– What do you get when you mix Uber with a Hospital? Royal Pains.
Beewoop! (hip hop music) Oh, ball time.
All right, good dish, good dish.
Oh, oh, oh.
We have a athlete that's collapsed.
What are you gonna do? Check for a pulse.
Call for help! Call for help, first thingyou do, call for help.
Lawson] Alright, call 911! – Yes, he pointed the person out.
– I need those two gym bags, right now.
– If he- – I want some ice from those cooler, okay? Move it! – Does he have a pulse? – [Dr.
Lawson] Ice, ice, bring it in! Okay, I need to ice his crotch, his armpits, and his scalp.
He can't breathe.
– All right we have to break this little scene down.
Athlete collapses whileplaying basketball.
He's saying he's notbreathing, it sounds like he has no pulse.
At that point, you call help, 911.
Point somebody out, becauseif you just yell it, hoping someone else will call911, that may not happen.
So point to someone, say, “You call 911!” and then right awaychest compressions, chest compressions, chest compressions.
Don't push with your arms, push with your upper body.
Because then you could useyour weight to your advantage and not tire as quickly thanjust by using your arms.
When you're pushing youwant to do it to the tune of Stayin' Alive! Stayin' Alive! Ah, ah, ah, ah! All right, that was badsinging but good effort.
(tune of Stayin' Alive!) Chest, chest, chest, chest compressions.
– [Female Nurse] Aren't youoff today, Doctor Lawson? – [Dr.
Lawson] I was.
Status, post cardiac arrest.
Got his pulse back an opened his airway.
– [Female Nurse] Didyou really use gym bags for immobilization? – Yeah, can't wait to tellhim some sweaty boxers saved his neck.
– So the thing with opening up his airway, if the patient is stillbasically in a coma state, they can't protect their airway.
That's why we do theGlasgow Coma Scale to see whether or not the personcan protect their airway, and if they can't theyshould be intubated.
Because what can happen issome secretions, whether its saliva, mucus, vomit, canget into the mouth and then get aspirated intothe airway which will go into the lungs and thatwill create a pneumonitis, which is a very seriouscondition which causes serious inflammation of thelungs an can be deadly.
Wolf] O2 sat 80.
BP 100 over 60.
– Drop five of versa and 150 of sucs.
Lawson, paramedicsbringing in a 68 year old with a STEMI.
– When? – Now.
– A 68 year old with a STEMI means an ST-Elevation MI.
And ST-Elevation is something that we look for on an EKG when someone'shaving a heart attack.
An MI means myocardialinfarction, just another name for a heart attack.
Lawson] And intothe femoral artery.
(machines beeping) And there's the blockage.
You can finish up, I'm gonna go out.
He's stable, he just needs an angio.
Wolf, how's the kid? – [Dr.
Wolf] The EKG showsa third degree AV block and he's unresponsive to meds.
I placed an external pacerbut I'm not getting capture.
– What's his BP? – [Dr.
Wolf] Hovering around 60 systolic.
– All right, he needs a wire, stat.
– Is Hank a cardiologist? I'm so confused.
What I'm interested in hereis, this young athlete, he said he as an AV block, which is a problem with the electricity withinthe heart that can cause the heart to stop beating.
He's saying that they'retrying to create capture which is when they puta device on the outside of the chest that tries tocapture the heart's beat and reset it and giveit the proper rhythm.
Now, they're not having success with that so he says, “I'm gonna put in a wire.
” essentially what he'ssaying is he's gonna go from the internal structures and control the electricity of the heart that way.
Now, we do this allthe time for pacemakers and defibrillators, basically for all sorts of congestive heart failure and electrical anomalies of the heart.
– Priority is Mr.
Gardner! You'll see him all the way through.
– Gardner is stable, his BP is up, his sat is 98% on two liters.
The ST segments are normalizingand his pain is gone.
So, how about today we savetwo for the price of one.
– I mean I totally agree with him here.
Why, what does she want him to do? Babysit the other VIP patient? What good is that going to do them? If he did the procedure, he opened up his arteries, his ST segments arenormalizing, which means that the EKG is improving, what else is he gonna do? (smooth jazz music) Ooh! – Wow.
– Still can't stop with the romance in these medical shows.
With the making and the (kissing noises).
Medicine is fun, we don'tneed the (kissing noises).
– Let's go give that longday of yours a happy ending.
– This is a dirty show.
Lawson] I recognizedMr.
Gardner's level of blockage, I knew ithad to be relieved and I was confident that hewould be successfully angioplastied and survive, barring any bad luck.
– Well bad luck rainedand poured, didn't it? While you had our seniorCT surgeon in another room.
– To help me try torescue a crashing patient, I made a judgment call.
– You made a mistake, a fatal one, and that's a shame, Dr.
Lawson, because we all know you're the most talented physician this emergency departmenthas seen, and your star was only on the rise.
– Was? – I know for the averageperson that may watch this, and think, “Oh, thatmakes sense he got fired.
” To me, it makes no sense at all.
I have no idea what hedid wrong, it looked like he completed mostof the procedure and then left the rest of it for another doctor and then went to performanother procedure.
He didn't go home tohang out, so I'm still flabbergasted as to why he got fired, but whatever, it's clearlynot important for the show's story line.
– [Man In Black Shirt] Youreally need to get out of this apartment and getsome fresh air, bro.
– In Brooklyn? – Honestly it smellsso bad, it smells like moose had sex with a bucketof Chinese food in here.
And you kind of look likeJesus and Patrick Dempsey had a child and thatchild grew older and then got really sick.
– That's weird.
– Look, look, look this trip is gonna get you back on your feet, I promise.
– Trip? What trip? – Are you kidding? To the Hamptons! I've been telling youabout this all month! – Yeah, and all month I'vebeen saying, “No way.
” – A lot of medicine up front, a lot of no medicine in the middle.
(retching) – [Dr.
Silver] Clear, clear.
When are you damn kids gonna learn how to hold your drugs? (laughing) – Concierge doctor.
Silver] Start with some oxy? Then a little crystal? Ripped a few lines and chase a little down with champagne.
Having salad, you kids call that, right? – What? Ava doesn't do drugs.
– Why? Because she says she doesn't? Newsflash, pretty boy, most drug addicts are also liars.
Sorry, April, we're gonna get this straight into your system.
– Doctor, you may have misdiagnosed.
– Oh really, who are you? – Just a concerned observer.
– Well I observed nausea, photosensitivity, disorientation, a few of the tell talesymptoms of a opioid overdose.
What are you observing? – The same symptoms you are, plus a couple you're not.
Like her miotic pupilsand sludge toxidrome.
– I don't understand, hedidn't even look at her eyes.
How does he know whather pupils look like? I mean, it sounds likehe has x-ray vision.
He can see from across the room.
Especially in a dark room, how is he able to see a- Not buying it, Hank! – [Lifeguard] All right lookout, lookout.
I've got this from here, guy.
– Who are you? – I'm a lifeguard.
(laughing) – Are you board certifiedin clinical toxicology? – Huh? – Help me get her up, Baywatch.
– I somehow doubt that thisguy's an interventional cardiologist, clinical toxicologist.
How many boardcertifications does he have? And they're not even onesthat go hand in hand.
Like if you're an ER doctorand you're a toxicologist, I get it, but being aninterventional cardiologist and a toxicologist, eh.
Those are nice Ferraris.
360 Modena? – This isn't my blood, it's my girlfriends.
Can you come inside? – Yeah, yeah sure.
– No malpractice insurance, no anything.
Just oh yeah, I'm just gonnabe casually your doctor.
Lawson] I got you! – Uh oh, fainting.
Is he gonna vomit? (retching) – [Dr.
Lawson] Tucker, Tucker.
– He's sweating.
Ooh! – [Libby] Are you okay? – Is that the seatbelt mark on his chest? (groaning) – Could have a cardiac contusion, which is a bruise of the heart.
– Why didn't you tell me you're a hemophiliac? – Ooh.
– Dude, my chest is killing me.
– Where's your Factor VIII supply? – Bottom drawer, next to my aquarium.
– So he has a bleedingdisorder that if you get into a car accidentor any kind of accident, for that matter, you startbleeding excessively.
And you're missing oneof the clotting factors, specifically Factor VIII.
That's what he's talking about here.
I don't know how heknows it's specifically Factor VIII, that's really impressive.
And also how he knows exactly that he's a hemophiliac.
Its very impressive diagnostic skills that I feel are a little bitpast human abilities.
– Stay with me pal.
– I can't breathe.
– Stay with me.
Tucker, stay with me.
Tucker, stay- (choking) Tucker.
All right, jugular's up, muffled heart sounds, minimal pulses, damn it's a bex.
– What's happening to him? – I don't know what a bex is.
– [Libby] What do you mean, bex? – He probably contused his heart and bled into the paracardial center.
– What are you talking about? – Look at that! (horns) – His heart is being squeezed and not circulating blood to his brain.
He needs the fluid drained, but because of hishemophilia, I could kill him trying to save him.
– This is actually reallysimilar to what happened with The Good Doctor's pilot episode, where the patient gotinto also an accident and blood was poolingaround the heart and we were worried about cardiactamponade, where the heart's trying to beat butthere's a build up of fluid in the sac surrounding theheart, so it has no room to beat properly, therefore, all the vital organs are not getting enough blood supply.
What complicates this case even further, I have no idea, again, howhe knows he's a hemophiliac, is that he's a hemophiliac.
So if he's to do any kindof procedure like insert a needle into the paracardialsac and take the fluid away so that the heart canbeat properly, he can kill him because he could bleed out.
(laughing) – Oh my god, this is so fake, its crazy! – He's clotting, he's clotting.
Give me the pen.
He's doing great, he's clotting.
– Get it in.
(gasping) – Its okay.
– Ow, ow! – Tucker! – Just take it easy pal, take it easy.
– Take it easy, I just cutopen into your heart and your ribs, you're all goodthough, just take it easy.
– [Libby] He saved you, hesaved you that's what he did.
– What?! – Libby helped out big time.
– Libby helped out?! My man, call 911.
This show is reallyfunny, I actually enjoyed watching it as a regular show, not just as a medical drama.
There's obviously some crazy, unrealistic situations that go on.
But the one part that is true, is VIP Concierge Doctors are all the rage.
What my goal was when Iwas in medical school, was to become a VIP ConciergeDoctor, but for everybody.
Make it as a low-cost option.
And that's sort of cominginto existence with something known as Direct Primary Care, and I'm kind of excited about it.
Click here for my three favorite videos from the last few months.
As always, stay happy and healthy.
(R&B music playing).