芝加哥急救

Chicago Med S03E19

Part 5 Jan. 23, 2020, 11:14 a.m.

Well, the anatomy of these hearts is highly irregular,
所以有可能是我们夹住窦房♥结
so it's possible that we clamped the SA node
导致其阻断了心脏的电传导
and it cut off the heart's electrical activity.
这么说你建议从侧向移♥动♥组织钳
So are you suggesting moving the L.A. Clamp laterally?
值得一试
Worth a shot.
罗德斯医生我们不如在下次模拟之前
Dr. Rhodes, why don't we test your theory
测试一下你的理论吧
before the next simulation?
一小时后在实验室见吧
Meet me in the lab in an hour.
好
Okay.
这么说翠西和孩子有好消息了
I take it that means good news for Tracy and her baby?
老话说得好
You know what they say, right?
天佑勇者
Fortune favors the bold.
导尿管已经就位
Catheter's in good position.
检查一下循环管道
Let's double-check circuit tubing,
把目标流量设定为35到40cc每千克每分
and set goal flow at 35 to 40 ccs per kilogram per minute.
我运气好有台体外膜肺氧合机空出来了
I was lucky there was an ECMO available.
我还担心全都被占用了呢
I was afraid they'd all be taken.
能过来一下吗
Um, you...
我觉得不该让他上体外膜肺氧合
I don't think we should put him on ECMO.
为什么
Why not?
科迪注射部位周围出疹子了
The rash on Cody's IV site,
再考虑到他曾有严重的过敏史
given his history of intense allergic reactions?
他可能有未诊断出的系统性肥大细胞增多症
I think he may have undiagnosed systemic mastocytosis.
你从疹子就想到了这么多
You're jumping to that from a rash?
有这种病的孩子一般都会产生
Kids with mastocytosis generally produce
过量的组胺
an overabundance of histamine.
如果科迪真的有让他的血液
If Cody has it, passing his blood
流过机器可能会导致他发生过敏性休克
through the machine could send him into anaphylactic shock.
再考虑到他的肺的情况
Given the state his lungs are in,
他肯定挺不过去的
he would not survive that.
肥大细胞增多症极其少见娜塔莉
Mastocytosis is extremely rare, Natalie,
而我们没时间做活检来确诊了
and we don't have time for a biopsy to confirm it.
霍斯特德医生准备好了
Dr. Halstead, we're ready.
好
All right.
-那PLV呢 -部分液体通气
- What about PLV? - Partial liquid ventilation?
我还以为只有早产儿才用
I thought that was reserved for preemies.
曾经有几例临床试验
There have been some clinical trials
结果非常好
with encouraging results.
理论上PLV是个好办法
PLV's a good idea, in theory.
但我不确定该不该拿孩子的命冒险
I--I'm not sure we should be risking a kid's life
来上这个未经证实可靠的疗法
by using a treatment that's unproven.
威尔我知道我们意见有分歧
Will, I know we've had our disagreements,
但我真的认为这个办法♥会♥起作用的
but I really think this could work.
你的病人你说了算
Your patient, your call.
停不做体外膜肺氧合了
Stop. We're not putting him on ECMO.
等等你说你想淹死我儿子
Wait a minute, you--you're saying you wanna drown my son?
我向你保证凯伦科迪不会被淹死的
I assure you, Karen, Cody will not drown.
但你想把他的肺灌满液体
But you--you--you're gonna fill his lungs with fluid.
这叫做潘氟隆
It's called Perflubron.
其特性非常奇特
It has unique properties,
其中就包括能留存大量的氧
including the ability to hold large amounts of oxygen.
眼下科迪的肺受损太过严重
Yeah, at this point, Cody's lungs are too damaged
已经不能通过空气吸收氧气了
to absorb oxygen through the air,
所以我们希望这次治疗
so our hope is that this treatment
能帮氧气进入科迪的肺
helps oxygen penetrate Cody's lungs
让他恢复呼吸
and restore his breathing.
你们以前做过吗
Have you done this before?
这个手术在新生儿身上做的比较多
This procedure is performed quite often with neonates.
我们觉得这是救你儿子的
We feel strongly it's the best chance we have
最好的机会了
at saving your son's life.
-好 -做吧
- Okay. - Go ahead.
麦基我出去一下
Maggie, I'm gonna be out of pocket for a little bit.
-多久 -三四个小时吧
- For how long? - Uh, three or four hours.
如果有人找我就让他们去找权医生
If anybody needs me, just redirect them to Dr. Kwon.
-好 -丹尼尔...
- You got it. - Daniel...
你要去哪
Where are you going?
罗伯特·海伍德在威斯康辛州麦迪逊市
Robert Haywood still has a storage locker
还有个储藏库
in Madison, Wisconsin
是在奥利维亚·科文尼消失之前租的
that he rented before Olivia Coveny disappeared.
是吗
Okay?
是的所以我要去那看看
Okay, so I'm going up there to check it out.
拜托丹尼尔
Come on, Daniel,
让相关部门处理
let the proper authorities handle it.
相关部门
The proper authorities,
他们现在并不感兴趣
they're just not that interested right now.
-机不可失 -别说了
- I have a limited window. - Stop.
我知道你想保护里斯医生
Look, I know you're trying to protect Dr. Reese,
但是无论你找到什么
but no matter what you find,
你都把你俩的之间的关系置于危险之中
you are really putting your relationship with her at risk.
莎伦就算这些
Sharon, if there's even a remote chance
只有极小的可能是真的...
that any of this stuff is true--
相信我我不想...
and, trust me, I don't want it to be--
我愿意冒这个险
it's a risk I'm willing to take.
听说你可能找到解决办法了
Hear you might have found a solution.
祈祷吧
Fingers crossed.
看来你今天可能会一直走运下去
Looks like it's all coming up roses for you today.
-你们俩过来 -好
- You two, join me. - Yes, sir.
我依然希望做这手术的人是我
I mean, I'm still hoping it's me who gets to do the surgery.
并不意外
No surprise there.
如果我们把两个止血钳移到桥的中心
If we move the two clamps to the center of the bridge,
在两个心房♥之间
between the two atria,
就能解决我们的问题
that could solve our problem.
我去告诉弗里斯医生我们准备好
I'll let Dr. Frisch know that we're ready
-做另一个模拟实验 -好
- to run another simulation. - Okay.
罗德斯医生贝克医生
Dr. Rhodes, Dr. Bekker,
他们需要你们去重症监护室
they need you back in the ICU.
怎么了
What's going on?
她的血压刚刚开始骤然下降了
Her BP just started plummeting.
上氧气
Bag her.
我女儿怎么了
What's going on with my daughter?
-女士... -她出血了
- Uh, ma'am... - She's hemorrhaging.
好吧
Uh...all right.
挂2单位O型血
All right, hang 2 units of o-neg on a pressure bag.
上超声波影像我们得检查一下她的胎儿
Give me the ultrasound. We need to check her fetus
看看她的胎盘
and take a look at her placenta.
轻微的胎盘分离
Placenta's marginally separating,
-造成了她的出血 -胎儿心音很强
- causing her to bleed. - Fetal heart tones are strong.
缓解血液稀释剂的效果
We'll reverse the blood thinners.
希望胎盘可以自行填塞
Hopefully, the placenta will tamponade itself.
如果我们消除稀释剂的效果
If we reverse the thinners,
她的新瓣膜可能会凝血
her new valve could clot off.
大人小孩都保不住我们得带她去手术室
We'll lose mom and baby. We have to get her to the O.R.
我们还可以保住孩子
Look, we can still save this pregnancy.
太晚了
It's too late for that.
如果我们还有希望控制住出血的话
If we have any hope of getting control of this bleed,
她需要做个急症子♥宫♥切除术
she needs an emergency hysterectomy.
停止滴肝素一克血栓素
Stop the heparin drip. Bolus a gram of TXA.
我们谁都不会失去的
We're not gonna lose either of them.
-他还没醒 -不
- He still hasn't woken up. - No.
你有多了解杰里米
How well do you know Jeremy?
不是很了解普通朋友而已
Not that well. I mean, just from around.
我不知道他吸食海♥洛♥因♥
I had no idea he was using heroin.
我不认为杰里米是吸那个过量的
I don't think that's what Jeremy OD'd on.
-不是吗 -不是
- No? - No.
我很确定是扑热息痛
Pretty sure it was Percocet,
巧合地是和药房♥
which, coincidentally, is the same drug
上周丢失的药是同一种
that went missing from the dispensary last week.
所以呢
So?
怎么你想说是我拿的
What, are you suggesting that I took them?
-是吗 -你知道
- Did you? - You know how easy it is
从大街上搞到药有多简单吗