1 00:00:05,840 --> 00:00:08,407 Like any good detective, ER doctors 2 00:00:08,409 --> 00:00:10,976 need to follow the evidence. 3 00:00:15,850 --> 00:00:17,916 RUBY ROSE: Whether it's mysterious fragments 4 00:00:17,918 --> 00:00:19,752 embedded in a wound. 5 00:00:19,754 --> 00:00:21,620 I want to be like Nancy Drew. 6 00:00:21,688 --> 00:00:23,555 Figure out what these are. 7 00:00:23,557 --> 00:00:27,126 RUBY ROSE: A knee ravaged by an incurable disease. 8 00:00:30,731 --> 00:00:33,399 Or an injury that seems to defy logic. 9 00:00:38,939 --> 00:00:40,372 When we have questions-- 10 00:00:45,046 --> 00:00:46,445 Your answers-- 11 00:00:49,950 --> 00:00:52,117 RUBY ROSE: --just might save you-- 12 00:00:54,822 --> 00:00:56,422 --From an absolute nightmare. 13 00:00:57,858 --> 00:01:02,094 [music playing] 14 00:01:06,367 --> 00:01:10,369 First impressions in the ER can be deceiving, 15 00:01:10,437 --> 00:01:13,705 whether it's someone who looks perfectly fine that's dealing 16 00:01:13,707 --> 00:01:16,842 with a potentially life-threatening problem 17 00:01:16,877 --> 00:01:19,344 or new information that sends us back to the drawing 18 00:01:19,413 --> 00:01:21,914 board for a treatment plan. 19 00:01:21,949 --> 00:01:25,050 That's why we ask so many questions about your ailment 20 00:01:25,052 --> 00:01:28,921 and medical history, so we can get to the root of the problem 21 00:01:28,989 --> 00:01:30,155 faster. 22 00:01:31,659 --> 00:01:33,792 So let's talk about toys. 23 00:01:33,828 --> 00:01:36,361 Today's toys are so freaking cute. 24 00:01:36,430 --> 00:01:38,397 You just want to eat them up. 25 00:01:38,666 --> 00:01:42,835 And for four-year-old Mavis at our Killeen facility, 26 00:01:42,903 --> 00:01:45,137 that's exactly what she did. 27 00:01:46,507 --> 00:01:48,373 And I need to get the scoop. 28 00:02:48,702 --> 00:02:52,004 RUBY ROSE: Researchers have found that over the last 20 29 00:02:52,006 --> 00:02:57,409 years, foreign body ingestion in children have actually doubled. 30 00:02:57,411 --> 00:03:00,145 Most of these objects are harmless. 31 00:03:00,214 --> 00:03:03,782 80% of them will just pass right through you. 32 00:03:03,784 --> 00:03:05,951 But there are some things that kids swallow 33 00:03:06,019 --> 00:03:08,620 that can be really dangerous. 34 00:03:08,689 --> 00:03:10,522 Button batteries, for instance. 35 00:03:10,591 --> 00:03:13,025 You know, the ones that are shaped like a coin? 36 00:03:13,093 --> 00:03:16,828 If they get stuck inside, they can burn through tissue in just 37 00:03:16,864 --> 00:03:19,765 two hours, which can be fatal. 38 00:03:19,800 --> 00:03:22,734 If a child swallows more than one magnet, 39 00:03:22,803 --> 00:03:27,606 they can cause serious damage to the stomach and intestines. 40 00:03:27,674 --> 00:03:31,743 Basically, the magnetism pulls them together inside you, 41 00:03:31,812 --> 00:03:33,645 messing with blood flow and possibly 42 00:03:33,681 --> 00:03:35,647 creating puncture wounds. 43 00:03:35,683 --> 00:03:38,483 So knowing exactly what your kid just swallowed 44 00:03:38,485 --> 00:03:41,220 is important for us at the ER. 45 00:03:50,931 --> 00:03:53,365 RUBY ROSE: I'm happy Mavis is moving and talking 46 00:03:53,467 --> 00:03:54,933 and breathing so well. 47 00:03:55,002 --> 00:03:57,536 If she did swallow something, it's not 48 00:03:57,538 --> 00:03:59,104 currently causing a problem. 49 00:03:59,106 --> 00:04:01,640 But you cannot be too careful when it comes to a potential 50 00:04:01,675 --> 00:04:03,742 obstruction of the airway. 51 00:04:03,744 --> 00:04:06,178 I have to find out if there's something in there. 52 00:05:03,637 --> 00:05:05,771 So for Mavis, I want to make sure 53 00:05:05,839 --> 00:05:09,141 that the foreign body isn't in her trachea or windpipe. 54 00:05:12,813 --> 00:05:15,280 My first step is to put in an X-ray. 55 00:05:15,349 --> 00:05:17,749 If the toy is radio opaque, we'll see it on the X-ray. 56 00:05:17,785 --> 00:05:20,585 You can't judge a book by its cover, 57 00:05:20,587 --> 00:05:24,356 know where a swallowed doll went without an X-ray, 58 00:05:24,424 --> 00:05:27,025 and you can't judge a wound by its size. 59 00:05:28,929 --> 00:05:33,865 At our South Austin location, 32-year-old Bailey sustained 60 00:05:33,934 --> 00:05:36,802 what looks like a small injury. 61 00:05:36,804 --> 00:05:39,938 It's only about a quarter of an inch, 62 00:05:39,973 --> 00:05:41,740 but it's hiding a mystery. 63 00:05:41,808 --> 00:05:45,477 Dr. Steven Elsbecker is already extracting 64 00:05:45,545 --> 00:05:49,047 a bit of unidentified debris that was lodged inside. 65 00:05:49,116 --> 00:05:53,085 And now, the question becomes, what other secrets 66 00:05:53,087 --> 00:05:54,886 could this wound be hiding? 67 00:05:54,888 --> 00:05:58,957 [music playing] 68 00:06:37,431 --> 00:06:39,698 So basically the spring came loose, 69 00:06:39,733 --> 00:06:42,567 snapped back, and hit her in the leg. 70 00:06:42,636 --> 00:06:45,470 There was some debris in the wound itself. 71 00:06:45,539 --> 00:06:46,772 And the injury happened so quickly 72 00:06:46,807 --> 00:06:49,775 that she's not quite sure where it came from 73 00:06:49,777 --> 00:06:51,610 or whether it was from the environment 74 00:06:51,678 --> 00:06:53,845 or a piece of her own bone. 75 00:06:53,881 --> 00:06:55,680 So there's already a little mystery building up with what 76 00:06:55,682 --> 00:06:57,416 that debris might have been. 77 00:06:59,553 --> 00:07:02,854 RUBY ROSE: Behind every ER doctor is a true detective. 78 00:07:02,923 --> 00:07:05,957 And when Dr. Elsbecker is not tearing up 79 00:07:05,992 --> 00:07:08,794 the streets of Austin on his beloved road bike, 80 00:07:08,796 --> 00:07:10,495 he's glad to put his Sherlock Holmes 81 00:07:10,564 --> 00:07:13,899 hat on in the name of medicine. 82 00:07:13,967 --> 00:07:17,035 You see, when a good mystery hits the ER, everyone has 83 00:07:17,037 --> 00:07:21,873 an opinion, including the Watson in this case, Townesend, 84 00:07:21,909 --> 00:07:23,842 the radiology technologist. 85 00:07:23,910 --> 00:07:28,547 Inspecting the wound, we pulled some fragments which, 86 00:07:28,582 --> 00:07:30,782 to me, I thought it was bone. 87 00:07:30,851 --> 00:07:33,618 But the person most interested in what came out of Bailey's 88 00:07:33,654 --> 00:07:37,022 leg is, well, Bailey. 89 00:07:42,830 --> 00:07:46,064 RUBY ROSE: While Doctor Elsbecker isn't exactly 90 00:07:46,132 --> 00:07:49,401 sure what the foreign body is, he does 91 00:07:49,403 --> 00:07:51,369 have an idea what it isn't. 92 00:07:59,780 --> 00:08:02,681 So it seems like that spring carried something 93 00:08:02,683 --> 00:08:04,883 into the wound, and then a little bit of a mystery 94 00:08:04,951 --> 00:08:07,285 as far as what that is and how the heck that spring 95 00:08:07,287 --> 00:08:09,187 carried it into your leg. 96 00:08:10,891 --> 00:08:13,758 So even if that is just debris from the outside environment, 97 00:08:13,827 --> 00:08:15,827 that was forceful enough to cause the wound 98 00:08:15,896 --> 00:08:17,762 and embed the debris in her skin. 99 00:08:17,831 --> 00:08:19,965 So we're going to get an X-ray. 100 00:08:19,967 --> 00:08:22,000 That X-ray might show extra debris 101 00:08:22,068 --> 00:08:23,935 and if there is, where it is. 102 00:08:32,079 --> 00:08:33,445 All right. 103 00:08:33,513 --> 00:08:35,413 Let's take a look at that leg. 104 00:08:35,849 --> 00:08:37,582 The worst case scenario if we don't do our due diligence 105 00:08:37,651 --> 00:08:41,553 and leave something behind is it could get really infected. 106 00:08:41,555 --> 00:08:44,256 If that were the case, she could require additional treatment 107 00:08:44,258 --> 00:08:46,491 in the ER or an operative intervention 108 00:08:46,493 --> 00:08:48,293 to remove whatever was left behind. 109 00:08:54,701 --> 00:08:57,502 RUBY ROSE: Ultimately, when a patient has a concern, 110 00:08:57,504 --> 00:09:00,038 we have to take it seriously. 111 00:09:07,481 --> 00:09:11,449 At SignatureCare Emergency Center in Austin, Texas, 112 00:09:11,518 --> 00:09:15,320 our resident Sherlock Holmes, Dr. Steven Elsbecker 113 00:09:15,389 --> 00:09:18,690 has pulled some mystery shards out of Bailey's leg, 114 00:09:18,692 --> 00:09:19,925 and there could be more. 115 00:09:19,993 --> 00:09:21,693 The X-ray might show us where that 116 00:09:21,695 --> 00:09:23,862 debris or those extra bits are. 117 00:09:23,864 --> 00:09:27,866 So Dr. Elsbecker ordered an X-ray to see if there are more 118 00:09:27,934 --> 00:09:30,735 unidentified objects or even bone 119 00:09:30,804 --> 00:09:32,771 fragments that broke off when her 120 00:09:32,839 --> 00:09:34,339 leg was hit by an attic door. 121 00:09:35,842 --> 00:09:37,876 And the results are in. 122 00:09:37,944 --> 00:09:40,779 So you have tibia, the fibula. 123 00:09:40,781 --> 00:09:43,949 The impact was mid-shaft. 124 00:09:43,951 --> 00:09:46,418 And so what we're looking for is possible fracture, 125 00:09:46,420 --> 00:09:47,986 possible foreign body. 126 00:09:48,989 --> 00:09:50,822 From the looks of it, it looks clear. 127 00:09:50,824 --> 00:09:52,691 The bone looks fine. 128 00:09:52,759 --> 00:09:56,795 RUBY ROSE: With no more debris found in the wound, 129 00:09:56,797 --> 00:10:00,365 Dr. Elsbecker is now confident he can repair the injury 130 00:10:00,467 --> 00:10:02,167 without complications. 131 00:10:23,724 --> 00:10:24,990 There's a little pinch and a little burn 132 00:10:24,992 --> 00:10:26,558 with this medication, OK? - OK. 133 00:10:26,626 --> 00:10:28,960 Just do your best not to kick me in the face. 134 00:10:29,896 --> 00:10:33,965 After the wound is cleaned, the last step is closure. 135 00:10:41,908 --> 00:10:44,009 RUBY ROSE: We've seen some pretty 136 00:10:44,077 --> 00:10:45,577 wicked lacerations in the ER. 137 00:10:45,612 --> 00:10:46,945 Woo. 138 00:10:46,947 --> 00:10:48,713 RUBY ROSE: Some patients are intrigued 139 00:10:48,782 --> 00:10:50,882 by seeing inside their body. 140 00:10:50,950 --> 00:10:53,752 Others refuse to even look. 141 00:10:53,820 --> 00:10:56,788 And sometimes just a small glance 142 00:10:56,823 --> 00:11:01,192 at that 1/4-inch cut makes the patient almost pass out. 143 00:11:23,917 --> 00:11:26,451 RUBY ROSE: It's not unusual for a patient to get 144 00:11:26,486 --> 00:11:27,986 dizzy during a procedure. 145 00:11:28,054 --> 00:11:32,057 The cause can be something as simple as low blood sugar. 146 00:11:33,727 --> 00:11:35,694 RUBY ROSE: We give patients juice 147 00:11:35,762 --> 00:11:37,896 because it has simple sugars that are absorbed quickly 148 00:11:37,931 --> 00:11:39,998 to bring their blood sugar up. 149 00:12:07,260 --> 00:12:10,528 So what was in the wound is still a little bit unclear. 150 00:12:10,597 --> 00:12:12,897 But any time something with that velocity hits the bone, 151 00:12:12,899 --> 00:12:15,033 it can cause a bony injury, whether it's 152 00:12:15,035 --> 00:12:17,469 a fracture, a chip off the bone, or a contusion 153 00:12:17,471 --> 00:12:18,970 to the bone itself. 154 00:12:22,042 --> 00:12:24,709 The good news is that she's on the path to healing. 155 00:12:24,778 --> 00:12:29,047 [music playing] 156 00:12:31,985 --> 00:12:34,285 Back at our location in Killeen, 157 00:12:34,354 --> 00:12:38,690 our little doll swallower, Mavis, is getting chest X-rays. 158 00:12:38,692 --> 00:12:43,094 Despite the fact that she's not showing any real symptoms-- 159 00:12:44,698 --> 00:12:48,466 --We still need to be careful that the doll was not aspirated 160 00:12:48,535 --> 00:12:50,368 or sucked down the windpipe. 161 00:12:50,370 --> 00:12:52,737 And if it's stuck in her esophagus, you know, 162 00:12:52,806 --> 00:12:57,242 the food tube, a toy can create tears in the tissue. 163 00:13:18,765 --> 00:13:21,132 RUBY ROSE: For my next test, I need to evaluate 164 00:13:21,167 --> 00:13:22,767 Mavis' swallow function. 165 00:13:22,769 --> 00:13:26,137 And this candy seems like the best way in. 166 00:13:51,698 --> 00:13:53,898 RUBY ROSE: I didn't see anything that 167 00:13:53,933 --> 00:13:56,634 looked like a doll-sized foreign object in the X-ray, 168 00:13:56,703 --> 00:13:59,571 but one of our radiologists needs to weigh in. 169 00:13:59,639 --> 00:14:03,007 Radiologists specialize in diagnosing ailments 170 00:14:03,076 --> 00:14:06,177 with medical imaging technology, like X-rays 171 00:14:06,179 --> 00:14:07,912 MRIs, and ultrasounds. 172 00:14:07,948 --> 00:14:10,381 They are specifically trained to interpret 173 00:14:10,450 --> 00:14:14,085 those diagnostic images down to the pixel. 174 00:14:14,153 --> 00:14:16,888 They will recommend treatment options and additional tests, 175 00:14:16,956 --> 00:14:21,125 and sometimes they see what we don't. 176 00:15:28,962 --> 00:15:30,795 I wish I could send all my patients 177 00:15:30,830 --> 00:15:33,564 home skipping like Mavis. 178 00:15:33,633 --> 00:15:37,101 But sometimes, even walking can be a challenge. 179 00:15:37,103 --> 00:15:40,772 The average person walks about 110,000 180 00:15:40,774 --> 00:15:42,840 miles in their lifetime. 181 00:15:42,842 --> 00:15:46,010 That's like circling the Earth four times. 182 00:15:48,081 --> 00:15:52,684 But at our Midland location, Josh, from Stanton, Texas, 183 00:15:52,719 --> 00:15:54,752 has sustained a unique injury to his foot 184 00:15:54,821 --> 00:15:59,023 while on the job that's not only going to affect his daily step 185 00:15:59,092 --> 00:16:01,993 count, it could have a devastating effect on his life 186 00:16:01,995 --> 00:16:03,328 forever. 187 00:16:05,966 --> 00:16:09,067 Well I have concrete in this one. 188 00:16:09,102 --> 00:16:11,469 They cleaned this one out a little bit. 189 00:16:11,537 --> 00:16:13,438 It was covered in concrete. 190 00:16:13,506 --> 00:16:15,873 I've got concrete that goes through these right 191 00:16:15,942 --> 00:16:19,544 here, right up in here, and then in these two big ones 192 00:16:19,612 --> 00:16:20,979 right here. 193 00:16:21,014 --> 00:16:22,380 There's concrete splattered in them. 194 00:16:22,448 --> 00:16:25,383 And the first question we had, obviously, 195 00:16:25,752 --> 00:16:27,819 is how did Josh get hardened concrete inside 196 00:16:27,821 --> 00:16:29,287 of his right foot? 197 00:16:30,890 --> 00:16:34,525 Two days ago, while I was at work I was cleaning 198 00:16:34,594 --> 00:16:36,294 out a 18-wheeler trailer. 199 00:16:37,764 --> 00:16:40,565 It had dried concrete in it and liquid that 200 00:16:40,633 --> 00:16:42,133 was in the bottom of the tank. 201 00:16:43,003 --> 00:16:45,937 I was in the water for about 10, 15 minutes 202 00:16:45,972 --> 00:16:46,971 trying to clean the concrete out, 203 00:16:47,039 --> 00:16:48,873 hitting it with jackhammers, stuff like that. 204 00:16:48,875 --> 00:16:50,842 And then I just started noticing my foot 205 00:16:50,910 --> 00:16:52,710 started hurting real bad. 206 00:16:52,779 --> 00:16:55,580 So when I went to go pull my foot out of the water, 207 00:16:55,648 --> 00:16:58,049 I actually just pulled the top part of my boot 208 00:16:58,051 --> 00:17:01,352 without the sole out of the liquid in the tank. 209 00:17:07,027 --> 00:17:10,028 What I think was mixed with it would be acid or something 210 00:17:10,096 --> 00:17:12,630 caustic, like a dissolvent. 211 00:17:12,632 --> 00:17:15,700 Concrete got up into my shoe and, I guess, 212 00:17:15,702 --> 00:17:17,835 collected on the already wounded spot 213 00:17:17,871 --> 00:17:20,338 that I had that had been burned away. 214 00:17:24,144 --> 00:17:28,046 It actually literally dried into the wounds on my feet. 215 00:17:35,088 --> 00:17:35,653 [music playing] 216 00:17:37,824 --> 00:17:41,793 RUBY ROSE: At the ER in Midland, Texas, 217 00:17:41,828 --> 00:17:44,796 Josh has received multiple chemical burns 218 00:17:44,864 --> 00:17:46,864 from a caustic liquid while cleaning 219 00:17:46,866 --> 00:17:48,699 out the tank of an 18-wheeler. 220 00:17:48,768 --> 00:17:51,335 And it's burned holes in his foot. 221 00:17:52,806 --> 00:17:56,641 Add to that, the wounds have filled with hardened cement, 222 00:17:56,643 --> 00:17:59,777 a combination that Dr. Mark Mauldin 223 00:17:59,779 --> 00:18:04,782 has never seen before in his 34 years of practicing medicine. 224 00:18:04,851 --> 00:18:08,252 I've certainly seen chemical burns before, 225 00:18:08,321 --> 00:18:12,390 not where the concrete was still kind of in the wound, 226 00:18:12,592 --> 00:18:15,026 almost burned into the top of the foot. 227 00:18:15,728 --> 00:18:18,529 This was an unusual presentation. 228 00:18:18,531 --> 00:18:22,100 RUBY ROSE: We see chemical burns pretty often in the ER 229 00:18:22,135 --> 00:18:25,603 as a result of contact with drain cleaners, bleach, 230 00:18:25,605 --> 00:18:27,371 and even acid. 231 00:18:27,373 --> 00:18:29,507 Compared to receiving thermal burns, 232 00:18:29,575 --> 00:18:33,077 you know, like the ones from fire or something hot, 233 00:18:33,112 --> 00:18:37,882 amputation is three times more likely with a chemical burn. 234 00:18:37,950 --> 00:18:42,353 So chemical burns are bad enough without being set in concrete. 235 00:18:44,657 --> 00:18:47,592 Well right now, it's definitely infected. 236 00:18:47,627 --> 00:18:49,460 It developed a little cellulitis. 237 00:18:49,462 --> 00:18:52,096 And you add some swelling to the top of the foot. 238 00:18:52,098 --> 00:18:53,664 It was quite painful. 239 00:18:53,666 --> 00:18:55,333 We put an IV in. 240 00:18:56,636 --> 00:18:58,803 We checked some labs, gave him some antibiotics, 241 00:18:58,838 --> 00:19:02,607 and then gave him pain medicine through the IV. 242 00:19:02,609 --> 00:19:04,942 RUBY ROSE: As the first line of defense 243 00:19:04,978 --> 00:19:07,945 against worsening infection, Dr. Mauldin wants the wound 244 00:19:07,947 --> 00:19:09,947 to be properly cleaned. 245 00:19:09,982 --> 00:19:12,416 But with an injury of this magnitude, 246 00:19:12,418 --> 00:19:15,253 Josh will need to be taken to a burn center for specialized 247 00:19:15,321 --> 00:19:18,122 treatment as soon as possible. 248 00:19:18,157 --> 00:19:19,257 OK. 249 00:19:24,464 --> 00:19:30,535 The concern is that if the foreign body, the concrete, 250 00:19:30,603 --> 00:19:33,738 the debris from the job site doesn't get cleaned off, 251 00:19:33,806 --> 00:19:36,040 then the infection will just get worse. 252 00:19:42,715 --> 00:19:44,849 And then he could end up, ultimately, 253 00:19:44,851 --> 00:19:46,384 perhaps lose his foot. 254 00:20:16,816 --> 00:20:19,083 MARK MAULDIN: We gave him pain medicine 255 00:20:19,085 --> 00:20:23,721 through the IV in hopes that it would be enough to allow us 256 00:20:23,789 --> 00:20:26,791 to debride the wound here in the emergency department, 257 00:20:26,859 --> 00:20:29,193 but he just did not tolerate it. 258 00:20:30,630 --> 00:20:33,764 So he needs to go to a burn center, where they can put him 259 00:20:33,766 --> 00:20:37,668 to sleep and and then adequately clean it out and check 260 00:20:37,737 --> 00:20:39,904 the depth of the burn to see if maybe he has 261 00:20:39,972 --> 00:20:41,038 some third-degree burns also. 262 00:20:41,040 --> 00:20:44,141 RUBY ROSE: While a first-degree burn only damages 263 00:20:44,176 --> 00:20:46,844 the outer layer of skin or epidermis, 264 00:20:46,912 --> 00:20:51,882 a third-degree burn destroys both the outer layer and 265 00:20:51,951 --> 00:20:53,317 the dermis, the layer beneath. 266 00:21:05,231 --> 00:21:06,430 All righty. 267 00:21:06,432 --> 00:21:07,865 Sounds good. 268 00:21:07,900 --> 00:21:08,833 Well, thank you, sir. 269 00:21:08,835 --> 00:21:09,500 All right. 270 00:21:09,502 --> 00:21:10,801 You take care. 271 00:21:10,803 --> 00:21:14,905 As Josh heads immediately to a burn center for more 272 00:21:14,907 --> 00:21:18,676 comprehensive treatment, another painful case has arrived 273 00:21:18,678 --> 00:21:20,945 at our Killeen location. 274 00:21:24,150 --> 00:21:27,585 I'm treating an older gentleman that has sustained a laceration 275 00:21:27,653 --> 00:21:29,186 right on the kisser. 276 00:21:29,188 --> 00:21:33,190 I was parked in the academy parking lot. 277 00:21:33,192 --> 00:21:37,628 I come around in front of the car, and I just fell. 278 00:21:37,664 --> 00:21:40,998 And next thing I know, I'm down on my face, 279 00:21:41,067 --> 00:21:43,367 and I feel the blood dripping out of my lip. 280 00:21:43,403 --> 00:21:45,069 Yeah. 281 00:21:45,137 --> 00:21:48,873 The hunk of skin that's hanging is just painting a lip. 282 00:21:48,941 --> 00:21:51,676 RUBY ROSE: In addition to his lacerated lip, 283 00:21:51,744 --> 00:21:54,512 Noel used his hands to break his fall. 284 00:21:54,514 --> 00:21:55,846 I can see a little bit of bruising there. 285 00:21:55,915 --> 00:21:57,882 Does that hurt when I press on it, though? 286 00:21:57,884 --> 00:21:59,717 And he's experiencing some swelling 287 00:21:59,785 --> 00:22:02,620 and tenderness in his wrists. 288 00:22:02,688 --> 00:22:06,057 So after I repair his lip, we'll need X-rays to make 289 00:22:06,092 --> 00:22:08,292 sure he didn't break any bones. 290 00:22:30,149 --> 00:22:32,983 RUBY ROSE: The lips have over a million nerve endings 291 00:22:33,052 --> 00:22:36,821 and are easily one of the most sensitive parts of the body. 292 00:22:36,889 --> 00:22:39,390 This is why babies put absolutely 293 00:22:39,458 --> 00:22:41,158 everything in their mouth. 294 00:22:42,929 --> 00:22:45,396 The lips provide a lot more information 295 00:22:45,531 --> 00:22:47,031 than the other senses. 296 00:22:47,066 --> 00:22:49,367 Even the fingertips are hundreds times 297 00:22:49,435 --> 00:22:52,403 less sensitive than the lips. 298 00:22:52,471 --> 00:22:56,941 So lip injuries can easily dial the pain up to 11. 299 00:23:13,826 --> 00:23:17,495 So he had a pretty good laceration to his lip. 300 00:23:17,563 --> 00:23:21,699 And lip lacerations can be pretty tricky 301 00:23:21,701 --> 00:23:23,901 because when they're with the Vermillion border, 302 00:23:23,969 --> 00:23:26,003 you have to line it up really well. 303 00:23:54,133 --> 00:23:55,399 Is that OK like that? 304 00:23:55,401 --> 00:23:56,367 Yeah. 305 00:23:56,435 --> 00:23:57,268 OK, good. 306 00:23:59,872 --> 00:24:00,738 You might feel some pulling. 307 00:24:00,806 --> 00:24:02,006 OK. 308 00:24:34,740 --> 00:24:37,074 I think he did really well. 309 00:24:37,142 --> 00:24:38,843 I think it came together very nicely, so yeah. 310 00:24:38,911 --> 00:24:40,244 So it's good. 311 00:25:10,042 --> 00:25:12,376 RUBY ROSE: While the lip repair went well, 312 00:25:12,411 --> 00:25:15,946 a funny thing happened before Noel went to get X-rays. 313 00:25:16,749 --> 00:25:19,984 Noel up and disappeared. 314 00:25:22,688 --> 00:25:25,122 You never know what mystery will hit the ER. 315 00:25:30,062 --> 00:25:33,297 Because now it's the case of the vanishing patient. 316 00:25:41,641 --> 00:25:43,674 [music playing] 317 00:25:43,742 --> 00:25:46,410 RUBY ROSE: At the ER in Killeen, Texas, 318 00:25:46,478 --> 00:25:49,980 after repairing his lacerated lip-- just a couple more, 319 00:25:49,982 --> 00:25:53,083 and then we're almost done-- my patient Noel pulled a Houdini. 320 00:25:53,085 --> 00:25:54,218 Uh-oh. 321 00:25:54,887 --> 00:25:56,287 Where'd he go? 322 00:25:57,623 --> 00:26:00,991 And disappeared before getting his wrist X-rayed. 323 00:26:10,836 --> 00:26:14,004 Elopement is when a patient leaves a health care facility 324 00:26:14,039 --> 00:26:16,340 unnoticed and unsupervised. 325 00:26:18,110 --> 00:26:21,378 It happens in ERs, hospitals, and nursing homes 326 00:26:21,447 --> 00:26:23,047 all over the US. 327 00:26:23,916 --> 00:26:26,383 For patients with decreased mental capacity 328 00:26:26,519 --> 00:26:29,787 due to medication, mental health issues, 329 00:26:29,855 --> 00:26:32,556 or even traumatic injury, these people 330 00:26:32,558 --> 00:26:34,925 are at risk for serious harm. 331 00:26:34,927 --> 00:26:36,627 And there have been many cases that 332 00:26:36,629 --> 00:26:38,963 have even resulted in death. 333 00:26:41,233 --> 00:26:45,002 And Noel's whereabouts has us scratching our heads. 334 00:26:54,947 --> 00:26:55,980 It happens. 335 00:26:55,982 --> 00:26:57,014 NURSE 1: He's right here. 336 00:26:57,082 --> 00:26:57,948 Oh, there he is. 337 00:26:58,017 --> 00:26:59,049 There you are. 338 00:26:59,051 --> 00:27:00,851 Phew, mystery solved. 339 00:27:00,886 --> 00:27:01,752 NURSE 1: We thought you ran out on us. 340 00:27:01,820 --> 00:27:02,820 I know. 341 00:27:02,822 --> 00:27:06,790 Here, come on in. 342 00:27:06,792 --> 00:27:10,394 Now we can take the X-rays to make sure Noel didn't fracture 343 00:27:10,462 --> 00:27:12,129 any of the bones in his wrist. 344 00:27:13,599 --> 00:27:16,834 He doesn't look like he has any fracture to the carpal bones. 345 00:27:16,836 --> 00:27:21,405 His metacarpal bones and his radial bone 346 00:27:21,407 --> 00:27:23,073 looks great, actually. 347 00:27:23,075 --> 00:27:24,875 So he didn't break anything. 348 00:27:24,877 --> 00:27:26,844 And the only thing he did was really cut up his lip, 349 00:27:26,846 --> 00:27:29,913 and that was a good repair. 350 00:27:29,915 --> 00:27:32,016 And I think it came together really nicely. 351 00:27:34,053 --> 00:27:36,954 Three, four, five, six, seven, eight. 352 00:27:36,956 --> 00:27:37,721 We did eight. 353 00:27:37,790 --> 00:27:39,023 Eight. 354 00:27:39,025 --> 00:27:41,592 We definitely did a lot. 355 00:27:41,594 --> 00:27:42,960 It should heal just fine. 356 00:27:43,028 --> 00:27:45,596 You might be a little sore tomorrow, though. 357 00:27:45,664 --> 00:27:47,331 Yeah, that's what I was thinking. 358 00:27:48,434 --> 00:27:50,834 On the face you have about 24 hours 359 00:27:50,836 --> 00:27:52,603 to come in and get it repaired because there's so much 360 00:27:52,671 --> 00:27:55,606 vasculature above the neck. 361 00:27:55,674 --> 00:27:58,876 But some of these, they develop infections and abscesses. 362 00:27:58,944 --> 00:28:01,679 And so if you wait too long, the complication rate's 363 00:28:01,681 --> 00:28:03,080 a lot higher. 364 00:28:03,082 --> 00:28:04,882 Well, it was so nice taking care of you. 365 00:28:04,950 --> 00:28:06,850 And we'll get your paperwork-- 366 00:28:06,852 --> 00:28:07,418 I know. 367 00:28:07,420 --> 00:28:09,153 I know. 368 00:28:09,221 --> 00:28:10,154 And I hope I don't see you again in the emergency room. 369 00:28:10,222 --> 00:28:11,255 But you know. 370 00:28:12,124 --> 00:28:13,157 You're welcome. 371 00:28:13,159 --> 00:28:13,857 OK. 372 00:28:13,893 --> 00:28:15,192 Take care. 373 00:28:18,597 --> 00:28:20,964 A lot of times we see patients that 374 00:28:20,966 --> 00:28:23,000 are dealing with chronic issues that 375 00:28:23,068 --> 00:28:25,536 manifest into painful emergencies 376 00:28:25,604 --> 00:28:27,771 time and time again. 377 00:28:27,840 --> 00:28:31,408 Like I said before, getting a detailed medical history 378 00:28:31,410 --> 00:28:34,945 from our patients can kick start our treatment plan. 379 00:28:37,483 --> 00:28:41,518 At our location in Killeen, Texas, a woman's painful battle 380 00:28:41,587 --> 00:28:44,688 with lupus, a chronic inflammatory disease 381 00:28:44,724 --> 00:28:46,890 where the immune system attacks the body, 382 00:28:46,892 --> 00:28:49,259 has brought her to the ER. 383 00:28:50,763 --> 00:28:52,896 And Doctor Mike Hasegawa will be fighting 384 00:28:52,965 --> 00:28:55,466 it off on the front lines. 385 00:28:55,534 --> 00:28:59,036 And I swear, the guy's always draining fluid. 386 00:29:05,010 --> 00:29:08,779 Mary, from Copperas Cove, Texas has come in with a painfully 387 00:29:08,781 --> 00:29:10,147 swollen knee. 388 00:29:23,496 --> 00:29:26,563 RUBY ROSE: Lupus is a devious disease 389 00:29:26,632 --> 00:29:31,668 that affects people of all ages, from newborns to grandmas. 390 00:29:31,670 --> 00:29:34,738 It's kind of like your body is betraying you. 391 00:29:34,774 --> 00:29:37,708 Your own immune system can't differentiate 392 00:29:37,776 --> 00:29:40,477 between normal healthy cells or the bad stuff, 393 00:29:40,513 --> 00:29:42,880 like viruses and bacteria. 394 00:29:42,915 --> 00:29:46,984 So it attacks everything, from the joints and skin 395 00:29:46,986 --> 00:29:49,720 to major organs, like the kidneys, heart, 396 00:29:49,788 --> 00:29:52,289 lungs, and even the blood. 397 00:30:18,617 --> 00:30:21,285 Having some fluid in there is one of the parts of it. 398 00:30:28,494 --> 00:30:30,761 When the joint fills with fluid, 399 00:30:30,763 --> 00:30:33,831 the pressure that builds on the nerves in the area 400 00:30:33,899 --> 00:30:36,366 can become excruciatingly painful. 401 00:30:36,368 --> 00:30:38,635 If this swelling and inflammation 402 00:30:38,637 --> 00:30:42,873 sticks around for long enough, it can lead to muscle atrophy. 403 00:30:42,875 --> 00:30:46,009 Essentially, the muscles will waste away. 404 00:31:15,841 --> 00:31:19,409 About 25% of adults in the US have 405 00:31:19,411 --> 00:31:22,079 an extreme fear of needles. 406 00:31:23,883 --> 00:31:25,749 So if you're one of those people, 407 00:31:25,817 --> 00:31:28,318 now's the time to look away. 408 00:32:01,020 --> 00:32:01,251 RUBY ROSE: At SignatureCare Emergency Center in Killeen, 409 00:32:04,623 --> 00:32:07,758 Texas, Doctor Mike Hasegawa is treating a patient who's 410 00:32:07,826 --> 00:32:11,395 knee is painfully swollen as a result of her battle 411 00:32:11,430 --> 00:32:14,431 with lupus, an inflammatory disease that 412 00:32:14,499 --> 00:32:16,833 can wreak havoc on the joints. 413 00:32:16,902 --> 00:32:20,737 Dr. Hasegawa has to reduce the edema, or swelling, 414 00:32:20,773 --> 00:32:22,406 caused by the excess fluid. 415 00:32:22,408 --> 00:32:23,740 MIKE HASEGAWA: OK. 416 00:32:23,809 --> 00:32:25,142 1, 2, 3, poke. 417 00:32:26,111 --> 00:32:28,045 NURSE 2: Oh, here it comes. 418 00:32:29,949 --> 00:32:30,447 MARY: Oh, wow. 419 00:32:30,515 --> 00:32:31,581 MIKE HASEGAWA: Yeah. 420 00:32:33,152 --> 00:32:35,152 So overall, I like the color that's coming out of it. 421 00:32:35,187 --> 00:32:35,652 OK? 422 00:32:35,721 --> 00:32:38,121 MARY: OK. 423 00:32:38,156 --> 00:32:41,124 MIKE HASEGAWA: This is kind of normal, not infected color. 424 00:32:41,193 --> 00:32:42,225 MARY: Cool. 425 00:32:42,227 --> 00:32:42,926 I like that. 426 00:32:42,928 --> 00:32:44,661 Yeah, exactly. 427 00:32:44,730 --> 00:32:46,997 I've had some knee taps where I'm 428 00:32:47,065 --> 00:32:49,733 basically pulling out pure pus. 429 00:32:49,801 --> 00:32:53,570 That's an extreme bad infection. 430 00:32:53,605 --> 00:32:55,672 Hers looked pretty darn clear. 431 00:32:55,674 --> 00:32:57,808 It was clear, straw-colored, yellow. 432 00:32:57,876 --> 00:33:00,811 And that's pretty much a standard, healthy fluid. 433 00:33:00,879 --> 00:33:03,113 MARY: That's a lot of fluid. 434 00:33:03,181 --> 00:33:04,848 MIKE HASEGAWA: I can feel your knee shrinking. 435 00:33:04,916 --> 00:33:06,083 MARY: Oh, yeah. 436 00:33:06,986 --> 00:33:08,919 NURSE 2: Do you need another-- 437 00:33:08,954 --> 00:33:09,820 MIKE HASEGAWA: I need another one. 438 00:33:09,822 --> 00:33:10,887 Yeah. 439 00:33:10,922 --> 00:33:11,555 MARY: Geez. 440 00:33:17,830 --> 00:33:19,196 MIKE HASEGAWA: Round two. 441 00:33:22,067 --> 00:33:23,400 MIKE HASEGAWA: For this, we're going 442 00:33:23,402 --> 00:33:25,268 to send to the laboratory. 443 00:33:26,739 --> 00:33:28,772 While the fluid does look healthy, 444 00:33:28,840 --> 00:33:32,976 it's always a good idea to get it analyzed at the lab 445 00:33:32,978 --> 00:33:35,379 to confirm that the joint is not infected. 446 00:33:35,447 --> 00:33:36,380 OK. 447 00:33:36,448 --> 00:33:38,115 So let's see. 448 00:33:38,183 --> 00:33:40,017 Officially that's like 30 cc's that came out of you. 449 00:33:40,019 --> 00:33:40,650 MARY: Wow. 450 00:33:40,652 --> 00:33:42,386 Yeah, right? 451 00:33:42,454 --> 00:33:45,522 RUBY ROSE: 30 cc's, or cubic centimeters of fluid, 452 00:33:45,590 --> 00:33:49,860 is only about an ounce, so it won't quite fill a shot glass. 453 00:33:49,928 --> 00:33:52,829 But when that much excess fluid is in your joint, 454 00:33:52,831 --> 00:33:54,097 just ask Mary. 455 00:33:54,166 --> 00:33:55,966 It can be extremely painful. 456 00:33:55,968 --> 00:33:57,801 Try to bend your knee. 457 00:33:57,869 --> 00:33:58,802 I bet you feel a little bit better with it. 458 00:33:58,804 --> 00:34:00,037 Look it there. 459 00:34:00,072 --> 00:34:00,904 It even looks different. 460 00:34:00,972 --> 00:34:01,972 Yeah, right? 461 00:34:02,040 --> 00:34:03,306 That's a lot better. 462 00:34:05,077 --> 00:34:06,910 Look at my knee now. 463 00:34:06,978 --> 00:34:08,979 They almost look the same. 464 00:34:09,715 --> 00:34:11,148 Yeah, that's a lot of fluid. 465 00:34:11,216 --> 00:34:12,149 That is a lot. MARY: [inaudible]. 466 00:34:12,151 --> 00:34:13,283 Yeah. 467 00:34:14,820 --> 00:34:17,888 So the worst case is really in terms of an infection. 468 00:34:17,890 --> 00:34:20,023 Now if there is an infection in that joint, 469 00:34:20,092 --> 00:34:21,758 it's really going to destroy that socket. 470 00:34:21,760 --> 00:34:23,460 It's called septic arthritis. 471 00:34:23,528 --> 00:34:25,595 And the treatment is almost always surgical. 472 00:34:25,664 --> 00:34:28,899 Now if there is any glimpse of an infection there, 473 00:34:28,967 --> 00:34:32,069 we'll catch it on the sample that we sent to the laboratory. 474 00:34:43,382 --> 00:34:45,182 Bye, take care. 475 00:34:45,250 --> 00:34:49,052 RUBY ROSE: Another satisfied customer walking out of the ER 476 00:34:49,121 --> 00:34:49,686 on their own. 477 00:34:49,721 --> 00:34:54,024 [music playing] 478 00:34:54,092 --> 00:34:57,894 But for a few of the patients we saw, their road to recovery 479 00:34:57,963 --> 00:34:59,996 is not yet complete. 480 00:35:01,300 --> 00:35:04,568 Remember Josh, who sustained chemical burns? 481 00:35:04,636 --> 00:35:07,871 Once he left the ER, he had to undergo surgery 482 00:35:07,873 --> 00:35:11,274 to remove the concrete that hardened inside of his foot. 483 00:35:12,711 --> 00:35:15,912 Well, I left signature care, escorted 484 00:35:15,914 --> 00:35:20,684 out by ambulance to UMC Hospital to their burn unit. 485 00:35:20,752 --> 00:35:22,819 I stayed there for a few days. 486 00:35:22,888 --> 00:35:26,056 They skin grafted to cut the concrete out of it. 487 00:35:26,058 --> 00:35:28,558 They used a laser to do it, and it cuts 488 00:35:28,627 --> 00:35:30,760 just little layers of skin. 489 00:35:30,829 --> 00:35:34,598 First, the specialist used a surgical laser 490 00:35:34,666 --> 00:35:38,068 to remove the embedded cement and burnt tissue. 491 00:35:38,136 --> 00:35:39,836 Then, artificial skin grafts were 492 00:35:39,838 --> 00:35:42,672 placed over the surgical sites. 493 00:35:42,708 --> 00:35:45,675 This artificial skin is made of collagen, 494 00:35:45,744 --> 00:35:47,811 an essential protein found in the body that 495 00:35:47,879 --> 00:35:50,013 helps new skin cells grow back. 496 00:35:50,048 --> 00:35:52,983 The skin graft was pulling the minute pieces 497 00:35:53,051 --> 00:35:54,751 of concrete, the rock, the hardened pieces 498 00:35:54,753 --> 00:35:56,586 actually out of the skin. 499 00:35:56,655 --> 00:36:00,624 And they did three of them consecutively on my foot 500 00:36:00,626 --> 00:36:03,560 and then did scrubbing to clean the rest of it out. 501 00:36:03,562 --> 00:36:06,429 I found out it was a third-degree burn on my foot 502 00:36:06,431 --> 00:36:08,498 and did muscle and nerve damage on it. 503 00:36:08,567 --> 00:36:13,069 So some of my nerves and my toes want to try to move my toes 504 00:36:13,138 --> 00:36:17,407 and my whole entire foot like literally 505 00:36:17,543 --> 00:36:19,309 locks up and everything. 506 00:36:19,344 --> 00:36:21,878 The spots that are wide open right now, 507 00:36:21,947 --> 00:36:25,682 that are still covered with my falsified skin, 508 00:36:25,750 --> 00:36:27,150 are the spots where I have the nerve 509 00:36:27,219 --> 00:36:28,852 and muscle damage in my foot. 510 00:36:28,887 --> 00:36:33,023 [music playing] 511 00:36:43,902 --> 00:36:45,435 The white stuff on here is a ointment 512 00:36:45,503 --> 00:36:48,905 that I have to put on it to keep it moist at all times. 513 00:36:48,907 --> 00:36:52,075 Because if I let it dry out, the skin, nerves, and muscles 514 00:36:52,110 --> 00:36:53,710 will not heal right. 515 00:36:53,778 --> 00:36:57,781 These white spots right here are third-degree burns through 516 00:36:57,783 --> 00:37:00,016 all three layers of my skin. 517 00:37:00,686 --> 00:37:05,522 If you can't tell, this black in the middle of these 518 00:37:05,590 --> 00:37:09,459 are actually my muscle, nerves, and tendons that it ate into. 519 00:37:09,461 --> 00:37:12,562 Been healing for about three weeks now. 520 00:37:12,597 --> 00:37:15,765 RUBY ROSE: He still has a long road to recovery. 521 00:37:15,767 --> 00:37:19,669 Josh avoided the worst possible outcome because he could 522 00:37:19,671 --> 00:37:21,738 have easily lost his foot. 523 00:37:21,806 --> 00:37:23,807 They told me I should be fully healed 524 00:37:23,875 --> 00:37:27,043 up in three to six months. 525 00:37:29,648 --> 00:37:32,415 RUBY ROSE: Now, there's another familiar patient back 526 00:37:32,417 --> 00:37:34,150 at our facility in Killeen. 527 00:37:34,152 --> 00:37:38,188 It's Mavis, the four-year-old with an appetite for dolls. 528 00:37:41,960 --> 00:37:44,094 RUBY ROSE: And as she comes in, we're 529 00:37:44,162 --> 00:37:46,329 already slammed with patients. 530 00:37:51,703 --> 00:37:52,369 [music playing] 531 00:37:52,737 --> 00:37:54,604 RUBY ROSE: At SignatureCare in Killeen, 532 00:37:54,673 --> 00:37:58,541 it's the anticipated return of Mavis for her follow-up visit. 533 00:37:58,610 --> 00:38:01,478 My colleague, Dr. Elsbecker, will be the lucky one 534 00:38:01,546 --> 00:38:05,048 to get the Mavis experience because I'm already 535 00:38:05,116 --> 00:38:07,651 bone deep in a wound sustained from a run-in 536 00:38:07,686 --> 00:38:09,686 with a glass coffee table. 537 00:38:09,754 --> 00:38:12,856 When I looked at my finger I was like, oh, oh. 538 00:38:12,891 --> 00:38:14,891 Yeah, it's pretty deep. 539 00:38:14,959 --> 00:38:16,226 I don't want my finger falling off. 540 00:38:23,568 --> 00:38:25,068 Yeah. 541 00:38:34,880 --> 00:38:37,814 RUBY ROSE: So unfortunately, I'm not going to be able to see 542 00:38:37,849 --> 00:38:39,983 Mavis for her follow-up. 543 00:38:40,051 --> 00:38:42,552 Dr. Mike Hasegawa is also busy. 544 00:38:42,620 --> 00:38:44,988 And yeah, you guessed it. 545 00:38:54,900 --> 00:38:57,901 RUBY ROSE: Yet again, Dr. Mike Hasegawa 546 00:38:57,903 --> 00:39:00,870 is draining fluid and blood from a patient, 547 00:39:00,939 --> 00:39:03,540 after he sustained an injury to his ear 548 00:39:03,542 --> 00:39:05,942 while doing some Brazilian jiu jitsu. 549 00:39:07,579 --> 00:39:09,746 MIKE HASEGAWA: It's an injury to the cartilage. 550 00:39:09,814 --> 00:39:12,115 As part of the healing process, it bleeds everywhere. 551 00:39:12,117 --> 00:39:15,785 So we're trying to drain that blood out of there. 552 00:39:15,854 --> 00:39:16,553 See? 553 00:39:16,555 --> 00:39:17,620 He loves it. 554 00:39:20,659 --> 00:39:23,993 So for little Mavis, our resident Sherlock Holmes 555 00:39:24,029 --> 00:39:27,831 is now on the case, Dr. Steven Elsbecker. 556 00:39:27,833 --> 00:39:31,534 And for him, it'll be elementary. 557 00:39:31,603 --> 00:39:33,870 So today Mavis came in for follow 558 00:39:33,905 --> 00:39:35,705 up of a possible aspirated foreign body 559 00:39:35,707 --> 00:39:38,074 or ingested foreign body. 560 00:39:38,143 --> 00:39:40,377 And that's something that either went down into the lungs 561 00:39:40,445 --> 00:39:41,778 or down into the GI tract. 562 00:39:41,846 --> 00:39:43,913 We're going to let the doctor see you real quick, 563 00:39:43,982 --> 00:39:45,115 and then we can go get your snacks, OK? 564 00:39:45,183 --> 00:39:45,849 OK. 565 00:39:45,917 --> 00:39:47,083 OK. 566 00:39:47,085 --> 00:39:47,851 I'll come get you, OK? 567 00:39:47,919 --> 00:39:49,052 OK. 568 00:39:49,120 --> 00:39:49,786 I'll be right back. 569 00:39:49,854 --> 00:39:50,453 OK. 570 00:40:17,983 --> 00:40:19,282 Take a really deep breath. 571 00:40:20,919 --> 00:40:21,818 Good. 572 00:40:21,886 --> 00:40:22,352 Again. 573 00:40:24,656 --> 00:40:26,022 Last time. 574 00:40:29,661 --> 00:40:32,629 RUBY ROSE: If she did aspirate little dolly, 575 00:40:32,697 --> 00:40:35,932 she most likely would have symptoms-- 576 00:40:35,967 --> 00:40:39,369 Choking, coughing, difficulty breathing. 577 00:40:39,437 --> 00:40:42,405 And if it was stuck in her esophagus or bowels, 578 00:40:42,474 --> 00:40:44,274 it's the same story. 579 00:40:44,342 --> 00:40:48,244 She might be vomiting, drooling, develop a fever, 580 00:40:48,313 --> 00:40:48,778 or have abdominal pain. 581 00:40:48,847 --> 00:40:50,246 Look at that. 582 00:40:51,783 --> 00:40:53,716 So since her first visit she's been doing really well, 583 00:40:53,785 --> 00:40:56,386 and she hasn't had any symptoms. 584 00:40:56,454 --> 00:40:58,888 Our suspicion for anything bad is a lot lower now that we've 585 00:40:58,890 --> 00:40:59,889 had the luxury of time. 586 00:40:59,958 --> 00:41:01,791 It's looking good for Mavis. 587 00:41:01,860 --> 00:41:04,894 But the real proof will be in the X-rays. 588 00:41:04,929 --> 00:41:07,397 So Dr. Rose, who saw the patient initially, 589 00:41:07,666 --> 00:41:08,965 wanted her to come back for repeat 590 00:41:09,000 --> 00:41:10,900 imaging, which we did today. 591 00:41:10,936 --> 00:41:13,069 And fortunately, it didn't show anything in the lungs 592 00:41:13,104 --> 00:41:14,137 or in the gut. 593 00:41:26,985 --> 00:41:29,385 So we had quite a long talk with mom today 594 00:41:29,487 --> 00:41:30,954 about what to expect going forward. 595 00:41:31,022 --> 00:41:33,656 We didn't see anything obvious on X-ray, which doesn't 596 00:41:33,725 --> 00:41:35,625 mean there's nothing there. 597 00:41:35,693 --> 00:41:37,660 It just means it's unlikely that there's something there. 598 00:41:37,662 --> 00:41:40,797 We did talk about what to expect if and when it passes. 599 00:41:40,832 --> 00:41:42,932 But the good news is she'll be able to go home 600 00:41:42,968 --> 00:41:44,701 today and follow up with her pediatrician, 601 00:41:44,769 --> 00:41:46,336 and she should do really well. 602 00:41:48,740 --> 00:41:51,975 RUBY ROSE: And just like that, little Mavis 603 00:41:51,977 --> 00:41:56,913 heads back to resume life as a boisterous four-year-old.