芝加哥急救

Chicago Med S04E14

Part 3 Jan. 21, 2020, 1:49 p.m.

先检查一下管子
But let's just check the tube first,
然后再看怎么处理好吗
and then, we'll go from there, okay?
-好的 -那就好
- Okay. - All right.
霍金斯小姐你的检查结果显示钾含量9.2
Ms. Hawkins, your tests show potassium 9.2,
氯化物115 尿素氮105 肌酸酐6
chloride 115, BUN 105, and creatinine 6.
这都是什么意思
What that mean?
这说明你的透析没有起作用
It means your dialysis hasn't been working.
你上次去中心是什么时候
When was the last time that you went to the center?
几天前怎么了
A few days ago. Why?
他们有没有提到流量问题
And did they mention any problems with your flow rates?
因为你的导尿管已经凝结了
Because your catheter is clotted.
他们应该告诉你要来医院换新的了吧
Maybe told you to come to the hospital and get it replaced?
好像是说了应该吧
Oh, something like that, maybe, yeah.
但之后我就病得太重了
But then I got too sick.
没事我们会处理好的
That's okay, we'll get it all fixed up,
也会给你做紧急透析
and get you emergency dialysis.
同时我们也得把你体内的钾含量降下来
Meanwhile, we need to lower your potassium.
给她打一剂碳酸氢盐
Let's give her an amp of bicarbonate,
十单位的胰岛素一剂D50
ten units regular insulin, an amp of D50,
再打8.4克的帕蒂米尔
and then, 8.4 grams of patiromer.
好的
Got it.
全都要打吗
All of that?
情况真的很糟糕是吗
It's really bad, isn't it?
你需要一个新肾
You need a new kidney.
我看看我能不能在移植名单上把你的名字提前
I'm gonna see if I can get you moved up on the transplant list.
麦基
Maggie...
你把我照顾得真好
You're taking such good care of me.
谢谢你
Thank you.
不会再有滑雪旅行了我保证
No more ski trips, I promise.
我知道你不想去
I know you didn't want to go.
霍斯特德医生我们要让他做体外膜肺氧合吗
Dr. Halstead, should we get him on ECMO?
如果你没办法保证他能下来
We can't put a patient on ECMO
就不能让他做
unless we have a plan to get him off it.
-那我们还能做什么 -只有这个了
- Then what can we do? - This is it.
没别的办法了
There's nothing else.
在他恢复脉搏之前我不会停的
I'm not gonna stop until his pulse comes back.
你需要休息让我替你一会儿
You need a break. Let me take over for a while.
好吧交换
All right. Switch.
你还好吗
Hey, you good?
我马上回来
I'll be right back.
根据我的经验
Based on my experience,
这绝对是最好的做法
it's definitely the best course of action.
好的
Okay.
萨姆
Hey, Sam.
枪击案受害者那个报告上说了什么
What's the report on the GSW victim?
他什么时候成了你的病人了
Since when is he your patient?
别这样萨姆
Come on, Sam.
子弹卡在了第12胸椎的脊髓中
Bullet lodged in his cord at T12,
脊髓周围血肿
hematoma surrounding the cord.
那孩子左侧偏瘫
Kid's hemiplegic on his left side,
右腿还能用
right leg still works.
等等所以如果你把子弹取出来
Wait, so there's a chance he'll regain feeling
他的左腿有可能恢复知觉
in his left leg when you pull the bullet out?
不我们要把子弹留在里面
No, we're leaving it in.
取出子弹有大出血的风险
Removing the bullet risks substantial bleeding
并且可能对脊髓造成更大的损伤
along with more potential damage to the spinal cord,
可能导致他截瘫
which could result in the kid being paraplegic.
但是如果他可能
Well, isn't that worth the risk
恢复全部功能不值得冒险吗
if it means he might gain full function back?
我宁可要一条能用的腿不要两条不能用的腿
Well, I'd rather have one good leg than two bad ones.
等等我们说的是一个孩子
Wait, look, we're talking about a kid, here.
他还有大好的人生
Okay, with his whole life ahead of him.
霍斯特德没人问你的无知看法
Halstead, no one asked for your uninformed opinion,
而且他们一家已经做出决定了
and the family's made their decision.
回急诊室去给病人贴创口贴吧
Go back to the ED and put a Band-Aid on someone.
好消息尿液毒品检测结果为阴性
Good news, the urine tox screen came back clean.
我根本不担心
I wasn't worried.
莫妮克给她用第一剂纳曲酮
Monique, let's administer the first dose of Naltrexone,
然后送她去介入科放置外周中心静脉导管
then send her up to the IR for a PICC line.
请侧身好吗
Could you turn on your side, please?
亲爱的
Honey...
你确定要这么做吗
Are you-- are you sure about this?
这是很大的一步
This is a really big step.
是的妈妈我确定
Yes, Mom. I'm sure.
会有一点疼好吗
Just a little pinch, okay?
-好了 -谢谢你们
- That's it. - Thank you, both.
我明白她以什么为生
I understand what she does for a living,
但她一直都对自己的健康负责的
but she's been responsible with her health.
不
No--
她不是高危人群
She's not high risk.
是的我明白
Yes. I understand.
是关于西妮的吗
That about Sydney?
是的她排在移植名单最后
Yeah, she's on the bottom of the transplant list
因为她是性工作者
because she's a sex worker.
她来的时候我让她等着
When she came in, I kept her waiting.
我没有相信她
I didn't take her seriously.
我没意识到她是败血症
I didn't realize that she was septic.
如果我没让她等
Maybe if I hadn't kept her waiting,
也许就不会变成这样了
this wouldn't have happened.
麦基你无法确定
Maggie, you don't know that.
我们隔着几个街区长大
You know, we grew up a couple blocks from each other.
隔几个街区差距巨大
Huge difference, those couple blocks.
艾普尔
April?
我想要你给我抽管血
I want you to do a blood draw on me.
抽血
A blood draw?
麦基你不是认真的吧
Maggie, you cannot be serious.
四号♥诊室没人我们走
Treatment 4's open. Let's go.
-她没有呼吸了 -血氧饱和度降到60%
- She's not breathing. - Sats are down to 60%.
-开始通气 -血氧饱和度回升
- Start bagging. - Sats are coming back up.
-88 93 -需要插管
- 88, 93. - Need to intubate.
进去了通气
I'm in. Bag her.
叫人来装呼吸机然后做胸部X光
Call for a vent and get a chest x-ray.
-她暂时稳定了 -怎么回事
- She's stable for now. - What's wrong with her?
我还不知道但我们会弄清楚的
I don't know yet, but we're gonna get to the bottom of it.
回来帕特里克求你了
Come back, Patrick. Please?
回来吧
Just come back.
霍斯特德的医生已经十分钟了
Dr. Halstead, it's been ten minutes.
求你别走宝贝
Stay with me please, baby.
不好意思威尔跟你说两句
Excuse me. Will, I need a word.
加布里埃尔和他的父母现在又说
Gabriel and his parents are now saying
他们想要做手术取出子弹
they want the surgery to remove the bullet.
很高兴听到
Glad to hear it.
你无权干涉我的病人
You had no right interfering with my patient.
我只是确保他们知道所有的选择
Hey, all I did was make sure they knew their options.
不你进去提倡做一台
No, you went in there and advocated for a surgery
他们已经决定不做的手术
that they had decided against.
康纳这孩子不应该
Connor, this kid shouldn't have to live
余生只有一条能用的腿
the rest of his life with only one good leg.
对他不应该但事已至此
No, he shouldn't, but what happened happened,
我们无力改变
and we can't change that.
也许我们可以
Well, maybe we can.
也许他可以恢复以前的样子
Maybe he can go back to the way he was.
威尔我明白伙计是你的枪
Will, I get it, man. It was your gun.
你可能脑子有问题
You might have some messed up idea
觉得这是你的错
that this was somehow your fault,
但是提倡那台手术
but pushing for that surgery,
那个孩子最终可能会坐上轮椅
the kid could wind up in a wheelchair.
或者他可能会完全康复
Or he could be made whole again.
我有病人要照顾
I have a patient to attend to.
救命快来人救救我女儿
Help, help! Somebody help my daughter!