Miami Medical

Great detail, Ben.

Thanks, Ms. Wilson.

I can't get the shading.

Try smudging across the pencil lines.

You okay, Ben?

Yeah. It's just my hands.

Hold it like this.

Circular motions.

Might ease the pressure.

Yeah, that feels pretty good.

Keep your heads down!

Everybody, get down!

Kids, hold on!

Hey, bro, it's Rick.

I'm coming down to Miami- kind of a last-minute thing.

We really should get together.

Hey, bro, it's Rick.

I'm coming down to Miami- kind of a last-minute thing.

We really should get together.

We got a school bus crash on I-90.

Yeah, ten minutes out.

Everything okay?

It's Rick.

He left a voice mail.

That's pretty strange behavior,

considering he's your brother.

You know, with Rick, it's complicated.

Yeah, if you're talking about the guy

who kissed me rather than tell you he has kidney cancer,

I'm familiar with his work.

Past ten years, I've seen him maybe a dozen times.

Only shows up when he wants something.

He doesn't call,

and he never, ever leaves a message.

Well, he just found out he was sick.

Maybe he's reaching out.

Yeah, except I make the mistake of thinking

he's reaching out to connect, only to realize he's trying

to get ahold of my throat or my wallet.

Oh! Oh, okay. Take it easy.

We don't need you on a gurney this morning.

Totally under control.

12 years of ballet, six en pointe.

Ooh.

I stand corrected, Madam Baryshnikov.

Is all this for Tuck?

Yep-- first day back in three months.

So, uh, how long

before our guest of honor arrives?

Soon.

And we still haven't picked up the cake.

I'm not overdoing this, am I?

No. If I got stabbed in the chest,

I'd want cake, too.

Damn. I need another box of gloves.

Let me run over to supplies. Or...

you can look in the cabinet behind CT.

Keep a couple boxes stashed back there.

Tuck. Oh!

You're not supposed to be here yet.

Yeah, the marching band

and Chinese acrobats don't show up

for another half hour.

Ow. How are you feeling?

Rusty.

Oh. Update on the, uh,

school bus crash- got two red-bands

with a few stable heading to the ER.

Vehicle went off the road into a canal.

Okay, let's grab...

An airway cart-- and I'll grab eight units of O-neg

and prep crash carts in Trauma 1 and 2.

Damn.

Rusty, my ass.

Ben Sims, 16-year-old male,

tachy and hypotensive,

severe hyperflexion injury

to the C-spine.

We had to pry him out from under the seats.

We could be looking at a spinal cord injury.

What was his GCS?

One-four-two, and no purposeful movements.

Pupils are reactive-- that's good.

Strict spinal precautions when we move him.

And I want a head and neck scan ASAP.

Lori Wilson, 26-year-old female. She was unconscious

when they pulled her out of the canal.

Patient came to en route,

complaining of head pain.

BP 110/60.

All right.

Here we go-- on my count.

Ready? One, two, three.

So, how's our young man doing?

BP's stable, lungs are clear,

but his score on the coma scale is below eight.

Check the gag reflex to determine

the extent of his spinal injury.

No gag response. Right.

Let's get him intubated.

Push etomidate and SUX.

Hey, Lori. How are you?

I'm Dr. Deleo.

Heard you went for an unexpected swim today.

Did all my kids make it out of the bus?

Most of them went to the regular ER, which is good news.

Only one ended up here in trauma-- Ben Sims.

Oh, God, not Ben.

He-he sometimes has this weird problem with his hands.

Uh, numbness or something.

That's great information, Lori.

We'll let his doctor know. Hurts.

Oh, my ear. Oh, we got bleeding in the right ear.

All right, five morphine for the pain.

Let's order up a head CT just to rule out

any bleeding on your brain, okay?

Bet my students would love to hear that.

All right.

Follow my finger.

What do you teach, Lori?

Uh, art, graphic design.

Really? My favorite class

at good old Lake Wimico High.

You liked art?

I can't draw a stick figure to save my life,

but my teacher, Ms. Kendrick--

she was the only one that liked me more than my brother.

Dr. C, her arm is swollen.

Oh, my God.

What's happening?!

No evidence of arm trauma.

Maybe it's an allergic reaction the the morphine.

I haven't given her the morphine.

All right, let's get a Duplex ultrasound, and an MRI.

Make sure there's no clots forming in her arm.

I'm going in with the scope.

Careful you don't move his head.

It could paralyze him.

I can't see the cords.

Sats are dropping. 78%.

Lighted stylet please.

Serena, the lights, please.

That's right, over the base of the tongue.

Look for the jack o'lantern effect,

the pretracheal glow.

There it is.

You're at the cords.

Advance the tube.

Sats are returning to normal.

And his X rays are up.

Oh, my God.

His skull is detached.

Yeah.

He's internally decapitated.

It's atlanto-occipital dislocation.

Ben's skull has been separated from his spine, but the, uh...

the skin and blood vessels

in the surrounding area are still intact.

Poor kid.

He's probably looking at a lifetime of paralysis.

Maybe not.

the spinal cord's intact as well.

I think there's a chance

that he'll recover some, maybe all of his mobility.

Is that a bulge in the cord at C-7?

Looks like it could be syringomyelia--

a spinal cyst.

You know, Chris mentioned that the boy was experiencing

numbness in his hands before the accident.

That would explain it.

I'll page Neurosurge for a consult.

Yeah, and get him into traction tongs

to decompress the spinal cord.

If we move his head in the wrong direction a few millimeters,

he might be on a vent for the rest of his life.

Incoming on Heli-1.

Hunting accident out in the Everglades. I'll take that.

Um, if you get him stabilized, then we'll, uh...

reattach his head.

Jesse Shane, 45-year-old male

hunting guide.

Through-and-through gunshot wound

to the right chest and flank.

BP 80 over 50 with normal sats.

Hi, Jesse, I'm Dr. Proctor.

Do you know what happened to you?

Damn right, I got shot! Excellent recall.

Do you know how it happened? Got hired by a couple

of trophy hunters to track wild boar.

Didn't ask the Great One

to release the animal spirit.

The great who?

The Great One.

He's been babbling like that the entire flight.

Maybe delirious from blood loss.

Let's get him downstairs.

Which way are we facing?

Is that east?

All right, Jesse, just try and relax.

Let's take a look at you first.