芝加哥急救

Chicago Med S09E06

Part 3 March 12, 2024, 9:51 a.m.

我只是想检查我的手，现在你却要推销我更多？
Oh, I just wanted my hand looked at but now you're trying to upsell me?
穿上病人袍，不要乱跑
Just put the gown on and stay put.
马上有人会进来帮你照胸腔和手的X光
Someone'll be by soon to image your chest and hand.
还有…不要为难人家
And, um, don't give them a hard time.
喉咙看起来还好
Throat doesn't look that bad.
你已经这样多久了，阿德瑞娜？
How long have you been feeling this way, Adriana?
几个礼拜了吧？说不准
A few weeks? Hard to say.
我一直在旅行，所以时间感有点混乱
Been traveling a lot so my sense of time is outta whack.
去了哪些好玩的地方吗？
Anywhere fun?
中西部酒店大会巡回赛壮游
Grand tour of the Midwest's hotel convention circuit.
我办了一场桌游展
I organize tabletop and board game cons.
总之，我还以为这只是又一次展览咳
Anyway, I thought this was just another con-cough.
就是在满是玩家的宴会厅里
You know, something you pick up
会被传染的病，可是…
when you're stuffed in a ballroom full of gamers but...
可以呼吸一下吗？
Can you breathe for me?
那样会痛
That hurt.
你的肺听起来的确有点罗音
Your lungs do sound a little junky.
意思是里面有很多痰
Just means that there's a lot of phlegm.
有可能是流感、冠状病毒病或肺炎造成
Could be from flu, Covid or a pneumonia
我们要先做一些检查确认才能知道病因
but we won't know until we run a few tests to be sure.
我才刚打过疫苗，但肺炎？天啊
I just got my shots, but pneumonia? Wow.
交给我们吧
We'll take good care of you.
先从胸腔X光开始
Let's start with a, uh, chest x-ray,
全套血液检查、基本代谢指数，拭子检验冠状病毒病、流感和链球菌
"C.B.C.", "B.M.P.", swabs for Covid, flu and strep,
安排胸腔和颈部电脑断层扫描
and put in a "C.T." for chest and neck.
-好哦 -我很快就回来
-Okay. -I'll be back to check on you soon.
嘿，我只是想再确认，关于电脑断层扫描的医嘱
Hey, um, I just wanted to double check on those CAT scans.
我们不用先等胸腔X光的结果吗？
Shouldn't we wait for the chest x-ray first?
这样似乎有点躁进
It seems aggressive.
老实说，我不确定这会否只是感染
Honestly, I'm not even sure that this is just an infection.
但是检查结果出来的时候还是呼叫我吧
But page me when those tests are back.
好，没问题
Yeah, you got it.
洒一点糖
There you go.
你真的很擅长这个
You're a real pro at this.
我也没想过我会擅长这个，但谢啦
It's not a skill I planned on mastering but, thanks.
加列，黛
Caleb. Deb.
好消息，你的实验室检验报告都正常
Good news. Your labs came back normal.
真是太好了，宝贝
Oh, that's great, hon.
看起来你的脱垂
Well, it looks like your prolapse
消肿的速度并没有如我们所愿
hasn't reduced as quickly as we'd like.
也许是因为持续充血的关系
It's probably because of persistent congestion.
根据我看到的状况，还有加列最新的电脑断层扫描
So, based on what I'm seeing here and Caleb's latest "C.T.",
我想接着进行造口关闭术会比较好
I think it would be better if we went ahead with your reversal surgery.
-你说什么？-等等，什么意思？
-Excuse me? -Wait what?
说实话，我建议越快进行越好
Truthfully, my recommendation would be to do this as soon as possible.
你的意思是我可以摆脱这东西？就在今天？
You're telling me I can get rid of this thing? Like, today?
我应该可以帮你安排在几个小时后手术
I should be able to get you on the schedule in a few hours.
没错
Yeah.
动手术吧
Let's go!
妈，我们可以打电♥话♥给马克教练
Mom, we can call Coach Mark.
跟他说我今年夏天可以在战士队打球
Tell him I'm running with the Soldiers this Summer.
这是好消息
This is good news.
方便借一步说话吗？
Can I speak with you for a moment?
我不明白
I don't understand.
你…你不能在病房♥把脱垂复位吗？
You...you can't reduce the prolapse bedside?
这个嘛，我应该可以
Well, I probably can,
但我想这时候，长♥期♥来看，手术应该是更好的解决方法
but I think surgery is the better long-term solution at this point.
加列已经手术完几个月，他的复原状况很好
Caleb is several months out and his recovery is going great.
他的检验报告显示他很健康，很强壮…
His, uh, labs indicate that he's healthy, he's strong...
恕我直言，戴维斯医生，从一开始就是他的医生
All due respect, Doctor Davis has been with us since day one.
但我们才认识你多久，两小时？
We've known you for what, two hours?
艾卓亚医生在这方面经历丰富
Doctor Archer has a lot of experience with this.
我们的医生坚持要我们等
Our doctor was adamant we wait.
再加上加列所有的手术
That with all of Caleb's surgeries,
沾黏需要时间才能消退，我们才能关闭造口
the adhesions needed time to break down before we could do the reversal.
那是很周全的计划
That was a solid plan.
不过…
However,
加列的脱垂复发
Caleb's recurring prolapses
会令他更有可能再次脱垂
could make it more likely for him to prolapse again.
有可能导致最后的修复更棘手
And possibly make the eventual repair more challenging.
你们又不能确定
You don't know for sure.
我不会用我儿子的健康来交换
I won't trade my son's health for that.
我知道你希望等到回家再处理
I know you wanna hold off until you get home,
但我很乐意跟你的小儿外科医生沟通
but I'd be happy to speak with your pediatric surgeon.
就像我说的
Like I said,
戴维斯医生认为加列最好再等等
Doctor Davis believes Caleb is better off waiting,
所以除非他有不同看法，不然我都不想再讨论手术的事了
so until he says otherwise, I'm not discussing surgery any further.
我可以请你帮我看个东西吗？
Can I "get your eyes on something?"
当然
'Course.
直接跳到电脑断层扫描啊？
Skipped right to "C.T." scans, huh?
病人到院时出现典型的感染迹象
Patient came in with classic signs of an infection...
但是又有呼吸短促和胸痛
but with the shortness of breath and chest pain,
我担心这是败血性肺栓塞
I was afraid that it was a septic pulmonary embolism.
我知道这不太可能
Know that's a longshot.
不，完全正确，你看
No, you were "on the money." Look.
绝对是一个小小的肺栓塞
Definitely a small "P.E."
你看这个颈部的电脑断层扫描
Check out this neck "C.T."
我不确定自己看到什么
I'm not sure exactly what I'm looking at.
扁桃腺周围脓疡，浸润渗入颈静脉
Peritonsillar abscess with infiltration into the jugular vein.
拭子检验结果是什么？
What'd the swab come back as?
链球菌
Strep.
这样啊
Hm.
这是雷米尔氏症，对吧？
This is Lemierre's Syndrome, isn't it?
我只有在书上看过
I've only read about it.
颈部有感染的血块，没错
Infected blood clot in the neck, yeah.
非常罕见
Very rare.
非常危险
Very dangerous.
这样很多问题都说得通了
Explains a lot.
感染是从喉咙开始
Infection starts in the throat,
扩散到颈部，血块顺流向下
spreads to the jugular, starts throwing clots downstream.
好，我们需要尽快，让你的病人接受抗凝血药
Okay, we, uh...we need to anticoagulate your patient ASAP.
开始帮病人输注肝素
So go ahead and start her on a heparin drip,
以防原有的血块蔓延
prevent the existing clot from propagating.
我也会开始让她服用抗生素，好吗？
And I'd also start her on antibiotics, okay?
明明可以用取栓手术处理血块，又能完全消除风险
Why wait when we can go after the clot with a thrombectomy
为什么要等？
and eliminate the risk entirely?
还没到那一步
We're not there yet.
先给药物一点时间发挥药效，让她退烧
Let's give the meds some time to get the fever down.
但如果她短时间内都没有起色，我想你的方向就是对的
But if she doesn't "turn the corner" soon, I think you're right.
手术可能是我们最好的选择，好吗？
Surgery may be our best bet, okay?
-我会跟阿德瑞娜说明最新状况 -好
-I'll get Adriana up to speed. -Good.
我会联络耳鼻喉科，他们需要帮她做内视镜检查
And I'll call "E.N.T." They'll need to scope her.
-好吗？-好
-All right? -Uh-huh.
沙利文先生？
Oh, Mister Sullivan?
叫我沙利就好
Sully.
沙利
Sully.
我很抱歉
I'm so sorry.
大哥，但是我们不能让病人在这里闲晃
Buddy, we can't really have patients wandering around out here.
这里的人潮太多了
We just have too much foot traffic out here.
是医院的规定
It's a hospital policy thing.
希望你能谅解
Hope you understand.
但我只是想要找个地方抽烟
But, I was...I just want to find a place to smoke.
我不能在病房♥里抽烟
I just can't be in that room.
我完全明白
Totally get it.
要一直等真的很烦
It's such a drag having to wait,
但我跟你保证，里普利医生马上就到了
but I promise you Doctor Ripley will be by any second.
哦，说人人到
Oh, "speak of the devil."
嘿，真不敢相信是同一个人
Hey, hard to believe it's the same guy
以前小时候还跟我一起去偷糖果
who had us stealing candy when we were kids.
你跑去哪了？我不是叫你不要乱跑
Where the hell were you? I told you to stay put.