The Pitt

Dr. Al?

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.

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. - 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.

- What? - Nothing.

Your play.

Start with a head CT.

If normal, LP, rule out encephalitis.

Put in your orders.

Has he been here before?

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.

- 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, it is an open dislocation.

Can you be more specific?

I think it's inferior, yeah?

Do you remember the name for that?

Sounds like a Harry Potter spell.

I...

Luxatio erect a.

Correct. Check the neuro-circ.

Sir, can you feel me touching you?

- 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, counter traction.

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.

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, 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.

It's best if they watch the first one.

- I can prep and drape. - Yeah.

- After your albumin's in. - That's correct.

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.

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.

Yeah, 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.

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. 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 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 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?

Cell count to rule out spontaneous bacterial peritonitis.

Ding.

What would make that diagnosis, Joy?

Absolute neutrophil count over 250.

- How are we doing in here? - They are doing great.

I think they got this.

Hey, Dana, can you get Kiara down here for me?

She isn't answering her Spectralink.

She's not working today. It's...

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?

Honestly, yes.

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 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?

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.