 What is up, YouTube? Welcome back to my channel. I've decided to jump on the trend of doctors reacting to medical TV dramas. I think Dr. Mike was the first one to do this like way back in 2018, but I've gotten tons of requests to do it. So today we're going over Grey's Anatomy, which as you guys know, I love this show or I used to love this show and watch it in med school. And you may have seen this video right here in which I've talked about that. I haven't seen this show since like 2011 or 2012 or something. So I figured I'd dive right in to season 11, episode 15, and let's get into it. On to some Grey's Anatomy right now. I just went to prep losing agents for a biopsy and it was already done by you at 5 a.m. You're welcome. That's your going to DC. So this actually doesn't happen. Unless they're working together in a group of surgeons, you don't just poach on other people's procedures. So for instance, if Grey saw a patient in clinic and scheduled a biopsy for that patient, Alex Karev would not go swoop in and steal that biopsy from her because it is her patient. And that's just not good. When the earth literally quakes. That's great. Do you remember your list? That's not good. Did you guys see all those CT scans in the background there? We're not moving. Yeah, safety feature. It did this to me after the last earthquake. Last earthquake? They don't happen to all. It's West Coast. I mean, when you ride in elevators, apparently. Apparently. Remind me not to ride in an elevator with you again. Sure, Dr. Pierce, Lord. I guess I could just start taking the stairs. It is Dr. Pierce, right? Yeah. Ethan. Sorry, Ethan. Yeah, homcology, right? Radiology. Sorry. No problem. She's catching feelings for a radiologist. You see that? You get the double take. Obviously I'm super pumped. There's a radiologist in this episode. Someone told me there was some radiology action going on here, but they didn't tell me what it was. So I love seeing a good looking radiologist on camera. It makes me happy. The only thing I don't like is that he's wearing a short white coat, which is something a med student would wear. So that's kind of strange, because usually once you've finished med school and you're a resident or an attending physician, you wear a long white coat. Some people don't know that. Unit Domini 75, Angioplasti patient discharged last week, brought in today with shortness of breath after a fall. You can fix it, right? I'll tell you what, we're gonna get you some films and then we'll go from there, okay? Okay, okay. Films first. You always need radiology. You sound right. Is Sony gonna answer that call? That is, you know, all yours. Great Sloan Emergency. Is this a hospital? I need help. We need to hang up and call 911. I tried, it was busy. My mom's a lot of tears. She's not moving. I don't know what to do. All right, so let's hold off right there. So first off, attending physician will not answer the main line to the emergency department. We usually have receptionists who answer the phone because it is raining off the hook constantly. And I'd imagine if a kid called with this kind of scenario, they would just tell them to call 911 and we wouldn't have spent all this time talking to him. Quiet, please. That's the reason I don't work in the emergency department because things can get heated pretty quickly. And I don't know how people don't lose the cool more often. I prefer a more chill, laid back environment. That's just me. Ruby, I am gonna move to another phone so I can hear you better. Don't hang up. No, no, no, I'm just, I'm just moving to another phone. I'll be right there, okay? Let's screw this up. What? No, no, no, nothing. Don't worry. I'll be right back. Just hang on. I'd be worried about switching phones because I try to transfer phone calls all the time when people call the reading room and I try to transfer it to another station or another department. And I screw up like 95% of the time. So this is not the time you'd wanna screw up. It's fine. These injuries look pretty superficial. Maybe she's gonna hurt. I guess fall. I guess fall. He can't sit in a chair because I- Now, so she has an ultrasound machine on his abdomen which means she's probably looking for fluid. Also called a fast exam or a focused assessment with sonography for trauma test or a fast exam, which is what we do. We just scan the abdomen in a couple of different spots to look for fluid. I'm not really sure why she has the Doppler on as you can hear that whoop, whoop, whoop because she's in like the right upper quadrant liver area. So I don't know what she's doing with that. Well, you have what is called a below the stem femur fracture. Oopsie. Now you have two cracks in the bone. All right. So as you can see, before she even says this, I'm gonna go over the imaging because obviously love imaging. So she has a right hip arthroplasty or a right hip replacement. And what she's saying is the portion that she's pointing to right now is the distal stem of the femoral component of the arthroplasty. And it's very common for those things to shift around and cause a fracture into the adjacent femur. So that's probably what she's going to say here. One here and here. So, how do we get me back in the saddle? So to speak. I would like to completely replace the hardware. Now it's a very big surgery and it does carry risks, but you would come out of it with full flexibility. Okay, but considering your cardiac history, I'm not sure a big surgery is a great idea. I want that surgery. Sounds good. That is a five hour surgery on a 75 year old who has a stent and is on blood thinners. I can't believe you would suggest a surgery like that to a patient without running it by me first. I'm sorry. So I think she's doing a very good job here trying to protect the patient because it's easy to get swayed or convinced that she needs the surgery, even though she's not a good candidate for surgery. So someone with a history of heart disease needs to have a full workup to make sure they can tolerate anesthesia and tolerate the procedure before they go into the operating room. Sir, you called me for my opinion. Look, I do hip replacements all the time on far older patients with far bigger hearts. She is clearly still active. I think her heart's in pretty good shape. That's not your call. So it's important to have conversations with your colleagues. Surgeons always want to operate. Cardiologists always want to make sure the surgeon can operate safely. So it's good to have a good conversation and talk it out before a surgery, which is why most surgeons will consult a cardiologist before the surgery to make sure they can tolerate the surgery. They don't usually get in arguments. They kind of just trust each other's professional opinion. Kepner told me about the little girl. What can I do? What, can I help? We are trying to get an airway. By risk. Ruby, put your head on your mom's chest on the left side and listen. I don't hear anything. What am I listening for? Breathing. Do you hear her breathing? No. All right, so now we're trusting that a child is making a physical exam diagnosis of absent breath sounds, which I mean, he may just not be hearing the breathing because he doesn't have his ear on the chest or he has his ear over a rib. So they're trusting the clinical acumen of this young child with no training that she has absent breath sounds. Okay, it could be attention pneumo. Ruby, now just push the phone into your mom's chest right where you were just listening. Just push the phone in and move it. That's subcutaneous, can you hear that? All right, this is doing it a little crazy here. They're diagnosing attention pneumothorax and subcutaneous emphysema or the crackles you're hearing all over the phone. It's pretty amazing. So if it is a true attention pneumothorax, I hope they don't ask this kid to stick a needle in the chest because I mean, I don't know if he can do that. She's gonna need to. She's gonna need to release the trapped air. There's a chest here, there's something there. It's the only way over here in mom's chest, okay? What do you mean? You're gonna ask that. Ruby? You're gonna ask me to try something. Can we find? See, Dr. Weber has the same concerns I do here. You're gonna ask a young child to put a chest tube in and decompress the air. Not ideal. All right, so now we're in the CT scanner and I love that Alex Karev who is a tending physician, Meredith Gray who is a tending physician and I think the other female is a resident physician but they are all down operating the CT scanner by themselves and this is a very complicated job which is why we have specific CT technologists who do this. I don't even know how to operate the CT scanner so I don't know how these non-radiology folk can do that. Got a straw. Great, now we're gonna need you to get it. I don't wanna ask her to do this. A knife? We're gonna need you to get a knife. Not a big one, but a sharp. You're making s'mores, the skewer's there? Yeah, yeah. Ruby, you can do this, you can. It's gonna help your mom, okay? We just need you to find it. I mean, a lot of physicians don't even like doing this procedure so I can't imagine a young child able to do this. Touch your mom's left collar bone, the one that looks like a wing coming out from her neck. Now, walk your fingers down from it, two steps. You got it? Okay. So you're supposed to go to the mid-clavicular line, second intercostal space above the rib in order to do a decompression so let's see if they can walk them through this. Take that rib. With your other hand right above that finger, push the skewer in about an inch. So you're actually supposed to go on top of the rib because the vascular and the neurovascular bundle lies underneath the ribs. So if you were to insert a skewer underneath the rib, you could nick the intercostal artery and cause a bleed. So go above the rib. Now you don't have to actually go in that far. You can just insert the needle right through the pleura and you can release the air. So I don't know if he, so hopefully he didn't stab all the way through the back, but you never know. Let's take a look. So you can see here, so she has a right hip arthroplasty like we spoke of. And you can see at the very bottom portion of the femoral stem component, there are two fracture lines going through the cortex. Those are the peri hardware fractures that we were talking about. Then you have no idea. Could you please? Also my boy Ethan up here. Yeah, careful or you'll get sick of me. Ooh. So you see all those films hanging up in the background. Nobody uses films anymore. Yep, see that? There, her femoral artery to the stem is cracked. Maybe I could put in a plate to bridge the fracture going from the side. It'd be a little less invasive. And last time in the OR. Oh, a lot less actually. Good, so she could stay on her blood thinner substantially lowering the risk to her heart. I have been taking the stairs blood thinner since this morning, you know, just in case. Oh, I wasn't serious before I was. Oh, no. I'm not actually taking the stairs. Oh, okay. I would like to take you out though sometime, maybe for coffee. Let's go. Gord, the point is I'm flexible. I'm gonna start over. No, no, I'm gonna stop you actually. I'm sorry, then you seem really tall. I'm nice, but I'm just, I'm not, I don't. Sure, that's okay. I understand. All right, so obviously I love that interaction. That's awesome. They have news on Micros table, but I'm afraid it's in serious worse than we thought. His spleen is ruptured and he's lost a lot of blood. He had a cardiac episode in CT and his heart's not beating. Oh God, we're taking him to surgery now. We do have to remove his spleen. So splint and belacerations are actually where interventional radiology can play an important role. We embolize splint and belacerations all the time, especially in the case of trauma like this. The only time you actually take them to the OR is if they are acutely decompensating or coding like this patient from his hyperbolemic shock. Otherwise, if they're stable, you can at least try to give interventional radiology a call and we can try to embolize them. So it looks like the helicopter got the patient and brought him to the hospital. So I used to go up to the helipad all the time when I was volunteering in the emergency department at a level one trauma center. And it was like my favorite part of the job, watching the helicopter come in, going to the helicopter on the helipad, looking over at the entire city and getting the patient down to the OR and getting them to the trauma bay. That was like the most fun thing ever. That was before I went to med school and it was like so pumped. So if you are ever volunteering, make sure you go to the helipad. How is she? Subdural hematoma with a shift. Subdural hematoma with a shift. That is a subdural hematoma with midline shift of the brain into the opposite side, secondary to mass effect from the bleeding clot that's sitting on top of the brain. It's not because he's a radiologist, and it's not just because I don't date people from work. I just, I kind of don't date. Hey, listen, I was just kidding. It better not have anything to do with him being a radiologist. He's still bleeding from the short gastric arteries. I see it. That's what I think. I see it. I get to it from here. How many years did he use? Four years. If everyone would just shut up and give me two freaking seconds, I can get the suture to hold. So these short gastric arteries are small arteries arising from the distal splinic artery and they supply some of the stomach. So if a spleen is injured in trauma or it's lacerated because it jostles back and forth, it can kind of rip off some of those short gastric arteries in the process. All right, so that was a whirlwind show of emotions and drama. And we got through it. And hopefully you guys liked it and hopefully you learned something in the process. We had some good radiology stuff in this episode, which was awesome. If you liked this video and want me to do more, let me know in the comments below. If you want me to do a different show, also let me know. So smash that like and subscribe button, turn on post notifications so you know when I post a new video. Follow me on Instagram if you don't already. Otherwise, I'll see you guys on the next video.