Doctor Reacts To The Pitt Season 2 Episode 3

Season 2, episode 3.

Things are really starting to heat up this July 4th. Let's get started.

Huge thanks to Rocket Money for sponsoring this video.

STOP TALKING TO ME. TITLE 27.

>> Hard to assess pupils.

Hard to assess >> Yeah. Yeah.

Wait till after he's

15 minutes to kick in.

500 paradol puts him down at five.

>> No, you can't give it without knowing his fat.

>> Two beats of a rhythm shred before we take off the bleed.

>> So, you got to be careful with some of these medications.

They can have implications

on the heart rhythm.

We talked about this earlier

uh on an earlier episode when we were discussing

torsads as a potential rhythm that can happen as a result of a prolonged

QT interval, but that's what they're trying to check on this EKG

even though it's very short obviously. Get out. >> That looks good.

Go with the paradol.

>> The medications that they're discussing

are antiscychotic medications to help sedate him.

>> Get off me, man. Sweetie 901. Get out.

That would be an IM dose because it's intramuscular

and it's going to be very quickly absorbed.

>> 57 108 section 1938.

>> I wonder why he's acting so aggressively.

Could be substance abuse, but it could also be a whole host of other issues.

So, need a lot of blood work, a lot of imaging here.

Really >> I'm sorry, Miss Graham.

I just saw the ASO

note in your chart. This is Lindsay.

We'll bring you back as soon as >> Stay with her. All right.

>> Who here needs help?

>> Let's listen and see what you >> you need help.

>> Oh, no, no, no, ma'am.

I've been on these since 1987.

This one here, he got dizzy, fell down.

>> Forgot my blood pressure medication.

>> A lot of patients end up going to the ER for forgotten medications

because they don't have good contact with a primary care doctor.

I have patients that message me all the time when they're on vacation, they

forgot their medicine, they lost their medicine.

And if you have a good relationship with the doctor that you see regularly,

that should be an easy correction for a temporary solution,

not clog up an ER.

>> Yo, can I get some help over here? Yeah.

What's going on, man?

Crazy kid in there screaming.

All right, have a seat. Yeah, that's him. Still going nuts. Probably meth.

What's your name, sir?

>> Tony Chiniello, campus security.

Yeah, I was at work when this happened, so I'm going to need everything documented. >> All right.

Heart rate's 89, pulse ox 97.

>> So he's not tacocartic. He's oxygenating well. Reassuring vitals. >> Scalp black's tiny. 5 mm.

Should hold together with Dermabond.

>> So they're just going to put some skin glue.

Basically, they are not going to even need to put staples in, which is

pretty common uh on the scalp. >> Okay.

So you're going to want to clamp

where the shaft meets the barb. >> Yeah. Stabilize the skin. >> What is that?

What's impaled in his

>> Like a taser electrode. >> Harder. Yep. Martyr.

>> Oh, do we suture those? >> Nope.

Just a band-aid, >> Mel.

We need orders, right?

>> I got a rainbow.

>> Uh, CBC, CMP, UA,

blood alcohol, and toxins. >> Oh, they both.

>> Those are all blood tests that we would

order preliminarily to gauge what's going on.

They'll give you an insight as to

potential infection, electrolyte abnormalities, substance use, etc.

If this young man's stable, can he go to Central 10 pronto?

Double trauma at the back door.

>> Okay, you heard the boss. Let's get going.

The day is starting to heat up.

>> Marquee, 32-year-old restrained driver, auto versus motorcycle,

altered with normal BP setting 992 L.

>> So, in situations like this, because of the mechanism of injury, you're going to

pan scan this patient.

You're going to get a CT scan likely

chest as well and then if there's any other signs of trauma when they're

doing their uh full analysis

because again they're doing their basics ABCDE.

>> 1 2 3 >> Okay, Joy, you stay with me.

Samira, you stay with Dr. Alashimi.

>> Open skull fracture tubed for agonal respirations.

BP60 palp initially started a liter of NS but lost pulse and root.

So this is a person who's

very very sick, bleeding

into their skull, losing a lot of blood because the blood pressure is really low.

But now this person is pulsless.

So to clinically they're dead and they're trying to resuscitate

them using chest compressions,

chest compressions, chest >> Oh boy, this doesn't look good.

>> And one liter of normal saline

is some fluids, but it's not enough fluids when you're trying to bring back

volume to a patient who has lost a tremendous amount of blood.

Fluids like normal saline,

they can help fill the intravascular

space inside the blood vessels to boost pressure,

which technically does improve the patient's state, but really what the patient is losing

is red blood cells because

of the blood loss.

And when you have

loss of red blood cells, you have the decreased ability to deliver oxygen to tissues.

So, it's not enough to just put IV fluids in.

You also need to do blood transfusions. >> One, two, three. Joey checking pupils.

Somebody hand me a pair of scissors.

>> 8 mm non-reactive >> aka

blown pupils fixed and dilated.

>> Yeah, blown pupils fixed and dilated means that there's significant

neurologic damage bleeding inside the >> Oh god.

>> Skull with tons of gray matter extravisation.

At least it was quick. >> No helmet? >> Nope.

Cuz you took the pendot motorcycle safety course.

>> Isn't that what you took, Robbie? >> Pull compressions.

Yes, but I still wear a helmet.

AH, caught in the lie on camera.

Little did Robbie know that HBO

Max was following him around with a drone.

>> Is he a donor? Also, nope.

That is too bad. Hey, sisterly.

I think we are done >> What's next door?

>> The guy who hit him. >> Yeah.

Uh, with the amount of injury that's present,

uh, the chance of bringing him back is almost nothing.

and also potentially trying to even bring him back is

not giving any kind of valuable quality of life.

So it's very reasonable to call time of death here.

>> Paulox 99 BP 108 over 72

fast negative hell of a lot better than the guy next >> How's the airway?

>> Good volume, good sats, gag reflex

>> Those are part of the glass

scale that we use to

uh create a rating in order to decide management of this patient.

>> Intubate maybe, maybe not. >> Mr. Yay.

Joy, start a rub on his chest like this. Really hard, please. Mr.

Ye, >> spontaneous eye movement response to pain. GCS is 10.

Borderline for >> The number that I learned is when you're GCS8, you intubate.

There has been some changes to this, but a lot of it is dependent

on the clinical situation.

>> No muscle tone, flaccid paralysis in the left arm.

A lot of times if they're fearful

for a patient to not be able to protect their airway,

meaning that they have no gag reflex, as an example,

that if they were to vomit or a foreign body goes uh into the

airway, the tongue falls back,

they're worried about the airway being obstructed

so that they preemptively

sedate the patient and put in uh an ET tube.

>> Same on the right and both legs.

hand scan with 3D reconstruction

of the >> which is what we were talking about earlier, making sure that the

patient is fully scanned. >> He's quadripollegic.

If so, it's a low cervical injury.

>> Why is that, Joy?

>> C3, four and five helps you breathe to stay alive.

>> I'm sure you have some questions.

I know it's a lot to take in. >> It's a tumor.

It's a brain tumor.

Is it a glyopblasto?

>> About 4 cmters in in the frontal lobe. >> Is it cancer?

>> We can't say for sure right now.

It could be many things.

Uh infection, inflammation, a benign cyst.

>> Usually there are radiographic

findings that could point you in one direction or

>> Is it what made me fall? >> Yeah, possibly.

We'd like to keep you here and treat with dexamethasone,

which is a steroid to take down the swelling

>> and then we'll need a brain biopsy.

>> And not all brain tumors

are in a position where it's possible to get a biopsy.

Sometimes it's in an area where doing a biopsy

could be more harm.

So it needs to be really evaluated

by a experienced neurosurgeon.

>> You You're going to cut open my head?

>> It's just a small hole.

We'll do a a CTg guided stereotactical

biopsy with a a blunt thin needle,

which sounds crazy, but it's actually pretty amazing.

I mean, most patients go home the next day.

>> I'm also surprised that this is happening in the ER.

Generally, a patient like this, we would recommend that they stay.

We uh admit them to the service meaning to the internal medicine floors

maybe the neurologic floor if they have one

and uh the internal medicine resident would take over admitting the patient and ER

would sort of sign off

given the fact that they've stabilized

the patient and created a dispo

which means a disposition

meaning that the patient is scheduled to be admitted in-house.

>> I think this is a pretty good plan.

I would also offer to call one of his loved ones

uh to see because he's clearly confused

and perhaps it would be of benefit to have a loved one near him

during a moment of stress like he's

>> BP 95 over 67.

>> 95 over 67 is technically a normal blood pressure as long as he's asymptomatic.

>> Seems a little on the low side. >> It is.

>> Have you ever had low blood pressure in the past? >> No, sir.

My blood pressure is always high.

Unless he's taking too much of his

>> Hansen's all run high except for money.

Well, he ran low, but he's dead. >> It's not helpful.

You want to help?

Quit playing family pharmacist.

>> Pooling meds is how we've always done it.

You put everything in a big pile in the middle of the table.

>> Look where that got us now.

>> No, I'm going to jump in here and echo that sharing meds which haven't

been prescribed to you is actually a real big no no.

It's a real big no no because there are medication interactions

and certain medications depending on a patient's

other medical conditions, other co-orbidities

we call them, could get them in a lot of trouble because when we

prescribe a medication, even an anti-hypertensive,

we do it thinking about the patient as an individual.

What other meds are they on?

What risks do they face?

What other med uh medical problems do they have?

>> Well, how we doing on remembering what your brother might have taken?

>> We could call back to the house. Great >> Okay.

Whatever little round pill you took, sir,

has caused your heart rate and blood pressure to drop so low, you're at

risk of fainting, falling, or having a serious injury.

>> So, that is hypotension,

low blood pressure because it is symptomatic now.

>> When you take him back to the ER,

>> yeah, his pulse is quite low at 56.

So, I wouldn't be surprised if he took either a combination

pill, uh, meaning like a beta blocker

with an ACE inhibitor

or a hydrochloroioide with an ACE inhibitor.

So there there there's a world where there's two medications

involved or perhaps one

at a very high dose.

>> So we can get a liter of fluids.

We can check his blood tests and monitor his heart rate and blood pressure

till he >> I also would like to see an EKG. >> Hold still, sir.

No talking while we do the EKG.

>> Which would show if there is heart block present because

that might uh encourage you to act more

aggressively than just giving fluids.

>> Socks holding steady at 99.

Good title >> How you doing there, Mr. Ye?

>> Scanner can take him now.

I'll check the results from upstairs.

Why is he so altered?

Could be concussion, maybe a small intraanial hemorrhage.

>> All will be revealed by the donut of

>> The donut of truth is the CT scan.

>> Did I hear someone say he's paralyzed?

>> There are signs of weakness in both arms and legs.

But before we can make any prognosis,

we'll need a full body scan.

>> Not just a full body scan, but also for some time to pass.

Because unless you see

how the person starts

improving over time, it's hard to give a long-term

accurate prognosis, especially when it comes to the neurologic system.

>> Head CT will show us any brain injury and neck CT will show us

any spinal cord injury, chest, abdomen, pelvis.

We'll rule out any internal bleeding. >> Oh my god.

The scan should only take about 15 minutes.

In the meantime, perhaps you'd let us look you over as >> I'm fine.

The medics checked me.

I just want to stay with my husband.

>> Well, you can't go into the CT with him, but you can wait just

outside if you >> Princess, this is Nancy. Mrs.

Ye is going to go with her husband to CT.

Will you show her where to go? >> Sure. Come on in. Thank you.

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All right, let's get back to the pit.

>> So, you bandaged the burn yourself?

>> Oh, no, no, no, no, no, no.

>> Ma'am, you're making it difficult for me to see under this dressing.

Is that a >> Part of a window curtain. Cleaner than tablecloth.

I'll for the doctor. Thank you.

But >> may I ask how this happened?

for weeks on end.

The kids with their hoochney

firecrackers going all day and

>> Oh, is this a firecracker burn? >> No, sweetie.

This is from the full samaar

I drop on the floor when this >> I'm assuming she's Russian.

>> The firecracker started going on again. >> I'm sorry. What's a samavar?

>> It is a big metal urn for coffee or tea.

It can get super duper hot

and I was never allowed to touch ours.

>> This is so embarrassing to share on camera.

When I was a child,

I well, I'm gonna blame my father for this.

My father would always recommend that my sister and I whenever we had upper

respiratory infection, we would lean over a steaming

pot of water with a towel

and get the humidity

of the steam in order to open up our airways.

In theory, good idea.

However, not a good idea

to let a 5-year-old

carry said steaming pot because I spilled it all over my lower body, including

some sensitive part, but it it burned bad.

I cried a lot.

>> I'm still crying internally. Emotional damage. Hello, Mrs. Kovaleno.

My name is Dr. Michael Rabinovich.

Everybody calls me Dr. Robbie. >> Rabinoich. Jewish. >> You guessed it.

And I see that you are here today for a burn.

>> Please close the drape.

What's with the show?

Not closing the drape.

>> What did you put on this?

>> Ooh, that's a pretty extensive burn there.

That looks full thickness already.

Second, third degree >> on your burn. Is this honey? >> Yes, honey.

Where do you go on holy >> Uh, my grandparents.

Um, I grew up going to Rodealum.

You >> tree of life. They're rebuilding. >> Yes. Something new. >> Remember, rebuild, renew. >> That's a slogan. >> I'm sorry.

Did you say honey?

>> You think honey is funny?

>> Works like a charm.

>> Honey does have antibacterial properties.

And actually when I worked at the wound care center, sometimes when we had

multi-drugresistant organisms, honey would be the sole product that would work for our patients

who have terribly infected wounds.

>> If the honey is medical grade and the burns are not too bad, honey

actually does have some antibacterial and anti-inflammatory properties.

>> I love that we just echo each other back and forth.

There is actually a medical grade honey that you can prescribe.

>> These burns are very deep in some places.

They're going to need debreedment.

Deb breedment is what we talked about in the past about

uh needing either well it used to be maggot

driven but now that we have chemical deb brements or even physical deb brements

and sometimes physical debriements

can be painful so we do

uh give patients pain control in those instances

>> you mentioned that you dropped the samavar

when >> you heard firecrackers

I was on my way inside

October 27, 2018 to the synagogue when the shooting

>> There's nothing I could do.

>> This is a really powerful conversation,

but I still am I'm am struggling here.

This is they're working on an upper thigh of a patient.

So, she's pretty exposed.

It's a heavy conversation.

It's an exam room, so they're not like in a hallway.

Why is the drape open?

>> Anyone here treating Kylie Connors? >> She's my daughter. She's nine. I'm Benny >> Mr. Connors, I'm Dr. Santos. I'm treating Kylie. >> She Okay.

>> Can I see her?

My My girlfriend Gina says she got a cut on her chin.

>> Yeah, I can take you to her.

She has a small laceration

on her chin, but it was easily repaired with medical superglue,

so no stitches necessary.

>> She chipped her tooth, but it's a baby tooth, so it won't need dental work. >> All right.

Well, that's a relief.

>> Has Kylie had any previous injuries? >> Uh, yeah.

She um she broke her wrist last year. She was skateboarding.

>> Dana, if you could get Dylan to come to North One and Ahmad. You bet.

>> Okay, I got it now. 1 2 3. >> Daddy, you came. Oh, baby. What's going on? Huh? >> My chin's broken.

My chin got cut. >> Oh, no. >> What happened?

>> She was running up the stairs.

>> Jana was chasing me. >> We were playing.

>> As I was saying, Mr.

Connor, the laceration's pretty minor. >> Down the stairs.

>> It was an accident.

Perhaps we can >> accident that wouldn't have happened if you weren't running up the stairs.

Do you understand what I'm saying?

This is the last thing that I need

>> right now is her mother finding out that she got hurt when she's with you.

>> It was an accident.

And before you get all high and mighty, I've got questions of my own.

>> So far, this is a pretty typical family argument.

Like, this happens all the time.

They already had baseline suspicions,

so it's making them act a certain way.

But still, this is well within reasonable

communication of certain families.

>> Why do I got to talk to a social worker?

>> Anytime a child's injured, we have some standard questions that we ask parents and caregivers. >> Good. That's fine. Great. Ask me here.

Well, we noticed some bruising

on Kylie's body, some old, some new on her back and legs.

>> Any idea how she got those? >> Yeah, soccer.

She plays for a club team.

They're, you know, little girls, but they play like they're in the Hunger

>> Well, I understand that you and Kylie do a fair amount of roughousing. >> I'm sorry.

Are you kidding me?

>> Where are you going with this?

Are you saying that I hurt my daughter? >> Mr.

Con is no, >> Gina. Mr.

Connor, >> just just Gina,

>> sir, take a break.

>> Gina, what did you say to them? >> Nothing.

I said that you're a great dad. >> Okay. What else?

>> That you guys like to wrestle. >> What?

They wanted to know where all her bruises are.

>> Who the are you to talk about me and my daughter? Separation. Separation.

Who's the family member? Who's the father? Who's not? Should >> BACK UP.

>> KYLIE'S playlist only 9,000. >> Ooh. Ooh. Thrombocytoenia.

It's not what we thought.

>> It's not what we thought.

YOU SHOULDN'T THINK ANYTHING

until you get some tests back.

You do a full investigation. My god. >> It's probably ITP.

>> That's a quick jump.

Uh, it certainly can be uh immune thrombocytoenia.

I I'd like to know

what the rest of the blood tests show.

Is it just isolated

>> What the hell is ITP?

>> Something we can treat.

I mean below 20 30 I forgot the exact number

uh with bruising uh the patient should be treated with steroids.

Now ITP usually follows a course of a viral illness but that still doesn't

add up to the fact that

uh she has the thing is she doesn't have easy bruisability

which is a hallmark of ITP.

She has bruises from

a lot of accidents.

And I saw the elbow hyperh

god, why am I going EDS this whole time?

Cuz when when you're thinking easy bruisability,

you're thinking connective tissue disorders.

Ellers danlos obviously is one that I mentioned.

But there's also issues that can happen with platelets

themselves or the coagulation

factors down the line like hemophilia, etc.

So, I don't know.

I I wish I saw all the blood test results. ITP.

>> So that's u intra

>> immune thrombocytoenia >> used to be called idiopathic thrombocytoenic perpa.

Know what idiopathic means?

>> Well that we don't know the exact cause. >> Yeah that's true.

Usually this uh shows up not with big deep bruises.

Usually that's more of a coagulation factor uh diagnosis.

ITP usually shows up with these like little bleeding spots. Tiny little spots.

Please make him be okay.

>> I can assure you that we are going to do >> everything you can. I know.

>> God, this is all my fault. >> Mrs. E.

>> No, he's been so stressed.

So, I plan this weekend away as Seven Springs, but he didn't want to

go because of work.

So, we fought this whole morning.

And then I >> I said awful things.

Those can't be the last words we say to each other.

Doctor, please see this is a very dramatic portion here.

As an ear doctor,

you can't spend too much time with family members when they're having these kind of emotional outbursts.

Not because you don't want to, but

you can say a few words of affirmation,

allow them to feel seen, explain what you're going to be doing,

but then you ultimately can't give them

a proper shoulder to cry on, a proper conversation.

So that's when you would call in a team member.

But remember the ER,

family medicine, inpatient, we're all very team based.

We have social workers, we have counselors.

Setting her up early with that is going to be >> Good news. CT looks normal.

No bleeding inside the skull, CP spine, no fractury.

>> So if that's happening, why is he having such bad uh reflexes?

>> He didn't break his neck.

>> Then why is he paralyzed?

>> You can have spinal injuries without radiologic abnormalities.

>> Sometimes it doesn't show up on CT, only on MRI. >> Ah, okay. Hold on.

We just covered this in one of our videos.

When you have, is it a spinal bruise?

Yeah, look at that.

A spinal cord contusing

like a a bruise on the spinal cord caused by trauma

can result in inflammation,

swelling, and temporary or sometimes permanent neurologic deficits.

And you won't always see a contusion

on a CT scan. >> Dr.

Mullen, >> are you sure? Okay.

Critical potassium level 1.2. >> sounds sketch.

I would obviously repeat, but 1.2 is death.

How do you live with a potassium of 1.2?

>> That's got to be a lab.

>> Extremely low potassium with generalized

weakness and no cervical injury.

We may be looking at >> hypocalemic periodic paralysis.

>> I've worked on a lot of ERS.

I worked on different internal medicine floors.

When we get a number like that, we would be really concerned for a lab error.

But they're going to hypocalemic periodic paral.

That's a that's a zebra right >> It's a rare condition where potassium gets shifted

into the cells causing profound weakness just like paralysis.

>> Will he get better? >> Yes.

Back to normal in a few hours.

>> How do they know?

I mean, is this a diagnosis of exclusion?

All they know is that a person was involved in a major trauma

and has a critically low potassium

that they don't know if is a lab error or not and they don't

really know the cause and they're jumping. I don't know.

I feel like this is a really rare diagnosis

outside of my scope to even speak on but very very shocking.

Like if I was going down an algorithmic

pathway in an ER setting

and I see a potassium

of that low that number that low

I don't know if I jump to that as the first diagnosis.

I think you have to rule out other conditions and you have to make

sure that the heart is stable

getting an EKG >> bag him.

>> Yo that was crazy.

That that was legit crazy

because that was the perfect

>> Starting compression charge at 200. What is that?

>> Is he going into VIB?

Low potassium can harm electrical activity in the heart. >> Charge clear.

>> That was probably the coolest call we've had on the channel so far.

That's why they were so calm.

Like, how are they so calm about a potassium 1.2? Thumb.

Four finger make a C. Bottom.

Three fingers make an E for jaw lift.

One breath every 5 seconds. Come here. All right.

Yo, I was taught every 6 seconds, but the same difference.

And I would like to see the

balloon fully get compressed and then fully open. >> Holding compressions. Normal sinus. >> Cora. Strong. Cora.

Okay, let's try for BP.

He said strong karateed.

I didn't see anyone check it, but I'm glad that they did.

Uh, bagging is important.

>> Why don't we check after the shock? >> 2024 ACLS guidelines.

Patients can remain pulseless

for a little bit, even after successful defense.

>> He came back with one shock.

That's as good as it gets.

>> So, in a patient like this,

even though his heart stopped,

the outcomes are not as bad

as it would be in another patient who was much more ill.

Reason being, the thing that caused

his heart to stop

is very reversible, which they're doing by giving him potassium

as well as having the defibrillator

put the heart into the correct rhythm.

>> Breathing on his own. Excellent sign.

>> So here at this point, you would have to decide if you're going to

fully sedate the patient, intubate them. >> Oh. Oh. Hey, Nancy. This is E.

I know I'm not an ER doctor,

but when someone collapses

and the first thing you do is not check their pulse, I'm going to lose my mind.

Why we went to

the the eyes first

is very very surprising to me.

I mean, granted, she had a trauma at this car accident, but clearly

it wasn't a significant trauma.

>> Weak cored, shallow breath.

So, she's saying she has a weak pulse and she's not breathing deeply. >> Positive seat belts.

Oh, >> Oh, she's bleeding internally.

They didn't do a full exam on her cuz she denied it.

She could be losing a lot of blood.

She looks pretty pale. Bruising internally.

Uh they need to get that ultrasound out quick.

>> Hang two units of the rabbit fuser. Somebody call Garcia.

>> They're using O negative blood cuz they don't know her blood type.

They're going to need to type and cross.

Once they do get uh her blood type, they can then switch off of

uh the O negative.

>> We really should have insisted on examining her.

>> You did ex and she said no.

which people are allowed to say no.

>> Platelets are these tiny things in the blood that help it clot

and thrombocytoenia is fancy for low platelets which explains why your skin bruises so easily.

>> Also, when you see a platelet

number that low, you also

have to do a smear and check for platelet clumping

to rule out pseudo thrombocytoenia.

I'm hoping they did, but who knows?

>> And what causes it?

>> It's actually her immune system that's causing the destruction of the platelets.

Sometimes it's a triggered response to

an environmental factor or a

>> And what's the treatment?

What are you giving her?

>> We'll be treating her with highdose

steroids to suppress the immune system and IV immunogloabbulin,

which reduces the destruction of the platelets in the

>> Also, with a platelet count of eight, the fact that she's

not bleeding a lot from that cut is kind of surprising to me.

This is Gretchen Williams. >> Actually, it's Lamden.

Ah, I called about my ex-husband, Michael. >> Yes. Yes.

Thank you for coming in.

You were um listed as his emergency contact.

>> Oh, she did do the thing that we asked. This is great.

>> I don't know why.

We have been divorced for years.

Is he all right?

>> He's He's going through a lot right now.

Would you like to see him? >> Uh, okay.

Leo, can you zoom in and please hold it a little steadier?

>> This is like the more ethical version of what would happen

versus what would happen on House. on house.

They would break into the person's home,

rummage through all their stuff, and then find some miraculous

poison that's causing the hypotension.

God, there's way too many meds there to know what's what. >> Okay.

A tovastatin, >> not it.

>> Simba statatin, >> not it. >> no.

People are storing cholesterol meds.

>> Those are all high cholesterol medications.

Can you go to the right?

>> Okay, that's that ACE inhibitor that I was mentioning could be the culprit. >> That's an ARB.

Angotensin receptor >> Propranol is a beta blocker. >> Wait, wait. That's it. Wendy's pile. Yellowish bottle.

Little round blue pills.

Just like I said. >> Bingo, little lady.

>> Um, propranolol is a high blood pressure medication.

Those are uh 20 milligrams

each and the starting dose is 40 migs.

How many pills did you take? Oh.

Uh, I think four, maybe five.

>> That is a lot. Okay.

>> Propanol is also the medication that some people take before doing a public speaking

appearance, a big uh musical

performance as a way to decrease

some of those symptoms that people get when they get nervous.

Sweaty palms, racing heart rate, etc.

>> Unit three and four running in.

BP 84 over 56, heart rate 112.

Free fluid's much bigger than before.

She's not turning the corner.

O's holding a room.

I'll let the husband know.

Why'd you guys wait so long to check her?

Good vitals in the field. No distress.

She refused to sign in.

You should have convinced her. 2020 hindsight.

She was stable until she wasn't.

>> Next time I'll use my X-ray vision

>> X-ray vision goggles and

uh ignore patient autonomy. Come on.

Is this how it works? >> How what works?

>> You think things are important

that everything's so important?

And then you end up here in C.

>> Yeah, that is how it works.

>> A lot of the biggest changes that patients have made in their healthcare

under my care have come as a result of a wakeup call like that.

I wish it didn't have to come to that.

In fact, when I rewatch some of my Jubilee debates and I see some

of the people who say, "Why don't patients take into consideration lifestyle changes?

It's because you doctors aren't telling them."

A lot of times we are.

patients don't want to, can't, whatever the reasons are.

And I would love to hear unique ideas

of how to get more people

to make lifestyle changes

happen because it seems like every person who I debate

makes this false comparison of like either do lifestyle changes or pharma

where I would love for lifestyle changes to be made, but it's not always

feasible to get a patient to make that change.

>> I'm sorry that they called you.

I never updated the form, I guess.

No, no, it's okay.

I'm, you know, they called and I was just kind of surprised.

>> Well, you didn't have to come, but I did.

>> Rekindling a little romance.

>> Why don't I I leave you guys to talk

for a few minutes? >> Fair play.

>> I have a patient to check on.

>> You should also probably warn her that he exhibited

some confusion and might say some stuff that he doesn't mean or

Jackson Daviscreen negative for cocaine, amphetamines,

marijuana, PCP, benzo, and opioids.

>> So, no drugs in his system.

>> But what is in his system or what is what is flagging on the blood tests? >> Changes things, Tony. >> how you doing?

>> I haven't seen him in like four years. I can't imagine.

That must have been >> so crazy.

You know, things were not good at the end.

>> It could be because of that tumor.

>> Could that mass have been there for a >> Yep.

Especially in the area in which they found it. >> Yes.

Could it be responsible

for how much he changed?

You know, his his moods and tempers.

He was he he was getting into fights with strangers.

People who have damage to that part of the brain

will frequently use vulgar language when they used to not get fights with uh with strangers.

So all of that

really does vibe with that diagnosis. >> PTMC charge nurse. Go ahead.

Medical >> Is this a drill?

>> Is this a joke?

It's the 4th of July. >> Got it. Thanks. What's up?

>> West Bridge has a code black and it's closing into internal disaster.

Central's subverting all their ambulance traffic to us. What's the issue?

Conspect didn't say It could be anything from a flooding toilet to a power outage. How >> Didn't know.

A couple of doctors probably got the holiday flu and they're

>> Oh, I should have left last night.

>> There's always a story.

The first doctor that recommended

we wash our hands was murdered.

Click here to check that out.

And as always, stay happy and healthy.