芝加哥急救

Chicago Med S03E16

Part 2 Jan. 23, 2020, 11:13 a.m.

- Scalpel? - You're gonna do it here?
没别的选择了他的胸腔无法扩张了
No choice. His chest can't expand.
必须释放他的表皮张力
Gotta release the skin tension.
古德温女士
Ms. Goodwin?
天啊卡特
Oh, my God, Carter!
莉迪亚小心点
Lydia, careful.
莎伦他会没事吧
Sharon, is he gonna be okay?
卡特二度烧伤
Carter suffered second-degree burns.
目前皮肤触碰会非常疼痛
They're gonna be painful to the touch for a while.
霍斯特德医生莉迪亚和马莱斯·辛勒顿
Dr. Halstead, Lydia and Maurice Singleton.
儿子这...都怎么回事
Son, uh, how... How did this happen?
波没事吧
Is Bo all right?
你和波在一起吗
Were you with Bo?
那孩子只会带来麻烦
That boy is nothing but trouble.
不是这样的妈妈
That's not true, Mom.
你知道你不准去他家的
You know you are not allowed to go over to his house.
莉迪亚先冷静一下拜托
Lydia, just lighten up a little bit, please.
玛利亚用肥皂和水清洗烧伤处
Uh, Maria, wash the burns with soap and water,
用磺胺嘧啶银霜我等下回来帮他换衣服
apply Silvadene cream, and I'll be back to help dress him.
谢谢你霍斯特德医生
Thank you, Dr. Halstead.
来
Here, please.
那孩子的情况很糟糕
That kid's in pretty bad shape.
你通知他父母了吗
Have you notified his parents?
他们去日内瓦湖附近拜访朋友了
They were visiting some friends over in Lake Geneva.
正在驱车回来
Driving back now.
回家就得迎接这种坏消息
That's terrible news to come home to.
是啊
Yeah.
好
All right.
一边为分离双胞胎做准备
So, sidelined for the conjoined twins surgery,
现在还在早上喝咖啡之前就做手术
and now you're doing procedures before your morning coffee?
-喜欢你的冲劲 -我不怕辛苦
- I like the fight in you. - I'm a glutton for punishment.
莱瑟的决定很明确
Latham made his choice clear.
下第一刀之前都没有定论
You know, it's not over until the first incision.
态度好一点也许能由你来主刀
Start playing nice, maybe you'll be holding the scalpel.
你这是突然开始支持我了吗
Are you all of a sudden rooting for my success?
并不是我只是不喜欢赢得不明不白
Not at all, I just hate winning by default.
布鲁斯·汉蒙德 34岁
Bruce Hammond, 34.
胸部因高速车祸
Blunt trauma to the chest
遭到钝器撞击
following a high-speed car accident.
没有回声但是左侧有些血胸
Negative echo, but a small left hemothorax
并胸骨骨折
and a sternal fracture.
CT显示没有主动脉损伤
CT's negative for aortic injury.
是的但是放射科表示可能还有
Yes, but Radiology read that there might be
一些心包积液
a small pericardial effusion.
既然他胸腔积血那我们插胸管
Since he's got a hemothorax, let's put a chest tube in
看看会怎么样吧
and see what comes out,
如果他需要手术
and if he needs surgery,
我们可以做一个左胸高位胸廓切开术
we can do a high left thoracotomy.
等等
Hold on.
右心房♥是一点阴影吗
Is that a blush of contrast over the right atrium?
如果他的心脏上有个洞那他需要正中胸骨切开术
If there's a hole in his heart, he needs a median sternotomy.
好眼力贝克医生
Good eye, Dr. Bekker.
如果这是阴影那就不能忽视
If it is a blush, we can't afford to ignore it.
我不知道把他开胸感觉太过了
I don't know, opening him up is highly aggressive,
我们都不知道这阴影是在
and we don't know whether the contrast
心脏内还是心脏外
is inside or outside of his heart.
如果多数人同意开胸
If the majority is in favor of sternotomy...
-那我也同意 -很好
- I'll follow. - Excellent.
贝克医生你主刀罗德斯医生你协助
Dr. Bekker, you'll lead. Dr. Rhodes, you'll assist.
别看上去这么痛苦
Oh, don't look so pained.
我觉得你给你自己赢得了一点人心
I think you just earned yourself some good will.
爱玛什么时候开始疼的
When did Emma's pain start?
一小时之前正在上芭蕾舞课
About an hour ago, halfway through ballet class.
我不知道该不该带她过来
I wasn't sure if I should bring her in,
但是她如果出事她妈妈绝对不会放过我
but her mom would have my head if something happened to her.
我担心可能会是阑尾炎
I was worried that it might be appendicitis.
不阑尾炎的疼痛应该是在右侧
No, appendicitis would be pain on her right side,
但我还是想做个超声检查
but I would like to get an ultrasound.
我小时候我想学芭蕾的
You know, when I was young, I wanted to take ballet,
可惜我一生下来就笨手笨脚的
but unfortunately, I was born with two left feet,
于是我就学小提琴了
so I went with violin instead.
我其实也不喜欢跳舞
Well, I don't really like dance,
但我妈妈小时候学过芭蕾
but my mommy did ballet when she was young,
所以她让我也学
so she makes me go.
现在我要把这个放在你肚子上
Right now, I'm gonna put this on your stomach,
让我看看这里面好吗
so I can see what's inside, okay?
好的
All right.
莫妮克能不能增加一下深度
Monique, can you increase the depth?
我看不到她的子♥宫♥和卵巢
I can't see her uterus and ovaries.
应景到深度了曼宁医生
It's already all the way up, Dr. Manning.
先输液吧
All right, let's start a line.
给她输一毫克吗♥啡♥缓解疼痛
Give her 1 milligram of morphine for the pain.
她妈妈到了就告诉我
And let me know as soon as her mom gets here.
我想和她谈谈
I'd like to speak with her.
爱玛会没事的吧
Is Emma gonna be okay?
是的但还好你带她过来了
Yes, but it's a good thing that you brought her in.
好了爱玛我马上回来好吗
All right, Emma, I'm gonna be back soon, okay?
-好的 -好
- Okay. - Okay.
-谢谢你 -谢谢
- Thank you. - Thank you.
查尔斯医生有时间吗
Hey, Dr. Charles, you got a sec?
我有个病例想请你看看
I've got a case I'd like to run by you.
-怎么了 -我的病人爱玛九岁
- What you got? - My patient, Emma, nine,
她的左腹部疼痛
she presented with abdominal pain on the left side,
于是我进行了快速的临床扫描查看她的卵巢
so I did a quick bedside scan to check her ovaries.
结果发现是睾丸扭转
It's actually testicular torsion.
-睾丸扭转 -没错
- Testicular torsion? - Yes.
超声结果显示没有卵巢和子♥宫♥
The ultrasound showed an absence of uterus and ovaries,
但是她有隐睾
but she has undescended testes.
她的病史中没有吗
Nothing about this in her chart?
没有我怀疑她的家人都不知道
No, I doubt the family has any idea.
好呼叫儿童泌尿科
Okay... page Pediatric Urology.
-我们得一起讨论个计划 -谢谢
- We need to get a plan together. - Okay, thank you.
我怀疑爱玛缺乏17βHSD3
I suspect Emma has 17-beta HSD3 deficiency.
这是因基因变异导致的
It's caused by a genetic mutation.
爱玛的睾丸无法进行
Emma's testes aren't able to carry out
睾酮的合成的最后一步
the final step of testosterone synthesis.
我确认一下基因上来说她是男性吗
So, just to be clear, genetically, she's male?
她有XY染色体所以是的
She almost certainly has XY chromosomes, yes.
至于睾丸扭结需要做什么
As far as the testicular torsion, what's required?
我们需要解开睾丸扭结
We need to untwist the testis
再用睾丸固定术进行固定
and then fixate it via orchiopexy.
我们能救下睾丸对吗
So we'll be able to save the testicle?
做手术就可以
With surgery, yes,
否则六到八小时之内
otherwise it'll die from lack of blood flow
它就会死于缺乏供血
in six, maybe eight hours tops.
谢谢你里奥斯医生
Okay, thank you, Dr. Rios.
我们会将情况告知她妈妈
We'll share the news with her mother
拿到手术许可
and get surgical consent.
这个消息会改变爱玛整个自我认知
This news could change Emma's whole sense of identity.
她的家人也需要一段时间消化
It is a lot for this family to process.
其实我在这种情况下的经验是
You know, my experience in situations like this
虽然很多人想不到
is that the children are often
但孩子们往往会很开明很坚强
surprisingly open-minded and resilient.
怎么回事
What's the story?
卡特说波在做BHL
Well, Carter said that Bo was cooking up BHL.
就是丁烷油
Uh, butane hash oil.
用足量丁烷烧大♥麻♥
You blast marijuana with enough butane,
就能得到高纯度四氢大♥麻♥酚
and you get pure THC.
现在的孩子们为了嗑药可真是拼了
Lengths kids will go to to get high these days.
是啊
Exactly.
卡特说听到另一个房♥间传来尖叫