芝加哥急救

Chicago Med S04E06

Part 3 Jan. 21, 2020, 1:47 p.m.

这家伙要输血拉尼克不行就换我
The guy needs blood. Lanik, step in or I will.
插♥进♥去了上气囊
I'm in, bag him.
好了搞定
Done. I got it.
为什么这里这么多血什么情况
Why is there so much blood? What happened?
该死你没插对刺穿动脉了
Damn it. You missed the vein. You went into the artery.
好吧我们不能用那条输血管了
All right, we can't use that line.
给我个工具包我要在锁骨下静脉上再插根管
Give me a kit. I got to get a line in the subclavian.
对不起
I'm sorry.
我在找标记时没弄好
I was having trouble finding my landmarks.
我...一切都太快了我...
I--everything was moving so fast. I--
那下次我们让这个家伙先停下来别死
Well, next time we'll just ask the guy to stop dying
你就可以跟上节奏了
so you can catch up.
好了我们开始输血
All right. Let's get the blood going.
把他送到混合手术室
Move him over to the hybrid OR.
我们在那儿给腿部血液分流
We'll shunt the leg there.
大家听到了我们准备走
You heard the man. Let's get ready to travel.
盖比父亲的检测结果出来了
Hey, results are back for Gabby's dad.
他们没法给妈妈做检测
They couldn't test the mom.
怎么会以前得过什么病
How come? Preexisting condition?
-狼疮 -那爸爸呢
- Lupus. - And dad?
很遗憾他不匹配
Unfortunately, he's not a match.
约翰是AB型血盖比是O型血
John's blood type is AB. Gabby's type O.
他不可能是她的生父
He can't be her biological father.
你记得我问珍妮特他们的家族病史时
Remember how Jeanette changed her answer
她是如何闪烁其词的吗
when I asked them about their family history?
约翰可能不知道
John probably has no idea.
我得找查尔斯医生帮忙
I'm going to pull in Dr. Charles.
放射科医生刚才看了达莉亚的扫描结果
The radiologist just read Daria's scans.
你看到那个光点了吗就在那儿
Do you see that blip, right there?
那是个假性动脉瘤
That's called a pseudoaneurysm.
是因为血管受到撞击和撕扯而产生的
The impact from the crash tore the vessel,
这里有个小血块挡住了出血孔
and now there's a small blood clot covering the hole.
如果它破裂就会造成大出血威胁你的生命
If it ruptures, it could cause a life-threatening bleed.
那要怎么治疗
So what's the treatment?
我们会先使用药物
We'll put you on medication
让你的血压保持在比较低的水平
to keep your blood pressure low,
接下来我们会观察24到48个小时
and we'll monitor you for the next 24-48 hours.
我也在这里你知道的
I'm here too, you know.
然后我们会输凝血剂之后再做核磁共振
Then we'll start anticoagulants and reimage you.
如果你的病情恶化
If your condition worsens,
我们就要准备手术了
we will need to perform surgery.
在此期间让达莉亚保持冷静
In the interim, it is very important
是非常重要的
that we keep Daria calm.
任何压力或激动都会使她的血压升高
Any stress or agitation could spike her blood pressure,
导致假性动脉瘤破裂
and cause the pseudoaneurysm to rupture.
我们需要禁止所有人探望
We'll need to restrict all visitors.
-你们不是在说我吧 -其实是在说你
- You don't mean me. - Yes, actually we do.
我希望你能理解
I hope you understand.
如果我不在这儿她会很慌的
She'll get nervous if I'm not here.
宝贝你不想让我离开的对吧
Uh, babe, you don't want me to leave.
我必须留下
I'll stay.
你的太太需要休息
Your wife needs rest.
你对我有意见吗
Hey man, do you have a problem with me?
没有卡尔森先生
No, Mr. Carson.
一旦楼上有空床位了我们就把你移上去
Once a room opens up, we'll move you upstairs.
谢谢你
Thank you.
威尔
Will?
给我三分钟我要和那个人单独谈谈
Give me three minutes alone with that guy.
我们告诉他他会怀疑我们要对他不利
We show him our cards, he'll suspect we're onto him.
这会使达莉亚更危险
It'll put Daria at even greater risk.
学聪明点
Be smart about this.
如果约翰不匹配而我没法捐献
So if--if John's not a match and I can't donate,
那现在呢
what now?
菲利普斯女士我们本不想
Ms. Phillips, it is not at all our intention to pry
打探您的私事
into your private affairs, but at the same time
但是给予您女儿最佳治疗是我们的职责
it's important to us to give your daughter the best care possible.
好吧
Okay.
在检查你和你丈夫的测试结果时
And in reviewing you and your husband's test results,
我们发现约翰不是盖比的亲生父亲
it became evident that John is not Gabby's biological father.
所以我们私下里找你商讨
And we wanted to be with you in private
因为我们不确定约翰知道此事
because we weren't sure that John knew.
不不不是你们想的那样
No, no. It's not what you think.
盖比是领养的
Gabby's adopted.
但是我问你家庭历史的时候你没有说
And when I asked about your family history, you didn't--
不我们不想在盖比面前说这些
No, uh, we didn't want to say anything in front of Gabby.
她还不知道
She--she doesn't know.
菲利普斯女士我知道这有些过分
Mrs. Philips, I know it's a stretch,
但是如果我们能找到和盖比有血缘关系的亲属
but if we could locate any of Gabby's blood relatives--
这是不可能的
That's not possible.
我们收养她的时候盖比是州政♥府♥的监护对象
Gabby was a ward of the state when we adopted her.
她的亲生父母已经去世
Her biological parents were deceased
而且她没有其他亲属了
and she had no other known relatives.
要是这样的话我们得把盖比
Well, in that case, we'll want to get Gabby
赶快放到移植匹配名单里
onto the transplant list right away.
好的谢谢你
Okay. Thank you.
动脉分流
Artery shunted.
夹住了
Clamps are off.
把他送到重症监护室去回温和苏醒
Let's get him up to the ICU to rewarm and resuscitate.
他动脉里的那条输血管怎么办
What about the line in his artery?
你不用把它拔♥出♥来♥吗
Don't you need to pull it out?
然后看着他大出血吗
So we can watch him bleed out?
现在不能这么做
We can't do that right now.
他体温太低容易凝血
He's too cold and coagulopathic.
等他体温回升了凝血改善了
We'll fix it when his pressure
我们再把输血管拔♥出♥来♥
and clotting are better.
你为什么要这么对他
Where do you get off treating him like that?
发生的事情你应该负全责
What happened was your responsibility.
又不是我刺破了他的动脉
I didn't stick that guy's artery.
你应该监督着他完成
You were supposed to be supervising.
唯有给予压力才有学习的动力
Look, the only way they learn is under pressure.
压力并不是危及我病人的生命
Not when it endangers my patient.
你放松好吗反正你也插♥进♥去了
Look, would you just relax? You got your line in.
避免了事故无伤大雅
Disaster was averted. No harm, no foul.
如果你再这样做
If you ever pull something like that again--
或许你曾是楼上心胸科的金童
Hey, you might've been the golden boy up in CT,
但这里是归我管的
but down here I'm in charge.
而且我会以我觉得合适的方式
And I will supervise my med students
来教导我的医学生
in whatever way I see fit.
很高兴看到你在这里找到了一个新的对手
Glad to see you found a new sparring partner down here.
没我在我可不想看到你独孤求败的样子
Would hate to see you getting rusty in my absence.
这家伙是个自大狂
That guy is an egomaniac.
你们俩半斤八两啊
Well, takes one to know one, right?
-走吧请你吃饭 -太好了
- Come on. Buy you lunch? - Yeah.
查尔斯医生
Dr. Charles?
我想问问盖比在匹配名单里的第几位
Hey, I was wondering how long does Gabby have to be
她还有多久才能得到一个新的肝脏
on the transplant list before she gets a new liver?
拜托请跟我说实话
Please, just-- just level with me.
恐怕我不能给你一个明确的答案
I'm afraid I can't give you a definitive answer.
有可能几天几周
It can take days. Weeks.
说实话有时候要等好几年
Sometimes, honestly, even years.
-好几年 -很遗憾
- Years? - Well, unfortunately,
需求远远超过供给
demand vastly outweighs supply.
所以活体供体移植才得以发展
It's why living donor transplantation was developed.
吸毒者不能捐献对吗
It's not possible for a drug addict to donate, is it?
-吸毒者 -亲爱的
- A drug addict? - Honey.
-我给你买♥♥了杯咖啡 -谢谢
- I got you a coffee. - Oh, thank you.
-有保拉的消息了吗 -没有她不能...
- Any word from Paula? - No, she can't--
她癫痫了给她五毫克安定
She's having a seizure. 5 of Ativan IV.
盖比
Gabby?
给她做脑部CT 以防有脑溢血
Let's get a brain CT, just to make sure there are no bleeds.