- 6/17/2025
Dr. Italo Brown, a Bay-area emergency department physician, reviews depictions of his profession on popular television series like The Pitt, Pulse, ER, and more.
Director: Jameer Pond
Director of Photography: AJ Young
Editor: Matthew Braunsdorf
Talent: Italo Brown
Producer: Emebeit Beyene
Line Producer: Natasha Soto-Albors
Associate Producer: Zayna Allen
Production Manager: Andressa Pelachi
Production Coordinator: Elizabeth Hymes
Camera Operator: Jon Corum
Audio Engineer: Gray Thomas Sowers
Production Assistant: Lauren Boucher
Post Production Supervisor: Christian Olguin
Post Production Coordinator: Stella Shortino
Supervising Editor: Erica DeLeo
Assistant Editor: Justin Symonds
Director: Jameer Pond
Director of Photography: AJ Young
Editor: Matthew Braunsdorf
Talent: Italo Brown
Producer: Emebeit Beyene
Line Producer: Natasha Soto-Albors
Associate Producer: Zayna Allen
Production Manager: Andressa Pelachi
Production Coordinator: Elizabeth Hymes
Camera Operator: Jon Corum
Audio Engineer: Gray Thomas Sowers
Production Assistant: Lauren Boucher
Post Production Supervisor: Christian Olguin
Post Production Coordinator: Stella Shortino
Supervising Editor: Erica DeLeo
Assistant Editor: Justin Symonds
Category
🛠️
LifestyleTranscript
00:00What's the strangest thing that you found retrieving from somebody?
00:04Some things that I've found are like flashlight handles, bowling pin tops, palm bottles, like pomegranate juice bottles, fist dildos, screwdriver handles, toothbrushes, whatever is available.
00:18I mean, I feel like it's been retrieved before.
00:20Hi, I'm Dr. Italo Brown, emergency physician in the Bay Area, California.
00:24Today we're going to look at some television shows that explore life in the emergency department.
00:29First, we're going to take a look at Holes.
00:31In this scene, you'll see an obstetric emergency.
00:34What's your name?
00:35Mariana.
00:35Uh-huh.
00:36Oh, I thought I just had to poop.
00:39Oh, this can't be helped.
00:40Sorry, but it actually, it is.
00:42First, she's nasty because she didn't even wash her hands.
00:46This is a fact.
00:46I think that for two reasons.
00:48One, every time when we're in the emergency department, we're using sterile gloves off the bat.
00:52And I know that she's not in the ideal place to get sterile gloves, but most of the time, the first thing you do is yell, help.
00:57And someone will come rushing, and you can tell them what you need.
01:01But her going straight, raw hand into this actually makes the situation worse for the child.
01:06It increases the risk of infection.
01:08She could get chorioamnionitis.
01:09In fact, most of the time, you're giving antibiotics preemptively before delivery.
01:14This just, to me, is all bad.
01:16The term they use is a precipitous delivery.
01:19This is a delivery that is happening in a fashion that's, like, unexpected.
01:22So, whenever you see scenes of someone, like, driving straight up to the emergency department and a pregnant woman coming out of the car and she's in labor actively, that's a precipitous delivery.
01:33As opposed to ones that are planned or C-sections that are planned or inductions that are planned, this is, like, worst-case scenario.
01:39We are going to have to do this here.
01:41Okay?
01:42Can't you just get my doctor?
01:44We're in the middle of a hurricane.
01:46Labor and delivery slammed.
01:47So, right now, I am your doctor.
01:49Can't you do this on your own?
01:51I think that the patient is raising some valid concerns right here, okay?
01:55Most of the time, pregnant women are working with, like, the same obstetrician, same team, midwife, sometimes doulas.
02:04And that relationship is what gives them comfort and trust in the process.
02:08And so, I understand that she's, like, completely taken off guard by the fact that this is a stranger about to deliver her baby.
02:15There's something wrong, isn't there?
02:16All right.
02:17Your baby's shoulder is stuck behind your pubic bone, okay?
02:20You're going to hate this, but I'm going to have to just push really hard just for a second.
02:24Are you short?
02:25Look at me.
02:26Hey, look at me.
02:27I know that you're scared.
02:29I'm not.
02:30So, trust me.
02:31One of the complications of delivery is shoulder dystocia.
02:35That's when a child's or the infant's shoulder is stuck on the pubic bone or the pelvis.
02:41And there are certain maneuvers that you can do to try to relieve that pressure.
02:45One is McRoberts' maneuver.
02:47This is, like, hyperflexion of the legs, pulling them back or pushing them back as far as they can go to try to change that entry angle.
02:53And what you see her do is try to shift the child a little bit by putting pressure on top of the pelvis area.
03:00All of this, to me, is appropriate, and it helps her relieve that jam for a second, and the baby can come out a little bit more fluidly.
03:08Also, you know, once the baby's delivered, you need to immediately warm the baby.
03:12This baby's just, like, sitting there, and I'm like, hey, this ain't working.
03:14You gotta, you know, stimulate the child, get those Apgar scores, and then warm the baby right off the bat.
03:21And so that, to me, is not super—like, on a cold floor, fam, that's not it.
03:25I'm sorry.
03:26That's just not—it's not it.
03:27Next, we're gonna watch a scene from The Pit.
03:29Your partner's in bad shape.
03:31What's his name?
03:31Rich.
03:32Rich Stefano.
03:33Hey, Rich.
03:33How you doing?
03:34What you see here is a gentleman who was shot essentially through the neck and then out of the side of the lower face.
03:40These are important zones of the neck, right?
03:42And when we talk about trauma assessments, zone 2 is where a lot of structures exist.
03:48All of the arteries—the vasculature, rather—and some vital organs, as well as the airway is all in zone 2.
03:56Now, that pathway of the bullet looks like it exits out of zone 3, which is the upper portion of the neck and the lower portion of the face.
04:04So, mostly, like, dentition, the mandibles, possibly the tongue.
04:08What I really am worried about here is how soon until all of that trauma causes swelling inside of the mouth and then the airway becomes a concern.
04:15And then there's the possibility of actual blood being in the airway and obstructing the view, making it difficult for him to breathe, making it difficult for someone else to take control of that airway as well.
04:26The first thing you want to do is put a sea collar on this guy.
04:29You want as much stabilization as you can, given that you don't know what the anatomy actually is, right?
04:34That bullet could have ricocheted, could have hit something else, and then you could end up having a spine, like a cervical spine injury.
04:40Just because you see the exit here doesn't mean that it didn't hit more posteriorly.
04:44And then immediately start to prep my airway stuff, because you know that this is going to be a traumatic situation and possibly a surgical airway.
04:51I want that killer to the right a little bit.
04:53Any better?
04:53Not really.
04:54Anytime there is a law enforcement officer injured in any capacity, there's usually more officers that, by protocol, have to come to the hospital in general.
05:03And so this is very accurate in terms of the presence that you see.
05:07And even in some mass casualty events, what you'll see is more personnel present floating through the ED.
05:13So, again, the visual of this is on target, highly accurate.
05:17You're doing a crack?
05:18Yep.
05:19No skin hooks, no bougie.
05:20Old school.
05:22Got a tactical airway in my bag here.
05:24What is that?
05:25It's a control crate kit.
05:26Oh, that's perfect.
05:27You're on the battlefield.
05:29Works in the pitch dark when you're under fire.
05:31I can do these with my eyes closed.
05:32I think that most ER physicians have a little set of things that they prefer to use.
05:40Sometimes they have their own kits, which might have different materials than actually available in the hospital that they work at.
05:46Because keep in mind, like, not everybody is at an institution that is a research center or that has access to a bunch of funds.
05:52So you might end up having to come with your own stuff.
05:55Things that might be in these kits might be your own shears.
05:59As this guy has, he's got a tactical airway kit.
06:02So that control crate is like a product that's designed to make surgical airways a little bit faster.
06:08And it helps you in terms of the anatomy.
06:10If you have something to help you find the airway, this small aperture, and you can place that rod inside of that small aperture, it gives you a better chance of getting the tube in the right location in as little time as possible.
06:24In real life, this dude would be bleeding like crazy.
06:27It would be blood all over.
06:29It's not just like this clean procedure.
06:32Often doing this, you'll see, like, significant amounts of blood.
06:37You're puncturing through somebody in a space that there's other structures that are deep to the incision site.
06:43But what's really cool about how he's doing it is this is like an all-in-one tool.
06:48And so the moment the incisions are made, he can basically drop in this introducer, and then it automatically has everything attached to it so you can start to ventilate right away.
06:58Next, we're going to take a look at this scene from Grey's Anatomy, where they discover a foreign object in one of the most unlikely places.
07:05We're going to make an opening in the sigmoid colon.
07:09Something feels hard.
07:11There's a small bleeder here.
07:12Stop. Wait.
07:13Okay.
07:13I got it.
07:14Let me get a clamp.
07:17Run, back away!
07:23I don't know the fascination, but a lot of people would try different.
07:28Objects for a variety of different reasons, but when those objects can't be retrieved manually, they end up in the operating room.
07:35And this, unfortunately, is, like, one of those situations where if you don't have great line of sight to what the object is, it can definitely become a catastrophe.
07:43So I feel bad for the fact that there's, like, lit on fire and shot around like a shooting star, but at the same time, you've got to follow instructions, man.
07:51You can't go rogue.
07:52He told you to chill, and he didn't.
07:54Let's get some laughter.
07:56What the hell happened?
07:57The aerosol hairspray, not shampoo, and it exploded.
08:01Is he all right?
08:02Yeah.
08:02Yeah, yeah, yeah, I'm okay.
08:03More laughs.
08:05Hurry.
08:05A part of it is driven by the stigma where, you know, folks who are exploring feel a little ashamed, and so they do this in the privacy of their homes.
08:15They do this in certain circumstances where it may not be fully safe, or they use objects without proper understanding of what it looks like to retrieve those objects.
08:24You've got to get this bleeding under control.
08:26Get me two units of blood.
08:29I need two vascular clamps.
08:30I need two vascular clamps.
08:31Talk to me, Roy.
08:32Roy.
08:33He exploded.
08:34Not until after I told you to back away, and you didn't.
08:37Get him out of here.
08:38Coming into the emergency department, one, that by itself is like a last-ditch effort for many individuals.
08:43They've tried everything at home, so you can imagine them coming in like, hey, this is an actual emergency.
08:48And sometimes they won't even tell you off the bat.
08:51You have to discover this from an x-ray or from some type of imaging studies.
08:55The desire for a prostate massage is absolutely normal.
08:59And if you have a simple conversation with your wife and explain to her your desire...
09:03Please stop.
09:04Not until you tell me what you put in there.
09:06My wife's hair stuff.
09:10Super common.
09:12Most people have a story of what they've retrieved.
09:14Some things that I've found are like flashlight handles, bowling pin tops, palm bottles, like pomegranate juice bottles, fist dildos, screwdriver handles, toothbrushes, whatever is available.
09:29I mean, I feel like it's been retrieved before.
09:31All right, let's bring in the power.
09:32Hurry.
09:33Come on.
09:36There's a lot going on in this scene.
09:39But did you see how no one was actually squeezing the ambu bag?
09:43Nobody, like that's movie magic.
09:48So this person has lost pulses and they're effectively trying to regain these pulses by doing compressions.
09:54But then they notice what I'm assuming they think is an arrhythmia.
09:57And the way to get this handled is by shocking or introducing electricity.
10:02They introduce electricity, but in between the shocks, no one is actually doing compressions or oxygenating the patient.
10:08And these are like vital steps in almost any resuscitation.
10:11Let's take a second to actually go through it the right way.
10:14You're going to take your hand and then another hand and almost interlace those fingers.
10:19Place it directly in the center of the chest to where you feel comfortable.
10:23Apply direct pressure down about two inches.
10:26And then you want to go at a rate of about 100 beats per minute.
10:28Some people find that singing the words to Staying Alive, Break My Soul by Beyoncé, or Not Like Us by Kendrick Lamar help to maintain the rhythm.
10:37It looks like this.
10:41If you're not breaking ribs on the first push, you're really not doing CPR right.
10:46It should be a very deep push on the first one.
10:49Break straight through the ribs and then keep going.
10:52Let's take a look at the scene from Lioness.
10:57Here you're going to see a needle decompression.
10:59Okay, I got it.
11:03Needle goes in second intercostal space.
11:08In this scene, she essentially took a round to it looks like the lower abdomen, like right side lower abdomen.
11:15It probably struck her liver and in the process probably nicked a lower portion of the lung.
11:21And that's why she's got this pneumothorax.
11:23What she's trying to do is instruct him on the proper placement to put what is actually not a full needle decompression.
11:31This is more like a pigtail almost, but essentially to create an area where air can be released and relieve the pressure that's building up inside of her chest.
11:42The location, she says, is absolutely on point.
11:46Usually it's second intercostal space, mid-clavicular line.
11:49So the middle of the clavicle, go down two ribs, and you want to push in that rib space just beneath it.
11:54And she's also right in saying that that area has a lot of tissue, like a lot of cartilage.
11:58And so you have to use a little bit of force, which I think he's about to do.
12:02The cartilage is thick.
12:04You're going to have to press really hard and straight down.
12:08You ready?
12:15There's a part that was missed there, but essentially once they placed it in, you're going to slide that plastic part all the way down and then remove the introducer.
12:24So you're seeing like a dilator and the actual tube at the same time, which is why it looked like it was a little longer.
12:31Once they got it in, throw the tube all the way down.
12:33And now she's got this device that's going to help her effectively relieve the pressure that's building up in her chest or her mediastine.
12:42You're doing great.
12:43That little whiz, that gush of air that you hear is kind of the one telltale sign that you've now entered the right space.
12:55So we're always looking for that wish of air.
12:57He got it on the first shot.
12:59First of all, we've got to acknowledge that folks who are in fields where there's combat, their temporizing measures and knowledge of these things are usually higher than the general public.
13:10That's the first thing that they got right is knowing what needed to happen right then and there.
13:14The second thing they got right is, as I said, the location.
13:16It wasn't like haphazard.
13:18She actually like lines up the shot.
13:20He nails it on the first time and you get all of the signs of the fact that the lung is starting to reinflate in this one shot.
13:28And her relief is a sign of that, right?
13:30The third thing I think that they got right, which I really love, is absolutely talking through why she needed it right now.
13:36You see her talk about her blood pressure changing, her heart rate is a little lower than normal, and so this is going towards the critical zone.
13:44Like, she is decompensating.
13:46And the accurate thing to do whenever this happens is this particular procedure.
13:50So I just think that, like, the medicine is right, the indication is right, the actual procedure itself is correct, and the circumstance is probably highly, highly accurate.
13:59All the ER shows, y'all need to take note.
14:01Now we're going to take a look at a scene from the classic ER.
14:05I'm just going to give it up.
14:08Coming up on two minutes.
14:09What about a needle crike?
14:11Not yet.
14:17What are you doing?
14:18I'm going in.
14:19I said not yet.
14:20Yeah, this is kind of bad form.
14:23When you think about patient management, often there's ownership over the patient, and so whoever is either at the head or the foot of the bed is typically running that resuscitation.
14:32For him to just, like, walk from one into another and then start doing something is, like, it's bad form.
14:37It's, like, a subtle violation.
14:39I understand what his goal was because he could see that he was struggling to get the airway.
14:44Like, George Clooney's character wasn't effectively intubating the patient, and so he was going to do something in a different location.
14:50But it really isn't his judgment call at that time to do it, and I think that that's kind of indicative of microaggressions in hospitals all the time.
14:58Intubation itself is still a procedure with considerable risk, right?
15:02You never know what a person's, like, anatomy of their mouth looks like.
15:06Some people have big tongues.
15:07Some people have short necks.
15:09Like, all of these different features make getting that airway on the first pass difficult.
15:14And with every successive pass, it becomes less and less likely that you're going to be able to effectively oxygenate somebody or give them oxygen.
15:23It's not an easy procedure to do.
15:25And honestly, a lot of the television shows make it seem like it's a one-shot entity, and a lot of times it takes multiple passes.
15:33Oh, two sets up to 95.
15:38All right, start them on 750 milligrams, septriaxone, IVQ12.
15:45Ultimately, the patient comes first.
15:48And so I, you know, you can handle this beef outside of the ER, but at this moment, I think the decision to use the surgical airway to do a needle crack is the right decision.
15:59I think as a society, we're indoctrinated to this belief that he or she who wears the white coat is the doctor and makes the rules.
16:07And that is starting to shift significantly, right?
16:10Like, in most of the emergency departments that I've worked in, people don't wear white coats.
16:15One, because it can cause a reaction for the patients.
16:18Like, sometimes white coat syndrome happens where their vital signs are irregular simply because of the experience of being in front of a doctor in that trauma.
16:25And then in some situations, it actually is unsanitary.
16:28You can carry germs in this, with this white coat from one patient to another patient.
16:33And imagine if one is like critically ill, now you've introduced something into another space simply because of the garment that you're wearing.
16:40I honestly don't think that this is the current school of thought.
16:44In fact, most people who wear white coats are doing this because it's to establish the role of a provider from other individuals in the department.
16:53Here's another scene from Pulse that looks at a hand amputation.
16:56I do want to know your name though, okay?
16:59And here's why.
16:59Look at me, look at me.
17:01I need to know your name because I'm responsible for you, okay?
17:03I'm going to bother people about you.
17:05I'm going to worry about you.
17:07Just so you're aware, what he's doing is distracting him because obviously the kid is like borderline panicking out,
17:13thinking about the loss of a limb while still doing the rest of the primary and secondary surveys.
17:18These are like the bread and butter components of a trauma evaluation to find out if there are any other injuries.
17:24The obvious injury is this one.
17:26You're trying to find the one that's not so obvious.
17:28My hand.
17:30Hey.
17:30Hey.
17:30My hand.
17:31They're looking for it, all right?
17:33And I'm not going to let them stop, I promise.
17:34Okay.
17:36I think the thing we have to kind of center here is that amputations like this, when they occur, in those twofold.
17:43One is you're actually trying to save the patient's life, thinking of how do I stop this bleed?
17:47Is it hemorrhaging?
17:48Is it properly tourniquated so that you can stop the blood supply and the person doesn't go into hemorrhagic shock?
17:54Then there's the extremity, right?
17:56So he lost his left hand, it looks like, and you want to be able to find that and assess the condition of the hand.
18:03If the hand is mangled, the chances of it being reattached is low.
18:06But if it's still preserved and intact, good condition, and under a certain amount of time, like 18 hours,
18:12you could put that hand inside of like some gauze that are damp into a bag that is sealed,
18:18and then put that into another container with some ice.
18:21The main thing is don't let the extremity touch the ice.
18:25It could cause deconditioning of the hand itself.
18:27It can lead to the actual cells themselves can be destroyed because of the ice that's there, the temperature change.
18:34That extremity can get what's like a form of frostbite, essentially,
18:37because you're transporting it and can't really temperature regulate.
18:40So I think that when they say this, the goal is really to keep the limb preserved for as long as you can,
18:46but try to shorten that time between identifying the extremity and then reattaching.
18:52Now we're going to take a look at a scene from 9-1-1 where the driver is impaled by a piece of steel.
18:57Airwaves sound good?
18:59What's your pain level?
19:00Not much pain.
19:03I don't think there's any spinal damage.
19:05I can feel my legs, but when I try and move my hand...
19:08No, no!
19:08Just be still.
19:10What's going on?
19:11Why don't you guys like cutting me out of here?
19:13It's complicated.
19:14Major shout-out to our first responders, right?
19:17Like, first responders go to scenes like this,
19:20and they usually see the most graphic images before the physicians or any care provider sees it.
19:25Something that they got right here is that moment where he tried to move and they told him not to move.
19:29Most people think about it because, oh, it's like this thing that's impaled in his forehead,
19:33but really it's, there are other injuries that could have happened from this accident,
19:37and you want to make him as stable as possible.
19:39Then there's the fact that this projectile that's now embedded in his head,
19:44it could shift even millimeters, and that could lead to an entire different outcome.
19:49He's relatively stable as you're talking to him, but you don't know how quickly that's going to change.
19:53So making sure that he didn't move is absolutely the right thing to do.
19:56Reality of this is people do survive different, weird kind of mechanism injuries all the time.
20:03There's neurosurgical miracles that happen,
20:05but I'd be worried about him even making it from here to the hospital.
20:09My first thing would be how quickly can we extract him as safely as possible.
20:13That's going to require stabilization of both the rebar, his head, his neck,
20:19and then effectively trying to transport him with very little movement from the site to the hospital.
20:25I'm surprised they didn't airlift him.
20:27Like, that would have been the first thing I would do.
20:29They literally just put the car on a tow truck and then towed the car.
20:33Now, I get it, but at the same time, it's like, to me,
20:36that seems like the worst possible way to take the person to the hospital.
20:40Now, here's a scene from Scrubs.
20:4115% of all surgical complications are anesthesia-related,
20:45so I would like to use hypnosis instead of the traditional anesthesia.
20:48With all due respect, I don't think hypnosis is an adequate way
20:53to sedate somebody for a full procedure.
20:56There's other elements that you can't control,
20:59and no matter how deep you can get someone into their subconscious, pain is pain.
21:02I'm sure someone has tried hypnosis for a variety of different things
21:06that are probably not as invasive.
21:08I can imagine hypnosis for, like, maybe a dislocated shoulder
21:12or doing some other minor surgical things,
21:15such as, like, suturing or even passing in certain types of tubes,
21:19but I don't think that this will work for, like, an appendectomy.
21:22Come on.
21:25What are you saying to it?
21:26You can do this.
21:27You can do this.
21:29Small world.
21:30Scalpel.
21:30Every procedure doesn't require deep sedation.
21:33There's different types.
21:34You can do moderate sedation where a person is in, for example,
21:39like a state of euphoria or slightly disoriented to do a quick procedure.
21:44We use, like, ketamine for a lot of these different things.
21:47Sometimes you can do local anesthesia, like give a nerve block
21:50and block that area and provide adequate analgesia
21:54so that the person doesn't feel the pain in that particular region
21:57because you did something smart.
21:59Women, when they give, you know, when they're giving birth,
22:02often don't need to be knocked out, right?
22:04They get epidurals, which gives them adequate anesthesia
22:08for that particular part.
22:10So, yeah, there's a variety of different things that can be done
22:13if a person doesn't want to be completely induced or sedated.
22:16But something like an appendectomy, I just can't see.
22:19I can't see without, like, good control of their airway
22:22and making sure that they are pain-free
22:24because, again, things go south very quickly.
22:26You can do this.
22:29Obi-Nobi.
22:31Well, it's clear that over time,
22:35as these types of medical dramas have become more popular,
22:39they've gotten better at the medicine.
22:41The procedures have gotten more accurate.
22:43The circumstances and dynamics are more realistic.
22:46And that's really rewarding as an ER physician to see.
22:49I mean, I feel seen by watching some of the newer shows.
22:52And also, we've got a generation of people
22:54who are consistently getting interest in this particular field
22:58because of shows like this.
22:59So I just take my hat off and salute them
23:01for continuously approaching this
23:03with a high degree of reality
23:06and also making sure that they honor the providers
23:08who do this for real.
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