- 2 hours ago
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00:00You
00:10Robbie yeah
00:12Cellulitis on the dorsum of the foot now spreading up the leg. Hello. I'm dr. Robbie. What if I take
00:18a look?
00:19How long do you think this is gonna take? I took an early lunch break. I?
00:24Don't know that you're gonna make it back to work today
00:26They're a thema and warmth halfway up her knee. When did you see you Donnie? He didn't I did
00:32When about four hours ago, I gave her a dose of catflex told her come back if things got worse
00:36things have definitely gotten worse
00:38Dana what's open trauma to Jesse
00:40Can you get her start in trauma to with some banco and blood cultures boss? I'm coming with suit yourself
00:47Santos you want in on trauma to uh, too much charting too little time
00:53Sixty-two year old male presents with chief complaint of left lower back pain consider the diagnosis of jesus christ
01:00I'm charting sorry
01:05Did I do something wrong besides interrupting me probably then I apologize I
01:11Know that second year of residency can be stressful. So there's anything I can do to help you
01:17Like stop talking that's a great idea. Yeah
01:20Consider the diagnosis of aortic aneurysm or dissection got a new one for you in 13
01:27I'm 20 charts behind and the new attending is threatening to make me repeat a year if I can't catch
01:31up
01:31I'm near river old lady with bad abdominal pain. Somebody's got to see you Dana
01:35Please do me as all a holiday weekend. Westbridge is down in our waiting rooms on overdrive
01:39I'm sorry, but your charting is gonna have to wait until after you're shipped
01:43Uncle V
01:44Dr. Santos needs you to pick up a new patient in 13
01:49Yes, ma'am. I'm on it
01:52Try it while you supervise best I can do
01:59Setting up a GoFundMe. That's what our generation does. That's how they support each other doctor. Tell him your wife's
02:05right
02:06Staying here is gonna cost more than we can afford look. I'm feeling better
02:10I'll just leave mr. Diaz even if your blood sugar is back to normal
02:15We have to continue with the insulin drip until we clear the ketones from your bloodstream
02:19Otherwise, you could experience electrolyte disorders heart and kidney problems more
02:24Your health is what matters
02:26I'll make you a deal
02:27You agree to stay on the insulin drip and I'll go find our case manager to discuss cost-cutting options
02:32for your stay deal
02:34And I'm sitting here and making sure he doesn't move
02:36You should go look for Anna. Mm-hmm. I can find her
02:40BRB
02:43Hang in vanco
02:44A really strong antibiotic to kill skin germs need a hand. Uh, no, we got this. I'll just observe
02:53Pretend I'm not even here. Uh, let's send off a cbc blood cultures and cmp and also a lactic acid
03:00crp and calcitonin
03:01But she's not febrile not tachycardic. No evidence of SIRS
03:05Yeah, what's SIRS systemic inflammatory response syndrome
03:11Sorry an exaggerated defense response
03:13Sorry, what a what sometimes the human body can have an overreaction to an infection
03:17So we're gonna monitor you and make sure that this does not progress
03:23It's my boss sorry, I have to take this or he's gonna fire me
03:28Hello
03:30Uh, no, i'm still at the hospital
03:33Uh being seen right now. Oh, no, they just stuck me with a needle
03:39Um, I don't know you want to talk to them
03:44They're kind of busy right now
03:46I know you are second iv's in
03:49Well, i'm not overreacting. My body's overreacting
03:54Please please don't fire me
03:57This is dr. Michael rabinovich. I am the chief of emergency medicine at ptmc. If you fire her she will
04:02sue you and I will testify on her behalf
04:05Okay
04:08Don't worry about it. We got you
04:14Do you know how long jack is gonna be asleep so there's no exact timeline the sedative suite gave him
04:20but he should be awake soon
04:21Have you spoken to your parents yet? Yeah, they're on their way back from columbus
04:25Maybe you should take some time for yourself before they arrive
04:28Um, yeah, a cafeteria is right down the hall decent grilled cheese stay away from the tuna. Thanks, but i'm
04:33not hungry
04:35You know, I just can't believe that a campus security guard tased my brother
04:38Aren't they supposed to be helping students and protect them not shoot at them?
04:42You have every right to be upset and you should absolutely pursue accountability
04:46But right now we are taking care of your brother
04:49And you should really take care of yourself
04:52I have your number. I'll text you as soon as jackson's lp results get back or he wakes up
04:58Okay
05:00Okay, thank you of course
05:05Uh hypoactive bowel sounds soft with moderate tenderness in the left lower quadrant
05:10Uh, mrs. Randolph do you take percocet every day?
05:13No
05:14Huh, and what about your water intake?
05:16Pause
05:17Mrs. Randolph you said you don't take percocet every day, but when was the last time you took some?
05:22Maybe three or four times last week
05:26Assisted living had a ballroom dance competition and I tweaked my back
05:31Any further questions ogilvy?
05:34Uh, when was your last bowel movement?
05:39I don't know sometime last week. I've been stopped up for at least five or six days
05:46Painkillers can cause constipation. I know
05:49That's why they put me on a stool softener and then they tried an enema
05:53And no movement sip and then they gave me this horrible drink
05:58Mag citrate
06:00Yeah
06:01Mag citrate
06:03Made me puke
06:05All right, what's next ogilvy?
06:07Let's get you an x-ray and see how we can help you mrs. Randolph. Thank you
06:13Differential?
06:14Uh, probable stool impaction but with her history of cholecystectomy it could be small bowel obstruction
06:19Or worse
06:21Sigmoid volvulus
06:23But that's a surgical emergency wouldn't you have tons of pain?
06:27Not always especially when you're in your 80s
06:36I am getting concerned this is a millimeter past the line
06:40Or my line was sloppy
06:41Any increase in pain?
06:43Oh, okay, sorry. Let's try fluoromorphine
06:45White counts only 10,000. It'd be over 12 for SIRS
06:48There are other criteria
06:50She's still afebrile
06:52Did you ask about past history of MRSA?
06:53Not specifically, but she's never been hospitalized
06:55Any evidence of an immunocompromised state?
06:57No, she's healthy
06:57Steroid use
06:58Never
06:59Maximum heart rate's only 89
07:00Is that okay?
07:02That's good, very good
07:04Stay with her
07:05Monitor her closely
07:06If there's any change in her condition, come find me
07:08I mean any change
07:13Roxy Hamler, 42, home hospice patient with a history of lung cancer
07:16New onset tonic-clonic seizure with right lower leg pain
07:20She hit it on the coffee table
07:24Initially non-verbal, now coming around
07:25That's normal after a seizure
07:27Hi, I'm Dr. Al-Hashimi
07:28Do you need a hand?
07:29Nope, we got it
07:29She hit her hand?
07:31No, I was there, I caught her
07:32No IV?
07:33Couldn't get one in
07:34Give her four of iron bursted for the seizure
07:3625 of fame for the pain
07:37Okay
07:38D number two
07:38Drama one
07:39This way
07:40Haven't seen you guys in a hot minute
07:43Pick up from SCI jobs forge
07:46Supposed to go to Westbridge, we got the burden of you
07:48Yeah, you and everybody else
07:49Princess, I need you to pivot to Central 9
07:51Got it
07:52Gus Varney, 54, victim of assault with diffuse blunt trauma
07:55He's got bruising to the face, the right chest
07:5710-centimeter laceration to the left arm
07:59VPs 136 over 84, pulse 102, good stats, 95 under merit
08:03How you feeling there, Mr. Varney?
08:05Fucking hurts
08:06Where?
08:07Everywhere
08:07I am Dr. Robbie, this is Dr. Al-Hashimi
08:10We'll get you something for the pain
08:11I've got a progressive cellulitis
08:13So, I'm good
08:13Thank you
08:15Gus, do you know who hurt you?
08:17One of the fine upstanding citizens of cell block six
08:19It's a deep lack in the through the muscle fascia
08:23Um, can we get the cuffs up once he settles?
08:24Not a chance
08:25Orange jumpsuit, he's cuffed for a reason
08:27Let's go
08:39Okay, everyone on my count
08:42One, two
08:45Hold on
08:50Go
08:50One, two, three
08:54E-Fast, Whitaker, primary assessment
08:56On it
09:03Oh, weird bruise
09:04Did he fall on something?
09:05Footbrain, got stomped
09:07Jesus
09:10Is it, is that necessary?
09:12Afraid so
09:14Airways patent
09:16Good lung sliding on the left
09:20Sorry, good on the right too
09:22How are the lungs?
09:23Ah, good breath sounds
09:24No crepitus
09:26No effusion
09:27Pulse ox 97
09:28BP 118 over 78
09:30Heart rate 112
09:30Tachycardic from the pain
09:32Start with four of morphine
09:33Repeat PR on it
09:34On it
09:35Okay, swollen mandible
09:36Open your mouth for me, Gus
09:38A little wider
09:39Can't
09:40Whitaker, you know the tongue blade exam?
09:43Yeah
09:43It's a great test for a mandible fracture
09:45Gus, bite down hard on this for me
09:51Sorry Gus, positive test
09:54No free fluid in the belly
09:56Any idea how long this will take?
09:57Too soon to tell
09:58Whitaker, your assessment?
09:59Fractured left mandible
10:00Multiple rib fractures
10:03Complex forearm lack
10:04Okay, log roll to the left
10:06Then pan scan
10:06Where were you when Mr. Varney got assaulted?
10:09I just move him
10:09I don't get to know him
10:10CT's ready for us
10:12Cycling the BP
10:13Okay, this redness is now
10:15A centimeter over that line
10:16And this might be a bullet for me
10:18Vanko takes a little time to work
10:19Vital signs are still stable
10:21122 over 78
10:23I got it
10:24How are you feeling, Debbie?
10:27I'm feeling a little warm
10:28That can happen with Vanko
10:29Thanks, man
10:31Lactic acid 4.2
10:34Uh, okay
10:36What's wrong?
10:37That can be a sign of a more serious infection
10:39But the good news is we know what to do
10:41Jesse, two liters of LR wide open
10:44This is severe sepsis
10:46I know, but at 7 a.m.
10:47It was a simple cellulitis
10:48Anyone want to give her a cat flex
10:49We could add carbapenem or zosin
10:51And brought in our antibiotic coverage
10:52Thanks for coming
10:53I got it
10:53Thanks
10:55Jesse
10:56One gram meropenem
10:57900 milligrams
10:58Climbed in page Dr. Garcia, please
11:00What's going on?
11:01We're adding new antibiotics
11:03It's serious
11:04We want to get ahead of it
11:05And make sure it doesn't become serious
11:09What else can I do?
11:10I think you've done enough
11:11You can go
11:16All good in there?
11:17Called sepsis
11:18Staple for the moment
11:19How about you?
11:21Perfect vitals
11:21E-Fast negative off to CT
11:23Good
11:24Keep me posted
11:26Ditto
11:31How's it going?
11:32Great
11:33If you ignore the hot mess in chairs
11:34Any update on our little baby Jane Doe?
11:36Security's reviewing the CCTV from last night and this morning
11:42You two kissing mic up yet?
11:43I think someone needs to smoke a cigarette
11:45Try to quit
11:45Why don't you quit when I'm on my trip?
11:48Everyone's glad to have you back
11:50Well, not everyone
11:53Hey, you want in on this betting board?
11:55Look, all you gotta do is pick why Westbridge went down
11:58How many of their patients we're going to get
12:00And when they'll be back in action
12:02Hey, already up to $500
12:05I got a pass though
12:07We're catching up on rehab bills
12:09Respect
12:12All right
12:14What's the rules on me changing my bet?
12:16Only if you double down
12:20Cinco
12:24You watch too many movies, man
12:28Considered the diagnosis of aortic aneurysm or dissection
12:32But the point of care ultrasound was negative
12:34Don't with that good luck, Granny
12:35Uh, ordered an acute abdominal series to rule out
12:38Obstruction still waiting on the x-ray
12:40Great
12:40Then you're free to treat our latest and greatest in SAS 16
12:42Oh, come on, Dee
12:44It's like every time I get a moment to chart
12:46I barely get a sentence out before I get
12:48Interrupted?
12:50Sucks to be you
12:50But trust me, it sucks worse for the poor gal in 16
12:54I'm beginning to think you enjoy torturing me
12:56Burks to the job
12:58Lumblebee, let's go
13:03Hold out your hand, Louie
13:07A little shaky
13:08I'm no surprise
13:10I've been here since 4 a.m.
13:12Well, we can get you something for that
13:13Oh, I can take care of it myself if you cut me loose right now
13:17Let's get Louie 50 milligrams of Librium
13:19I'll put in the order
13:23I will get it from the PDF
13:29I'm already assigned as Louie's treating physician
13:31Just makes sense that I put it in
13:34Yeah, yeah, yeah, of course
13:41Uh, any changes with our septic waitress?
13:43Not yet
13:44Wait, if you have a sept
13:45I don't
13:46The point of care ultrasound was negative for both
13:49I considered the diagnosis of quad aquina syndrome
13:52You're writing a great american novel?
13:54Um, charting and supervising
13:57That's Dana's idea
13:58Who is the lucky patient?
14:00A unhoused woman with a bad cough
14:02Ogilvy's all over it
14:08Okay
14:09Okay, deep breath in
14:10Blow it out real hard
14:11You haven't heard enough already?
14:14I need to check for wheezing with forced exhalation
14:21The fucking cough is killing me
14:23You smoke, Mrs. Yardley?
14:24Yeah, but I haven't been able to for a couple of days because of this cough
14:28You ever consider quitting?
14:30You ever considered minding your own business?
14:38Okay
14:38Well, the good news is that your test from earlier came back negative for both COVID and influenza
14:42But I'm gonna order a chest x-ray so that we can see what's really going on in those lungs
14:45You got time to let us do that?
14:48Where the fuck else you think I gotta be?
14:52Yeah, we're in three grams of Kepra for ten minutes
14:55That'll prevent another seizure
14:56Thank you
14:57Nobody can ever get an IV in her
15:00Yeah, midline cath is the way to go when your veins are shot
15:03Tacky to 114 BP 94 over 70 sat 91 on two liters
15:09Cool
15:10Is it possible to get her a blanket and some socks?
15:14Can do
15:16When was she diagnosed?
15:18Seven years ago
15:20Reset did a lobe
15:23Four cycles of platinum chemo gave us a couple good years, but then it spread to the bones
15:27Has she had radiation therapy?
15:30It shrunk down the mats, but they're still there
15:32That's why you're at hospice at home
15:34Yeah
15:35I'm sorry
15:36Me too
15:38Ah
15:40Sorry
15:42You have kids?
15:44Two boys
15:45Fifteen and nine
15:48My son's 12
15:49Goes fast
15:51Too fast
15:54Swelling and bruising over the distal tibia
15:56Uh
15:58Fifty of fentanyl, which is alex over 100
16:01What do you usually take for pain?
16:06Uh, MS continent, 30 milligrams twice a day
16:10Oxycodone for breakthrough and sublingual lactic for when it gets really bad
16:16That's a lot
16:18You handle pain meds?
16:19Sometimes
16:21All the time
16:22A hospice nurse comes by a few times a week, but I was alone when she had the seizure
16:27They told us that it could happen, but she couldn't breathe
16:31I freaked out, I called 911
16:35I'm so sorry
16:38I'm sorry
16:40I'm sorry
16:51Due to your family income, you make too much to be eligible for either penny or the hospital's charity care
16:59Well, we can't afford health care premiums
17:01It's unfortunately very common for people to fall between the cracks
17:05It's an imperfect system
17:07Can PTMC help with the cost in any way?
17:09We can offer financial assistance
17:12You pay the same that medicare or medicaid would pay
17:15How much is that?
17:16You pay 60%, we cover 40%
17:20Thank you
17:24Where have you been?
17:27How are you doing?
17:28I'm sorry, Mayita
17:29You were being thoughtful
17:31Just for a while
17:32Well, miss noel was just telling us that the hospital is going to give us a big discount
17:37We can knock 40% off your final bill
17:39That's great
17:40Mm-hmm
17:42I stay here for a few days
17:43My bill could be over 100,000, right?
17:47Yes, unfortunately
17:49It could end up being lower depending on your level of needed care
17:53Or higher
17:56So we would still have to pay 60,000
18:00Which we don't have
18:01She has to stay here to get better, right?
18:03Yes
18:04No
18:06Excuse me?
18:07I mean, not necessarily
18:09Couldn't we just admit him to med-surg instead of ICU?
18:12Wouldn't that be a lot cheaper?
18:14Med-surg won't accept him with an insulin drip
18:16Usually true, but let me talk to the charge nurse upstairs
18:20And I'll see what she says
18:22Thank you
18:26Food poisoning in the halls asking to leave
18:28Once you take your kids to the water park
18:30Those places are cesspools
18:32It's in the choir
18:33If she's feeling fine on his own friend, she's good to go
18:36All right, uh, Louie's in South 15
18:38Meds are coming down
18:39Another couple hours to monitor and then he can brew
18:41Straight to the liquor store
18:42Don't pass it out
18:43What about that clamshell case that went up anything?
18:46Out of surgery and recovery still sedated
18:48Good
18:48Keep me posted on that
18:50Will do
18:53Three times in one day to what do we owe the pleasure?
18:56I came down for a consult
18:58And to persuade Ahmad to start a new betting board
19:00Why is the Westbridge board full already?
19:03I was gonna ask him to start one about you and your midlife crisis trip
19:06I give up four weeks
19:08Seven tops
19:11You have little faith
19:12Not about faith, just facts
19:15Facts
19:15Based on my experience, you're a seven-week edge kind of guy
19:19Hey, Robbie, a med student's got a pickleball player in the North Hall
19:23A possible Achilles rupture, asking for your opinion
19:25Thank you, Perla
19:26At least somebody down here has a little faith in me
19:31You know what motorcycle Mike's sabbatical is really about?
19:34I never try to guess what's going on in that head of his
19:37Three months being on the open road by himself
19:39The man can't stand to be alone for more than a few hours
19:42He sleeps with the TV on in his bedroom
19:45I really don't think I needed to know that
19:49Maybe he's looking for something now
19:52We're trying to outrun some old ghosts
19:55I hope he finds what he's looking for
19:59Mantis are some peace
20:01Amen
20:01I consider the diagnosis of caudacuina syndrome, but the motor and sensory exam were both intact in
20:09Our own house coffer has pneumonia
20:10I'm cursed, fucking cursed
20:13Fuck
20:15What?
20:16That is a cavitary lesion in the right upper lobe
20:19Active TB
20:21What's next?
20:22Uh, AFB stand to confirm
20:24Move her to a negative airflow room, start her on meds
20:27Call infection control and public health
20:29And now you get to sign in as a patient and get your blood drawn for a quantifier in gold
20:34It's too soon to be positive
20:36Yeah, but you were exposed
20:37You need a baseline test and then again in eight weeks to see if you convert
20:42And if I do?
20:44Then meds every day for three or four months with regular blood tests to check for toxicity
20:49Jesus
20:49All right, let dana know what's up and for the love of god mask up when you move her
21:03Dr. Langdon
21:04Hey man, alex
21:05Let's take a look
21:10Ah
21:12Is it bad?
21:13It's not good
21:14Sorry, your chart says you were burned with dry ice?
21:17What happened?
21:17My jack-off brother
21:19Does he not like you?
21:21I asked him to do it, just not like this exactly
21:24What? Why?
21:25He was gonna brand me like I branded him
21:28Branding? Like cattle?
21:29Instead of hot branding, you stick the iron in dry ice, let it get super cold, and then you put
21:35it on your skin
21:35Cool, huh?
21:38Let's get some lead on this. I'll get some sniffs to the breed
21:44You good?
21:45Uh, yeah
21:46I'm good
21:47You sure?
21:49Doesn't seem like Robbie's all that happy I'm back
21:53Well, he's not going to be here, and I'm happy you're back
21:57Thanks
22:03Head and neck CT is negative except for mandible fracture
22:08Okay, let's get him off the board
22:09Roll him right side out
22:10Hey, we're gonna need the cuffs off
22:16Ready and one, two, three
22:18Ah, gentle
22:20Dr. King, how are the chest and belly?
22:22Uh, we have three anterior rib fractures and a small pulmonary contusion
22:27Not too bad
22:29When do pulmonary contusions peak?
22:31After a few hours
22:31And do we always admit for a three rib fracture?
22:34Uh, in the elderly, yes
22:35But not if a patient can manage the pain and doesn't need supplemental oxygen
22:38Good
22:40Okay, he's really hurting here
22:41You think you could set us up with a serratus anterior field block?
22:44No problem
22:44Oh, uh, as long as that's okay with Dr. Al Hashimi
22:47If the patient consents
22:50Mr. Varney, we want to give you a shot to numb your broken ribs so you can breathe easier
22:56Okay, get Mr. Varney prepped and draped
22:58Dr. Mohan, you're in charge
22:59Let's identify the landmarks
23:01Cuffs
23:03Yeah, you can just leave him off, man
23:05He's clearly not moving on his own
23:08We follow protocol for his safety and yours
23:15Do you need to get that?
23:17Nope, it's my mom
23:19Ignore it, just ignore it
23:21Amen, sister
23:22Form is numb, we can irrigate
23:24If I ignore a problem for long enough, it just goes away, right?
23:28I wish I could ignore my deposition
23:30That you can't ignore, but you'll be fine
23:33What's up with you, Whitaker?
23:35Trouble in roomy land?
23:37No, not really
23:38I think I overstepped with Dr. Langdon earlier
23:41Oh
23:42He was trying to prescribe the patient benzos
23:45And I told Langdon that it'd be better if I did it
23:48Only because I was already the assigned physician
23:52But yeah, now I feel like an asshole
23:54Langdon's fine
23:55He went to rehab, he's working the steps
23:58And hopefully, it's all behind him
24:02Place the needle in plane, superficial to the serratus anterior
24:06Between it and the latissimus dorsi
24:09You can see the fluid dissect and diffuse
24:12Dr. Mohan, we need you
24:13We've got two more rigs from Westbridge pulling up right now
24:17Go, we got this
24:18Thanks
24:19How are we doing in here?
24:21Uh, spiked attempt to 102, gave Tylenol
24:25Check out her leg
24:27That is a definite bowler
24:28Did surgery come down yet?
24:30Not yet
24:31I need surgery
24:32Page up again
24:33Surgery would be a last resort
24:35We would like them to come down and check out your leg in case we need to remove this infected
24:39skin
24:40I thought it was just a little swelling because I'm on my feet all day
24:45P's down to 85 over 40
24:46How much LR is it?
24:48Full bolus
24:48You know the leader
24:49And let's start leave a fed titrate to a man with 65
24:52Can someone please tell me what's going on?
24:54Full stock's down to 89
24:55100% non-rebreather
24:57Sometimes an infection can cause your blood pressure to drop and lower the amount of oxygen in your blood
25:02Am I going to be okay?
25:04We're doing everything that we can to make sure that you are
25:06Jesse
25:10What's up?
25:11Be ready to intubate if you need to
25:12You want me to call Langdon?
25:13No, I will be right back and you can call surgery and tell them to get their heads out of
25:17their asses and get down here
25:27Did you bring Langdon back here?
25:29No, Al Hashimi did
25:30You banished him to Scott Purgatory
25:32He did everything you would have done with that cellulitis patient
25:34If you think he missed something, tell him
25:36Well, we're probably going to need to intubate
25:38We're definitely going to need an ICU bed
25:39What happened?
25:40She is in septic shock on pressers
25:43Open shoulder dislocation is back
25:45Westbridge shut down all their ORs so they told us to bring them back here
25:48Are you joking? This ain't the Radisson
25:49Not my problem
25:50Where should we park him?
25:51Grab a wall
25:52On the well, call ortho, call the OR and tell them we got a patient back that needs surgery and
25:56admission
25:56Hey, so sorry about this ambulance tour of Allegheny County, Mr. Billings
26:00But we got you from here, I promise
26:02Yeah, I'm starved and is there any way I can get something to eat?
26:05Sorry, not before surgery
26:07Can I have a visitor?
26:08Sure
26:09I think we're from glory about what's going on at Westbridge
26:11Radio silence from the ivory tower and the charge nurse over there isn't responded
26:15Must be bad, I wonder if it's something that security needs to know about
26:17I'll keep you posted
26:18Hey, uh, you're kind of buds with Gloria
26:21Did she say anything to you about what's happening at Westbridge?
26:23No, you?
26:24Nope
26:25How are your patients?
26:27Our prisoner Gus has stable injuries and our law student in Central 10 is awake
26:31Normal LP and awaiting a site consult
26:33Good
26:34Quicker we can treat him, street him, move him up the food chain, the better
26:38Question
26:40Why are you treating me like one of your residents?
26:44I'm not
26:45As the attending, I'd like to know the status of all the patients and doctors in the ED in case
26:49I need to jump in quickly
26:51Makes sense
26:52Now your turn
26:55What?
26:56As your fellow attending in our ED, it only makes sense for me to know the status of all the
27:00patients and all the doctors
27:02In case I need to jump in on a moment's notice
27:06Touché
27:09You have a non-displaced fracture, distal tibia, so if you look at the bone here, it's pretty well aligned
27:14Hi, sorry, hi
27:16Hi, I was in the shower and I came as soon as I got Paul's message
27:19Lena?
27:20Hi
27:21What happened?
27:23I had a seizure
27:24You load her with Capra?
27:26Uh, yeah
27:27Yeah, she's back to baseline mental status
27:29I'm sorry I'm confused, aren't you off duty?
27:32I'm Roxy's death doula
27:34Her what?
27:36I help advocate for people like Roxy to make their transition to death a more peaceful process
27:41It's like a birth doula, but for the end of life
27:44She's been a real lifesaver for our family
27:48My husband cracking jokes while I'm dying
27:51See why I married him?
27:52Whatever you have to say about my condition, you can share with Lena too
27:56Um, we were just explaining that Roxy has a pathological fracture through a metastatic lesion
28:01Can you fix that?
28:03The bones are well aligned, so she won't need surgery
28:06The treatment is immobilization and a long limit
28:08Maybe we up her pain meds?
28:12Uh, yeah, sure, we could do that
28:15The bones should heal in about six weeks
28:17If I live that long
28:21Still numb here?
28:23Yeah, bruh
28:24Great
28:26You think it's gonna leave a scar?
28:28I don't think it, I know it
28:33Holy shit
28:33What the fuck are you doing here?
28:36I'm sorry, who are you?
28:37Concerned brother
28:37That looks not too bad
28:40You good at me?
28:42Yeah, it's nasty
28:43Thanks to you
28:44Wait, you did this?
28:46Oh yeah, you want to see the video?
28:49Yes
28:50Definitely
28:50What are you doing here?
28:51I got you
28:54All right, all right
28:56All right, I'm getting close
28:56Brothers unite!
29:00Dude
29:01Why in the world would you ask to have that done to you?
29:03He's trying to brand me with our family crest
29:09Your family crest is the penguins logo?
29:12We were gonna be bonding for life
29:13You already are
29:14With DNA
29:15Yeah
29:16I love you, man
29:18I'm real sorry
29:19It's okay
29:20Doc said it's gonna take some time, but it'll heal okay
29:23Awesome
29:25So maybe we can try again in a couple of months or
29:27No
29:30Okay
29:30Thank you
29:33Yellow on the end title
29:35Sorry, got backed up
29:36Sounds a little wet
29:37Someone asked for surgical consult
29:38Yeah, that's because of all the fluid
29:39Do you have the lines for now?
29:40And setting 50%
29:41Title volume 500 AC 12
29:42Yep, that's perfect
29:44Surgery here
29:45Hello
29:45Hey, it's about time
29:46Where's Garcia?
29:47Stuck in the OR
29:48She sent me down
29:48What you got?
29:49Septic shock
29:49Respiratory failure
29:50Impossible necrotizing
29:51Fasciitis
29:52She needs to go to the OR
29:53ASAP
29:53The infection was isolated at the door some of the foot five hours ago
29:57But now we're almost to the knee with bullet crevice and edema
29:59Yeah
30:00You seen a neck fashion before?
30:01In a textbook, I was a med student two weeks ago
30:06Gotta show this to Dr. Garcia
30:07Okay
30:08Okay
30:08Jesus Christ
30:09Go get anybody else from your service down here
30:10Shamsie, Miller, Walsh
30:12I don't know any of this people but
30:12Don't take this personally
30:13I just need a fucking grown-up down here
30:17Nice job on the sub-Qs
30:19Really took the tension off the wound
30:21Thanks
30:21I can help with the skin layer
30:23Four hands are faster than two
30:28Whoa
30:29Uh that just tore right through the skin
30:31May need to take bigger bites farther away from the wound edges
30:37Skin seems pretty fragile
30:45Oh yeah this is not working
30:47He has the skin strength of an 80 year old
30:50Put down steristrips with benzo in
30:52Not across the wound but along each wound edge both sides
30:55It'll hold the sutures
30:57Yeah
30:58What say you Dr. Robbie?
31:00Great
31:01MacGyver move go for it
31:05Does it have Dr. MacGyver work here?
31:08I don't know
31:11The patient's symptoms are consistent with lumbar radiculopathy at L4 L5 most likely due to disc herniation
31:18Coughing patient admitted to isolation for verified medication administration and started on right therapy
31:22Yeah
31:23Yeah why do I even bother just fail me now
31:24Okay
31:26Get in touch with a social worker
31:27They're gonna want to do contact tracing and help her figure out transitional housing for when she's discharged
31:32Got it
31:32And make sure infection control responded the people in the waiting room could have been exposed they need to be
31:38notified and tested
31:40Okay
31:44Relax you can take the mask off you don't have tb
31:47At least not yet
31:49Oh great
31:53This is fucked up
31:55How are you so calm?
31:57Expected job hazard
31:59You can get used to it
32:00Yeah no thanks
32:02Seventy percent of doctors in training at urban hospitals get exposed to tv and wind up on meds
32:07Jesus
32:09They don't teach you that in med school
32:12Mrs. Randolph's back
32:14Pulled up her x-ray
32:16Okay
32:16No volvulus
32:18No air fluid levels
32:19What do you think of this?
32:22Fecal material
32:24A shit ton
32:26Sorry it had to be said
32:27So what she needs an enema?
32:29No tried and failed remember?
32:30Yeah
32:31Time to dig in
32:33How are we gonna do that?
32:34Oh there's no we in disimpaction
32:43I haven't done one before
32:46Shouldn't I observe first?
32:48I know just the guy to teach you
33:00I spoke to the charge nurse in med surg
33:03They can take orlando today
33:04Yes
33:05That was wonderful
33:06They know he's on an insulin drip
33:08They know and they can change to a squid protocol
33:10Squid?
33:11Sub q insulin and dka
33:13So no iv drip
33:14Just shots of short acting insulin every four hours prn
33:18The med surg nurses have time to check a glucose every hour?
33:21They say so
33:22And five days on med surg is gonna cut your hospital bill down by two thirds
33:28Okay um
33:30So what's that gonna cost?
33:31I can't give you an exact amount but roughly 35,000
33:35So after about 40 percent
33:37I'll still have to pay what like 20 grand?
33:40The hospital can work out a payment plan
33:43Orlando we'll be okay we'll figure it out
33:46I'll take on extra shifts at the coffee shop
33:48We got you dad
33:51Let's give you some private time with your family
33:54Okay
33:57Sorry thank you was worried he might bail
33:59My pleasure
34:01The real thanks goes to the newbie here for thinking outside the box
34:07Sorry I doubted your med surg pitch
34:09Ah no sweat
34:11How'd you think of that?
34:13My family had to think of a lot of creative ways to help manage her grandma
34:19Leukemia
34:20System doesn't work for you you gotta work the system
34:24She survived?
34:26For a while until she didn't
34:28She died before my freshman year of college
34:31Sorry
34:33Her death taught me a lot
34:35Mainly that I don't want to be around people dying
34:43Hi
34:48Uh morphine PCA looks ready to go
34:51This should do the trick
34:53Do you notice a difference?
34:55Better
34:55Oh great
34:57Great
34:58How does this thing work?
35:00There's a baseline rate of morphine and if you're having pain you can push this button you'll get some extra
35:05And you can push for another dose every 10 minutes if needed
35:08Your very own morphine butler
35:13Amazing
35:14Because she can go home with this?
35:16Uh yeah
35:17Though you'll need more equipment for the house now that she can't bear weight on her leg
35:21Okay like what?
35:24Uh a wheelchair to go to the bathroom
35:26A shower chair
35:27Uh wall bars if you don't already have them
35:30And a hospital bed could be helpful too
35:33How do we get all that?
35:34You don't
35:35I do
35:36I will get everything so that the two of you can get out of here and back to the kids
35:40At home
35:41Thank you
35:49Nice of you to join us huckleberry
35:51What do you need?
35:52Some help with a disimpaction
35:56That is a med student procedure
35:58Oh you know the old adage see one do one teach one
36:02Say hello to teaching young Ogilvy here
36:06Okay
36:07Double glove Ogilvy
36:08All right
36:09Mrs. Randolph we're going to need to manually unblock your rectum so that you can get your bells moving again
36:14I know
36:16Here we go
36:18Mrs. Randolph
36:20I would like you to relax like you're having a bowel movement
36:24Nice and deep
36:28Okay
36:29Curve the finger like an ice cream scoop
36:35And bring it out
36:38You're up Ogilvy
36:44Some more pressure Mrs. Randolph
36:47Ready
36:54And here I thought you weren't a quick study
36:59Keep going
37:01Mrs. Randolph in order to prevent this from happening again I think you need a better stool softener
37:06You can try Miralax
37:07Just a tablespoon with a big glass of water every morning should do the trick
37:11Okay
37:14Oh
37:16Sorry
37:17Passing gas is good means we're making progress
37:20Does that mean that I can I can stop?
37:22No, no, keep going
37:28Okay, Ogilvy
37:29You you might want to
37:37Much better
37:40Maps hold none leave a fed
37:42One mic per keg per minute
37:44Give me a favor give me some four by fours and some betadine
37:46Sorry
37:47We're getting killed with transfers from Westbridge
37:49Mosenteric ischemia
37:50Perforated bowel
37:51Got a hot one here
37:52Yeah
37:53Possible max ash
37:55Possible
37:55Need CT with contrast to confirm
37:57This is spreading like wildfire
37:58By the time you get your CT it's going to be up to her waist
38:00She's going to need a hemicorporectomy
38:01She needs a CT scan
38:02How about stainless steel scan
38:05For christ's sake
38:07Rabinovich
38:08Robbie what the fuck are you doing
38:11Oh god I think it might be
38:12That's called dirty dishwater exudate without purulence
38:15There's a great appearance to the fascia
38:17And in the OR you'll see easy separation in the tissue planes
38:19When do you start your sabbatical?
38:21Tomorrow
38:21Not a moment too soon
38:22Thanks for coming down
38:28I'm catching up on my charting as fast as I can
38:31Why don't you give my generative AI app a try?
38:34It's 30% more efficient
38:36And providers report increased job satisfaction
38:39And you'll rarely have to stay over time to complete charts
38:41Yeah?
38:43Okay
38:44Yeah I'm usually here at least a couple hours after every shift trying to catch up so
38:48Sure AI will make doctors more efficient
38:50But hospitals will expect us to treat more patients without any extra pay of course
38:55All the while eliminating staff positions for attending and residence
38:58Oh Dr. Robbie I am not an advocate for erasing my own profession
39:02But I am advocating for getting to spend more time with my son
39:06Nothing can replace family
39:09What's the status of your septic patient?
39:11Neck fascia
39:11Surgery's taking her up
39:13Think they'll be able to save her leg?
39:16Right now I'm just hoping they can save her life
39:18Hey uh how's Ogilvy doing?
39:20A little tb exposure a touch of asplosion all in all pretty good day so far
39:26I see you came
39:27Hey I ain't no way I was going to let you miss Peter and Aubrey's epic fourth of july party
39:31Come on now hey
39:33Brought some bro
39:35You are the man
39:36Appreciate the bromance over here but no food because you might go into surgery
39:40No beer because we're a goddamn hospital
39:46Starting your sabbatical early?
39:48I know somebody who could really use a drink right now
39:50In the hospital?
39:52As a parting gift
39:58How's it looking?
40:00Good
40:01The stair strips did the trick
40:02CT is ready
40:04We already scanned him
40:05A head and neck want thin cuts and a 3d reconstruction of the mandible before they decide if Mr. Varney
40:11needs surgery
40:11Had they even come down to examine him in person?
40:14No they must be backed up
40:15Or there's a july 4th sale at the bmw dealership
40:19The labs are back albumin's low total proteins low he also has megaloblastic anemia
40:23Malnutrition probably jail
40:25Cuisine Whitaker what labs should we add?
40:27B12 folate iron levels
40:29Good
40:31We're going to run some more tests Mr. Varney hang in there
40:38I have to pee
40:40Oh there's no pure wick here but here you go hon I'll help you get on
40:45No no no bedpan
40:47I can walk to the bathroom I just need a little help
40:49Are you sure?
40:50Hey babe
40:50Oh we got this Mr. Hemel
40:52You'll have to bring your IV and portable oxygen
40:56Please
40:58I'll grab a wheelchair
41:00Let's try to suit you up and dangle your legs
41:02Okay
41:07One, two, three
41:15This is not a good idea
41:17I don't think we're going to need this
41:19Hey Paul, Paul um why don't you come grab a cup of coffee with me
41:23I'm still long for my all-nighter and I want to go over some delivery instructions with you
41:28Uh sure um Rox you okay?
41:33Mm-hmm
41:33Yeah it's okay
41:43Bedpan it is
41:52You lose your pulse ox again bud
42:01Louie Louie
42:03He kept pulling off his pulse ox
42:06It's on it's at 71 Louie wake up
42:10I'm gonna get the carotid
42:11I got the airway
42:12Hey Carla crash car intubation tray please
42:31I got the airway
42:32Never got the airway
42:37I have left
42:37updates
42:37What else was leaving it?
42:42I got the airway
42:44up
42:57automatic
42:57reflectionむako可
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