芝加哥急救

Chicago Med S04E14

Part 2 Jan. 21, 2020, 1:49 p.m.

监控她的体征化验结果回来了叫我
Repeat her vitals and let me know when her labs are back.
好
Okay.
好了
Okay.
-你认识这个病人 -她住在我家附近
- You know this patient? - She grew up near me.
几周前因为败血症被送进来了
Came in a couple weeks ago with sepsis.
我当时应该立刻安排诊疗的
I should have seen her immediately.
感觉就好像我的前胸和后背
Feels like somebody sitting on my chest
都坐着个人似的
and my back at the same time
是自从两天前
ever since we got back from
我们从那次越野滑雪回来就开始了
that cross country ski trip two days ago.
我以前从没有过这种感觉
I never felt anything like this.
他通常不这样帕特里克总是很健康
This isn't like him. Patrick's always so healthy,
即便是过去几年有点放纵了
even if he sort of let himself go the last few years.
不是吧艾莉丝
Really, Alice?
这可是你的病史啊
It's your medical history.
很重要的是不是
It's relevant, isn't it?
没错
Uh, yeah.
疼痛有没有延伸到胳膊或者下颚
Does the pain extend down your arm or up to your jaw?
-没有 -这样疼吗
No. Does this hurt?
如果按10分最疼的话大概几分
Out of ten, ten being the most painful.
大概有个5分吧
Mm, I guess a five.
好吧做个血常规血培养和肌钙蛋白
Okay, let's get a CBC, CMP, troponins,
然后送诺瓦克先生去做心电图
and set Mr. Novak up for an EKG.
帕特里克
Patrick?
-没有脉搏 -什么
- No pulse. - What?
-没呼吸了上气囊 -好的
- He's not breathing, bag him. - Got it.
可是他有正常窦性心律啊
But he's got normal sinus rhythm.
没有脉搏了
There's no pulse.
无脉搏电活性了开警报
He's in PEA. Call a code.
-帕特里克 -这里需要帮助
- Patrick? - We need help in here!
-扩展气道 -看啊
- Need an airway! - Look.
他睁开眼了自主呼吸了
He just opened his eyes. He's breathing on his own.
谢天谢地
Oh, thank God.
亲爱的你还好吗
Honey, are you okay?
-帕特里克 -心脏停搏了
- Patrick? - Asystole.
打一毫克肾上腺素
Milligram of epi, now.
插管
Intubate him.
慢着病人自主呼吸了
Hold off. Patient's breathing on his own.
能有人告诉我到底是什么情况吗
Can someone tell me what is happening?
您丈夫心搏停止
Your husband is in cardiac arrest,
但只要我继续压胸
but as long as I'm doing compressions,
他就能呼吸氧气供应大脑
he's getting oxygen to his brain.
我们要压到他的心脏恢复功能为止
We'll keep at it until his heart takes over.
帕特里克亲爱的我就在这呢
Honey, Patrick. I'm right here.
你是说这不是戒断反应
You're saying it's not just the withdrawal?
而是心脏有问题
I have a heart infection?
感染性心内膜炎的征状一般出现缓慢
Symptoms of endocarditis usually come on slowly
而且常常会与海♥洛♥因♥戒断反应混淆
and they're often mistaken for heroin withdrawal.
就是你今天早上感觉到的胸痛
The chest pains you were feeling this morning.
感染性心内膜炎可以用长效抗生素治疗
We can treat endocarditis with long-term antibiotics,
这样就需要在手臂上置入导管
which normally involve leaving a catheter in the arm.
也就是静脉管
A PICC line.
没事我习惯扎针了
It's okay, I'm used to needles.
布里特我们知道刚刚戒毒会很难受
Britt, we really get how tricky early sobriety can be
而我们只想让你达到最好的状态
and we just want to put you in
以便能成功戒毒
the best possible position to succeed.
所以如果要置入静脉管的话
So if we're gonna give you this PICC line,
还有件别的事我们希望你能考虑一下
there's something else we'd also like you to consider.
-什么 -是一种药叫做纳曲酮
- What? - Well, it's a drug called Naltrexone
能阻断类鸦♥片♥活性肽对大脑边缘系统的作用
that blocks the effects of opioids on the brain's limbic system,
就是说你再也无法嗑药嗑嗨了
essentially making it impossible to get high.
还有这种药能阻止我嗑药磕嗨
There's a drug that'll stop me from getting high?
那就用吧
Let's do that.
是这样纳曲酮无疑是一种特效药
Listen, Naltrexone is by no means a magic bullet,
不过也是有一定的风险的
and it comes with certain very real risks.
问题在于布里特如果要用这种药
The thing is, Britt, you can't take it
你在过去至少14天内是不能接触任何毒品的
unless you've been opioid free for at least 14 days.
如果你体内有任何类鸦♥片♥活性肽
If there are any opioids in your system,
纳曲酮就会产生极其严重的副作用
the Naltrexone could trigger severe side effects.
-我绝对干净 -两周以上了
- I'm clean. - For over two weeks.
那好还有一点很关键你要明白
Okay, well, it's also crucial for you to understand,
一旦有过复吸就很有可能会吸毒过量
if you were to use, it could very well lead to an overdose.
我不会再吸了永远
I'm not going to. Ever.
她已经非常努力了
She's been trying so hard.
那好我们只需要再做个尿检
Okay, well, we just need to do a urine test
以防万一然后就没事了
to be safe and, uh-and we're set.
-好吧 -这很好我是说...
- Okay. - This is great, I mean--
-艾娃 -你好康纳
- Ava. - Hello, Connor.
你的手怎么样了
how's the hand?
好多了这要怪我自己
It's much better. It was my fault.
我应该把手拿开的
I should have gotten my hand out of the way.
也许我也可以更小心一点的
Well, maybe I could have been a little more careful.
很抱歉我一直没机会
Look, I am sorry that I haven't been able
-过来看看你 -没事
- to come by to check on you. - It's okay.
我知道这里不是说这些的最佳场所
I know we're not in the best of places right now.
-好 -罗德斯医生
- Yeah. - Dr. Rhodes.
又一次你在竭尽全力毁掉我的一天
Once again, you are doing your best to ruin my day.
-或许我该离开 -不你留下贝克医生
- Maybe I should go. - No, no, you stay, Dr. Bekker.
这件事也跟你有关两个月前
This concerns you, too. Two months ago,
你为一名叫肖恩·科克伦的中枪者进行了手术
you operated on a gunshot victim, Shawn Corcoran?
-所以呢 -是你协助的对吗
- Yeah? - And you assisted?
他死了并且有人说
He died, and someone is alleging
你在没有给他关腹的情况下
that you brought him to the ICU with his abdomen left open
就让他进了重症监护室
when you should have closed him.
并且你过早的减轻了他的麻醉剂量
And then, you lightened his anesthesia prematurely
这也导致了他的死亡
while contributing to his death.
是谁这么说的
Who made these allegations?
是匿名投诉
It was an anonymous complaint.
很遗憾医院监察委员会被要求
Unfortunately, the hospital oversight committee is obliged
对这个病例的真正死因进行分♥析♥
to do a root cause analysis into the case.
-你们都会被谈话 -然后呢
- You'll both be interviewed. - And then what?
如果委员会发现指控成立
Well, if the committee finds that the charges have merit,
你罗德斯医生就会被带到
you, Dr. Rhodes, will be brought before
同行评议委员会的面前
a peer review board.
但愿这件事不要发生
But hopefully that does not happen.
你的混合手术室花了医院一大笔钱
Your hybrid OR has cost this hospital a fortune,
但这对公♥关♥确实有好处
but it has made for some good PR.
我最不需要的就是牵涉到手术室主管的丑闻
The last thing I need is a scandal involving its chief.
康纳同行评议你可能会被吊销执照的
Connor, peer review? You could lose your license.
是啊
Yeah.
戴维斯先生你回来了
Mr. Davis, you're back.
是啊现在开始感觉像我们住在这里了
Yeah, it's starting to feel like we live here.
我就是有点担心苏菲
But I'm just a little bit worried about Sophie.
-她怎么了 -她没有正常进食
- What's the matter with her? - She's not eating like she should,
并且睡眠时间比平时长
and she's sleeping more than usual.
好吧不如让她躺在这里
All right, well, why don't you lay her down right here
我来看看好吗
and I'll take a look, okay?
好吧你没事的哦
Okay. You're okay.
就放在这里
Just right here.
没事的
You're all right.
-37.8度 -她发烧了
- 100.1. - She is running a fever.
没什么意外的情况
I'm not seeing anything unexpected.
那就好
Okay.
别担心我们会弄清楚的
Don't worry, we'll figure this out.
给她打个点滴然后检查一下胃管是否开放
Put in an IV and check the patency of the g-tube.
可能她只是没有摄入流体和营养物质
It could just be she's not getting her fluids and nutrition in.
-好的 -这和她的心脏问题有关吗
- Right. - This have anything to do with her heart condition?
目前还不清楚
I don't know yet.
目前有可能只是
It could just be that, right now,
她没有得到足够的营养
she's not getting the nourishment she needs.