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The.Pitt.S01E02.540p.x265.AAC [Full Movie] [Free Online HD]Full EP - Full
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00:00The
00:00R.
00:00R.
00:01R.
00:10R.
00:11R.
00:14R.
00:15R.
00:16R.
00:17R.
00:18R.
00:19All right.
00:23Robbie.
00:28Robbie.
00:30Collar skin and respiratory distress is here.
00:32Right.
00:33You okay?
00:33Yep.
00:34I wanted to talk to the patient at Central 12th Sun, 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?
00:46Uh, you 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 or 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.
01:28No response to pain, GCS3.
01:31Does that fit any toxidrome?
01:33No.
01:34If it was just opiates with Narcan, he'd be breathing on his own.
01:39Uh, beta blockers shouldn't give pinpoint pupils.
01:41Maybe parents had some prescription meds in their bathroom.
01:43They're on their way.
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.
01:57Hemo-Q's good.
01:5815.
01:59BP 84 over 58.
02:01Okay.
02:02What's your plan, Dr. Collins?
02:04Um, push dose epi, 0.1 milligram, foley for urine, stabilized for CT, and throw a wide net.
02:17Where are we going now?
02:18We 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, and, uh...
02:39Now, they sacrificed a lot to get me here.
02:42How's your pain, Mr. Milton?
02:44Uh, I'm fine.
02:45I could use a latte, though.
02:47Well, that could bring back the gallstone pain.
02:49How about a bourbon?
02:50It's barely 8 o'clock.
02:52Uh, how about some ice chips?
02:55Uh, no thanks.
02:56I prefer my whiskey neat.
02:58Uh, yeah, that's not happening.
03:04Is this Stalick 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?
03:18Do, too.
03:19Hypoxic injury, massive hemorrhage.
03:21Samira, escort him to CT.
03:23Take the drug box with you.
03:26Call 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, 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.
03:52History of hypertension.
03:54One hour of right upper quadrant pain
03:55after eating a fatty meal now resolved.
03:58A febrile, non-tender.
03:59There was a gallstone present on POCUS.
04:01EKG shows no acute ischemic changes,
04:03but 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.
04:18Hey, 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,
04:34and a condition called sepsis.
04:37What is that exactly?
04:38It means that the bacteria has spread
04:40from 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.
04:54Fury.
04:55Boom.
04:57Blood.
05:01It's the nowhere man from Yellow Submarine.
05:04It's what he used to call me when I didn't do my homework.
05:06Is this his baseline?
05:08He has good days and bad days.
05:11Why don't we step out for one more second?
05:18So your father came in with low blood pressure, which is improving.
05:22Can he go back to Assisted Living?
05:23Eventually, we hope so.
05:25Your dad has an advanced directive expressing his wishes,
05:28which says that IV fluids and medications are okay,
05:31but no artificial life support, no CPU.
05:33He doesn't want a bunch of machines keeping him alive.
05:37Okay.
05:38Then we will continue with oxygen and IV fluids and antibiotics.
05:42But if his lungs stop working,
05:44we're not going to place a tube in his windpipe for a breathing machine.
05:46But pneumonia is treatable?
05:50Most of the time it is.
05:52But if he can get better in a week, then put him on a machine.
05:54That's not what he wanted.
05:56Do either of you have durable power of attorney for health care?
05:59Yes.
06:00We both do.
06:01Okay.
06:02Well, this is a decision that does not need to be made right now.
06:05Well, why don't you think about it?
06:07Talk about it.
06:09If things get worse,
06:11sometimes allowing for a comfortable natural death can be the most humane path.
06:18No routine cases until we assess the Tier 1.
06:21Thanks.
06:22Dr. Langdon?
06:25So, uh, how's the VA?
06:28Yeah, it was, uh, good.
06:29Uh, you know, challenging.
06:31I learned a ton.
06:32I just think it, maybe it should be mandatory that all doctors spend time there,
06:36like, on a regular basis,
06:37because of all they've sacrificed for us.
06:39That's a nice thought.
06:40How'd you choose the pit?
06:42Oh, I have a sister with special needs,
06:43and she got into this really great facility here in Pittsburgh.
06:46And PTMC has such a great reputation,
06:48I thought, you know, I'd be a good...
06:50Can I present my headache to you?
06:51Uh, yeah.
06:51What do you got?
06:52Uh, 36-year-old woman with severe headache
06:54due to paracervical trigger point.
06:56Her pain went from 11 to 0 after two cc's of IMR cane.
07:00Wait, wait, wait.
07:00You did a trigger point injection before presenting the case?
07:03Yeah.
07:04Interns always present first.
07:05I spent a month at the pain clinic at home.
07:07No, it's not okay.
07:08I'm very comfortable.
07:09It's definitely not okay.
07:1123-year-old Ben Kemper.
07:12No helmet, got doored, riding an e-scooter.
07:14Neck versus handlebar, then face planted to the pavement.
07:16Obvious facial fractures,
07:18but alert and oriented with good vitals.
07:22Here we go.
07:25One, two, three.
07:29How we doing, Ben?
07:31Come on.
07:32I'm back in my throat.
07:33That's probably from the nosebleed.
07:35Short rapid rhino, please.
07:37Tacky at 120, pull socks borderline at 90.
07:40We'll buy it 15 liters for now.
07:42Neck contusion, larynx shifted to the right, no crepidance.
07:454-morphine.
07:46I'm going to stick something in your nose
07:49just to stop the bleeding.
07:52No hemotimpanum.
07:53Inflate the balloon.
07:56How about now, Ben?
07:58Better.
08:00What's up?
08:01Good vitals.
08:02A and O.
08:03Let's have a look.
08:07Whoa, whoa.
08:08Ouch.
08:09Ah, floating face.
08:11Before three fracture.
08:12You don't see that every day.
08:13Okay, okay, let's prep for an airway.
08:15Double set up just in case.
08:31Nice work.
08:33Thanks.
08:34All right, Mr. Chagari, you are good to go.
08:36Oh, thank you.
08:38Remember, 10% off for doctors and nurses.
08:42I'm a student doctor.
08:44All right, sorry.
08:45I hit my head, remember?
08:46Well, my son loves pizza, so I will take you up on it for sure.
08:50Okay?
08:50Wait for a nurse.
08:51Okay, thanks.
08:54I just realized it sounds like I always feed my kid junk food.
08:57Oh.
08:58No?
08:58Pizza, s'mores?
09:00No, no, please.
09:01I like pizza and s'mores.
09:03Who doesn't?
09:04Thanks.
09:05How many kids do you have?
09:07Just one.
09:08Harrison, he's 11 now.
09:11What does your husband do?
09:12No husband.
09:13Just being my son.
09:15I take it you don't have kids?
09:16I don't mean on account of your age.
09:19Or, I don't know, maybe I do.
09:20I mean, most medical students don't have kids.
09:22Yeah, no, no.
09:25No kids.
09:26Just, I'm not even a boyfriend.
09:28It's just school, for now.
09:29Yeah.
09:30That'll keep you pretty busy.
09:31I do not miss it.
09:33Must have been difficult as a young mother.
09:35It had its moments, but my life has been full of challenges.
09:39Med school was not one of the hardest, by far.
09:42It was one of the most rewarding, though.
09:45Other than having my son.
09:47Hey.
09:48Facial act with a possible foreign object in the eye,
09:51which is always a solid seven on the WMMB scale.
09:54What makes Mateo vomit?
09:59You okay?
10:01Yeah.
10:02Yeah, um, he's funny.
10:05The nurse.
10:06Oh, Mateo.
10:07You can say his name.
10:09Um, yeah, uh,
10:12a foreign object in the eye could be really serious.
10:22Hey, fruitcake.
10:25Hey, I'm talking to you, fruitcake.
10:27Myrna, I've told you a hundred times, my name is Dr. Robbie.
10:31You want to see my vagina?
10:33I have already seen it.
10:35And once was enough.
10:38Robbie.
10:39Parents of Nick Bradley, the ODT, are here.
10:41Okay, park him in trauma one.
10:43He's not back from CT yet.
10:44But I'll be right there in a minute.
10:46Behaving yourself, Myrna?
10:47Oh, yes, ma'am.
10:53How we doing?
10:54Ketamine and socks on board.
10:55Pulse socks holding at 94.
10:57Prepping the neck just in case.
10:58Let's have a look.
11:01A little deeper?
11:03Lots of swelling.
11:04I can't see the cords.
11:05To the right?
11:06The left?
11:07Yeah, really distorted from the trauma,
11:09and the demon's only going to get worse.
11:10Which is why we should crike.
11:11You don't crike a laryngeal fracture.
11:13Don't listen to Edwina scissorhands here.
11:15If they can't cut it, surgery doesn't know how to fix it.
11:16The contusion is high at the thyroid cartilage,
11:19so you just stand there looking pretty, ER Ken,
11:21and let me fix this.
11:23We're down to 85.
11:24All right, pull out.
11:25Eye gel.
11:25Bag and crike.
11:26Eye gel, please.
11:27Turn off the alarm.
11:28I've never done a crike before.
11:29No, Mel will do the crike.
11:31You've already had a busy morning.
11:32Glove up, Mel.
11:33No, I'm doing the crike, doctor.
11:35You would be doing it, doctor, if it wasn't an odd day.
11:37Surgery gets even days.
11:38ED gets odd days.
11:39You know this.
11:39For crike's sake.
11:40It's because you're all fucking odd down here.
11:42Okay, teamwork, please.
11:43Let's focus on the patient.
11:44I so appreciate your gracious understanding.
11:45I'll assist in case she screws up.
11:48You're longer.
11:48Plain nice.
11:49Stats are up with the eye gel.
11:51You ready?
11:52Hello.
11:53Oh, hello.
11:55You've done this?
11:57Yes.
11:57In the cadaver lab.
12:00Let's hope that's not where this poor soul ends up.
12:03We'll do an open technique since we have a minute.
12:05Okay.
12:07Okay, you're going to be making a vertical incision
12:09to avoid the jugulars and the carotids.
12:14Good.
12:15If this was a crike that needed to happen in seconds,
12:16you could use a 10 blade, your finger, and a bougie.
12:23This is called a wheat laner.
12:25And this is your tracook.
12:27C-spine, head CT, OMF, start a propofol drip.
12:31Okay, now we're going to make a horizontal incision
12:33across the cricoth-lyroid membrane.
12:394-0 Shiley next.
12:42Get ready to bag the crake.
12:45Yeah, yeah, yeah.
12:46Good.
12:54Oh, excuse me.
12:55No worries.
12:57Entitled CO2 is yellow.
12:59Yellow is yes.
12:59Nicely done.
13:00Sew it in.
13:00Okay.
13:01I will be next door.
13:05Does your resident know how to suture,
13:06or do I need to teach?
13:07You're all class, yo-yo.
13:09I know.
13:10Thanks.
13:10That means a lot of nothing coming from you.
13:13Mel, you okay?
13:14If you're done fighting.
13:15We're not fighting.
13:16This is playing.
13:17Langdon's too soft to fight.
13:19Oh, yeah.
13:19I have nothing but respect for Dr. Garcia.
13:21In fact, I think she would make
13:22a wonderful hostess at Applebee's.
13:24Waiter odds.
13:28Let's go.
13:30Okay, thanks.
13:31Just received a word.
13:32Your son's head CT is normal.
13:34And he's maintaining a good heart rate.
13:36You got him back.
13:36I need blood pressure.
13:38Thank God.
13:38Right now, he's unconscious
13:39with a tube in his throat for oxygen.
13:42Why don't we step out for a minute
13:44while they get him settled,
13:45and then you can come back.
13:45You can sit with him as long as you want.
13:48Nikki, it's Mama.
13:50I'm here, babe.
13:50You're doing great, son.
13:53Blown.
13:56Okay, let's step outside.
13:58I gotta go.
14:06So, we don't know how long
14:08he was at home without breathing.
14:09He's breathing now?
14:11Not on his own.
14:13But he's gonna wake up.
14:14We certainly hope so.
14:16We're gonna know better
14:17after we get some more test results back.
14:18Nick, are you sure that he didn't take anything
14:21that could have caused this?
14:22No.
14:23No, he's a good kid.
14:24He's in college.
14:25He has a part-time job.
14:26He even chose to live at home
14:28so he can focus on school.
14:30Dr. Robbie, from the urine.
14:31What's that?
14:34It's a drug test.
14:35And it is positive for fentanyl.
14:38No, that is impossible.
14:39Nick doesn't do drugs.
14:40There are a lot of pills
14:42that are sold illegally
14:43that have fentanyl,
14:44not just painkillers.
14:46Xanax, out of van.
14:47No, not our son.
14:49Well, maybe he didn't know
14:50that he took something with fentanyl.
14:52I don't know.
14:53The hows and the whys don't really matter.
14:55What matters is spending time with Nick.
14:57We've got some more tests to run.
14:58We'll know our options after that.
14:59But in the meantime,
15:00why don't you take a seat?
15:01Talk to him.
15:05Can he hear us?
15:06You know, we're never really sure,
15:08so you should just assume that he can.
15:10And we'll come find you
15:11as soon as we know more, okay?
15:12See you.
15:19Can we move Nick Bradley
15:21to a private room?
15:22Like you're gonna make it?
15:25Didn't he respond to Narcan?
15:26I think his pinpoint pupils
15:28just grew into blown pupils
15:29from brainstem death.
15:30Shit.
15:32Yeah, not much older than Jake.
15:36Don't go there.
15:38Hard not to sometimes.
15:41Mr. Spencer's room.
15:44Hey, Robbie.
15:45Teresa, the mother of the young man David
15:47who bolted.
15:47She's asking for her son.
15:48Okay, I'll be there in a minute.
15:50What is happening?
15:51Uh, his oxygen levels are dropping.
15:54Mr. Spencer, how are you feeling?
15:57I don't remember where I parked.
15:59Mr. Spencer, do you know where you are?
16:01It's so loud in here.
16:04Dad, do you know where you are?
16:06Dad, look at me.
16:07What's my name?
16:08I don't know where my car is.
16:13I-PAP 15 over 5.
16:14Step out.
16:20What's a bi-PAP?
16:21It is a pressurized air mask
16:23that can improve his oxygen.
16:25Either his pneumonia is getting worse
16:27or his heart couldn't handle
16:28the fluids that we gave him
16:29to treat the sepsis.
16:30His lungs are filling up with fluid.
16:32Can't you take the fluid away?
16:34Not without his blood pressure crashing
16:35with very bad consequences.
16:37So let's just hope the bi-PAP works.
16:39And 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
16:52a week that would be a very painful week he wouldn't get a lot of rest with all the monitors
17:00and all the blood tests he might need to be sedated he might need to be restrained because
17:04he'd be in an unfamiliar place with a very uncomfortable tube down his throat and he
17:09wouldn't really know what was happening elderly patients can often develop psychosis but he might
17:15get better or he might get worse what would you do i really can't answer that for you this is
17:22your
17:22father that's your decision to make i can guarantee you that we will keep him as comfortable as possible
17:27if a natural death is what you choose but he's not your father and he can recover from us what
17:32my
17:33sister means is that we're still deciding the best thing to do
17:38well the sooner you decide the better i'm really sorry i wish there was more that i could do
17:44i'm not sure that he has that much time left
17:53dr robbie
18:01you'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
18:26no harm no foul will you let me know if she says anything else
18:38at the risk of seeing me then you probably shouldn't and i just no trust me how do you
18:44know i just know i just wanted i know look i'll let you know if she says anything else that
18:51could
18:51be important to your investigation
18:57thank you you know for the record nope
19:12any luck getting our uh seg borders upstairs yeah right at least the kraken's still sleeping
19:20is it me or was that opposite no what you don't even know what you were gonna say
19:26maybe you do
19:29you seem nice absolutely not
19:33there's no possible scenario in which you and i have this conversation
19:37you of all people should know better i was new
19:42just walk away best possible scenario just keep on walking
19:48you gotta lay off mixing adderall and energy drinks
19:51trust me i will
19:53all right thanks
19:56that's the thing about emergency medicine you never know what you're gonna get
19:59and we get everything
20:00is that why you chose it
20:02ah maybe a little i also get to pick my shifts which for a single mother is amazing
20:08but mostly i just like the people you know
20:10they're always there 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
20:29do you have permission to be outside this area
20:31yes 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 fucking thing if it doesn't even work
20:54sorry
20:54you're doing great take your time
20:57you okay
20:58i am i get frustrated when i can't do things or at least it looks like it
21:02yeah you and me both
21:05thanks but um my frustration manifests itself emotionally
21:08and then i get upset and then it looks like i can't handle things and
21:12you know then i can't cry in front of the patient because no one wants to see
21:15their doctor cry that's just a big red flag
21:17you you just did a perfect crike
21:19you're doing great
21:23hey you pasty white how about a sandwich
21:27uh what brings you here today sir
21:30i'm here for a fucking sandwich
21:33okay
21:35okay uh excuse me
21:38perla
21:38perla
21:39can this patient get a sandwich
21:40i already gave you a sandwich ro
21:42i ain't ate this whole week
21:46sure give them another sandwich
21:48they're on the food cart just make sure it's not egg salad or he'll throw it on the floor
21:51okay good to know
21:53thanks
22:08any quick ones up here
22:10it'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
22:21that's sad
22:23there's still no reason to take it out on me
22:26i'm just saying
22:28dr mohan
22:29samira please
22:30i just wanted to apologize
22:32when my phone went off earlier that was really unprofessional
22:35don't sweat it
22:36trust me
22:37we'd need to laugh otherwise we'd never stop crying
22:40thank you
22:41besides with all the craziness that comes through here every hour
22:43nobody cares and notices
22:45got an unresponsive unhoused man coming in
22:48might be a good teaching case funky music
22:54let's go
22:55caucasian male approximately 60 to 70 years old
22:58found unresponsive
22:59no signs of trauma
23:00no id
23:03on three
23:05one
23:05two
23:06three
23:10did you take anything
23:12smell the alcohol from here
23:13this guy's wearing the spring summer and fall collection
23:17oh
23:17jeez
23:18whoa
23:18whoa
23:19whoa
23:20whoa
23:21what's wrong
23:23what's wrong
23:23what's going on
23:25patient tested positive for rats
23:28no
23:30if it matters i only counted three
23:33oh there goes one
23:39because your son tested positive for thc the psychoactive ingredient in cannabis
23:43we're gonna have to admit him for overnight observation and monitoring
23:47what about his brain
23:49is there a chance that much pot is going to do some damage and he's only four
23:53the honest answer is we don't know
23:54there haven't been any long-term studies
23:56but the fact that this is a one-time occurrence suggests that there should be no long-term effects
24:00like you don't know
24:01so my son could end up with learning disabilities psychiatric problems or even autism
24:06because there's no evidence to suggest any of that
24:08hello i'm kiara alfaro
24:10i'm the department social worker
24:13kiara will help you navigate the next steps
24:16what steps
24:17well a case like this requires mandatory reporting to child services and sometimes law enforcement
24:23no
24:24why do you have to involve the police
24:25it's a controlled substance
24:26they're not taking my kid away
24:28no one's suggesting that
24:29fuck your suggestions no one is touching my child
24:32in fact we're leaving
24:33well you know you can't take your son he could stop breathing
24:35he could have a seat
24:36i'll observe him at home
24:37amanda please
24:38fuck off drew
24:39get security
24:40if you can't cooperate i'm gonna have to ask you to leave
24:42amanda please he needs to stay here
24:44and you need to get a fucking hotel
24:46your son can't leave the hospital but i can have you removed
24:48don't you dare touch me get out of all of you
24:51mrs johnson i know this is scary and stressful
24:54oh fuck you fuck you this is my son my son and nobody is touching him
24:58whoa whoa whoa what's going on
24:59i was worried about a CYF
25:01man doctor
25:04this is a hospital
25:05it's in the jerry springer show
25:06ma'am
25:07nobody's trying to take your child
25:09so why don't you stay here with him while your husband talks to our social worker outside
25:13and straightens all this out
25:14well i don't want him speaking for me and my son
25:17well it is either you or him
25:19your son is not leaving
25:20but you can be escorted out and even arrested if you refuse to cooperate
25:24nobody wants that
25:25so you tell us
25:26what do you want to do
25:30i'm staying with my son
25:31okay great
25:33you do that
25:35we all on the same page here
25:37thank you olsen
25:38you okay
25:39yeah we got this
25:40it's all good
25:42it's all yours
25:43so mrs joe's
25:48is everything all right out there
25:50yeah just another day in paradise
25:52how are you feeling
25:53better
25:53where's the unit
25:55he left
25:56he said he had to
25:58get back to school
25:59what
26:00um
26:01maybe you could try calling him
26:02get him to come back
26:07what's gonna happen to him if i do
26:10hopefully he'll be willing to talk to somebody
26:12will you talk to him
26:13i can try
26:14i don't think he wanted to talk to me
26:18have you
26:19shared with anyone about
26:20the writings of his you found
26:22no
26:23i didn't know who to tell
26:25i just don't want to see him get hurt
26:28neither do we
26:38he's just going straight to voicemail
26:40maybe if you can text him
26:54he's not texting back
26:55he's
26:56oh i'm sorry about all this
26:58it's okay
26:58it's okay
26:59what you're doing for david is very brave
27:03i'm his mother
27:03i'll do anything to protect him
27:08do you think he would hurt anyone
27:09no
27:12but
27:17i'm sure a lot of parents felt that way
27:20before their children did unspeakable things
27:26does he have any history of violence
27:28has he ever been in any trouble
27:29no never
27:30he's very quiet
27:33and he takes great care of me
27:35he
27:36he's
27:38struggled
27:38with his father's death
27:41we both have
27:42the flight is ten minutes out
27:44within electrocution
27:45okay grab collins
27:46i'll be right there
27:48keep trying to reach him
27:49if you do have someone come find me
27:51okay
27:53thank you
27:55of course
27:55you got some good news for me
27:57i sure do
27:57there are two rooms in icu being clean
27:59they'll be ready by now
28:01great
28:01and i got bagels in the lounge
28:02nice job
28:03thank you
28:07is it true
28:07you have to be more specific
28:08are there rats in the ed
28:10uh apparently
28:11if somebody already snitched
28:13do you know how bad this looks
28:15one more reason to shutter this place
28:17only the emergency department
28:19admits rats
28:19the emergency department
28:20would never admit rats
28:21unless they have the right insurance
28:22did you catch any of them
28:24one and i charged him
28:25for a full visit
28:26i'm glad you think this is funny
28:27i'm sorry that you don't
28:28did you call an exterminator
28:30he's waiting on a second opinion
28:34you're pushing your luck today
28:35don't worry
28:36last i heard
28:37they were headed for the cafeteria
28:38so they should be dead
28:39within the hour
28:40i'll be here all week
28:41well maybe not
28:47drug-seeking woman
28:48kicked off a city bus
28:49for disrupting and disturbing
28:50passengers
28:51she's been screaming
28:52for narcotics non-stop
28:53we found an empty
28:54purchasing bottle
28:55what the hell are you doing
28:56why are you calling
28:57she's been uncooperative
28:58and combative
28:59since we picked her
28:59take the offer
29:00let her go
29:01stop fighting
29:02come the fuck down
29:03or i'm calling the cops
29:04my beds at home
29:05aren't working
29:06please
29:06i have sickles
29:08okay stop
29:09everybody stop
29:10stop
29:13what's your name
29:14it's joyce
29:15it's joyce
29:17is this your sickle cell pain
29:19yes
29:1910 milligrams of ivy morphine
29:21you really want 10
29:22yes repeated in 5 minutes
29:23if needed
29:23and she needs a dilatidrib
29:24this is a vaso-occlusive crisis
29:26i'm so sorry this happened
29:27we're gonna be okay now
29:28we're safe here
29:29come on
29:31we're gonna be safe here
29:32i promise
29:32just breathe
29:33okay
29:59live wire
30:01hit his left four off
30:02shocked him once for v-pip
30:03was there a power pole down
30:04no abandoned factory
30:05he found bolt cutters
30:06head aside
30:07got electrocuted
30:07did you try to steal copper
30:09most likely
30:09power line fried his arm
30:11and the current through his whole body
30:12stopped his life
30:15ready
30:18steady lift
30:21add a myoglobin
30:22and a ck to the labs
30:23two liters normal saline
30:25wide open
30:26dr santos
30:27what are we worried about
30:29robdomyolysis
30:30from tissue damage
30:31can kill the kidneys
30:31ongoing risk of cardiac irritability
30:34excellent
30:34ap pad in place
30:35guy fell off a telephone pole
30:36no he was on a platform
30:38boring
30:39cut into a live wire
30:42tense ventral compartment
30:43set up the stick pressure monitor
30:46v-pip
30:47charge at 300
30:47am i running this or are you
30:49sorry reflex response
30:50clear
30:52ah fuck
30:54sorry
30:55sorry
30:57so what
30:58what happened
30:59i bought it
31:00for my girlfriend's dog
31:01i work nights
31:03and he yaps
31:04all day
31:05long
31:06and when i woke up
31:07i was wearing it
31:08stupid bitch
31:11sorry
31:12sorry
31:14i think
31:15she must have
31:16used crazy glue
31:17yeah
31:17it um
31:18it looks that way
31:20have you tried
31:21removing the batteries
31:22of course
31:23she glued the case shut
31:26all right
31:27i think we have
31:28a couple options
31:29gary
31:29um
31:30we can try to find
31:31a solvent
31:31that will dissolve
31:32or at least soften
31:33the glue enough
31:34for you to peel it off
31:35without taking your skin
31:36with it
31:37or um
31:39that's your buddy
31:40um
31:41i i guess
31:42your skin cells
31:44on your neck
31:44will naturally slough off
31:45and you should just be able
31:46to remove it in time
31:48how much time
31:49um
31:50couple weeks maybe
31:51couple 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
31:58on dollar store ramen
31:59uh there's parapollicular
32:00hemorrhage
32:01gingivitis
32:02bleeding gums
32:03and um
32:04yeah
32:04no fruit or vegetables
32:05in his diet
32:06i suppose that could do it
32:07as long as you've ruled out
32:08piracy
32:08no parrot
32:09no peg leg
32:10doesn't reek of sweat
32:11and rum
32:12well i thought you mentioned it
32:13there was a smell
32:14probably a pirate
32:17tell him to pick up
32:18some vitamin c
32:18next time he docks
32:19a dollar store
32:22i can't tell if you're joking
32:24no
32:24captain scurvy's got a vitamin c deficiency
32:26cheapest way to fix it
32:27is with a daily supplement
32:29captain scurvy's another joke
32:31i'd like to think so
32:32that's a good one
32:32dr langdon
32:33dr king
32:34this is arthur carlson
32:35from children youth and families
32:36he'd like to speak to the parents
32:37of tyler jones
32:38right
32:39right
32:40uh mel
32:41would you mind showing him
32:42to kiara and the family
32:43yeah
32:43right this way
32:49vedo
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
32:57i have to work today
33:00right
33:00right just stay
33:02stay right here okay
33:02i i have a lot of cleaning to do
33:04yeah no i'll just
33:05i'll be just one second
33:06hey doc
33:07doc
33:08how about a sandwich
33:09sure earl turkey
33:10no egg salad
33:10i got you
33:11just give me one minute
33:15so
33:15beto said he's working here
33:16yeah
33:17he just started wandering
33:18fortunately 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
33:26gives him a break
33:27and look at him
33:28he's talking to people
33:29feeling useful
33:30getting some exercise
33:31hell i wish i was that happy
33:33think he's any good at catching rats
33:35stop
33:36oh
33:36earl wants a sandwich
33:37earl always wants a sandwich
33:39hey check it out
33:40i got my kids a puppy
33:42cute
33:42hope that wasn't your idea
33:44why
33:45seriously
33:46you really think your wife
33:48needs 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
33:52well i'm pretty sure it's illegal to own a penguin
33:54pretty sure you're missing the point
33:55the point is
33:56tanner promised you to take care of it
33:58a four-year-old
34:00yeah
34:00okay
34:06how's she doing
34:08still breathing after 20 of morphine
34:13how's the pain joyce
34:15oh
34:15a little better
34:17you've ordered an exchange transfusion
34:19figured i needed that
34:22what's your normal regimen at home
34:2590 of extended release morphine every 12 hours
34:28and oxycodone for breakthrough pain
34:31but
34:31it wasn't working
34:33starting iv dilaudid up for an hour
34:36you can press this button
34:38if you need a little extra
34:39uh that only works once an hour though
34:41so 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
35:02do 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 you'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
35:3649
35:36burn caused massive swelling
35:38what does he need dr santos
35:40uh fasciotomy
35:41but he still has a radial pulse
35:43pressure to have to be over a hundred to lose the pulse
35:45and at that point he'd lose the arm
35:4749 is enough to destroy all the nerves and muscles
35:49in a matter of hours
35:51compartment pressure is 49
35:52yeah i'm gonna make the initial incision down here
35:55ortho can finish up in the or
35:56good plan i'll let him know
35:58hey robbie
35:59always good to see you friend
35:59hey like my rock star
36:00she's pretty good
36:01she's a great teacher
36:03sterile gloves for dr santos
36:06oh we don't teach forum 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
36:20maybe just watch the first time
36:22she'll hold the blade i'll cut
36:2410 blade of dr santos
36:30i'll start proximal
36:31how much pressure
36:34just about this much
36:44through the skin and sub-q
36:53good
36:58how are they making out
37:00they're still talking
37:03you okay
37:04yeah for sure i just
37:06hate seeing families torn apart
37:07oh they'll be fine
37:09how can you be sure
37:10they're white
37:12probably get off with a slap on the wrist
37:13if they weren't
37:15she'd probably lose her child
37:17and he'd end up going to jail
37:18but
37:20sorry i did a fellowship in cynicism
37:23you sure you okay
37:24100% i'm just gonna get some air
37:32i am a savage
37:34classy
37:34bougie
37:35ratchet
37:36sassy
37:37moving
37:37nasty
37:39i am a savage
37:41how do you know
37:43i gotta stop
37:43can you guys help
37:46what's your name
37:47alice
37:48okay alice
37:49let me take a look
37:51the fuck it hurts
37:52oh i know
37:53all right
37:54we're gonna take good care of you
37:55you guys got us up here
37:56alice
38:00i have an abdominal gsw
38:02in the ambulance bay
38:03code trauma now
38:05gsw just got dumped
38:06by homeboy ambulance
38:07okay you got this
38:08yeah go
38:10two grams of ansep
38:11ortho's on their way
38:18systolic's only
38:1980 14 gauge
38:20left ac
38:20we got two units of whole blood going on the rapid infuser
38:23call the or will be right up
38:24lungs up
38:25you take medications every day
38:26any allergies
38:27no
38:29morse's a full blood
38:30see that
38:30yeah
38:30torp 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 gonna die
38:37not now that i'm here
38:38spoken with humility in the surge
38:40always ready
38:40how's he doing
38:41he's coming up a bit
38:42let's go
38:43are you coming mom
38:43just isolate myself
38:44of course
38:45of course
38:47so he didn't have to wait for or
38:50nope
38:50we're a trauma center
38:52we always keep one or
38:53we're stocked and ready to go
38:54well that's awesome
38:58what happens if
38:59there are multiple traumas needing or
39:01we get a lot busier
39:04mr milton
39:05i'm sorry we had to move you
39:07into the hall
39:07i know it gets pretty chaotic
39:08and noisy out here
39:10mr milton
39:12hey
39:12hey bennett
39:13wake up for me
39:17oh shit shit shit
39:18um i need a little help here
39:21help
39:22when did you check on him last
39:23i don't know around
39:25half an hour ago almost
39:26i was waiting on labs
39:26what's going on
39:27it's my gallstone guy
39:28you saw zk g
39:29unknown downtime
39:29he was sleeping in the hall
39:31crash guard let's go
39:37i got it
39:41hold compressions
39:45assistively
39:46resume compressions
39:48amp of epi
39:50slow slow temp
39:51slow temp
39:51should i intubate
39:52no drop it down on one day
39:53we don't want to hold compressions
39:56pupils are fixed and dilated
39:58it's been down a long time
40:11how we doing in here
40:12so much better
40:14dr mohan
40:15this is my wife andine
40:17dr samira mohan
40:18nice to meet you andine
40:19and thank you for helping her
40:21of course
40:21and again i'm so sorry
40:24about how you were treated
40:25when you first arrived
40:26not everyone who works here
40:28is accustomed to dealing
40:28with sickle cell
40:29we will be doing
40:30everything possible
40:31from here on in
40:32to manage choices crisis
40:33in the meantime
40:34can i get you anything
40:35i'm fine
40:36on dean
40:37no thank you
40:38okay well have the nurses
40:39come find me if you need
40:40anything
40:43take slow deep breaths
40:45for me ian
40:46ordered a neb
40:47five albuterol
40:47and five solid medel
40:48keep an eye on him
40:51and present to dr langton
40:52okay
40:52okay great
40:54i'll see you back in triage
40:55once he settles down
40:56yeah
40:58let's take this off
40:59all right hang in there ian
41:00this should really help
41:01with your asthma
41:06how can i help you hon
41:13um i'm looking for dr langton
41:15yeah let me see where he is
41:20dr langton
41:21we have a med student
41:22at central looking for you
41:25copy that
41:26he's headed this way
41:27thanks
41:30hey crash
41:30you missed a pretty cool
41:32fasciotomy
41:33i'm not sure i'd be
41:34describing a fasciotomy
41:35as cool
41:36you would if you were the
41:37one who did it
41:39how's it going out in
41:40a rival's lounge
41:44do you know anything about
41:45dr mckay
41:47i've been here for less than
41:49two hours
41:49i don't know anybody
41:51including you
41:53i thought you were some
41:54kind of kid genius
41:55i'm like any other
41:56third year med student
41:57clearly
42:01hey i'm just trying to
42:02break the ice
42:02i'm not trying to annoy you
42:04and yet
42:05you're still calling me crash
42:06when i asked you not to
42:07really you're still on that
42:09still on that
42:12yeah okay
42:13sorry
42:14i had no idea genius
42:17was so sensitive
42:19but i get it
42:21big brain
42:22big feelings
42:23makes total sense
42:24i'll try to be softer
42:50we switch out every few
42:52minutes you can take a
42:52break
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
43:03we could be fine v-fib
43:05not a chance
43:07okay uh
43:07when was his last epi
43:09three minutes ago
43:10okay well acls says
43:11every three to five minutes
43:12right so let's push
43:12another round
43:14fine
43:14robbie
43:15mr spencer's adult children
43:17are asking for you
43:18and their parents
43:18and nick bradley
43:19the fentanyl overdose
43:20also want to speak with you
43:21okay
43:22three rounds of epi
43:23and then
43:24call it
43:26mr spencer's maxed out
43:27on bi-pap
43:27twenty-five on ten
43:28sats
43:29not great
43:30high 80s
43:34hi
43:35i heard you wanted to talk to me
43:36yeah that alarm kept going off
43:37yeah why don't we step outside
43:41the alarm is for low oxygen
43:43does he need more of that bi-pap
43:45i'm afraid that's as high as we go
43:47so the decision at this point
43:49we want you to put our father
43:50on the breathing machine
43:54even though that goes against
43:55his 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
44:28if not we can talk to your hospital attorney
44:35jeremy you're on board with this
44:38yeah i guess so
44:41okay you can sit with him until we're ready
44:44when will that be
44:44momentarily
44:58please don't tell me you're going to intubate that poor man
45:00it's what the family wants
45:02so what they want to torture him
45:03i explained all that
45:06if i co-sign
45:07we can override their durable power
45:10they're threatening to go to the hospital attorney
45:12let them call the ethics committee
45:14they'll agree with us
45:15no you're probably right
45:16but we don't have that kind of time
45:17we're stuck
45:19what are you talking about
45:20shit
45:24what
45:26i gotta go tell those parents
45:27their 18 year old son is brain dead
45:30you want me to come with you
45:31nope
45:31it's okay
45:32what are you going to say
45:33i'm going to say that it's likely
45:35but we still need to do an apnea test
45:37and a cerebral perfusion study
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
45:53before they can accept what's happening
45:55you ever
45:56consider taking that advice
45:58physician heal thyself
46:02don't you have patience
46:25no no no no no no no people wake up from coma
46:28you can wake them up
46:31you can do that
46:32you can you can talk
46:34you can talk
46:35you can talk
46:35and do that
46:42please
46:45please
46:48please
47:01Oh
48:08No change.
48:10No 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.
48:27Let's do it.
48:28Let's take it.
48:29Come on.
48:31Come on.
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