芝加哥急救

Chicago Med S09E01

Part 6 Jan. 29, 2024, 9:20 p.m.

-I don't know. -I'm sorry, but it's time to go.
-哈里斯，你没事的 -不，我要走了
-Harris, you're okay. -No, I'm gonna go.
拜托冷静下来
Please come down.
你得让我离开这里，好吗？
You gotta let me get out of here, okay?
-哈里斯？-让我出去
-Harris? -Let me out of here!
保安
Security.
我说让我出去
I said let me outta' here!
一毫克咪♥达♥唑♥仑♥，五毫克氟哌啶醇
One of...one of Versed and five of Haldol.
不，他们会杀了我
No, no! They're gonna kill me!
他们会杀我
They're gonna kill!
让我出去
Get me out of here!
好，好了
Okay, okay.
不，不要
No, no!
-你为什么要带我来这里？-不，哈里斯
-Why did you bring me here? -No, Harris.
-你为什么要这样？-我没事
-Why did you do it? -I'm good.
好了
There you go.
没事了
There you go.
我没事，各位，谢谢
I'm good, guys. Thank you.
可以让我看一下他的病历吗？
Could I take a quick look at his chart, please?
里普利医生，可以麻烦你…
Doctor Ripley, could I, um...
借一步说话吗？
could I get a...a quick word please?
所以，你停掉了哈理斯先生的喹硫平
So, you took Mister Harris off his Quetiapine.
我只是好奇你为什么这样做
I'm just curious why you did that.
你有看他的病历吗？他是个不定时炸♥弹♥
He's "a bomb about to go off." Did you look at his chart?
呼吸困难、高血压、高血糖
Dyspnea, high "B.P.", blood sugar,
高密度脂蛋白偏低、中♥央♥肥胖
low "H.D.L.", central obesity.
我需要确认是不是药物的关系
I need to find out if that's from his meds.
而你就没有想过
And it didn't occur to you to maybe
也许联络精神科来会诊一下吗？
just call in psych for a little consult?
看看我，我整天都在这里
I mean, I've been here all day.
他又不是你的病人
He's not your patient.
就我看来，他非常像精神科病人
Lookin' an awful lot like a psych patient to me.
今天不是，今天他是有代谢综合征的急症室病人
Not today. Today he's an "E.D." patient with metabolic syndrome.
却因为你停了他的药而失控了
Who just "flipped out" because you took him off his meds.
是为了预防他罹患冠状动脉疾病或中风他过度用药了
To keep him from having a coronary or stroking out. He is over-medicated.
你根本说不准
You can't know that.
喹硫平、锂盐、拉莫三嗪？
Quetiapine, Lithium, lamotrigine?
全都是神经递质调节剂用途重叠又多余
All neurotransmitter modulators. They overlap, they're redundant.
它们并不多余
They are not redundant.
两种情绪稳定剂其实是互补，好吗？
The two mood-stabilizers are actually complementary, okay?
而喹硫平则是不一样的药物
And quetiapine, a different drug...
好啦，对啦，你们就是喜欢用药
Yeah, yeah, you guys love to medicate.
你不能直接停药
You can't just stop it.
说真的，里普利医生
I mean, honestly Doctor Ripley,
我想你今天的行为，有一点鲁莽
I think what you did today was... a little reckless.
鲁莽？
Reckless?
鲁莽
Reckless.
少来了，查理斯医生你何不就直说呢？
Well, come on, Doctor Charles why don't you just say it?
“冲动控制障碍”
"Impulse Control Disorder."
你当时不是这样说的吗？
Isn't that what you called it back then?
哦，所以，你让他停药是因为我？
Oh, so you...you took him off his meds because of me?
我停掉薛尔先生其中一种药物
I took Mister Shorr off one drug.
我停用的是最有可能造成代谢症状的药物
The one most likely to be causing his metabolic symptoms.
而且我是在受控制的临床环境这么做
And I did so in a controlled clinical setting.
现在，我是这间医院的主治医生
Now, I'm an attending physician at this hospital.
不要把我当成20年前你认识的那个小男孩
Do not treat me like the boy you knew twenty years ago.
切开软组织
Dissecting soft tissue
准备前位第一节颈椎为寰枕关节置入经寰枢椎关节螺钉
to prepare the anterior "C"one-ring for the "A.O." transarticular screws.
2.0，理想的螺钉进入点在哪里？
2.0, what is the ideal screw entry point?
理想的进入点是第一节颈椎侧骨块中线的下三分之一
Ideal entry point is lower one-third of midline of "C" one lateral mass,
在第一和第二节颈椎关节囊正上方
just above "C" one-two joint capsule.
对，尸体研究和我们的模拟都这样建议
Yeah, that's what cadaver studies and our simulations suggested.
骨钻
Drill.
好，从左侧开始，从侧边钻入
Okay, starting with the left side, drilling laterally,
后侧进入，朝上
posteriorly, and upwardly.
他的潮气末二氧化碳下降了
The kid's end tidal "C.O." two just dipped.
2.0，请评估
2.0, assess.
根据基准值和生命体征变化
Based on baseline and trending vitals,
极有可能发生静脉空气栓塞
there is high likelihood of venous air embolism.
真的是这样吗？
Is that really the case?
稍微往下伸可能会发生支气管痉挛
Slight dip could be broncho-spasm,
组织灌流不良，或什么都不会发生
poor tissue perfusion, or nothing at all.
好，2.0，麻烦确认静脉空气栓塞
Yeah, 2.0, verify venous air embolism, please.
已确认
Verified.
死亡率或产生严重后果的概率
There is greater than seventy-five percent chance
高于75%
of mortality or catastrophic outcome.
请立即处理
Address immediately.
我不知道，也许那该死的东西又开始造假了
I don't know, maybe the damn thing's hallucinating again.
是啊
Yeah.
血压非常低，收缩压85，舒张压49
"B.P.'s" just a tad low. Eighty-five over Forty-nine.
嘿，我们必须完成这个手术让这孩子离开手术台
Hey, we need to finish the surgery, get this kid off the table.
不，等等
No, hold on.
把他的头调低一点
Lower his head,
放上胸前多普勒超声波设定经食道超声波
place a precordial doppler and set up for a transesophageal echo.
哥罗基
Crockett.
空气栓塞会要了他的命
An air embolism could kill him.
我们必须知道自己面对的是什么
We have to know what we're dealing with.
多普勒发出的那个声音就是空气气泡
That sound from the doppler, it's air bubbles.
对，我想我们钻进骨头的时候
Yeah, I think when we drilled into the bone,
空气被吸进去血管系统
it got was sucked into the vascular system.
直接进入心脏了
Went directly to the heart.
血压又更低了
"B.P.'s" dropping more now.
收缩压65，舒张压33
Sixty-five over thirty-three.
心率也是，36
And heart rate, too, at thirty-six.
找到了，好大的空气气泡
There it is, significant air bubbles.
对，它们栓塞进入肺动脉了
Yeah, they're embolizing into the pulmonary artery,
造成右心劳伤
causing right heart strain.
对，2.0是对的
Yeah, 2.0 was correct.
麦蒂，给这孩子100%的氧气用复苏器帮他通气
Marty, give the kid a hundred-percent "O" two. And bag him up.
马上来
Coming.
但是我无法帮他通气和氧合
But I'm having trouble ventilating and oxygenating.
氧饱和度80%
Eighty percent sat.
已确认
Confirmed.
严重缺氧和全身灌流不佳
Critically significant hypoxia and poor systemic perfusion.
我们得把空气从这孩子的心脏抽出来
We've got to suction the air out of the kid's heart.
给我肺动脉导管
Give me the Swan-Ganz catheter.
心电图上的ST节段出现变化
Seeing "S.T." segment changes on "E.K.G."
大概再一分钟心脏就会完全停止
Got about a minute before complete cardiac collapse.
好，我们要让现在的心脏浮起来
Okay, we're gonna float the existing cordis
直接进入肺动脉
right into the pulmonary artery.
生命体征几乎见底
Vitals are tanking.
收缩压40
Systolics in the forties.
去推急救车来
Get a crash cart.
我进入右心室了，气球往上
I'm in the right ventricle. Balloon up.
气球往上了
Balloon's up.
继续
Go ahead.
好，往前推
Okay. Advancing.
心脏随时要停了，哥罗基
Any day now, Crockett.
就快好了
Almost.
好，我进入肺动脉了，接上注射器
Okay, I'm in the pulmonary artery. Syringe.
马上来
On it.
没有空气
No air.
几乎看不到动脉血流了，他心搏过缓了
Barely seeing an arterial trace he is bradying down.
即将发生心跳停止
Cardiac arrest is imminent.
推注一毫克的阿托品，马上
Push a milligram of atropine. Now!
再往前推一点，气球往下
Advancing further. Balloon down.
加油啊
Come on.
抽到空气了
Got air!
血压、心率恢复了
"B.P.", heartrate.
肺气栓塞已成功解决
Pulmonary air embolism successfully addressed.
柯德莉？