Code Black

[ Sirens wailing, monitors beeping ]

[ Telephones ringing, monitors beeping ]

Mark: We have a double mvc trauma en route.

Leanne.

Leanne.

Can you hear me?

Hello?

I'm sorry. What?

Do you smell burnt toast?

No. Huh. Just ruling out an aneurysm.

Stay with me here. I-i need you in dispatch.

They're bringing in two boys, brothers.

They can't get an airway on the older one. Okay.

Now, I don't want to state the obvious,

but we're in the 36th hour of a code black.

Not kosher, I know, but I got to

send the residents into extra innings.

Since when have you ever worried about that?

Well, I'm the boss. I got to pretend to worry, don't I?

They're kids. They'll be fine.

Yeah, what about you? What about me? Medic: 19-year-old male,

massive facial trauma, cannot recognize normal airway. Well, you've worked 13 days in a row, leanne.

Yeah. You're welcome, mark. Failed three attempts at e.T.T.

Did you try a combi-tube? Yes, but with an air leak.

Then try an lma with a strong seal.

Better if it's an intubating lma.

He's coding! Start compressions.

How far out are you? Five minutes from your ramp.

Got it.

I'm gonna need two beds in there!

Angus: 45-year-old male fell off a truck ramp,

complaining of hip and back pain.

Probable chest contusions, rib and pelvic fractures.

Is he breathing normally?

Is somebody gonna take care of me or what?

He seems to be breathing just fine.

He's gonna need pain meds and a full blunt-trauma assessment.

Let's get him to the overflow room.

And good morning to you, Dr. Leighton.

Oh, it is morning, huh?

This one needs transport.

Rig's on the way. They want us.

Ugh. Do I have time to go to the bathroom?

Adult diapers. That's what I wear.

This one needs a social worker.

Kidding.

He seems to be getting nothing but worse.

His pressure's dropping.

I need a pelvic plain film,

stat trauma labs, and 8 of morphine.

Don't forget a pelvic binder.

You're gonna need to keep that stable

in case it's an open-book fracture.

I wasn't gonna forget. Thanks, Mario.

What's up with those chest contusions?

He has them... And rib fractures.

I'd concentrate on those, dude.

It's the a-b-c theory... Airway, breathing, circulation.

Not worth saving a pelvis if one of those are broke.

Well, look at us... Two residents

who learned the same things in medical school.

His pressure's still dropping.

I need a pelvic ultrasound and four units of o-neg.

I don't have time to cross-match them.

If I were you, I'd be a lot more worried about thoracic trauma

than internal pelvic bleeding.

I worry about all of it, okay?

What's coming in?

Two brothers. It's not good.

Come on, come on, come on!

Let's go!

Kevin: Patrick!

Medic: 21-year-old male, multiple chest deformities.

You've got to save my brother! Please! Please! Please help him! High-speed mvc.

It's okay, sir. We're gonna help him. Positive psi.

Patrick! Patrick! Positive l.O.C.

Dr. Pineda! Over here!

Don't stop compressions.

Let's get him intubated now.

How's my brother?

Patrick! Say something!

Hey! Hey! Can you hear me? Is he okay?

Okay, okay, you need to stay still. Patrick!

One of epi, an amp of bicarb, and pour n.S. In.

Take care of this, please.

10 milligrams morphine i.V.

I'm past the cords.

Breath sounds bilaterally.

Don't stop. Continue compressions, Dr. Pineda.

Patrick!

Seatbelt sign. Impact bruise from the belt. What does it tell you?

High likelihood of internal organ injury.

Ultrasound the abdomen, please.

Come on. Come on. Give me something.

Continue cpr.

Come on. Come on.

Neal: Lie still for me. Lie still.

Patrick!

Down trending blood pressure. He's circling now.

60 over 40.

What the hell is going on with this guy?

He's about to code. That's what.

His pelvis is clean. There is no sign of blood.

That's because his problem's somewhere else.

A pelvic fracture bleeding internally

would be retroperitoneal bleeding.

An ultrasound wouldn't necessarily detect it.

Risa: He's flatlining.

This is your patient, man. You got to act.

They only had two units.

Start compressions. Hang both units.

Run them wide open. Run fluids at the same time.

What the hell are you doing? His pelvis was unstable, okay?

It was tender when we put the binder on.

He's clearly bleeding down there.

I don't buy that he's decompensating this quickly.

It's much more likely a thoracic trauma,

an intercostal artery bleed, or a hole in his heart.

Okay, okay, let's ultrasound the heart.

Are you crazy? There's no time.

Well, what do you want me to do, cut open his chest

in the overflow room with no supervision?

How else are we gonna stop the bleeding?

This is angels. This is what we do.

We are residents... A thoracotomy is reserved for

the rarest of cases when there is absolutely no other option.

Is there an option I'm not aware of?

You have about four minutes to save this guy's life.

No heart rhythm, chest contusions...

A hard indication to open him up and fix what's wrong,

or he is dead.

What are we even talking about here?

Okay, I get it. I hear you. It's just I...

Stop thinking! This is how you get into trouble.

This is what you do. You have to trust yourself.

Angus, make a damn decision. Three minutes.

If you don't do it, i will.

No.

I will do it, and you will assist me.

Come on. Give me something i can shock.

Christa: There's a lot of free-flowing fluid in the abdomen.

Looks like blood.

I need to see my brother.

You can't right now. We need to get you some x-rays.

Patrick!

Patrick!

Is your patient ready for C.T.?

We're on our way.

Two large 18s in, trauma lab panel,

chest and pelvic x-rays.

Let's go.

Hey! Let's get out of here, please.

Let's go. Hey, what's happening to my brother?!

Hey! Tell me what's happening to my brother!

Patrick! Patrick!

Dr. Pineda. You can stop now.

There's nothing more we can do.

You can't shock flatline. Why is that?

You can't trigger an impulse in dead myocardium.

That's right.

Anyone have any suggestions?

Okay, I'm gonna call it.

Time of death... 7:01 A.M.

Back to work, everyone.

It's beating.

When did it start beating again?

I don't know.

The hard reason to do this... The "no heart rhythm" part...

We don't have it anymore.

No, we don't.

We opened him up for nothing.

Maybe there was a pulse all along

and you just didn't feel it.

Maybe you should have done the ultrasound.

Just shut your face, okay?

Sweet Jesus!

They opened this poor man's chest

expecting to find a swimming pool of blood,

and instead, they find normal anatomy

and a heart happily beating "nearer my God to thee."

A dry thoracotomy. That's a real buzzkill, huh?

You know, they're plenty pissed upstairs. I'll tell you that.

They should be.

Now your patient needs an orthopedic surgeon

to fix his pelvis, a thoracic surgeon

to clean up whatever you left of his chest.

And a lawyer to give us all a colonoscopy.

What were you thinking?!

Um...

"Um"?!

Use your words, Dr. Leighton. It's a very busy morning.

The patient presented with pelvic, chest, and rib fractures.

He coded.

I thought maybe it was a thoracic trauma

or maybe it was an intercostal artery bleed.

"Maybe"? You're having trouble convincing yourself of this.

I was looking for an attending,

but we were in code black, so I...

What the patient needed was a doctor. Are you a doctor?

Did you ever think to ultrasound his lungs and heart?