- New Amsterdam, season three, episode one, let's go.
(upbeat music)
Shout out to everyone who's gotten their vaccine
#ThisIsOurShot
is an amazing campaign of our healthcare workers
showing themselves getting their shots,
talk about leading by example.
And I hope that everyone talks to their primary care doctors
or other health professionals about getting their vaccines.
Linking my videos on vaccines down below,
I did one with Mama Doctor Jones in case you are pregnant
or thinking about getting pregnant as well.
- I just wanna tell everyone how proud I am
of this whole hospital.
- I don't know how I feel about this beard on him.
I think I liked him without the beard.
You know, actually him and I, before the pandemic,
walked in "Blue Jacket Fashion Show" to raise money
for prostate cancer.
He`s quite the model.
- I am committed to fixing the cracks around here.
Okay the system abandoned us when we needed it most.
(clouds roaring)
And I vow to fix the system that left us overburdened.
- Since when do hospitalists have a conversation
about something very important
like hospital funding in hallways around patients.
There's conference rooms for a reason.
(plane engine roaring)
Okay.
Is this a Sully moment?
"US Airways 1549 landing on the freezing cold Hudson River
all because of heroic Captain Sully
and his fabulous crew."
(plane engine roaring) - Whoa!
this is a Sully moment
(plane engine roaring)
(water splashing)
Whoa.
That look like a fairly smooth landing.
I mean, outside of some bumps and bruises
and depending on how cold it is, some hypothermia,
I think everyone should be pretty safe on board.
(woman wheezes)
But obviously,
cause it's a medical trauma (laughing)
That's not gonna be the case.
- Ma'am we're gonna take good care of you okay?
Let's go, a Trauma one.
Hey, I need an EKG of portable chest
and full blood panel,
including co-op. (woman crys)
- Ordering blood tests in a situation like this
is important but the first thing you wanna do is get big
large bore IVs into both arms to give fluids and blood
in case the person's bleeding out.
That kind of access is the most important thing
to someone's survival.
Obviously airway and breathing as well but I already saw
that she is in fact airway clear and breathing.
- That's been suspended with muffled heart cells
- Tamponade from blunt force trauma.
- That means, she's actually bleeding in an enclosed space
into the lung cavity, into the cardiac cavity.
And as a result, if you have so much fluid around the heart
it can't expand fully.
'Cause when a heart beats It doesn't just contract.
It actually has to relax.
And if it doesn't have room to relax and expand
it actually doesn't get enough blood flow to itself
because it's a muscle.
It needs its own level of circulation.
(door slams)
- Co-pilot with deep abdominal blood lac and blood loss.
Heart rate up to 118, BP down to 108.
- So with the patient who is bleeding from the abdomen
has a laceration to the abdomen.
A low blood pressure with a high pulse can mean
that that person is bleeding out, losing blood.
Because what's essentially happening
is you're losing pressure in this closed arterial
and venous system in the circulatory system,
and your heart is trying to compensate
by increasing the heart rate to try and get
more blood flow to the areas that aren't
getting enough oxygenation.
It's a compensatory mechanism.
- We'll do our best to stay out of your way.
We just need to interview every crew member and passenger,
who may have pertinent information.
- Well, Roger that.
Oh, well sorry.
As long as it doesn't interfere with patient care
I will help in any way I can.
- Understood.
We wanna start with the pilots, Captain Starks
- I'll find him for you.
- Why are they going to the director
of the hospital for this?
Like if they just walked in, went to the head triage person
in the emergency room, they can get all this information.
They are law enforcement technically.
They don't need to go to the chairperson of the hospital.
- It's your job to investigate and it's our job to heal.
So once we're done...
- Doctor Goodwin, to clarify
you're blocking access to a key witness.
- I'm pretty sure if you come with a federal subpoena
or like a judge's order,
you can get the hospital to order some blood tests.
But I think a patient has the right to refuse
unless it's like one of these
very specific orders by the court.
And I think as a pilot, you sort of give up that right
and allow them to test your blood.
I could be wrong here though.
Pilots weigh it.
(machines beeping)
- You smell that?
- Someone chewing gum? candy anything?
- It's the co-pilot.
It smells like ethylene glycol.
- Antifreeze.
- When the plane crashed,
maybe our host snapped her open abdominal wound.
- Absorbed it which is why we can't get the blood to clot.
- To clot, push Fomepizole.
It should act as an antidote
- That's a very advanced situation
that a part of the antifreeze of the plane stabbed him
in the stomach and is now pouring that poison
into his stomach, Jesus, what a story?
Oh, well he must have been stabbed
with tubing that had ethylene glycol
from the airplane and then it pumped
into his stomach and then hurt his bile duct
cause the liver enzymes were slightly inflamed,
never happening in reality.
- Liver enzymes are elevated'
- How high?
- Three and a half times normal.
- That's so mild.
Liver enzymes being elevated three half times normal
is not great, but it could be just shock
because it's not getting enough circulation.
That's a good time to mention some stuff
about liver enzymes.
They're called oftentimes LFTs,
which has liver function tests.
But the reality is they do not represent
whether or not your liver is functioning well.
They're actually signs of liver inflammation that
if you have damage to the liver,
you actually leak these enzymes.
And as a result if their elevated,
your liver function tests
are saying that there's damage to your liver.
(machines beeping)
- Now what?
- BP falling, temps dropping.
- She`s septic.
- Start on hand gentle pluzzer
hang a bag of dopamine at two mikes a minute.
- How did they not start that already?
The patient is open wound from a trauma.
You should have started them on antibiotics
broad spectrum.
- Enzymes are six times normal.
Liver's not gonna last much longer.
- I need to expose the entire organ.
We'd need to extend the surgical field
across the whole abdomen.
- Not proud of me.
- Scalpel.
- Do you wanna call in Gastro?
- No, there's no time.
- You're not getting your hands dirty?
- Of course not. But, it's been a few years.
- You have a steady hand?
- Yes.
- Clear field of vision?
- Yes.
- Still like that type of place on 17.
- Yes.
- Then what are you waiting for?
- The last I remember she was an Oncologist.
Am I wrong?
- [male] Yeah, she is an oncologist.
- Why is she operating?
Why is the oncologist operating?
(door slams)
- We've got a problem with Shanaz.
(door slams)
Dissecting aortic aneurysm.
Couldn't see it till I drained out the fluid.
- That's a problem.
So basically an aneurysm is a ballooning of the main artery.
That's usually coming off of the aorta,
which is the main artery that comes off of the heart.
If you have this ballooning, meaning that there's a weakness
in the wall and a dissecting aortic aneurysm
means that there's a tear inside this wall.
These ballooning sections of the arteries
these aneurysms are more likely to tear
because there's less tissue there.
It's thinner.
- And what does that mean Dr. Wolch?
- The aorta could rupture.
- If it tears, it's basically rupturing.
(laughs)
A lot of times the classic sign is that a patient comes in
either with very bad chest pain or very bad back pain.
And sometimes dissecting aortic aneurysms are missed
because sometimes doctors unfortunately misdiagnosis it
as like back pain or some kind of sciatic type pain.
When the reality is they need to rule out
this dissecting aortic aneurysm,
which can be done with an x-ray, an EKG
or a cheetah scan, an ultrasound.
(machines beeping)
- What are you doing?
- We`re not sending another patient off
into the great unknown when I can help them
right here, right now.
- We just paged cardio she's not your patient anymore.
- They are all my patients.
- How is she gonna perform
an aortic aneurysm repair in the, I don't understand
(machines beeping)
- The dancing catheter.
Okay, I'm at the aorta.
- Is she really performing some kind of aortic repair
as an ER physician?
I don't know, like I've never heard of this or seen this.
someone, please tell me if I'm wrong here.
I don't think this is appropriate
- BP is dropping
(machine beeps)
dissection's extending.
- It`s greater than 200 (door slams)
- What the hell are you doing?
- Trying to stop the dissection.
- Well you didn't, you made it worse.
- I'm trying to fix it.
- Not fast enough.
Thanks to you going rogue, I gotta crack her chest here.
- The way that they were trying to repair,
was putting in a catheter going through the blood vessel
to go from the interior portion and attack that problem
the tear from the inside of the artery,
without failing, now they have to go out from the outside
and open the chest.
Which means a longer recovery time
higher risk, et cetera, et cetera.
- Ma'am, we are authorized to speak
to any individual who may have information.
- Hey whoa, whoa, whoa enough.
You don't have the right to come
into this hospital and rip a patient away from their doctor.
violating HIPAA rules.
- As a matter of fact, we do.
(paper clatters)
- Yeah that's what I was looking for.
- What is this?
- A federal order?
- I'm kind of proud of myself.
And I think LegalEagle will be proud too
that I said a federal judge has to order this.
And he said, it's a federal lawyer.
- Smart.
- So I'll ask one more time, where's the pilot?
- Now you could be in trouble for obstructing justice.
- All right, so on take off,
if a pilot discovers that his airspeed indicator
is giving him an inaccurate reading
and he's flying too slow, what would that pilot do?
- Why is the hospital staff doing this investigation?
- Get the nose down.
You go into the dive in order to gain speed
and then you'd lift up at the very end
- which is exactly what you did, right?
- You think that Captain Starks
jeopardized the lives of 150 people,
We think he saved the lives of 150 people.
- Oh yeah, with this information that you just got
five seconds ago.
I've ranked all of the medical dramas that I've watched
including New Amsterdam.
See where it falls on my list by clicking here
and as always stay happy and healthy.
(upbeat music)