The Most Accurate Medical Drama Of All Time? | The Pitt

they say the pit on HBO is the most accurate medical drama of all time let's see if that's true oh and you got the med students and new intern starting today so good luck with that Lu you're luing me must be July that's the season when you residence and intern start come back here no more needles sir no more needles it's the ER so stuff like that does happen Drrabinovich Melissa King I will be joining you today I just came from two months in the VA hey welcome to the pit this is DrJack Abbott nice to meet you I can't take how excited I am to be here today so I wonder if this is a resident or a med student because these types of introductions happen exactly like this sometimes it's even during a stressful moment where you're trying to not get in the way but you want to announce who you are and you have to be there so it can get pretty awkward pretty quickly as you can see we have some new faces with us this morning good morning good morning come on over starting with seconde resident DrMelissa King from the VA everyone calls me Mel I'm so happy to be here Trinity Santos intern Victoria Java ms3 ms3 means med student year 3 means one more year to go uh Dennis Whitaker ms4 usually when you're a fourth year and you're rotating in a in a hospital you're choosing hospitals where you'd like to get a residency and that's called a sub internship because ideally you'd get your internship there as a first year resident and it's a time where you show off your skills your ability to learn your curiosity you create connections to people in the field so whether it's other residents other attendings or even some of the staff uh actually this is the most important person that you're going to meet today this is Dana she's our charge nurse she is the ring leader of our circus do what she says when she says it okay great senior residents you got your sign outs yep sign outs are basically when you're leaving your shift you have to hand over to another teammate the patients that you were taking care of basically the patients that are waiting for rooms patients that are in the middle of their evaluation and what's interesting and this comes up frequently when we talk about hours worked for residents during a hospital shift the less hours a resident works so for example if you're moving from a 24-hour shift to a 12-hour shift you're going to have more handoffs and statistically speaking with each handoff there are more likely to be errors because when there's a handoff mistakes happen we've seen that actually working perhaps longer hours can decrease chance of medical error in some instances simply because there's one less handoff okay let's do this patients they check in for registration here a nurse eyeballs them make sure they're not dying if not they're moved to one of two triage rooms for vitals and a quick chair exam where you can your labs and your X-rays and then they come back to waiting room till the bed opens up for how long 8 hours if they're lucky a lot of times 12 uh is it always this busy uh no it gets a lot busier ERS in hospitals are absolutely overwhelmed under under staffed these days the smaller hospitals especially are facing situations where bigger hospitals eat them up or they just close entirely and the people in that area are left hanging this is Sher hi Sherry I'm DrMcKay I have some student doctors with me today do you mind if they observe sure that's a good question to ask and that's the exact way you're supposed to ask it I just would rather the med students not hear that conversation cuz then as a patient you might feel some type of way of saying no when the pressure of the med students is already there what's going on Sherry oh that's a heavy burn the hand is a really bad place to get Burns because contractures form and contractors essentially squeeze the skin together close the skin together and as a result you can lose functional mobility of the fingers and obviously fine motor movement is very important with the hands a hand surgeon should ideally be involved as well as an occupational therapist who work really closely with patients in improving and fine-tuning find motor movement fine tuning find motor movement do you know how much longer this will take uh yeah let's see you taking anything for the pain not yet th000 of Tylenol 400 ibuprofen and saling dressing yes that's pretty good pretty good dosing I would just ask if the patient has any allergies maybe before doing that but maybe it's already in the charts I'll give them benefit of the doubt and you might be wondering why are they combining a non-steroidal anti-inflammatory with acetamin which is Tylenol you could do that in areas where you have very severe pain and there's nothing systemic going on and there's no reasons why they can't take those meds that's because aamin is processed by the liver while the non-steroidal anti-inflammatory is processed by the kidney so they don't necessarily impact the same organs hey and we all know Lou Cloverfield blood alcohol of 420 at 11:00 p. m. I've been cutting back how is he still breathing that's a lethal dose for you and me that's happy hour for Lou sober op had two rounds of r lorazapam is a bzo dipene it's similar type of medication to what most people know as Xanax and the reason we give it is actually to prevent symptoms of delirium tremin which is known as DTS more commonly it calms someone down it prevents Tremors it prevents even seizures that are associated with TTS usually the medication we used uh during someone's alcohol withdrawal is called Librium hold out your hands for me Lou another to on it and a script [Laughter] equilibrium 42-year-old male Sam Wallace blunt head with agonal respiration dropped down in the T tracks couldn't tube them L man place he's a good Samaritan took a spill helping a woman who fell off the track she's right behind us one go ahead woman fall from tea platform good vitals no head injuries de gloving injury oh de gloving injuri is one of the worst injuries to visualize I hope they don't show it basically imagine just full skin removal that that's the only way I can put it with open fracture dis oh they showed it how we doing ready okay here we go ready 1 2 3 good breath sounds bilaterally good breath sounds bilaterally signal that there's good air enty which means that there's lower likelihood for pneumothorax which can happen after an injury or trauma like that where the lung essentially collapses internally and when that happens the person's not able to oxygenate pupils 4 mm and reactors okay encouraging they're going to be looking for bleeding internally that's a lot more blood than expected the scalp does bleed a lot there's a lot of very small capillaries there so even a small gash inside the scalp can be bleeding a lot but in a situation like this you really want to get a stat CT scan of the head and make sure that the bleeding is only external not internal he's probably anti-coagulated for AP they suspect he's bleeding a lot more because he's taking a medication that will decrease his ability to form a clot because someone who has atrial fibrillation in their heart the heart beats abnormally meaning that it fibrillates it almost like shakes like this you'll see that on an EKG very clearly you can in fact feel an irregular Rhythm often times when you check someone's pulse who has atrial fibrillation when the heart beats irregularly like that it can form a clot in one of the chambers of the heart and then shoot it up to the brain leading to a stroke obviously a dangerous and deadly situation so many of these patients are on anti-coagulation meaning they're getting medications to decrease the risk of forming a clot but there's trade-offs to that which means that you have an increased chance of bleeding and now not just bleeding everyday life like GI bleeding losses or a minor cut but during a major trauma very very dangerous 50 Fant didn't touch her did she faint or did she trip off the platform no knows the other guy jumped down pulled her off the tracks just as the train was rolling in isolated iny to the foot the train ran over foot got CAU between the platform and the incoming train ma'am what's your name two G SE I hear that they're screaming about antibiotics absolutely you need that when you have such an open wound on the leg students C might have made her ft on the platform Tia is like a mini stroke that lasts for certain seconds a CVA is a full-on stroke the list is so long in a situation like this with no information it could be something as simple as a vasovagal where temperature pressure body didn't react as fast to clamp down the arteries and the legs in order to return uh blood flow to the brain upon standing could be orthostatic hypotension you could have more serious things like she just noted stroke or mini stroke heart attack I mean the list really goes on and on you need to First stabilize the patient and then start working your way forwards into diagnosing what could have led to the initial insult which was her falling so she needs EKG and Tron okay good EKG and troponin is how you rule out the heart attack that we just talked about EKG tells us the rhythm of the heart right now which would signal to us if there's a heart attack right now or perhaps one recently if you had an EKG to compare to in the past the troponin is an enzyme that's released by cardiac muscle tissue that essentially shows damage to the cardiac muscle all these things clinical picture the labs of the troponin the EKG all tell us a more complete picture as to whether or not someone is having a heart attack thatway train to glove your foot with an open fracture dislocation and I thought my heels were painful hemodynamically stable hemodynamically stable is a good sign that means blood pressure isn't falling that means we're not having a significant amount of blood loss to lose blood pressure and the fact that she's crying is actually a valuable sign that means that she has enough awareness to protect her Airway the cords are very interior yeah that's cuz we can't Flex the neck keep the hockey stick straight up this is a very high level when we had intubations uh back in my residency training you didn't have a fancy video monitor to assist you and you had to do it just manually intubated for agal respirations GCS 5 uh GCS 5 means you intubate cuz below 8 you intubate need to talk about your numbers of people we've saved [Laughter] H our door to balloon times be Federal standards door of balloon time is like the PCI uh when someone has a heart attack how quickly you get them into the door it is important to be able to uh be quick in a few situations so when a heart attack patient comes in how quickly you get them in as well as someone who is a stroke patient how quickly you get them through the whole system and there are national standards for this and if you don't comply with them that means you need to improve your protocols patient satisfaction if you're still alive you should be satisfied our goal is 36% very satisfied with their care your department is at 8 do you know how likely patients are to recommend this hospital um this is an emergency department not a Taco Bell 11% well if you want people to be happier don't make them wait for 12 hours I never know when they have these conversations with doctors and I've been in rooms where these unfortunate conversations have happened what do they want the doctor to do put on a smiley face sticker like what can he do outside of be good at practicing medicine in and be kind to patients nice job do you think he'll wake up maybe maybe not with neurologic damage it's really a touch andgo process where you have to monitor clinical Improvement there's really nothing that you could look on lab test to know if a patient will have neurologic deficits after an injury to the brain and I'm talking about injury like a stroke or a trauma like this no good deed goes unpunished oh has anyone um notified the family as a resident that's usually Your Role I could try calling family members calling phes to find out patients medications calling other hospitals to get prior medical records that's what you do as a resident hand scan is negative that means you can admit to Orthopedics but there may have been a a medical ideology If She fainted that's not surgical get an internal medicine consult or admit to medicine with ortho Consulting I agree that's completely right so which service is the main service matters a lot in the hospital for example if you have a patient with a medical problem like diabetes a heart issue a stroke and you admit them to Ortho that's a problem because Ortho is fixing and monitoring the surgical issue but no one's monitoring the internal medicine side of things so you either need to admit to Ortho with an internal medicine consult or the other way around usually with ortho at least in my experience it's been they're on the ortho Ward and then the internal medicine team comes in and monitors the medications does the diagnosing in addition to everything that the ortho team has done I was fine until about two weeks ago after the Rochester Marathon okay any Falls or injuries just tired sore muscles yeah I'd be in bed for a month was this your first triathlon God no no I do want every a few months he's going to have rabdomiolisis and kidney failure this goes under your tongue they're going to say his temperature is 104 temp 98.

2 take a deep breath from me I just little little pin PR now okay that was a quick IV he didn't even palpate there he just went bam threw it right in there Otis see that happens very frequently when someone uh gets blood drawn so could be that but you got to be careful check for a pulse still take all the precautionary measures no pulse crash card land flat let's check a rhythm pads okay very good call for help right away code blue First Code Blue first VCH oh my God why are they doing chest compressions oh no they didn't even do chest compressions all right it's back to normal sinus yeah see like this is wonderful but the crash card isn't always available turning it on takes some time all that time you could be on the chest profusing healthy 31-year-old vac arrest 2 weeks after traon NSR with one shock he's a little young than am mine exactly right what's the differential DrCollins drug overdose electrolytes on QT electrolytes is probably the leading one especially post Triathlon Bata syndrome wpw Bata syndrome wolf Parkinson White what she's talking about these are all abnormal rhythms of the heart that can predispose someone's hard to very quickly stopping and very frequently it happens in young people cuz they weren't aware that they had this and their heart is otherwise healthy but the electrical rhythm is abnormal so much so that it could trigger them to go into this vtac situation Otis oh groaning is good five of nasal O2 CBC CMP ponent and is he pushing epinephrine or B gram calcium glate IV push oh he's trying to stabilize the heart theor why Cs and PT waves hyperemia how'd he get that intense exercise cause muscle breakdown red in my house come on props not bad C RS is narrowed much better potassium is 7. 7 creatinine 5.