芝加哥急救

Chicago Med S03E20

Part 3 Jan. 23, 2020, 11:14 a.m.

I'm a--I'm a forensic psychiatrist
法医心理学家
here in Chicago,
我对你女儿的案子感兴趣
and I'm interested in your daughter's case
只是出于临床考虑
purely in a clinical point of view.
你来找我们吧我们跟你讲奥利维亚的事
Come visit us. We'll tell you about Olivia.
她真的是个好女儿
She was really remarkable.
查尔斯医生如果你有什么发现
Dr. Charles, if you find out something,
就打给我们
call us, please.
当然
Uh, of course.
我把我的号♥码给你
Let me give you my number.
止血钳用上了
Clamps are on.
来了不少大人物
A lot of bigwigs here:
霍普金斯医院梅奥诊所杜克医院
Hopkins, Mayo, Duke.
点点的下腔静脉
Dot's inferior vena cava
比我们预计得更偏向前侧
is more anterior lateral than anticipated.
我们需要重建心房♥才能合上
We'll have to reconstruct the atrium to get it closed.
什么意思
What does that mean?
他们需要做搭桥手术才能继续
They need to continue the surgery on bypass.
我们需要让双胞胎接受搭桥手术
I'm afraid we're gonna have to put the twins on bypass.
你说对了
You were right.
谢谢凯利
Thanks, Kelly.
伯特
Hey, Bert.
介意我坐在这里吗
You mind if I sit?
声明一下我来这里可不是为了公事
Just for the record, I'm not here on official business.
我只是
I just...
来跟老伙计打个招呼
Came to say hi to an old pal.
别烦我丹尼尔
Leave me alone, Daniel.
那天我听到两位住院医生
The other day, I heard these two residents
聊起十天清肠活动的事
talking about this ten-day master cleanse.
你听说过吗
You ever heard of that?
让我想起那次我们一起节食吃西柚
Reminded me of the time that you and I went on that grapefruit diet.
西柚里的某种酶...
You know, something about the enzymes in the grape--
行了
Please...
别浪费时间了
You're wasting your time.
走吧
Just go away.
你已经退烧了
Your fever's gone down.
心率和血压也好转了
Heart rate and blood pressure have improved.
都是好迹象
All good signs.
那奇奇呢
Uh, what about Kiki?
她也在好转
She's doing better too.
麦基如果黛比和奇奇都稳定了
Maggie, if Deb and Kiki are both stable,
我们可以给她们转到儿童重症监护病房♥
we can send them up to the PICU.
有更多病人进来了
We got more coming in.
曼宁医生
Dr. Manning?
你去二号♥治疗室
You're going to Treatment Two.
十六岁女孩疑似甲肝
16-year-old female, suspect Hep A.
发热低血压
Febrile and hypotensive.
我的肚子好痛
My stomach hurts.
我们会帮助你的好吗
We're gonna help you with that, all right?
艾米莉
Emily?
可能也是甲肝
Possibly Hep A also.
你去四号♥治疗室
You're going to Treatment Four.
发热心动过速呼叫放射科
Febrile and tachycardic. Call Radiology.
我们需要她的肝脏超声右上腹
We need an ultrasound of her liver, right upper quadrant.
明白
Got it.
听我口令转移她
Transfer her on my count.
-准备好了吗 -好了
- Ready? - Yep.
一二三
One, two, three.
去做血常规血液生化肝功能
Let's get a CBC, BMP, LFTs,
肝炎检查和胸透
hepatitis panel, and a chest X-ray.
好
Got it.
她讨厌我
She hates me.
她没有讨厌你
She doesn't hate you.
我不怪她
I don't blame her.
休息一下吧
Just get some rest.
我哪里也不去
I'm not going anywhere.
劳拉消瘦虚弱
Laura is emaciated, lethargic,
并且黄疸很严重
and profoundly jaundiced.
潜伏期应该差不多
Incubation time should be similar,
但她的症状要比其他人严重得多
but she's presenting so much worse than the others.
我知道是你给这个女孩接生的
I know you delivered this girl's baby.
很遗憾娜塔莉
I'm sorry, Natalie.
两颗心脏已搭桥
Both hearts on bypass.
我们准备好了
We're ready to go.
还有一个回声来确认定位
One more echo to confirm positioning.
我在点点的心脏中看到一个相当大的
I'm seeing a pretty large muscular ventricular
心肌室间隔缺损
septal defect in Dot's heart.
之前的影像上怎么没有看到
Why didn't we see this on previous imaging?
这不重要
Doesn't matter.
我们在继续下一步之前必须先纠正它
We'll have to correct it before we can proceed.
这个问题严重吗
Is this a big problem?
在心尖附近修补一个未知大小的孔
Patching a hole of unknown size near the heart's apex,
位置也很难触及
a difficult spot to reach,
是的问题挺严重的
yeah, it's a very big problem.
要做这个我们需要做心室切开术
To get access, we need to make a ventriculotomy.
不在这种情况下心脏的异常解剖
No, in this case, with the abnormal anatomy
切入心室的话
of the heart, by cutting into the ventricle,
我们可能会破坏心脏的传导系统
we can disrupt the heart's conducting system.
心脏可能会永远停止跳动
The heart might never beat again.
我们失去一个女孩就两个都失去了
We lose one girl, we lose them both.
借过
Excuse me.
我认为我们应该用夹层铺筑法修补这个洞
I think we should patch the hole using the sandwich method:
每边各两片戈尔补片
two pieces of Gore-Tex on either side.
她微小脆弱的心脏中会有更多的切口
More incisions in her tiny, fragile heart.
不风险太高了
No, too risky.
用经导管室间隔缺损封堵设备
Use a transcatheter VSD closure device.
那是导管室的操作
That's a cath lab procedure.
我们从来没用在切开的心脏上
We never do it on an open heart case.
这是唯一能解决室间隔缺损
It's the only way to reach the VSD
又不损伤点点的心脏的办法
and not damage Dot's heart.
没有切口
No incision.
我们通过心房♥进行填补
We snake the patch in through the atrium.
-莱瑟医生 -不他说得对
- Dr. Latham-- - No, he's right.
我们只有这个选择
It's our only option.
我对结果全权负责
I will take full responsibility for the outcome.
当然是你
Indeed you will.
罗德斯医生来负责操作
Dr. Rhodes will perform the procedure.
去洗手准备
Go scrub in.
好的
Yes, sir.
-康纳 -我必须这么做
- Connor... - I have to do this.
你明白如果孩子们没有撑过去
You realize if those babies don't pull through,
你的事业就完蛋了吧
your career is over?
是的我明白
Yeah. I do.
莎伦
Sharon?
我能和你谈谈吗
Can I just talk to you for a second?
好
Yeah.
所以...
So...
伯特不肯和查普曼医生说
Bert isn't talking to Dr. Chapman,
不肯和里斯医生说
he isn't talking to Dr. Reese,
也不肯和我说
not even talking to me.
你们之前婚姻维持了三十年
You two were married for 30 years.
三十年
30 years.
抱歉我只是...拜托我请求你
Oh, I'm sorry, I'm just-- please, I'm asking you,
你能不能和他谈谈
could you-- could you talk to him?
试着让他敞开心扉
Just try and open him up.
所以你是认为
So, you think that
因为那些美好的岁月
because of all those good years,
现在我欠他的
I owe him something now?
我只是想说如果是你的话
I'm just saying that, coming from you,
可能会不一样就是这样
it might make a difference, that's all.
我问你丹尼尔