- Dr. Al?
[baby cooing, monitor beeping]
Dr. Al.
- Trauma's at the back door.
- Let me know when the rest of her labs are back.
- The girlfriend hasn't been much help.
- Is she being uncooperative? - No, not really.
Apparently, she's only been going out
with the little girl Kylie's father for a few months.
- Where is he now? - He's in New Castle for work.
I left him a message to come in.
- Okay, come find me when he gets here.
You talk to the trauma counselor this week?
- I'm going to.
Promise. - Okay, good.
- Medics are rolling in. - I'll be right there.
- How's our little girl who took a stair tumble?
- I'm going to check for internal hemorrhage
with an ultrasound.
- What is your gut telling you? - Her gut?
- Yeah, it's this thing that AI will never have.
- I don't want to think
about what my gut is saying right now.
- Come find me when you know more.
- Us, if you don't mind. - I don't mind.
Us--come find us when you know more.
Do you want to jump on this trauma?
- I've got my hands full.
I don't want this one getting away from me.
- We don't know what this is yet.
Don't go jumping to conclusions.
- I'm not jumping to anything.
I'm just looking out for my patient.
[device whirs]
- Uh, something I should know about Santos?
- Very confident, not afraid to get her hands dirty,
strong patient advocate, fearless.
- Seems like you were suggesting
she jumps to conclusions. - No, no, no, no.
I was merely suggesting or reminding her not to.
Yeah. - Uh, 58-year-old guy.
Tripped with a scaphoid fracture.
Epistaxis, non-focal neuro, but denies head trauma.
But every time I check on him,
his affect has drastically changed.
My gut is telling me something's not right.
[indistinct chatter]
What? - Nothing.
Your play.
- Start with a head CT.
If normal, LP, rule out encephalitis.
- Put in your orders.
Has he been here before? - No.
- Have you called the family to rule out
any psychiatric history? - No, but I will.
- Do you want to jump on this trauma in the meantime?
- What is it? - It's a surprise.
- Wonderful.
- Mel, you want to jump on this?
- What is it? - It's a surprise.
- What do you got for us, Amboy?
- Allen Billings-- Pallet of roofing tiles
fell eight feet, hit his upper arm with an open dislocation.
- Ouch.
- Two rounds of fent, 1 then 0.5 per kilo.
A and O, with good vitals.
- Mel, hold the arm steady. - Sure.
- Uno, dos, tres.
- [groans]
- Mr. Billings, I'm Dr. McKay.
- And I'm Dr. Garcia from surgery.
- And this is Dr. King. - Hi.
- Oh, it really hurts. - Give us a minute.
And we're gonna take care of that, okay?
- Any headache, chest or belly pain?
- No, just the arm. - Sats 99. Pulse 104.
BP 116/78.
- What do you think, Dr. King?
- Oh, um, it is an open dislocation.
- Can you be more specific?
- I think it's inferior, yeah?
- Do you remember the name for that?
[monitor beeping]
- Sounds like a Harry Potter spell.
- I... - Luxatio erecta.
- Correct. Check the neuro-circ.
- Sir, can you feel me touching you?
- [grunting] - Okay.
Can you wiggle your fingers? - Yeah.
- Good radial pulse. - E-FAST is negative.
- Okay, what's next, Dr. McKay? - Ancef and gentamicin.
Sedate for traction, countertraction.
- And he needs a CT angiogram to rule out vascular injury.
- That sounds like a plan.
- But with an open joint, he needs a washout
in the OR with ortho. - Agreed.
- Instead of wasting time down here,
it should be easier to reduce under general anesthesia
with fewer risks. - Possibly.
- Let's get an opinion from ortho.
[Garcia and Robby laugh]
- You're definitely new, Doctor--wishful thinking.
- Ortho like to take their sweet time.
Okay, sedation orders, Dr. McKay.
- 100 of propofol. Titrate to effect.
- Be back with that.
- Excuse me.
- How's your day going, Doc? - Yeah, pretty good.
Looks like your albumin's infusing.
Oh, uh, medical students Ogilvie and Kwon
are gonna be working with me.
- Hello. - Student doctors.
- You want them to try it?
They got to learn sometime.
- Uh, it's best if they watch the first one.
- I can prep and drape. - Yeah.
- After your albumin's in. - That's correct.
Uh, to prevent hypotension, we introduce albumin
if we anticipate more than five liters.
- Last time it was six.
- That's, like, a gallon and a half.
- Of high-octane premium. [laughs]
- Okay, you need anything else, Mr. Louie?
- No, ma'am. - Okay.
Grab me when you're ready? - Yeah.
- Whitaker, wife of your DNR this morning is in Central 8.
- Does she know her husband died?
- Not till you tell her.
- I'll be right there.
Uh, yeah, uh, always make sure
your entry point is safe
by identifying the pocket of fluid.
- That's not a pocket. That's a lake.
- Yeah, but you do not want to hit a vein or artery
on the way in, so make sure you check with color Doppler.
- Huh.
- Joy?
- I can't see. I can't see anything.
- That's 'cause your eye is shut.
- I can't open it. It's glued shut.
I was trying to put on lashes.
Oh, my God. Am I gonna go blind?
- No, no, I'm pretty sure this is something we can fix.
Just take a deep breath.
Okay, so you, uh, glued your eye shut with what exactly?
- Super glue. - Okay.
Well, is it something you typically use
to apply your lashes?
- No, it's typically something you use
to glue shit you break, like coffee mugs and stuff.
You know what I'm talking about.
It's--it's--it's super glue. - Okay, okay. Yeah, got it.
- Can I just talk to Dr. J?
She'll know what to do.
- Is that an ophthalmologist?
- No, she works here in the ER.
- Yeah, I don't think so.
But I know what I'm doing...
most of the time.
- For a Z-track, we pull up the skin
before advancing into the peritoneal space.
- Looks good. - Fluid's clear.
- Does that hurt as much as it looks?
- Oh, it's not too bad.
- Ogilvie, spike the bottle for me.
- What tests do we want on these fluids?
- Uh, Cell count to rule out spontaneous
bacterial peritonitis. - Ding.
What would make that diagnosis, Joy?
- Um...
- Absolute neutrophil count over 250.
[door opens]
- How are we doing in here? - They are doing great.
I think they got this.
[door opens]
- Hey, Dana, can you get Kiara down here for me?
She isn't answering her Spectralink.
- She's not working today. It's, uh...
I forget. I'll find out and get 'em down here.
What else you need?
- How about a double espresso martini?
- I like the way you think.
- Hey, Trudy, it's Dana. What's going on up there?
- What's up, Crash?
- You mean besides my mother driving me insane?
- Just tell her that her efforts would be better suited
endorsing someone like myself.
- If you're seriously thinking of a double residency,
let me save you the trouble-- you can't do it.
- Why? Just because you couldn't do it?
[keys clacking] - Honestly, yes.
- [gasps] Because you're a genius.
- Yes.
- What's the square root of 841?
- I'm not a human calculator.
- Social worker Dylan Easton is covering
for Kiara this weekend.
They're on their way down. - Thank you.
- Yep.
- Oh, shit.
I have a nun with conjunctivitis.
Her swab is showing
gram-negative intracellular diplococci.
- Gonorrhea?
- Come to Jesus.
- Well, the lab--the lab must have made a mistake.
- Maybe it's an immaculate infection.
- I'll call the lab supe, clear this up.
Tread carefully, missy.
- There's a nun with gonorrhea in her eye.
Seriously, you guys are gonna take this away from me?
I'm disappointed in you two.
- 29.
- What?
- The square root of 841.
- How we doing with Mr. Digby?
- He's in a gown in South 21.
Is there someplace we can get this laundered?
- Those are going right in the incinerator.
We'll get him a whole new wardrobe.
You ever use a cast saw before? - Uh...
- Of course you haven't. Well, today's your lucky day.
Follow me.
Dr. Mohan, you got a minute? - Yeah.
- Have you met Emma? First day. New grad RN.
- Hi. - Nice to meet you.
- Emma needs to learn cast removal.
- How long has the cast been on?
- Months, maybe years.
Probably gonna want to breathe through your mouth.
[indistinct announcement over P.A. system]
All right, Mr. Digby.
Dr. Mohan can cut your cast off now.
- How long's the cast been on?
- I don't know, but it's really getting itchy.
- Okay, this cuts the cast... [saw whirring]
Not the skin.
This should relieve the itching.
[saw whirring]
- Get the cast spreader. - Oh, uh...
[whirring slows, stops]
- Thank you.
Okay.
[sighs]
Okay.
- [gasps]
- Oh, I see you brought some friends.
- Oh, my God, are those-- - Maggots.
I'll need ethyl chloride spray to freeze them off.
- Never saw that in nursing school, am I right?
- Now irrigate like hell, Mel.
- Okay.
- Okay, on my count.
One, two, three.
- Come on, motherfucker.
Humeral head is not reducing.
- Should be done in the OR. - I am the OR.
- Okay, we're gonna get this back in
before ortho even answers the page.
Mel, stick four fingers under that humeral head.
- Really?
- Yeah, get in there really, really deep.
And when you feel the traction and lift it above the glenoid,
that will convert this to an anterior dislocation,
and it should pop right back in.
- Okay.
- Ready to go.
- One, two, three.
[squelching, bone cracks] - Okay.
- Ooh. - Oh, very cool.
- Sterile saline dressing. - [chuckles]
- Shoulder immobilizer and CT. - Okay.
Guess you guys don't need me anymore.
- You all right, Dr. King? - Yeah.
- You don't seem all right.
- Well, my deposition is today.
- Ah, do you want to talk about it?
- I'm not allowed to.
- No, we don't have to talk about the deposition,
but we can talk about how it is affecting you.
Average emergency physician
catches a med-mal case every seven years.
Nine times out of ten, the doctor wins.
I've been sued four times myself.
Dr. Al?
- I've never been named in a lawsuit.
- Mm, mm, mm...
- Um, but sometime...
[door opens]
- Sister Grace...
this is one of my residents, Dr. Mohan.
- Nice to meet you. - You as well.
- I wish we could recruit as dedicated
and talented young women as you two.
- I imagine it's a calling, much like medicine.
- Yes, very much so.
- Sister Grace, under the microscope,
we're seeing something called a gram-negative bacteria.
- Is that serious?
- It can be if left untreated.
But, fortunately, we can give you a shot of antibiotics,
irrigate your eye with a liter of saline,
and give you drops to use at home every few hours.
- How did I get it?
- So the--the appearance of the bacteria in your eye
suggests that it's--
it's gonorrhea.
Um, traditionally, that's a sexually--
- I know what gonorrhea is, Dr. Javadi.
I'm a nun, not a numbskull.
I do a lot of work at an unhoused shelter.
- Are--are you handling dirty sheets,
pillowcases, soiled clothes? - Yes.
Uh, part of my day is spent doing laundry, making beds,
disposing of old clothes.
- Do you wear gloves?
- When they're available. - Okay.
Uh, well, let's-- let's get you your shot
and set up for irrigating your eye.
- I bet we can scrounge up a couple boxes of gloves
while you're here.
It's important to protect yourself.
We'll be back.
- Why am I here?
I'm not sick.
- Oh, we took care of your husband, Ethan, earlier today.
- Is Ethan sick?
- Well, he was very ill.
And, um, we did everything we could to treat him,
but his heart stopped beating.
And...
I'm so sorry to say that he died.
- He died?
Ethan?
No, no.
Are you sure?
- Yes.
- [crying] No, no, no, no, no.
Ethan isn't sick.
No!
- I-I know how difficult this must be for you.
- [sobbing]
- Uh, kidneys look good on ultrasound.
No intra-abdominal injury.
- Hey, Dylan. - Robby.
- Is this the "tumble down the stairs" kid--Kylie?
- Yeah. - And?
- I'd like to talk to the girlfriend first,
away from the little girl. - We can arrange that.
- Okay. - Keep us informed.
- Yes, keep us informed.
- More labs are back on our abandoned baby Jane Doe.
Everything looks normal so far,
but you seemed really concerned earlier.
- She still needs a cathed urine.
- Or not.
- You can't trust a bagged urine.
- Agreed, but we can avoid the trauma of a catheter.
- With a suprapubic tap?
- Oh, I may have a trick or two up my sleeve, Dr. Al-Hashimi.
- Hey, Princess, hold up.
Hi.
How you feeling, Mr. Williams? - Okay.
A little nervous about going in the machine.
I can get a tad claustrophobic.
- Yeah, well, um...
we're sending you for a CT, not an MRI.
So it's like a open doughnut.
- Oh, good. I like doughnuts.
[McKay laughs]
- There you are. Thought you forgot about me.
- Oh, no. I was just with other patients.
- So what do you do for fun?
- I mainly do what my sister likes.
Um, she loves Kennywood and the zoo.
- No, what about you?
What do you like to do?
- Um, I used to like, um, the Renaissance fair.
- Really? - Yeah.
- Isn't that kind of dorky, though, where everybody
dresses up like somebody they're not?
- Yeah, but that's the fun, you know?
You can be anyone or anything you want.
I, um, actually had this alter ego
that was a 17th-century French woman--
[chair clanking] - Stop!
[panicked chatter]
- You okay, kid?
- That was a doozy. [chuckles weakly]
- Okay, are we ready?
- Cleaned and dried with sterile gauze.
- Is that water cold? - Right out the fridge.
- Okay, Jesse, you can take the armpits.
I'm gonna take the legs. [Velcro rips]
One, two, three, up.
Dr. Al-Hashimi, you're gonna be our catcher.
And, Samira, you're gonna do suprapubic circles
with that gauze.
And the cold should stimulate voiding.
Even if she pees, it's likely to be contaminated.
- Not according to the "British Medical Journal."
They did the wee-search. - [scoffs]
- Any leuks or nitrates, and we cath.
- Oh. Oh. Dr. Al-Hashimi, get it.
I was gonna invite you to join the softball team,
but now I'm not so sure.
There we go.
Looks like you got a good midstream sample.
- Here's a fresh blanket.
- Okay. Plan.
- Ceftriaxone, two-day admit till blood culture is negative.
- Next steps?
- Foster care.
[baby cooing] - Oh, yeah.
Ha.
Someone must have been in a bad way
to walk away from you, little one.
- We need to call the police?
- Let me know what the urine dip shows.
- We will let you know what the urine dip shows.
- You must be Dr. Al-Hashimi.
- And you must be Dr. Langdon.
I've heard all about you.
Welcome back.
And this is? - Uh, Linda Stevens.
One episode of substernal chest pressure resolved with rest.
12-lead negative for STEMI.
Heading for North 4.
- Hello, I'm Dr. Al-Hashimi.
- Nice to meet you. - Nice to meet you.
Ma'am, this is a teaching hospital.
Is it okay if some of our trainees join me?
- Not--not a problem.
Dr. Whitaker, Javadi, Ogilvie, Joy...
gather round.
Dr. Langdon, you are more than welcome to stay, too.
- Uh, maybe for a minute. We're pretty busy in triage.
- Okay.
Ms. Stevens...
I have an app on my phone
that can listen to our conversation
and the details of my physical exam
and write it all up in your medical record.
- Wow. - [chuckles]
It's protected, confidential, doesn't even stay on my phone.
And it means I can-- - What's going on?
- Some A-hole perp took off when he saw the cops,
knocked her backwards off a stool.
- Oh, Jesus. - Head trauma, no LOC.
- Okay, you need to get checked out.
- I'm fine. - No choice. It's work-related.
Let's, uh-- let's find her a room
and prep for a burr hole. - What?
Oh...
I forgot how much you like to joke, Captain Scurvy.
- Who the hell's Captain Scurvy?
- It's an inside thing.
- How's our shoulder guy? - Oh, he slept like a baby.
CT angio shows no vascular injury.
- What about your slip-and-fall guy with a labile affect?
- Mm, Michael Williams.
He's still in the scanner.
He seems to have settled down, so he doesn't need babysitting.
- Good. Maybe he's coming around.
Ortho can take Mr. Billings here up for surgery.
- Belay that order, sailor.
Dr. Robinavitch. - Nurse Hastings.
You can call me Robby.
- You can call me Noelle.
- Uh, you could just tell me what the hell's going on here.
- This is Noelle. She's our, um...
- Bed control manager. No, we met.
both: Case manager.
- And this guy won't be staying.
- Oh, he needs surgery.
- Which his insurance will pay for at Westbridge Memorial,
not here.
- Wait, so we have to transfer? - If--if he's stable.
- I believe that he is.
Look on the bright side.
We're gonna free up a bed, discharge a patient.
- I mean, that's great for us, not so good for him.
- He will get great care at Westbridge.
Don't you agree, Robby?
- I'm sure that he will. - Yeah.
- What am I missing?
Is there something else happening with Allen Billings
that I don't know about?
- Not medically.
- This is just a simple insurance transfer.
- Mm, yeah, okay.
- What's that about?
- Nothing. - Didn't feel like nothing.
- Dr. McKay has a very heightened sense of empathy.
- Meaning?
- Meaning she's good at picking up on stuff.
- You didn't say anything, did you?
- Nope.
I subscribe to the Falstaff advice.
Discretion is the better part of valor.
- Oh.
You still planning on leaving tonight?
- Yep.
- I don't understand why you can't leave in the morning.
- [sighs] Will you excuse me for a second?
I got to go talk to a patient while she's separated
from her caregiver. - Oh, yeah.
That doesn't sound ideal. - It's not ideal.
I got to figure out what's going on.
And I'll find you before I leave.
- Okay.
Okay, you got to stop this.
- Hastings.
- Evans.
- Hope you know what you're doing.
- [scoffs] What is that supposed to mean?
I'm a big girl.
- Okay, big girl.
- I'm fine.
- That's good. Follow my finger.
How's the head?
- It's a little sore.
- Lean forward. Let me take a look.
Yeah, you're gonna have a pretty good goose egg.
Headache? - A little.
- I can get you some Tylenol,
unless you need something stronger.
- Oh, no, that's okay. I'm not very drug tolerant.
- Lucky you.
- You know, I'm glad you're back.
- Thanks. Yeah, I'm glad to be back.
You know why I was away? - I should see my patient--
Um, no, not really.
I mean, I heard rumors, but I learned
a long time ago not to listen.
- I was in rehab... - Oh.
- For an addiction to benzos.
- Oh.
- Yeah, but I'm--I'm clean now.
A-and it never affected my work.
I just...
needed to get it all out of my system once and for all.
Yeah, I-I didn't handle things the way I should have.
I thought I could treat myself, and I let a lot of people down.
I'm sorry, Mel.
- You never let me down.
- Yeah.
Yeah, I did.
I should be setting an example, not a cautionary tale.
[knock at door, door opens]
- Hey.
How you doing? - I'm okay.
- Listen, I'm really sorry about all that.
The guy robbed a liquor store last night.
He tried to get away on a bicycle
but wiped out and took off on foot.
He must've hobbled in here--
more so to hide out than to get stitched up, I think.
- You catch him? - We will.
Anything you could tell us about him will help.
- You think he gave legit information?
- Probably not, but it's all we have at the moment.
If we do find him,
you may have to testify in court, Dr. King.
- "In court"? - As a material witness.
Attest to his injuries, his treatments--
simple stuff.
- Yeah, but we'll cross that bridge
when we come to it, right?
Mel? - [groans softly]
- Rest here a minute. I'll be right back.
- Mm.
- You know, I'm-- I'm fine, really. I should--
- Ten minutes, please. Doctor's orders.
ER can be a little bright and noisy.
[door closes]
- Dorsalis pedis
and posterior tibial pulses 2 plus and equal.
Your exam is perfect, ma'am.
- Oh, that is good to hear.
- I will be back when your blood tests are ready.
Let us know if the chest pain returns.
- Thank you. - You are so welcome.
[device whirs]
What do you think?
- Well, I don't think it's cardiac.
- I mean, what do you think of the app?
- I mean, it's hard to say without seeing the full thing.
- Take a look.
- Oh, my God.
Do you know how much time this will save?
- Studies show you can spend 80% less time charting.
You'll get out of here sooner,
improving both patient and physician satisfaction.
- Oh, excuse me.
It says here she takes Risperdal, an antipsychotic.
She takes Restoril when needed for sleep.
So is that, um...
- [scoffs] AI, "almost intelligent."
- Generative AI is 98% accurate at present.
You must always carefully proofread
and correct the minor errors.
It's excellent but not perfect.
- This is amazing.
Moteshakeram.
- Khahesh mikonam. [speaking Farsi]
You speak Farsi? - I did my undergrad at UCLA.
A lot of my friends were Persian.
- So you learned the language?
- Enough to break the ice.
- I am impressed.
- Me too...
that you had friends.
- Dr. Whitaker, I said hello to your widow
with Alzheimer's, but she only wants to talk to a doctor.
She's also very overdue for a diaper change.
- Okay. Yeah, thank you.
Uh, Ogilvie, you're with me.
Come on.
Ah, Mrs. Bostick?
- Takotsubo?
Broken heart syndrome? - Uh, no.
- Aah!
Hello?
- Hey.
Um, you wanted to see me?
- No.
Who are you?
- I'm Dr. Whitaker.
We talked about your husband?
- [gasps] Oh, Ethan.
Oh, can he please come see me?
- Um...
um...
no.
Unfortunately, he was very sick...
and he died.
- Ethan?
Died?
No.
Oh, no.
No, that's impossible.
No.
No, no, no, no, no.
- What do you like to do for fun?
- I love horseback riding.
- Does your dad take you? - Yep.
Sometimes he even rides,
but most of the time, he just watches me.
- Have you ever fallen off? Have you ever been thrown?
- Nope. I'm a very good rider.
- Do you have your own horse? - I wish.
We live in an apartment.
- Okay, Kylie, we need to take some blood now.
- Do you have to do that?
- Yeah, but I promise it'll go super fast
and only hurt for, like, a moment, okay?
So I'm just gonna put this rubber band
around your arm to help me find your vein better.
And then this makes sure no germs get in your body
when we do it.
Okay, now you're just gonna feel this teeny little prick.
But you can look away, okay?
Worst part's over.
- Tough little girl.
- Yeah, well, little girls can be
just as tough as little boys, even tougher.
- Yes. I just hope it's not because she's become
accustomed to pain.
At the very least, she's gonna need a visual exam
of external genitalia to look for signs of trauma.
I can have Dr. Al-Hashimi--
- No, she's my patient. I can do it.
[indistinct chatter]
- Nice and clear.
Uh, with an infection, it'd be kind of cloudy.
Joy, get ready to spike the third bottle here
after I clamp.
- All good in here? - Yes.
Uh, Dr. Whitaker was just explaining that with SBP,
we would see a turbid appearance.
However, he failed to mention that bloody fluid indicates
either a traumatic tap or the likelihood
of hepatocellular carcinoma,
in which case, we would send for cytology.
- That is correct.
- Kid knows his shit.
- He's so smart.
- Oh, hey. - Hey.
- How's it feel to officially be a doctor?
- It's pretty cool, actually.
Uh, I get my first paycheck today.
It's only for the first week, but I will take it.
- How are the med students? - Um, Joy is pretty peculiar.
And the other guy, Ogilvie, is really smart
and likes to show people.
- He's obnoxious. - Well...
- What he is, is your competition.
He's a gunner. - [chuckling] Yeah, right.
He's not my competition.
- He's from out of state for a four-week sub-internship.
You don't think he's angling for an emergency residency spot
here next year?
- I mean, even if he was... - What?
He couldn't possibly compete with your gigantic brain?
I'd step it up if I were you, Crash.
- Oh, she's still calling you that, huh?
- I don't really even care anymore.
I mean, she still calls you Huckleberry.
- Yeah, but, you know, friends now, so...
- Friends don't give each other shitty nicknames.
- You think Huckleberry is a shitty nickname?
- No.
No, H-Huckleberry is cute.
- Oh.
- It's cool. It's not like Crash.
- Oh, come on, man. Crash is pretty cool.
It's, like, you know... Crash.
It's got momentum.
- Dr. Javadi, Dr. Whitaker.
- Oh, I'm--I'm still a student doctor.
Whitaker's the real deal now.
- Right.
- Welcome back.
- Thanks. Yeah, thank you.
It's good to be back.
Okay, I will be in exile on Triage Island
with the rest of the drug addicts,
if anyone needs me.
- That was weird. - Very.
[both speaking Tagalog]
- What?
- Mm-hmm.
- Ooh! That's got to hurt.
- Dr. Langdon, Clint Hansen, his cousin Mona.
- How'd this happen?
- [chuckles]
- Bacon grease from a big griddle.
- Oh, looks like more than a splatter.
- Yeah, some fool poured it in the sink
while I was washing dishes. - I was so far away.
You reached for the soap without even looking.
You couldn't hear me?
- No, not with the water running.
- Who the hell pours bacon grease down the drain?
There's a jar under the sink. - You could have told me that.
- You're a guest in my house,
and now you've totally fucked up my plumbing.
- Okay, how about we focus on treating this burn?
- I'll grab the LET.
- We're gonna need to trim off some of the dead skin
so it doesn't get infected.
- I'm in charge of the brunch buffet.
Can you make it fast? - Sure. Yeah, we--
- This one came in by car. All I got is a name.
Orlando Diaz. - What's the story?
- He tripped over some rebar.
- Tripped or fainted? - I don't know.
- Orlando, open your eyes.
Hit his head? - I guess.
- Why didn't you call 911? - He wouldn't let me.
He was talking-- not so much now.
- Orlando. Mr. Diaz.
Jesus. - He drunk?
- No. Ketones on his breath.
He diabetic? - I don't know.
- Altered head trauma, possible DKA.
Call it overhead.
- Code trauma tier one now. Code trauma tier one now.
- Dr. Whitaker, your assessment was spot-on.
Your Alzheimer's widow definitely needs placement.
- Do you have a nursing home that can take her today?
- I wish.
Medicare requires a three-day hospitalization
before they'll approve that.
- I don't really have a reason to admit her.
- But I do. She's gravely disabled.
I'll put her on a cycle. We'll make it work.
- Thank you, Caleb.
- Yeah, you have a few moments, Michael?
- Actually, I do not.
But once I get things settled here, I will come and find you.
- Okay.
- Dr. Robby, Dylan just talked to the girlfriend.
- Robby!
- You'll have to fill me in in a minute.
What do you got? - AMS.
I can't tell if he fell 'cause he was altered
or he's altered because he fell.
There's ketones on his breath. - Okay, I got this. Thank you.
- All right, I guess it's just us.
Um, what did the girlfriend have to say?
- Well, Gina seems a little confused and on edge by this,
but I'm not suspicious about abuse on her part.
- What about Kylie's father?
- Well, I'm a social worker, not a mind reader.
I need to speak with him.
- Yeah, he's supposed to come in.
If he doesn't, looks pretty guilty.
- Let's not jump to any conclusions just yet.
- I'm not jumping.
I'm just saying, if this dude doesn't show up,
hell, I'll go find him myself.
- [chuckles awkwardly] - Kidding.
- I will speak to Kylie before her dad gets here.
- If he shows up.
- Yes.
- That's definitely ketones. We need to do an Accu-Check.
- I'm on it. He's tachy at 124.
Pulse ox 97. BP's 106/72.
- Lung sliding bilaterally. - Good bowel sounds.
Abdomen is soft, non-tender.
- How do you know it's non-tender?
- Because I didn't see any grimacing.
- He's altered. He didn't even flinch for the IV start.
- I meant to say non-rigid. - Huh.
- Toes down--going bilaterally.
No evidence of upper motor neuron deficit.
- Good.
- E-FAST negative. - How can I assist?
- You can check in with Dr. McKay or Dr. Santos.
- If you don't mind, I'd like to observe,
learn how you handle things.
- Whoa, blood sugar's critical high--it's over 500.
- Ding, ding, ding, ding.
- Sounds like diabetic ketoacidosis.
We need to start treating that, then right to CT
to rule out an intracranial bleed.
- Severe respiratory distress coming in--ETA three minutes.
I'll stick them in Trauma 1. - Yep.
- Would you like me to take that?
- Yes, please. Thank you.
- This guy needs an insulin drip, right?
0.1 units per kilo?
- No, not without knowing his potassium.
Insulin causes an intracellular shift.
And if the potassium is under 3.5, the drip would kill him.
- That is very true.
- We can start with lactated ringers.
1 liter per hour until we get the results
from the chem-7 and the VBG.
- Why is he in DKA?
- Maybe he's not taking enough insulin.
- More frequently, a precipitating event
can be identified, such as pneumonia,
urinary tract infection, stroke,
myocardial infarction, pancreatitis.
- Yeah, we always check for those.
They're part of the standard order set, right, Dr. Mohan?
[monitor beeping]
- He's from crazy Grandpa Jimmy's side.
- She's from my grandfather's brother's side.
Grandpa Ricky is still a psycho.
Clearly runs in the family. - Well, hold on.
Your grandparents are Ricky and Jimmy Hansen...
from the racing family?
- Unfortunately.
- I got something that needs attention.
- Not another baby.
Sorry. Excuse me.
- This is Mr. Randall.
He's been erect for the last eight hours.
- Should have gone down by now, right?
- It happens.
It's a good thing you came in, Mr. Randall.
I'll take him right back.
Do you mind finishing up with the Bickersons?
- I'd rather not.
- So, Mr. Randall-- - Ian.
- Ian, did you take anything
that might have led to this condition?
- I used an ED injection-- two, actually.
I gave myself a second shot, one on each side.
- So double the recommended dosage?
- Uh... [chuckles]
It's our wedding anniversary.
- Ah. Is this a big one?
[stammers] The anniversary, is it important?
Like, uh, significant? Like, a milestone or--
- It's our 20th. - Oh, nice.
Well done. Congratulations.
- Glucose 521.
Sodium 129.
Potassium's 3.7.
Chloride's 97.
Bicarb's 8. - Meaning?
- We can start the insulin drip and add 20 of K to each liter.
- Big anion gap of 24.
It should be under 10.
We follow it to assess progress.
- Actually, the 2024 international guidelines
state that anion gap should not be used,
as they can be misleading in the presence
of hyperchloremic metabolic acidosis.
I-I recently had a case in the ICU.
- VBG is back-- pH of 6.97.
- Normal's 7.4.
- What causes the acidemia?
- Without insulin, the body can't use glucose,
so it breaks down fat-producing ketones,
leading to severe acidosis, which can cause cardiac arrest.
- But the hyperglycemia causes the body to excrete more water
and electrolytes, leading to severe dehydration,
cardiac and renal dysfunction.
- Insulin drip, fluids with KCL,
capillary glucose every hour, chem-7 every four hours.
- ICU is gonna want a double lumen midline, too.
both: I can do it.
- 6 1/2 gloves. - 7 1/2 gloves.
- Can I just say, we evaluate our students
not only on their fund of knowledge
and on their procedural mastery,
but, also, maybe more importantly,
on their skills as team players?
- He can do it. - She--she can do it.
- Otero, will you update everyone?
- Barry Mitchell. Eating breakfast at Pamela's.
Sudden onset respiratory distress.
Some stridor.
Decent pulse ox but trouble speaking.
- And they tried the Heimlich? - Three times.
- [wheezing] - Any history of asthma?
Set up for intubation. - Agreed.
- Okay, sir, scoot across.
- Always a good sign when they slide over on their own.
- Came from a diner with an upper-airway obstruction.
Didn't clear with abdominal thrusts.
We got to take a look.
- Heart rate's 118. Pulse ox 96.
- Mr. Mitchell, we're gonna sedate you
to look down your throat, okay?
- Draw up ketamine and rocuronium.
- What about ketamine only?
- No, we need full paralysis
for a successful first-pass intubation.
- Might not need an intubation if it's just a foreign body.
- We can't assume that.
It could be subglottic stenosis, epiglottitis.
- I got ketamine and roc.
- Ketamine only, 80 milligrams.
- In that case, I'll leave this in your capable hands.
- Cetacaine spray and a Yankauer, please.
- 30 minutes ago, I told you I'd never been sued.
I'd like to keep it that way. - Mm.
[door opens]
- Instead of showing up here, you'd think
he'd put an eight-hour hard-on to good use.
- Well, it is a medical emergency.
If left untreated, priapism can cause
permanent damage to the penis
and erectile dysfunction forever.
- Thanks for the PSA.
- Pharmacist mixed up phenylephrine.
10 cc's of 100 mikes per cc.
- Great. That's the maximum dose.
- Sterile bolus saline.
You might need to refill
since they'll be flushing over and over again.
Hold out the empty basin to catch whatever they pull out.
Got it? - I think so.
- Holler if you need me.
- How we doing? - Oh, he's out from Versed.
Did a lidocaine block to the dorsal penile nerves
at 10 and 2. - Yeah, he's ready.
- Excellent.
- Enter the dorsal side to hit the corpus cavernosum.
I'll hold the glans.
- How deep? - 2 centimeters.
Ah, now aspirate.
- You guys do this, like, every day?
- If we're lucky.
Come here.
[blood squirting]
- Okay, let's lay him down and take a look.
- Okay.
[monitor beeping]
Good view of the epiglottis.
And mystery solved.
- This is what you get for eating broccoli for breakfast.
- Get a good grip on it.
- Okay.
Okay.
I can see why the Heimlich didn't work.
- Rotate a little bit.
Voilà!
That is why you give ketamine alone,
because if we gave a paralytic,
we would have to intubate and ventilate for an hour.
[door opens]
- All right, this guy is going to Westbridge for surgery.
Trauma 1 will move out shortly.
And our Alzheimer's widow, Evelyn Bostick,
can see her husband in the viewing room.
God bless her.
- My CT results back on Michael Williams?
- Not yet--neither are the labs on our little girl, Kylie.
- That's not me.
- I did, however, get a few things back
on our abandoned baby Jane Doe.
- Still not me.
- I'll take those.
- Just keeping you informed.
- Yep.
Okay.
We're just trying to get her upstairs.
Okay. All right, got it.
- Superbaby's urine dipped negative 0 WBCs.
Respiratory panel is positive for rhinovirus,
giving us a benign source.
Procalcitonin and CRP are pending.
- Now peds is saying they want a urine tox screen
and an HIV antigen before they'll take her.
- That sounds excessive.
- I feel like they're just trying to keep her down here.
- Can you blame them?
Never met a peds nurse yet that wasn't a little wacky.
You know what 12 hours of crying babies does
to a person's psyche?
- [scoffs] I almost went into peds.
- Good thing you didn't, trust me.
Too long up there, you're cuckoo for Cocoa Puffs.
- You are very punchy today. - Punchy's my new baseline.
Anyone even looks at me funny, I'm taking them out,
going right for the eyes.
I'll eye-gouge you.
[laughing] Bet you never knew that about me.
- I did not.
Where is Dr. Al-Hashimi? - In North 5 with the priapism.
- Ha! Better her than me.
I did not intend for that
to come off as sexual in any way.
And on that note, I'm gonna go check on Louie,
and then I'm gonna get some air in the ambulance bay.
So if anybody needs me, that's where I'll be.
- Got it, Cap.
- Ah, ah, ah!
- It looks like some pus at the base of the lateral incisor.
We can drain that for you. - [breathing heavily]
Sounds like it's gonna hurt. - No, we'll numb you up.
- Make sure you-- you use the good stuff.
- [chuckles] It'll be top shelf, Louie, I promise.
- How we doing in here? - Good.
Almost 4 liters out.
- I already feel like a million bucks.
I just needed an oil change.
- And I'm just about to drain an apical abscess.
- That's what I'm talking about.
I feel like I'm having a spa day.
- [chuckles] [Louie chuckles]
Keep it up, Whitaker. - [sighs]
- How long does this take?
- Up to an hour, sometimes two.
Mel, any suggestions?
Mel, you did these at the VA.
How can we facilitate detumescence?
- Oh, um, sometimes massaging the shaft can help.
- Oh, that's what she said.
- You can break up the clots with massage or compression.
- Got it.
- You okay, Mel?
- She's thinking about her deposition.
- Just stick with the facts of the case,
and it always goes well.
- I thought you said you hadn't been sued.
- I haven't, but I know many colleagues who have.
I also know your work, Dr. King.
Your medical decision-making in the chart
is always extremely thorough.
- Now we're getting somewhere.
First signs of flaccidity.
- I don't know how I could ever thank you.
- Mm, well, I think you just did.
- You saved my life.
- I didn't do anything.
- This is what happens
when your wife starts being a Nazi about your diet.
She's got me keeping a food journal.
- It's a good way to count calories.
- What calories?
She insists I eat five servings of vegetables a day.
A rabbit don't even eat that many vegetables.
I ain't never choked on a Sausage Egg McMuffin.
- I feel like I've been here all day.
- It's actually only been
a couple of hours, Mrs. Bostick.
- Well, where are we going now?
- Um...
I thought you...
might like to see your husband.
- Is Ethan still here?
- Yeah. - Oh.
Yes, yes, please. [chuckles]
Oh.
Oh...
this has been such a long day.
I'm so glad to see you resting,
but I think it's time.
We should be going home.
Uh, if--if we stop at the store on the way,
I can pick up what I need to make your shepherd's pie.
But not if it's hot out. [chuckles]
You know how I hate using the oven in the heat.
[chuckles]
We're ready to leave now.
- [groans]
[groans]
- Dr. Robby, is this a good time?
- That depends on what you have in mind, Dr. Al-Hashimi.
- I'd hoped you would have viewed my ideas
for improving the department.
I was looking forward to getting some feedback from you.
- Okay, well, I think the department functions
pretty well, all things considered.
I mean, we face the same challenges
that most emergency departments face.
- Let's take generative AI, for instance.
ER doctors spend 40% of their time charting,
only 28% of their time at the bedside.
[distant siren wailing] - That doesn't sound accurate.
- I've included the study in my packet.
- Right.
- And patient passports have been shown
to increase satisfaction
because they show the time required
for each phase of the visit. - Yeah, I got it right here.
What do you got? - Combative college kid.
Flipped out in the library,
Tased in the neck by campus security.
5 midazolam didn't touch him. - Will you get the fuck off me?
2901! 2901, motherfucker!
Get off! Fuck you, man!
- Want to tell me some more about your ideas?
- Maybe later. - Let me out.
Let me the fuck out! Let me out! Let me out!