1. E.R.Copy !req
2. Previously on ER...Copy !req
3. I like kids.Copy !req
4. Fear of flying cannot be conquered.Copy !req
5. Mom got her real-estate license at 40.
I helped with her homework.Copy !req
6. I can help you with yours if you want.Copy !req
7. You're probably too tired
after your trip to dance.Copy !req
8. - Kind of, but...
- So maybe later.Copy !req
9. - Do you know what you're doing or not?
- I'm just confirming-Copy !req
10. If you have to keep confirming,
you don't know what you're doing.Copy !req
11. I worked just as hard
as everyone else.Copy !req
12. You have to work twice as hard, stay
twice as late to be twice as good.Copy !req
13. "Fear Of Flying"Copy !req
14. Oh, God!Copy !req
15. The flight rotation was, like, the
highlight of my residency. You'll be fine.Copy !req
16. I'll be thousands of feet
in the air in something...Copy !req
17. shaped like a baked potato
with a frat beanie on it.Copy !req
18. Well, actually,
it's only hundreds of feet.Copy !req
19. Oh, God!Copy !req
20. Don't they have ambulances
in the sticks?Copy !req
21. They don't have a trauma center
in Boone County. So if it's bad, we go.Copy !req
22. - How far?
- Fifty, 60 miles.Copy !req
23. Head up. Didn't you know this
was a requirement for your residency?Copy !req
24. What was I thinking?Copy !req
25. All right, deep breath.
Let it out slowly.Copy !req
26. Okay. My knees won't move!Copy !req
27. Come on. Stay low.Copy !req
28. - Dee McManus, Susan Lewis.
- Hi. First flight?Copy !req
29. The sum of the angles of a triangle
equals 180 degrees, right?Copy !req
30. - Hey, Carol.
- Hi, Doug.Copy !req
31. - Hi.
- Doug Ross, this is William Litman.Copy !req
32. - William is my lab partner.
- No kidding?Copy !req
33. How's it going?Copy !req
34. You know, I have an intuitive
19th-century Euclidean mind.Copy !req
35. - Congratulations.
- Thanks.Copy !req
36. It's crippling to the understanding of the
geometric projection of the universe.Copy !req
37. - I'm flunking out.
- So, what are you working on?Copy !req
38. String theory.Copy !req
39. Explains the multi-dimensional
curvature of time and space.Copy !req
40. - Oh.
- "Oh" is right.Copy !req
41. So the Riemannian manifold
is M-dimensional space...Copy !req
42. that locally looks
like N-dimensional space...Copy !req
43. when M is less than N.Copy !req
44. Information, one-five- Yankee's radar
contact. 5 miles west of the airport.Copy !req
45. Susan, take a look. It's beautiful.Copy !req
46. - What are you doing?
- Hyperventilating. Leave me alone.Copy !req
47. Oh, God.Copy !req
48. You should really check out
this view, okay?Copy !req
49. Because it helps you
set your gyroscope.Copy !req
50. - What was that?
- The pilot.Copy !req
51. He was just adjusting
the rotor pitch. Absolutely normal.Copy !req
52. - Right. Normal.
- I got a visual on you, Air-Vac.Copy !req
53. - Do you read?
- There it is.Copy !req
54. Oh, man! We' re first on scene.Copy !req
55. We' re gonna need
the O-neg and blood Y's.Copy !req
56. There's a field near 5 o 'clock.Copy !req
57. Oh, God!Copy !req
58. Oh, God.Copy !req
59. Oh, God. Oh, God.Copy !req
60. Stay low and watch for the tail rotor.Copy !req
61. We've got five victims.
Hay truck and a van hit head-on.Copy !req
62. Two ejected and three are trapped.Copy !req
63. - Where's fire response?
- Two engines and an ambulance en route.Copy !req
64. - ETA?
- Thirty minutes. They're all volunteer here.Copy !req
65. Triage first.
Susan, you check the car.Copy !req
66. - It's all right, sweetie. Oh, my God!
- Okay.Copy !req
67. - Please get us out of this car!
- Okay.Copy !req
68. Yes, I'm still holding
for authorization. Hello?Copy !req
69. So Dallas by three, you think?Copy !req
70. ER. Hold on.
I don't think, Bubba, I know.Copy !req
71. ICU's got no beds till 1999,
and they're sending us two vents.Copy !req
72. - Terrific.
- Way to go, Mr. Gomez! Good job.Copy !req
73. Chuny, we need
more IVACs in 3.Copy !req
74. Patrick Brazil,
metastatic prostate cancer.Copy !req
75. Cough, fever, two months
progressive weakness. BP, 150/70.Copy !req
76. Gave 300 cc's of saline.Copy !req
77. - He's a no-code.
- Inn's full. Exam 4.Copy !req
78. I've been Mr. B's
caretaker for 22 years.Copy !req
79. He wants to be cryogenically preserved
when he deanimates.Copy !req
80. - He wants to what?
- Be put on ice when he croaks.Copy !req
81. - Frozen?
- Like a Popsicle.Copy !req
82. He's been waiting eight years to join
Mrs. B in their suspension capsule.Copy !req
83. Easy now. One, two, three.Copy !req
84. His wife's been frozen
for eight years?Copy !req
85. It was their 50th anniversary
present to each other.Copy !req
86. Faint pulse, poor respiratory effort.Copy !req
87. They want to be preserved together...Copy !req
88. so they could come back
in the future.Copy !req
89. Just like those dinosaurs
in that movie.Copy !req
90. Isn't it romantic?Copy !req
91. Let's hang a dobutamine drip.Copy !req
92. Start at 10 mics per kilo
and titrate to a systolic of 100.Copy !req
93. - Watch the IV.
- Settle down, Mr. Sotcheck.Copy !req
94. - Rescue 116 for you to rule out Ml.
- Okay.Copy !req
95. - We're swamped.
- Who's covering Haleh's vacation shift?Copy !req
96. Got a float coming at 9.Copy !req
97. The last nurse who floated down here
hid in the bathroom all day.Copy !req
98. - Who is it?
- Sterling from Med-Surg West.Copy !req
99. Rhonda Sterling?Copy !req
100. - Yeah, what's wrong with her?
- She's a floor nurse.Copy !req
101. Come on, give her a chance.Copy !req
102. - I'm not babysitting her.
- Me neither.Copy !req
103. The fire's out!Copy !req
104. - What's your name?
- Gail. She's only 10 days old.Copy !req
105. - Is she all right?
- She's moving and crying.Copy !req
106. These are good signs.Copy !req
107. - I'm Dr. Lewis. What's your name?
- Zach.Copy !req
108. - Gail, does your neck hurt?
- Is he all right? Please help him.Copy !req
109. Get a C-collar on her.Copy !req
110. Sir? Sir, can you hear me?Copy !req
111. It's brain matter. The guy's a goner.Copy !req
112. Next.Copy !req
113. Let's get him on oxygen.Copy !req
114. Where, Zach? Your neck?Copy !req
115. Does this hurt?Copy !req
116. David? David? Where's my husband?Copy !req
117. Gail, where are you hurt?Copy !req
118. My right leg and my side.
David. Please!Copy !req
119. - Dr. Greene's working on him.
- My husband's a doctor.Copy !req
120. - He has to check on the children.
- Susan!Copy !req
121. - He's a pediatrician.
- Go, I'll stand by.Copy !req
122. Okay, I'm gonna go check
on your husband. I'll be right back.Copy !req
123. The trucker's gone.
I need you over here.Copy !req
124. He's still moving.Copy !req
125. He's pulseless
with massive head trauma.Copy !req
126. I've got a tension hemopneumo
that we can save.Copy !req
127. Needle him, left side.Copy !req
128. He's decompressing.Copy !req
129. Thirty-two French.Copy !req
130. This guy's a pediatrician.Copy !req
131. - Really?
- Yeah. His family's in the van.Copy !req
132. Wife and newborn baby girl.Copy !req
133. Both stable. There's a boy
about 8 years old.Copy !req
134. Number 14 facial fracture.
I'm worried about his airway.Copy !req
135. - I'm in. Hook it up to the Foley bag.
- He's hemorrhaging.Copy !req
136. - Grab two units O-neg out of the cooler.
- Okay.Copy !req
137. I'll start a line.Copy !req
138. - What about my husband?
- Gail, we're getting you out. Hang on.Copy !req
139. Yeah, I'm still holding.Copy !req
140. Hey, you like Green Bay
minus seven over Washington?Copy !req
141. I thought the World Series was over.Copy !req
142. Excuse me.Copy !req
143. - Hang on one second.
- Please don't tell!Copy !req
144. Please don't tell! Mommy!Copy !req
145. All right. Where do you want him?Copy !req
146. - Curtain Area 3. End of the hall.
- Don't tell her! Don't tell her!Copy !req
147. Don't tell her! Don't tell her!
Please!Copy !req
148. - Carol Hathaway?
- Carol.Copy !req
149. - Hi.
- I was pulled off my ward...Copy !req
150. - ... and assigned down here.
- Rhonda, right?Copy !req
151. - What patient do you want me to take?
- Well, actually...Copy !req
152. we share our patients here.
Let me show you.Copy !req
153. Over here are the patients
that are waiting to be seen.Copy !req
154. Nursing orders are flagged
and put over here, so when you're-Copy !req
155. I'll take Mr. Washington.
Where is Curtain Area 3?Copy !req
156. - There.
- Thank you.Copy !req
157. - Secure his head.
- All right. We need to start a second line.Copy !req
158. Dr. Lewis!
The boy stopped breathing.Copy !req
159. Go, go!Copy !req
160. Watch his C-spine!Copy !req
161. Keep in-line traction.Copy !req
162. You're in the way.Copy !req
163. There's too much blood.
I need suction. 6.0 tube.Copy !req
164. - Another 6.0.
- That was it.Copy !req
165. Damn it. Okay, 5.5.Copy !req
166. Mark, I need your help.Copy !req
167. Get him on the chopper.Copy !req
168. We're taking care of him, Gail.Copy !req
169. Please don't let him die!
Please don't...Copy !req
170. - I can't see. Turn it up.
- It is up.Copy !req
171. There's better control in the chopper.
Let's bag him and move him.Copy !req
172. Ready? One, two, three.Copy !req
173. - Doctor, I need you to start this IV.
- Okay.Copy !req
174. Go on, I'll check it out. Thanks.Copy !req
175. - What's up?
- She needs an IV. I tried and missed.Copy !req
176. Usually we try a few times
before we call a doc, especially an intern.Copy !req
177. Up in Med-Surg
we call the doctor when we miss.Copy !req
178. All right. I'll do it.Copy !req
179. Mrs. Fesmire needs 20 of KCL
in her IV in 3. Why don't you go do that.Copy !req
180. - Where's the potassium?
- It's in the Med Room under "P. "Copy !req
181. I can see the vocal cords.
I'm in.Copy !req
182. - I'll be right back.
- Susan!Copy !req
183. All right, Fred, fire it up.Copy !req
184. Susan!Copy !req
185. - How much longer?
- Twenty, 30 minutes.Copy !req
186. Gail, we're taking your son
and your husband...Copy !req
187. to County General Hospital
by helicopter.Copy !req
188. - Are they all right?
- They're stable but need a trauma center.Copy !req
189. - How will I know what's happening?
- I will get word to you, Gail.Copy !req
190. - Oh, please! Oh, please!
- I promise. I promise.Copy !req
191. Oh, God! Oh, God...Copy !req
192. - Are you okay?
- Yeah.Copy !req
193. - It's Dr. Greene from the whirlybird.
- Where's Mrs. Fesmire's potassium?Copy !req
194. I'm on break. I'm getting to her.Copy !req
195. This is County General on Beta-two.
Go ahead.Copy !req
196. We're incoming on Air-Vac One
with two major traumas.Copy !req
197. Seven-year-old boy and his dad,
both multiple trauma.Copy !req
198. Grab Lydia and Chuny and tell them
to clear the trauma rooms.Copy !req
199. - Go ahead, Air-Vac One.
- I'm gonna need a vent...Copy !req
200. Goodbye, Mr. B.Copy !req
201. You will keep him cold
until they come for him, won't you?Copy !req
202. So that he could be with his wife.Copy !req
203. - Okay.
- Please?Copy !req
204. - Sure.
- Thank you.Copy !req
205. Should I clean out the fridge?Copy !req
206. What have you got?Copy !req
207. The dad's got a hemopneumo
and a head trauma.Copy !req
208. Seven-year-old had an obstructed
airway. He's getting shocky.Copy !req
209. - Good job, Susan.
- What?Copy !req
210. I said, good job.Copy !req
211. Draw up meds.Copy !req
212. Watch that IV. Fluids wide open.Copy !req
213. Let's get a cross-table, CBC, type and
cross for four units and dip a cath urine.Copy !req
214. Draw up a saline-flush crash cart.Copy !req
215. - Where is the saline?
- BP's only 65 palp. Pulse 160, thready.Copy !req
216. - He's waking up.
- Hey, Zach.Copy !req
217. Hi, I'm Carol. That tube in your throat
is helping you breathe, okay?Copy !req
218. - Set up for lavage.
- Want a gas?Copy !req
219. - Yeah.
- Blood gas kit, top drawer.Copy !req
220. Got it. You bet.Copy !req
221. Chuny, give me a hand, right here.Copy !req
222. Okay, we got a bloody tap.
Page Benton.Copy !req
223. See if the dad will sign
a consent form for an ex-lap.Copy !req
224. - Put that O-neg on the rapid infuser.
- Is he conscious?Copy !req
225. He's responding to pain.
Dr. Herlihy, open your eyes.Copy !req
226. Somebody needs to sign his
son's surgical consent if he can't.Copy !req
227. - We'll do it.
- BP's low, 70 palp. Pulse ox is only 85.Copy !req
228. Lydia, ask Jerry to find
the number of the hospital...Copy !req
229. in Boone County where they're
taking the mother and the baby.Copy !req
230. - The heart sounds seem distant to you?
- What do you think?Copy !req
231. Tamponade?Copy !req
232. Hang in there, Zach.
Hold him still. Just hold him still.Copy !req
233. - He's scared. He's gotta be sedated.
- Give him Versed, 1 milligram IV.Copy !req
234. - Where is it?
- Top drawer.Copy !req
235. - It's clotted. I need that saline.
- BP's unchanged.Copy !req
236. - I need another liter.
- Let's go!Copy !req
237. Zach, I'm gonna give you
something to help you sleep, okay?Copy !req
238. - To help you sleep.
- Here we go.Copy !req
239. Hold him.Copy !req
240. What was that?
Did that hurt? It hurts.Copy !req
241. Are you sure that's saline?Copy !req
242. - Oh, my God! That's potassium.
- How much went in?Copy !req
243. - About a quarter cc.
- Insulin and glucose.Copy !req
244. - Where is it?
- Second drawer.Copy !req
245. Hold on. It's probably
not enough to stop his heart.Copy !req
246. I think we're gonna be okay.Copy !req
247. - What do you got?
- Got a 7-year-old TC.Copy !req
248. Passenger space intrusion.
Airway compromised at the scene.Copy !req
249. Intubated. Peritoneal lavage was positive.Copy !req
250. - BP's crashing, 60 palp.
- Pericardiocentesis tray.Copy !req
251. Go ahead.
I'll drop the central line.Copy !req
252. Okay. Hook an alligator clip
to an EKG lead. Use V-1.Copy !req
253. Not mine.Copy !req
254. It's the patient's.Copy !req
255. He's a doctor. It might be his office.
Try dialing the number.Copy !req
256. Jerry called Dwight Hospital.
The wife and baby haven't arrived.Copy !req
257. - Are they on their way?
- Don't know.Copy !req
258. Find out.Copy !req
259. - What do we have?
- Blunt abdominal trauma.Copy !req
260. Hypotensive intraperitoneal hemorrhage
confirmed by lavage, probably his spleen.Copy !req
261. Facial trauma. Intubated in the field
with an RSl. H&H is 11, 32.Copy !req
262. Type and cross four,
650 cc's of saline. Versed on board.Copy !req
263. - Way to go, Carter!
- All right. Let's take him up.Copy !req
264. - Can I tie?
- Where are his parents?Copy !req
265. Second unit's in.Copy !req
266. So you got his partner to take calls?
All right, okay. Okay, we'll let you know.Copy !req
267. Forty cc's non-clotting blood, out.Copy !req
268. Dr. Herlihy, you've been
in an accident. You're in the ER.Copy !req
269. - BP's back up, 120/80.
- What do you got?Copy !req
270. - I'm worried about an intracranial bleed.
- Stable enough for a head CT?Copy !req
271. - The nurse goes with him.
- Am I on call?Copy !req
272. No. You're a patient.
You were involved in a traffic accident.Copy !req
273. Accident?Copy !req
274. Your son, Zach, has just
been taken up to surgery.Copy !req
275. - Surgery?
- He was injured in the accident.Copy !req
276. Accident. What accident?Copy !req
277. Get a rush on that head CT.Copy !req
278. Zach, everything's gonna be okay.Copy !req
279. - We could've killed that boy.
- I got confused.Copy !req
280. - You have no business working the ER.
- You think I don't know that?Copy !req
281. I want you to restock supplies. I don't
want you anywhere near my patients.Copy !req
282. Yes, this is Carol Hathaway in the ER.
Clear a CT room, please.Copy !req
283. Where's the number
for chopper dispatch?Copy !req
284. - Mark, can I run something past you?
- Sure.Copy !req
285. I've just got a sweet old guy who died,
and I don't know what to do...Copy !req
286. - ... about his cryogenics request.
- His what?Copy !req
287. He and his wife bought a tank
so they could be frozen when they died.Copy !req
288. - Where is his wife now?
- In the tank.Copy !req
289. I have an 800 number for
a cryogenics company in California.Copy !req
290. Call it.Copy !req
291. Yeah, still holding.Copy !req
292. - What?
- Nothing.Copy !req
293. Yeah, page me as soon as you know.Copy !req
294. The helicopter's standing by. We may have
to go back and get the wife and the baby.Copy !req
295. - Okay, DeBakey.
- 5.0 Prolene on a Castroviejo.Copy !req
296. - Retract caudally.
- Retractor.Copy !req
297. Splenic vein's repaired.
What about this pancreas?Copy !req
298. The tail has most
of the devitalized tissue.Copy !req
299. I'd resect rather than do
a pancreatectomy.Copy !req
300. Good. I agree. Metz.Copy !req
301. - How would you repair after resection?
- Interrupted horizontal mattresses...Copy !req
302. and a figure eight
in the pancreatic duct.Copy !req
303. Do it. DeBakey?Copy !req
304. - 3.0 silk on a needle driver.
- Anything else to do?Copy !req
305. Irrigate. Run the bowel under control.Copy !req
306. Insert a Jackson-Pratt drain
through a separate stab wound.Copy !req
307. And use cautery instead of a scalpel
to minimize bleeding.Copy !req
308. - And after that?
- Close.Copy !req
309. Keep it simple. Do exactly what
you just described. No more, no less.Copy !req
310. Okay. All right, cut the suture
3 millimeters, no longer.Copy !req
311. Irrigate. Normal saline.
Make sure it's warm.Copy !req
312. Park her in the hall
till we can clear an exam room.Copy !req
313. - Have you seen Susan?
- She got paged to chopper duty.Copy !req
314. You're kidding.Copy !req
315. - What's up?
- I need ice, lots of ice.Copy !req
316. California Cryonics said to put him
on ice until their local rep arrives.Copy !req
317. They'd better hurry.Copy !req
318. Dr. Lewis!Copy !req
319. - Susan, are you sure you're all right?
- Yeah, I want to bring them in.Copy !req
320. - I'll go.
- No. No, I'm fine.Copy !req
321. - Really? You can stay here with Herlihy.
- No. Really.Copy !req
322. - Dr. Lewis. We gotta go.
- I'm okay.Copy !req
323. May I? See your orders?Copy !req
324. Okay. John, will you take these to ICU
and make sure they're carried out...Copy !req
325. - ... as meticulously as written.
- Sure.Copy !req
326. Peter, care to join me
in a sarcoma resection?Copy !req
327. - Yeah. Yeah, I'd love to.
- Good.Copy !req
328. Gant can cover any trauma calls.
Scrub in, in 45 minutes.Copy !req
329. Don't you just love her?Copy !req
330. Where's Zach?
Where's my husband?Copy !req
331. Your husband was unconscious
for a while.Copy !req
332. He woke up confused and disoriented.Copy !req
333. He has a head injury?
What about my son?Copy !req
334. - He's in surgery.
- Don't worry, Gail. They're in good hands.Copy !req
335. Move!Copy !req
336. Does this hurt? Yeah.Copy !req
337. BP's okay, 115/65.Copy !req
338. Let's get a C-spine. H&H, type and
cross for four. And dip a cath urine.Copy !req
339. - Good set of lungs on her.
- Respiratory rate's kind of high.Copy !req
340. - Who knows with all that crying?
- It's 60, pulse 160.Copy !req
341. Abdomen's distended,
but she's been taking in a lot of air.Copy !req
342. - You want a Pedes surgery consult?
- Yeah.Copy !req
343. Get a baby-gram, CBC and a gas.Copy !req
344. Darling, are you hurt,
or are you just mad at the world?Copy !req
345. - What'll it be?
- Do you believe in reincarnation?Copy !req
346. Sure, why not? Next life
I'm coming back as Cindy Crawford.Copy !req
347. Could you do us a favor?Copy !req
348. A deceased patient of mine
wants to be cryogenically preserved.Copy !req
349. We gotta freeze a dead guy.
You got any ice?Copy !req
350. - Neck looks okay.
- CT was normal.Copy !req
351. But Dad's still altered,
so they're doing an MRl.Copy !req
352. Why did they take Megan away?Copy !req
353. She's next door.
It's a little crowded here.Copy !req
354. - I called upstairs. Zach's out of surgery.
- He's gonna be all right?Copy !req
355. He's in ICU.
I'll check on him as soon as I can.Copy !req
356. Oh, God! Oh, God! I need my husband.Copy !req
357. Please. Where is David?
Please, where's David? Please.Copy !req
358. - Her abdomen's kind of firm.
- She swallowed a lot of air.Copy !req
359. It's a tough call with a newborn.Copy !req
360. - What shall we do?
- All right. What is it, Gant?Copy !req
361. Well, I'm not sure. Her abdomen's
persistently distended. She keeps crying.Copy !req
362. Her resps are high in the 60s,
but the BP, pulse and color are okay.Copy !req
363. - Why didn't you drop an NG?
- We considered it-Copy !req
364. - Stool guaiac.
- In such a small baby?Copy !req
365. All right. Do it off the rectal thermometer.Copy !req
366. You didn't do a full surgical
evaluation of the patient, Dr. Gant.Copy !req
367. It's positive for blood.
Prep a cutdown tray.Copy !req
368. Type and cross for two units
and page Keaton.Copy !req
369. - Where's her mother?
- Trauma 1.Copy !req
370. Dr. Ross and I thought
it was an equivocal exam.Copy !req
371. Ross is a pediatrician.Copy !req
372. If you don't know what you're doing,
call someone who does.Copy !req
373. Hi, I'm Dr. Benton.Copy !req
374. Your daughter has internal injuries
that's gonna require an operation.Copy !req
375. She's only 10 days old.Copy !req
376. It's okay.
Dr. Keaton will be with her.Copy !req
377. And, look, she's the best
pediatric surgeon in Chicago.Copy !req
378. Now, we need your consent for what's
called an exploratory laparotomy.Copy !req
379. Where's my husband?
I want him to sign for it.Copy !req
380. Her husband's a pediatrician.
He can't do it right now.Copy !req
381. He handles
all the family medical decisions.Copy !req
382. I don't know anything about this.Copy !req
383. - You can do this, Gail.
- But I don't know. I don't know.Copy !req
384. Your baby needs it.Copy !req
385. Okay. Okay.Copy !req
386. Cutdown tray. Use a volutrol.
We may have to transfuse.Copy !req
387. Gant was on track.
I just talked him out of it.Copy !req
388. Okay. Hang D5, 40 normal.Copy !req
389. - What do you think, Peter?
- She has an acute abdomen.Copy !req
390. Hi, pretty girl.Copy !req
391. - Vitals?
- BP's 80/40, pulse 160.Copy !req
392. - Resps 65, temp's 101.4.
- Pulse ox?Copy !req
393. - Oh, what blue, blue eyes!
- 92 room air.Copy !req
394. Teacup, that's too low.Copy !req
395. Let's get her on O-2,
4 liters by mask.Copy !req
396. Did you appreciate
the periumbilical redness?Copy !req
397. - The abdomen's a little tight.
- No. No, I missed it.Copy !req
398. Well, it's easy to miss.Copy !req
399. - Why a cutdown?
- No veins.Copy !req
400. Twenty-two angio.
This was a nice pickup, Peter.Copy !req
401. Thank you.Copy !req
402. Yes. There we go.Copy !req
403. Wow. I couldn't see or feel a vein.Copy !req
404. Well, it's just a matter
of knowing where it is.Copy !req
405. Let's get her a cross-table lateral
and check for free air. She may be perfed.Copy !req
406. - Any thoughts on antibiotics?
- Since you don't need...Copy !req
407. anaerobic coverage on newborns,
I'd go with amp and gent.Copy !req
408. You've been reading.Copy !req
409. Dennis, since you did the trauma
assessment, why don't you scrub in.Copy !req
410. Peter, let's go talk to Mom.Copy !req
411. Good girl.Copy !req
412. There you go, Mr. Brazil.
Shrimp cocktail time.Copy !req
413. Hubert Skinner, California Cryonics.
Mr. Brazil.Copy !req
414. - Do you have some kind of ID?
- It's all there.Copy !req
415. Give him
10,000 units of heparin, stat.Copy !req
416. I'll pack him up,
and we'll be on our way.Copy !req
417. - Is he a doctor?
- I don't think so. What do we do?Copy !req
418. Well, the heparin can't hurt,
him being dead and all.Copy !req
419. In the newborn, I use
a transverse abdominal incision.Copy !req
420. The rectus is thin,
so there's less pain post-op.Copy !req
421. Adson.Copy !req
422. We're using a respirator,
so atelectasis isn't an issue.Copy !req
423. Exactly. Zap that little bleeder.Copy !req
424. - Cautery.
- Fifteen blade.Copy !req
425. If there's a perforation...Copy !req
426. we should get a gush of air
when I nick the peritoneum. Yeah.Copy !req
427. - There it is.
- She's easier to ventilate.Copy !req
428. Very little bleeding. Dennis, why do we
want to keep bleeding to a minimum?Copy !req
429. Transfusions are dangerous.
You can't type and cross-match...Copy !req
430. the blood as quickly
because of the baby's fetal hemoglobin.Copy !req
431. There it is. Perfed jejunum.
You're teaching your interns well.Copy !req
432. He's in and out. MRl was normal.Copy !req
433. Dr. Herlihy,
do you remember my name?Copy !req
434. - Where's my wife and kids?
- I'm Mark Greene.Copy !req
435. Your family was involved
in a traffic accident.Copy !req
436. Your wife's in the ER,
with a tib-fib fracture.Copy !req
437. Zach had facial trauma
and hemoperitoneum.Copy !req
438. He's out of surgery in ICU.Copy !req
439. - Was it his spleen?
- No. Pancreatic injury.Copy !req
440. What about Megan?Copy !req
441. Megan just went up
to rule out intestinal perforation.Copy !req
442. Why? What happened to her?Copy !req
443. She was in the accident with you.Copy !req
444. - What accident?
- Dr. Herlihy...Copy !req
445. do you know my name?Copy !req
446. No. Should I?Copy !req
447. It's okay. It's okay.Copy !req
448. Gently. To repair it, we use
a 4.0 silk, interrupted Hufnagel.Copy !req
449. Field looks dry.Copy !req
450. You don't need
a two-layer anastomosis.Copy !req
451. - Cautery alone gives you hemostasis.
- Okay.Copy !req
452. Let's irrigate. Warm saline, please.Copy !req
453. Dr. Keaton,
Zach's abdomen is distending.Copy !req
454. - Any change in his vitals or pulse ox?
- No, but I think he's bleeding again.Copy !req
455. Damn! Peter, do you think
you're ready to finish alone?Copy !req
456. - Yeah.
- Nothing fancy. Just close.Copy !req
457. Yeah, okay.Copy !req
458. All right, people. Let's go.
Thank you. One more. Thank you.Copy !req
459. His abdomen is more distended
than before the surgery.Copy !req
460. - Has he regained consciousness?
- No. No.Copy !req
461. Four-by-eight. Thank you.Copy !req
462. - All right. Completely dry.
- What's that?Copy !req
463. Looks like a little fiber and debris
on the liver surface.Copy !req
464. - Should I call Dr. Keaton?
- No, no, no. I'll clean it out.Copy !req
465. Okay, got it. Let's close
the peritoneum first. 3.0 Vicryl.Copy !req
466. Now, retract medially. Cut.Copy !req
467. Good.Copy !req
468. - There's a little blood.
- Where?Copy !req
469. Oozing from the liver
where you just touched it.Copy !req
470. All right. I'll put a little pressure on it.
Use suction. Gently, okay?Copy !req
471. Damn it!Copy !req
472. - It's still oozing.
- I don't wanna close while it's bleeding.Copy !req
473. I'll put a stitch in for hemostasis. 4.0
chromic on an S-H now. Move. Thank you.Copy !req
474. Come on. Here we go. All right.Copy !req
475. Retract caudally.Copy !req
476. Come on, Gant. Retractor.Copy !req
477. - Is Anesthesia standing by?
- I called them.Copy !req
478. - You're right. He is distended. Vitals?
- Stable. BP's 90/60. Pulse is 96.Copy !req
479. Pulse ox is 99 percent.
Should I clear an O.R.?Copy !req
480. Hang on.
Disconnect the NG from the wall.Copy !req
481. Sometimes you get an erosive gastritis.
Hook it back up.Copy !req
482. Clots can block the NG,
causing acute dilatation.Copy !req
483. Irrigate it out and crisis resolved.Copy !req
484. It's just experience, doctor.Copy !req
485. - She's still bleeding!
- I can see that.Copy !req
486. I'll put a gelfoam
on the bleeding site.Copy !req
487. You apply pressure. Come on.Copy !req
488. - Do you want me to get Dr. Keaton?
- No.Copy !req
489. More suction. I'm gonna oversew.
2.0 chromic on an S-H.Copy !req
490. - Heart rate's starting to fluctuate.
- Give me a bolus of normal saline, 40 cc's.Copy !req
491. Damn it! The liver's so fragile,
my stitch cut right through.Copy !req
492. - I should get Keaton.
- I'll take a bigger bite. Retract this way.Copy !req
493. Pulse ox falling. You need to get
this baby off the table.Copy !req
494. All right, bag her. Faster, damn it!Copy !req
495. - I'm getting Keaton.
- No!Copy !req
496. Go! Go!Copy !req
497. Do you really think it'll help her
to see her husband like this?Copy !req
498. Megan's still in surgery, Zach's in ICU,
and your husband just got out of X-ray.Copy !req
499. - He's okay?
- His tests are normal, but...Copy !req
500. there's still memory loss.Copy !req
501. Could it be permanent?Copy !req
502. Probably not. You can see these
kinds of things in a concussion.Copy !req
503. - But it might be?
- We'll just have to wait and see.Copy !req
504. - Blood loss?
- A hundred cc's.Copy !req
505. A third of her volume.
What did you do to her liver?Copy !req
506. - I was peeling away some fiber and debris.
- Cut me a 1-centimeter square of gelfoam.Copy !req
507. Move.Copy !req
508. - 2.0 chromic on an S-H.
- It started to ooze. Clear.Copy !req
509. You ripped away the liver capsule.
No way to control the bleeding.Copy !req
510. I'll have to resect the left lobe.Copy !req
511. Peter, handle the suction.
Dennis, retract distally.Copy !req
512. Cautery. Crank it up to 18.Copy !req
513. Pulse and BP are destabilizing.Copy !req
514. We'll have to transfuse with unwashed
O- neg. 2.0 chromic. Keep them coming.Copy !req
515. She's bradying down. Rate's 80.
You've got to get out.Copy !req
516. 3.0 Vicryl for the peritoneum
muscles and staples for the skin.Copy !req
517. David?Copy !req
518. Oh, my God! David.Copy !req
519. - What happened to you?
- Didn't you tell him?Copy !req
520. - We did. Many times.
- Zach's condition is stabilized.Copy !req
521. - He should wake up soon.
- Zach?Copy !req
522. It's okay. It's okay.Copy !req
523. - What about Megan?
- Dr. Benton's closing right now.Copy !req
524. That's wonderful news.Copy !req
525. Was there a truck?Copy !req
526. Yeah.Copy !req
527. Yeah, there was a truck.Copy !req
528. - What were you thinking?
- I told you there was debris.Copy !req
529. - I told you not to do anything but close.
- In my judgment-Copy !req
530. I didn't ask for your judgment!
Perry, Dennis, set up a vent.Copy !req
531. Call up Respiratory
and get a blood gas right away.Copy !req
532. F- I O-2 at 100 percent.
Stand by with dopamine...Copy !req
533. - Does that say "chicken belt"?
- Conjunctivitis.Copy !req
534. I hate chart QA.Copy !req
535. - What?
- Nothing.Copy !req
536. Thanks for helping me in the chopper.Copy !req
537. No problem.Copy !req
538. Things can get really pressured in here.Copy !req
539. It just isn't a place
for someone who is inexperienced.Copy !req
540. I can't have you work here again.Copy !req
541. Zach?Copy !req
542. Oh, God!Copy !req
543. - Can I touch him?
- Sure.Copy !req
544. Zach, honey, it's Mommy.Copy !req
545. I'm gonna stay right here
until you wake up.Copy !req
546. What about Megan?Copy !req
547. - No one from Surgery's talked to you?
- No.Copy !req
548. - Okay. I'll go find out what's going on.
- Thank you.Copy !req
549. Carter.Copy !req
550. - Why hasn't anyone talked to her?
- I don't know.Copy !req
551. Benton was closing over an hour ago.Copy !req
552. - Blood gas has improved.
- Not by much.Copy !req
553. Could you excuse us, Kit?
Dennis? Thank you.Copy !req
554. I'm sorry. I should never
have left you unsupervised.Copy !req
555. There are nuances in neonatal surgery.
The liver's more friable in newborns.Copy !req
556. - I wanted a clean field before I closed.
- Yeah, you said that.Copy !req
557. It seemed appropriate.Copy !req
558. What's at issue here is that you
ignored my specific instructions.Copy !req
559. No, I didn't ignore anything.Copy !req
560. I followed standard
operative procedures.Copy !req
561. I've done it at least a dozen times
in other patients.Copy !req
562. This is not another patient.
This is an infant!Copy !req
563. Outside, now.Copy !req
564. You don't know anything
about pediatric surgery.Copy !req
565. I thought it was necessary.Copy !req
566. Are you unwilling
to learn from your mistakes?Copy !req
567. Does it say in the text
not to stitch a liver?Copy !req
568. It isn't in the text.Copy !req
569. The second you screwed up,
you should've called me!Copy !req
570. - Why did I find three stitches in there?
- Because-Copy !req
571. Because you arrogantly and blindly
think you have all the answers.Copy !req
572. If that baby dies,
it'll be my responsibility...Copy !req
573. - ... but it'll be your fault.
- Dr. Keaton, she's crashing.Copy !req
574. Pulse ox is 86.
Heart rate's down to 45.Copy !req
575. - Decreased breath sounds on the right.
- Atropine,04.Copy !req
576. Sounds like a pneumothorax.
Chest x-ray.Copy !req
577. Don't need it.Copy !req
578. Increase transillumination
on the right side. It's a pneumo.Copy !req
579. - Chest-tube tray.
- This is no longer a teaching case.Copy !req
580. 12 French.
She's gonna need a repeat ABG.Copy !req
581. Pulse is up to 72, but it's thready.Copy !req
582. - Dynamap's not registering a BP.
- Get ready with that Thora-Seal.Copy !req
583. - She's arresting. Heart rate's down to 20.
- Damn!Copy !req
584. Let's start CPR.
Epi, 1-to-10,000, 0.4.Copy !req
585. Atropine. 08 milligrams.
How's the blood gas?Copy !req
586. pH, 7.3. PO-2, 45.
PCO-2, 30 on 100 percent oxygen.Copy !req
587. We're gonna have to put her
on an ECMO bypass.Copy !req
588. Kit, call the tech. Get two units O-neg to
prime the system. I'll cut down.Copy !req
589. - So do we bring her back up to the O.R.?
- No, we're gonna bring the O.R. to her.Copy !req
590. Dr. Greene?Copy !req
591. Dr. Herlihy?Copy !req
592. - What time is it?
- Eight o'clock.Copy !req
593. P.M.? Where's my family?Copy !req
594. Your wife's upstairs.
Both the kids had laparotomies.Copy !req
595. A bed opened up for you in ICU.Copy !req
596. How'd they do?Copy !req
597. Your son's out of surgery in ICU.
I don't know about your daughter.Copy !req
598. - How do I find out about my daughter?
- I'll check on her for you.Copy !req
599. - Thank you, Dr. Greene.
- Mark.Copy !req
600. Mark.Copy !req
601. Pedes O.R. called. His daughter
decompensated in surgery.Copy !req
602. She's crashing in NICU.Copy !req
603. - She's still flatline.
- Repeat. 4 of epi.Copy !req
604. Go ahead, Kit.
How long has she been down?Copy !req
605. Twenty-two minutes.Copy !req
606. - Is the ECMO circuit primed?
- Yes.Copy !req
607. Good. I'm ready.
Venous connection first.Copy !req
608. Arterial.Copy !req
609. Turn it on.Copy !req
610. - We got a heartbeat and a pulse.
- Faint.Copy !req
611. She's pinking up.Copy !req
612. Okay. Let's get a repeat gas.
We need to anti-coagulate her.Copy !req
613. Heparin, 150 units IV.
Start drip at 10 units an hour.Copy !req
614. - How come we anti-coagulate her?
- We have to, or her blood will clot.Copy !req
615. - But won't she bleed out?
- We have to hope that she doesn't.Copy !req
616. I'll dictate an operative report.
Meet me in Pedes ICU in five minutes.Copy !req
617. - ICU?
- Yeah, we gotta tell the parents.Copy !req
618. Peter, how'd it go?Copy !req
619. - How's the baby?
- Not good.Copy !req
620. Dr. Benton...Copy !req
621. You didn't sign the code sheet.Copy !req
622. Hey, we're all human.Copy !req
623. You know, we all make mistakes.Copy !req
624. Any other words of wisdom, Gant?Copy !req
625. You're a real prick, you know that?Copy !req
626. Mrs. Herlihy, this is Dr. Keaton.Copy !req
627. She's the doctor who operated
on both Zach and Megan.Copy !req
628. Mrs. Herlihy...Copy !req
629. Megan had a perforated intestine
from the accident.Copy !req
630. When we operated to repair it,
there were complications.Copy !req
631. - What are you saying?
- She's in the NICU now on a device...Copy !req
632. that helps her heart and lungs
oxygenate her blood.Copy !req
633. There was bleeding during the operation,
and she went into shock.Copy !req
634. Then her lung collapsed,
and finally, her heart stopped.Copy !req
635. But we got it started again
by putting her on a bypass machine.Copy !req
636. Is she gonna die?Copy !req
637. She's in extremely critical condition.Copy !req
638. It's...Copy !req
639. It is a possibility.Copy !req
640. The Lord is my shepherd...Copy !req
641. I shall not want.Copy !req
642. He makes me lie down
in green pastures.Copy !req
643. He...Copy !req
644. The Lord is my shepherd,
I shall not want.Copy !req
645. He makes me to lie down
in green pastures. He's...Copy !req
646. Dr. Benton?Copy !req
647. I can't remember the words.Copy !req