50that much pot is going to do some damage and he's only four the honest answer is we don't know
23:54there
23:55haven't been any long-term studies but the fact that this is a one-time occurrence suggests that
23:58there should be no long-term effects like you don't know so my son could end up with learning
24:03disability psychiatric problems or even autism because there's no evidence to suggest any of that
24:08hello hello i'm kiara alfaro i'm the department social worker kiara will help you navigate the next
24:14steps what steps well a case like this requires mandatory reporting to child services and sometimes
24:22law enforcement no why why do you have to involve the police it's a controlled substance they're not
24:27taking my kid away they were pot gummies well fuck your suggestions no one is touching my child
24:32in fact we're leaving well you know you can't take your son you can stop breathing i'll observe him
24:36at home amanda please fuck off drew get security if you can't cooperate i'm gonna have to ask you to
24:42leave amanda please he needs to stay here and you need to get a fucking hotel your son can't leave
24:47the hospital but i can have you removed don't you dare touch me get out of you mrs johnson i
24:52know this
24:52is scary and stressful oh fuck you fuck you this is my son my son and nobody is touching him
24:58whoa whoa
24:58whoa what's going on mom's worried about to see what happened man doctor this is a hospital sitting
25:05in the jerry springer show ma'am nobody's trying to take your child so why don't you stay here with
25:11him while your husband talks to our social worker outside and straightens all this out well i don't
25:15want him speaking for me and my son well it is either you or him your son is not leaving
25:20but you can
25:21be escorted out and even arrested if you refuse to cooperate nobody wants that so you tell us what do
25:27you want to do i'm staying with my son okay great you do that we all on the same page
25:36here
25:37thank you olsen you okay yeah we got this it's all good it's all yours so mrs joe
25:44is everything all right out there yeah just another day in paradise how are you feeling better
25:54where's the end he left he said he had to get back to school what um maybe you could try
26:02calling
26:02him get him to come back
26:07what's going to happen to him if i do hopefully he'll be willing to talk to somebody will you talk
26:13to him i can try i don't think he wanted to talk to me have you shared with anyone about
26:20the writings of his you found no i didn't know who to tell i just don't want to see him
26:26get hurt
26:28neither do we
26:38no he's just going straight to voicemail maybe if you can text him
26:54he's not texting back it's oh i'm sorry about all this it's okay what you're doing for david is very
27:01brave i'm his mother i'll do anything to protect him do you think he would hurt anyone no
27:12but
27:17i'm sure a lot of parents felt that way before their children did unspeakable things
27:26does he have any history of violence has he ever been in any trouble no never he's very quiet
27:33he takes great care of me he he's struggled with his father's death
27:41we both have it the flight is ten minutes out within electrocution okay grab collins i'll be right
27:46there keep trying to reach him if you do have someone come find me okay thank you of course you
27:56got some good news for me i sure do there are two rooms in icu being clean they'll be ready
28:00by now great
28:01and i got bagels in the lounge nice job thank you
28:07is it true you have to be more specific are there rats in the ed uh apparently if somebody already
28:12snitched do you know how bad this looks one more reason to shutter this place only the emergency
28:18department admits rats the department would never admit rats unless they have the right insurance
28:22did you catch any of them one and i charged him for a full visit i'm glad you think this
28:27is funny
28:27i'm sorry that you don't did you call an exterminator he's waiting on a second opinion
28:34you're pushing your luck today don't worry last i heard they were headed for the cafeteria so they
28:38should be dead within the hour ah i'll be here all week well maybe not
28:47drug-seeking woman kicked off a city bus for disrupting and disturbing passengers
28:52she's been screaming for narcotics non-stop we found an empty purchasing
28:54bottle five days ago she's been uncooperative and combative since we picked her go stop fighting
29:02come the fuck down or i'll find the cops my vets at home aren't working please i have sickle cell
29:08okay stop everybody stop stop what's your name it's joyce it's just
29:16joyce is this your sickle cell pain yes 10 milligrams of ivy morphine you really want 10
29:22yes repeat it in five minutes if needed and she needs a dilata drip this is a base occlusive crisis
29:26i'm so sorry this happened we're gonna be okay now we're safe here come on we're gonna be safe here
29:32i
30:01promise
30:02Shocked him once for V-Pep.
30:03Was there a power pole down?
30:05No, abandoned factory.
30:06He felt bolt cutters at his side.
30:07Got electrocuted.
30:08Did you try to sip copper?
30:09Most likely.
30:10Power line fried his arm and the current through his whole body stopped his life.
30:15Ready?
30:18Steady, lift.
30:21Add a myoglobin and a CK to the labs.
30:24Two liters, normal saline, wide open.
30:26Dr. Santos, what are we worried about?
30:29Robdomyolysis from tissue damage can kill the kidneys.
30:32Ongoing risk of cardiac irritability.
30:34Excellent.
30:34AP pad in place.
30:35Guy fell off a telephone pole?
30:37No, he was on a platform.
30:39Boring.
30:39Cut into a live wire.
30:42Tense ventral compartment.
30:44Set up the stick pressure monitor.
30:46V-Pib.
30:47I charge the 300.
30:48Am I running this or are you?
30:49Sorry, reflex response.
30:50Clear.
30:52Ah, fuck.
30:54Sorry.
30:55Sorry.
30:57So, what happened?
30:59I bought it for my girlfriend's dog.
31:02I work nights and he yaps all day long.
31:06And when I woke up, I was wearing it.
31:09Stupid bitch!
31:10I should go...
31:11Sorry.
31:12Sorry.
31:14I think she must have used crazy glue.
31:17Yeah.
31:17It looks that way.
31:20Have you tried removing the batteries?
31:22Of course.
31:24We should close the case shut.
31:26All right.
31:27I think we have a couple options, Gary.
31:30We can try to find a solvent that will dissolve or at least soften the glue enough for you
31:34to peel it off without taking your skin with it.
31:38Or, um...
31:39That's your buddy.
31:40Um, I guess your skin cells on your neck will naturally slough off and you should just
31:46be able to remove it in time?
31:48How much time?
31:49Um, a couple weeks maybe?
31:51A couple weeks?
31:52I think this guy's got scurvy.
31:54What, is he a pirate?
31:55No, he's an unhoused man.
31:57Lives almost exclusively on dollar store ramen.
31:59There's paraphernalia hemorrhage, gingivitis, bleeding gums, and, um, yeah, no fruit or vegetables
32:05in his diet.
32:06I suppose that could do it as long as you've ruled out piracy.
32:08No parrot, no peg leg, doesn't reek of sweat and rum.
32:12Well, I think you mentioned it.
32:13There was a smell.
32:14Probably a pirate.
32:17Tell him to pick up some vitamin C next time he docks at a dollar store.
32:22I can't tell if you're joking.
32:24No, Captain Scurvy's got a vitamin C deficiency.
32:26Cheapest way to fix it is with a daily supplement.
32:29Captain Scurvy's another joke.
32:31I'd like to think so.
32:32That's a good one.
32:33Dr. Langdon, Dr. King, this is Arthur Carlson from Children, Youth, and Families.
32:36He'd like to speak to the parents of Tyler Jones.
32:39Right, right.
32:40Uh, Mel, would you mind showing him to Chiara and the family?
32:43Yeah, right this way.
32:49Beto?
32:50Beto?
32:50Hello, doctor.
32:51What are you doing here?
32:52I'm working day shifts now.
32:54Didn't you retire a couple years ago?
32:56No.
32:58I have to work today.
33:00Right.
33:01Right, just stay right here, okay?
33:03I have a lot of cleaning to do.
33:04Yeah, no, I'll be just one second.
33:06Hey, doc.
33:07Doc, how about a sandwich?
33:09Sure, Earl.
33:10Turkey, no egg salad.
33:11I got you.
33:11Just give me one minute.
33:15So, Beto said he's working here?
33:17Yeah, he just started wandering.
33:18Fortunately, he always winds up back here.
33:20Thinks he still works in the ED.
33:22I called his family.
33:23They usually pick him up after a few hours.
33:25Really?
33:26Yeah, gives him a break and look at him.
33:28He's talking to people, feeling useful, getting some exercise.
33:31Hell, I wish I was that happy.
33:33Think he's any good at catching rats?
33:35Stop.
33:36Oh, Earl wants a sandwich.
33:37Earl always wants a sandwich.
33:39Hey, check it out.
33:41I got my kids a puppy.
33:42Cute.
33:43Hope that wasn't your idea.
33:44Why?
33:45Seriously?
33:46You really think your wife needs anything else to take care of?
33:49Abby loves dogs.
33:50I love penguins.
33:51Doesn't mean I want to take care of one.
33:53Well, I'm pretty sure it's illegal to own a penguin.
33:54Pretty sure you're missing the point.
33:56The point is, Tanner promised you to take care of it.
33:58A four-year-old.
34:00Yeah, okay.
34:06How's she doing?
34:08I was still breathing after 20 of morphine.
34:13How's the pain, Joyce?
34:15Oh, a little better.
34:17You've ordered an exchange transfusion.
34:20Figured I needed that.
34:22What's your normal regimen at home?
34:2590 of extended release morphine every 12 hours.
34:29And oxycodone for breakthrough pain, but it wasn't working.
34:34Starting IV dilaudidum for an hour.
34:36You can press this button if you need a little extra.
34:39That only works once an hour, though, so don't go crazy.
34:42Could I confer with you?
34:44Yeah.
34:54You seem surprised by the opiate dosage.
34:57Seemed a little high.
34:58So was her pain.
35:00How do you know she's not drug-seeking?
35:01You can't fake a hemoglobin of six.
35:03Do you know what sickle cell crisis does to the body?
35:05Lots of get caught and plug up your capillaries
35:07and deprive all your cells of oxygen.
35:08It's been described as an electrical stabbing pain
35:11that feels like it's breaking your bones
35:13and flushing glass through your body.
35:15I never thought of it like that.
35:17Little empathy goes a long way
35:18with those suffering in real pain.
35:23Yeah.
35:23Don't worry.
35:24You'll get good at spotting the fakers,
35:25and half the time all those people need
35:26is someone to really listen to them
35:28and hear their story.
35:33Interior compartment pressure is 49.
35:37Burn caused massive swelling.
35:39What does he need, Dr. Santos?
35:41Fasciotomy.
35:41But he still has a radial pulse.
35:43Pressure would have to be over 100 to lose the pulse,
35:45and at that point, he'd lose the arm.
35:4749's enough to destroy all the nerves and muscles
35:49in a matter of hours.
35:51Compartment pressure is 49?
35:52Yeah, I'm going to make the initial incision down here.
35:55Ortho can finish up in the OR.
35:56Good plan.
35:57I'll let him know.
35:58Hey, Robbie.
35:59Always good to see you, Fred.
36:00Hey, like my rock star.
36:00She's pretty good.
36:01She's a great teacher.
36:04Sterile gloves for Dr. Santos.
36:06Oh, we don't teach forearm fasciotomies to our residents.
36:09What if she's all alone somewhere someday with no backup?
36:15This is the path to avoid the median nerve
36:18and all major vessels.
36:21Maybe just watch the first time.
36:23She'll hold the blade.
36:24I'll cut.
36:25Template to Dr. Santos.
36:30I'll start proximal.
36:32How much pressure?
36:34Just about this much.
36:41Mm-hmm.
36:45Through the skin and sub-Q.
36:52Good.
36:58How are they making out?
37:00They're still talking.
37:03You okay?
37:04Yeah, for sure.
37:05I just hate seeing families torn apart.
37:08Oh, they'll be fine.
37:09How can you be sure?
37:11They're white.
37:12Probably get off with a slap on the wrist.
37:14If they weren't, she'd probably lose her child
37:17and he'd end up going to jail.
37:19But...
37:20Sorry, I did a fellowship in cynicism.
37:23You sure you're okay?
37:25100%.
37:25I'm just going to get some air.
37:32I am a savage.
37:34Classy.
37:35Bougie.
37:35Ratchet.
37:36Sassy.
37:37Moody.
37:38Nasty.
37:39I am a savage.
37:41How do you know?
37:42I got stuff.
37:44Can you guys help?
37:46What's your name?
37:47Alice.
37:48Okay, Alex, let me take a look.
37:51What the fuck is it?
37:52Oh, I know.
37:53All right.
37:54We're going to take good care of you.
37:55You guys got stuff here.
37:56Alice.
37:59I got you.
38:00I have an abdominal GSW in the ambulance bay.
38:03Code trauma now.
38:05GSW just got dumped by homeboy ambulance.
38:07Okay, you got this?
38:09Yeah, go.
38:10Two grams of ANSEP.
38:11Ortho's on their way.
38:18Systallis is only 80, 14 gauge.
38:20Left AC.
38:21We got two units of whole blood going on the rapid infuser.
38:23Call the OR.
38:23We'll be right up.
38:24Lung's up.
38:25Do you take medications every day?
38:27Any allergies?
38:27No.
38:29Morrison's a full blood.
38:30See that?
38:30Yeah.
38:31Torp is liver.
38:32What's his name?
38:33Alex.
38:33Alex, you've lost a lot of blood.
38:35You need to go to surgery right away.
38:36Are we going to die?
38:37Not now that I'm here.
38:38Spoken with humility in the surgery.
38:40Oh, it's ready.
38:40How's he doing?
38:41You see it's coming up a bit.
38:42Let's go.
38:43Can you call my mom?
38:44Yep.
38:44Just isolate myself?
38:44Of course.
38:45Of course.
38:47So, he didn't have to wait for OR?
38:50Nope.
38:51We're a trauma center.
38:52We always keep one OR.
38:53We're stocked and ready to go.
38:55Well, that's awesome.
38:58What happens if there are multiple traumas needing OR?
39:01We get a lot busier.
39:04Mr. Milton.
39:05I'm sorry.
39:06We had to move you into the hall.
39:07I know it gets pretty chaotic and noisy out here.
39:10Mr. Milton?
39:12Hey.
39:13Hey, Bennett.
39:13Wake up for me.
39:17Oh, shit.
39:18Shit, shit.
39:18Um, I need a little help here.
39:21Help!
39:22When did you check on him last?
39:24I don't know.
39:24Around half an hour ago, almost.
39:26I was waiting on labs.
39:26What's going on?
39:27That's my gallstone guy.
39:28You saw his EKG?
39:29Unknown downtime.
39:29He was sleeping in the hall.
39:31Crash guard.
39:32All right, let's go.
39:37I got it.
39:41Hold compressions.
39:45Assistantly.
39:46Resume compressions.
39:48Amp of epi.
39:50Slow, slow temp.
39:51Slow temp.
39:51Should I intubate?
39:52No.
39:53Drop it down on the main.
39:53We don't want to hold compressions.
39:56Pumples are fixed and dilated.
39:58It's been down a long time.
40:11How are we doing in here?
40:13So much better.
40:15Dr. Mohan, this is my wife, Andine.
40:17Dr. Samira Mohan.
40:18Nice to meet you, Andine.
40:20Thank you for helping her.
40:21Of course.
40:22And again, I'm so sorry about how you were treated when you first arrived.
40:26Not everyone who works here is accustomed to dealing with sickle cell.
40:29We will be doing everything possible from here on in to manage Joyce's crisis.
40:33In the meantime, can I get you anything?
40:36I'm fine.
40:36Andine?
40:37No, thank you.
40:38Okay.
40:39Well, have the nurses come find me if you need anything.
40:43Take slow, deep breaths for me, Ian.
40:46I ordered a nib, 5-albuterol, and 25-cell-albuterol.
40:49All right.
40:50Keep an eye on him and present to Dr. Langdon.
40:52Okay.
40:53Okay, great.
40:54I'll see you back in triage once he settles down.
40:57Yeah.
40:58Let's take this off.
41:00All right.
41:00Hang in there, Ian.
41:01This should really help with your asthma.
41:12How can I help you, hon?
41:14I'm looking for Dr. Langdon.
41:15Yeah.
41:16Let me see where he is.
41:20Dr. Langdon, we have a med student at Central looking for you.
41:25Copy that.
41:26He's headed this way.
41:27Thanks.
41:30Hey, Crash.
41:31You missed a pretty cool fasciotomy.
41:33I'm not sure I'd be describing a fasciotomy as cool.
41:36You would if you were the one who did it.
41:39How's it going out in the arrivals lounge?
41:44Do you know anything about Dr. McKay?
41:47I've been here for less than two hours.
41:50I don't know anybody, including you.
41:53I thought you were some kind of kid genius.
41:55I'm like any other third-year med student.
41:58Clearly.
42:01Hey, I'm just trying to break the ice.
42:02I'm not trying to annoy you.
42:04And yet, you're still calling me Crash when I asked you not to.
42:08Really?
42:08You're still on that?
42:09Still on that.
42:12Yeah.
42:13Okay.
42:14Sorry.
42:15I had no idea genius was so sensitive.
42:20But I get it.
42:21Big brain.
42:22Big feelings.
42:23Makes total sense.
42:25I'll try to be softer.
42:30We want 20 bucks.
42:32There's more than one of them before we finish the shift.
42:37I'm afraid I'm afraid of it, even if it's small.
42:50We switch out every few minutes.
42:52You can take a break.
42:53I'm fine.
42:53All compressions.
42:57Still in asystole.
42:59Resume compressions.
43:01Well, should we shock him?
43:02You don't shock asystole.
43:04Well, it could be fine V-fib.
43:05Not a chance.
43:07Okay.
43:08When was his last epi?
43:09Three minutes ago.
43:10Okay.
43:10Well, ACLS says every three to five minutes, right?
43:12So let's push another round.
43:14Fine.
43:14Robbie.
43:15Mr. Spencer's adult children are asking for you, and their parents and Nick Bradley,
43:19the fentanyl overdose, also want to speak with you.
43:22Three rounds of epi, and then call it.
43:26Mr. Spencer's maxed out on BiPAP, 25 on 10.
43:28Sats?
43:29Not great.
43:30Hi, 80s.
43:32Was that epi?
43:33No.
43:34Hi.
43:35I heard you wanted to talk to me.
43:36Yeah, that alarm kept going off.
43:38Yeah.
43:38Why don't we step outside?
43:41The alarm is for low oxygen.
43:43Does he need more of that BiPAP?
43:45I'm afraid that's as high as we go.
43:48So the decision at this point...
43:49We want you to put our father on the breathing machine.
43:54Even though that goes against his desires to not be intubated?
43:58We're not ready to let go yet.
44:01And if your father is?
44:05He was a stubborn son of a bitch.
44:07He would never have given up on either of us.
44:09We're not giving up on him.
44:12You're absolutely certain you want to put your father through this after everything I've told you?
44:20I may have to honor his advance directive.
44:25No, you have to honor our durable power for health care.
44:29If not, we can talk to your hospital attorney.
44:35Jeremy, you're on board with this?
44:37Yeah, I guess so.
44:41Okay, you can sit with him until we're ready.
44:44When will that be?
44:45Momentarily.
44:58Please don't tell me you're going to intubate that poor man.
45:00It's what the family wants.
45:02So what?
45:02They want to torture him?
45:04I explained all that.
45:06If I co-sign, we can override their durable power.
45:10They're threatening to go to the hospital attorney.
45:12Let them.
45:13Call the ethics committee.
45:14They'll agree with us.
45:14No, you're probably right, but we don't have that kind of time.
45:17We are stuck.
45:19What are you talking about?
45:21Shit.
45:24What?
45:26I got to go tell those parents their 18-year-old son is brain dead.
45:30You want me to come with you?
45:31Nope.
45:32It's okay.
45:32What are you going to say?
45:34I'm going to say that it's likely, but we still need to do an apnea test and a cerebral perfusion
45:38study.
45:40There's no cranial nerve activity.
45:42Those people need some hope.
45:44False hope.
45:45Hope is hope.
45:46Is it?
45:47What are we praying for miracles today?
45:51They need time to process before they can accept what's happening.
45:55You ever consider taking that advice?
45:59Physician heal thyself?
46:02Don't you have patience?
46:24No, no, no, no.
46:26No no no no no no no people wake up from coma. You can wake them up. You can do
46:32that. You can talk and you can talk and do that.
46:42Please.
46:53Please.
46:59Please.
47:01Please.
47:02Oh, no.
47:03I don't know.
48:00I don't know.
48:08No change.
48:11No pericardial effusion, no tension, pneumothorax, no cardiac activity.
48:16That's like calcium.
48:17Could be hypercolemia.
48:19No, his potassium was normal.
48:21Ready to call this?
48:22Not yet.
48:23Dr. Robbie said three rounds of epi.
48:25It's time.
48:26Let's push another amp.
48:27This one could do it.
48:30All right.
48:32All right.
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