new amsterdam season three episode one let's go shout out to everyone who's gotten their vaccine this is our shot 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 dr jones in case you are pregnant or thinking about getting pregnant as well i just wanted to tell everyone how proud i am of this whole hospital i don't know how i feel about this beard on him i i think i liked him without the beard you know actually him and i before the pandemic walked in a 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 and i i vow uh 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 okay is this a sully moment u.s airways flight 1549 landing on the freezing cold hudson river all because of heroic captain sully and his fabulous crew whoa this is a sully moment that looked 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 but obviously because it's a medical drama that's not going to be the case ma'am we're going to take good care of you okay let's get a trauma one day i need an ekg of portable chest and full blow panel including coax ordering blood tests in a situation like this is important but the first thing you want to 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 neck veins descended with muffled hearts 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 because 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 co-pilot with deep abdominal blood lack and blood loss heart rate up to 118 bp down to 108 so with a patient who's bleeding from the abdomen has a laceration to the abdomen a low blood pressure with a high pulse could mean that that person's 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 com compensatory mechanism there 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 uh sorry uh as long as it doesn't interfere with patient care i will help in any way i can understood we want to start with the pilots captain starks they'll find them 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 dr 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 like 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 in you smell that someone chewing gum mince candy anything down it's the co-pilot it smells like ethylene glycol antifreeze when the plane crashed maybe a hose snapped our open abdominal wound absorbed it which is why we can't get the blood out to push from it should act as an antidote that's a very advanced situation that a part of the antifreeze of the plane stabbed them 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 ethanol ethylene glycol from the airplane and then it pumped into his stomach and then hurt his bile duct because the liver enzymes were slightly inflamed like oh 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 is 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 they're elevated your liver function tests are saying that there's damage to your liver now what bp falling temps dropping she's septic starter on amp jet and flagella hang a bag of dopamine at two mics a minute how do they not start that already the patient is open wound from a trauma like you should have started them on antibiotics broad spectrum enzymes are six times normal liver is not going to last much longer i need to expose the entire organ you'd need to extend the surgical field across the whole abdomen laparotomy scalpel do you want to call in gastro no there's no time you mind getting your hands dirty of course not but it's been a few years you have a steady hand well yes clear field division yes still like that thai food place on 17th yes then what are you waiting for last i remember she was an oncologist am i wrong she yeah she is why is she operating why is the oncologist operating we've got a problem with shanez 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 uh 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 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 what does that mean dr walsh the aorta could rupture well if it tears it's basically rupturing a lot of times the classic sign is a patient comes in either with very bad chest pain or very bad back pain and sometimes these uh dissecting aortic aneurysms are missed because sometimes doctors unfortunately misdiagnose it as like back pain or some kind of sciatic type pain when the reality is they need to rule out this dissecting uric aneurysm which can be done with an x-ray an ekg or a cheetah scan an ultrasound 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 paid cardio she's not your patient they're all my patients how is she gonna perform a repair an aortic aneurysm repair in the i don't understand advancing 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 this is i'm wrong here i i don't think this is appropriate bp is dropping dissections extending drainage greater than 200. the hell are you doing trying to stop the dissection no you didn't you made it worse i'm trying to fix it not fast enough thanks to you going rogue i got to crack her chest here the way that they were trying to repair it 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 with that 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 yeah that's what i was looking for what is this a federal order i'm kind of proud of myself and i think legal eagle will be proud too that i said a federal judge has to order this and he said it's a federal lawyer smart 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 takeoff if a pilot discovers that his airspeed indicator is giving him an inaccurate reading and he is flying too slow what would that pilot do why is the hospital staff doing this investigation get the nose down you you'd go into the dive in order to gain speed and then you you 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 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 healthy