芝加哥急救
Chicago Med S02E05
Part 2
Jan. 23, 2020, 12:08 p.m.
It doesn't end well.
他的血压很低
His pressure is down.
感觉气管偏到右边了
Trachea feels deviated to the right.
我要一把手术刀
I need a scalpel.
我们去5号♥治疗室
We're going to treatment 5.
-好的 麦基 -奥尔加·巴洛
- You got it, Maggie. - Olga Barlow.
74岁 独居
74, lives alone.
顽固心脏病史 因为呼吸困难而叫救护车
Complex cardiac history. Called EMS for dyspnea.
血压82/44
BP 82 over 44.
慢性心房♥纤维颤动 心率105
Chronic A-fib at rate 105.
呼吸急促 每分钟30
Tachypneic at 30.
这些是她的药
Those are her meds.
-我去叫崔医生 -好
- I'll page Dr. Choi. - Okay.
巴洛太太 今天又怎么了
Mrs. Barlow, what happened today?
外面太热了 我喘不过气来
It's so hot out, I'm having a hard time catching my breath.
你家里有空调吗
Do you have an air conditioner in the home?
-我也想啊 -把她搬过来
- Don't I wish? - Well, let's move her.
一 二 三
One, two, three.
好了
There you go.
脉搏血氧89
Pulse ox 89.
体温38.3度
Temperature 101.
她的心跳快到130
She's tachy up to 130.
我觉得应该是中暑衰竭
I think we're looking at heat exhaustion.
在她的腋窝和腹股沟放置冰袋
Let's pack her axilla and groin in ice
做全血细胞计数 血液生化 肝功能和尿检
and send a CBC, CMP, LFTs, and urine.
给她注射一剂D50
And give her an amp of D50.
-怎么回事 -非劳力性中暑
- What's the story? - Non-exertional heat illness.
我们要降低她的核心温度 并为她补水
We're going to lower her core temp and keep her hydrated.
你看过她的药了吗
You check her meds?
她好像患有肺动脉高压
Looks like she has pulmonary hypertension.
没错 颈静脉扩张
That's right. Jugular venous distention.
也就是说她现在容量过度负荷
That means she's in volume overload.
你为她输液很可能导致心脏衰竭
This fluid you ordered could've sent her into heart failure.
我会没事的吧
Am I gonna be okay?
我们会照顾好你的
We're gonna take good care of you.
拍竖直和水平胸透
Let's get a chest film. AP and lateral.
-心电图和回声测定 -好的 医生
- ECG and stat formal echo. - Yes, Doctor.
依前列醇水平设为2 多巴酚丁胺设为3
Start epoprostenol at two. Dobutamine at three.
你的关节炎让你很疼吗
Is your arthritis causing you pain?
-是的 很严重 -我想也是
- Yes, it's pretty bad. - I bet.
羟考酮的剂量还真大
That's a pretty good dose of oxycodone.
给她一...不 两毫克氢吗♥啡♥酮
Let's give her one--no, two milligrams of hydromorphone.
一毫克她根本没感觉
She won't even notice one milligram.
好
Okay.
你很快♥感♥觉就会好起来
You're gonna be feeling better soon.
下次下诊断之前
Next time do a complete history
做好全面的病史和身体♥检♥查
and physical before making a diagnosis.
很好 拿着
Great. There you go.
古德温女士 能和你谈谈吗
Ms. Goodwin, a word?
有什么问题 罗德斯医生
Problem, Dr. Rhodes?
昨晚我顶了创伤科的班
I filled in for trauma last night.
七台手术
Seven surgeries.
我得在手术室之间两头跑
I was double-booked going back and forth between ORs.
一个月前 你还抱怨
Well, a month ago you were complaining
没什么事做呢
about not having enough to do.
经过昨晚 我彻底不抱怨了
Well, last night cured me of that.
医院现在正超负荷运转 古德温女士
The hospital is over-scheduling, Ms. Goodwin.
也许有人觉得我们需要多赚钱
Well, maybe someone thought we needed the revenue.
-我会留意的 -谢谢
- I'll look into it. - Thank you.
我们现在各有各的烦恼 罗德斯医生
Look, we're all having our problems today, Dr. Rhodes.
回家睡一觉吧
Go home. Get some sleep.
不行 我还得去开一个关于腿冷患者的
I can't, I've got a consult on a cold leg in IR
股动脉搭桥手术会议
that needs an aortalfemoral bypass.
拉开肋骨
Retract his ribs.
吸管
Suction.
好
All right.
有东西吗
Anything?
只有血块
Nothing but clots.
我看不到 我得伸到肺部后面
I don't see it. I got to get behind the lungs.
还是有颈动脉搏动
Still has a carotid pulse.
天 肋骨刺穿了动脉
Oh, man. Rib perforated the aorta.
-你能夹上吗 -用什么 我的手吗
- Can you clamp it? - With what? My hand?
我们能争取...他能争取20分钟
It'll buy us-- him 20 minutes?
稍久一点的话他就有可能就此瘫痪
Any longer there's a good chance he'll be paralyzed.
不然他就会失血而死
If you don't, he'll bleed out.
好吧
All right.
-止血了 -止住了
- Hemostatic? - Yeah, it stopped.
现在他需要血 和一个奇迹
Now he needs more blood... and a miracle.
如果我们有便携式导管的话 的确有可能
Which could happen if we get him on portable bypass.
法国就有人这样做过
They've been doing it in France.
我们曾在医院进行过临床试验
We have a unit in clinical trial at Med.
艾普尔 打给麦基
April, call Maggie.
好的
On it.
我们还剩19分钟能赶在伊格纳西奥瘫痪或者
We've got about 19 minutes to get Ignacio hooked up
进一步恶化前为他接上设备
before he's paralyzed or worse.
我想问你来着
Hey, I meant to ask you.
今晚给你妈妈带花是不是有点太过了
Are flowers too much for your mom tonight?
看到她连玫瑰都会枯萎 不过吧
Roses tend to wilt in her presence, but hey.
别担心 她取消了自己的行程
Don't worry about it. She actually canceled her trip.
她太忙了
She's too busy.
这是她的歉意
This is her idea of an apology.
-一千块 -对
- 1,000 bucks? - Mm-hmm.
真希望我妈妈也这么道歉
I wish my mom apologized like that.
她只会烤饼干
She just bakes cookies.
烤饼干也要花时间的
It takes time to bake cookies.
这只要她给她的会计打个电♥话♥
This just took a call to her accountant.
蓝色警报
Code blue.
蓝色警报
Code blue.
她的舌头松弛了 堵住了她的气道
Her tongue has relaxed, closing off her airway.
我来做口腔导气管
I'll do an oral airway.
-交给我吧 -插管工具
- I got it. - Intubation kit?
不 静脉注射两毫克纳洛酮
No, two milligrams of naloxone IV.
我觉得是用药过度
I think this is an overdose.
-什么药 -氢吗♥啡♥酮
- Of what? - Hydromorphone.
我不明白
I don't understand.
她不应该有这种反应的
She shouldn't have had this kind of reaction.
-呼吸每分钟八次 -你来
- Respiration's at 8 per minute. - Take over?
好
Okay.
崔医生
Dr. Choi.
崔医生
Dr. Choi?
-怎么了 -我知道我开始诊断有误
- Yeah. - I know I was off on my original diagnosis,
但那不会再发生了 你可以信任我
but that won't happen again. You can trust me.
克拉克 你是来学习的
Clark, you're here to learn.
就会犯错误 知道吗
You're gonna make mistakes, okay?
杰夫
Jeff?
我需要你把这个便携旁通管 止血钳
I need you to run this portable bypass, Satinsky clamps,
还有十组电池跑去送到马拉松站点
and ten units of packed cells out to Dr. Halstead
给霍斯特德医生 可以吗
at the marathon aid station, okay?
-跑去 -你现在有其他事吗
- Run? - You doing anything else?
快去吧
Let's go.
-抱歉耽误了那么... -我要打电♥话♥给爸爸
- Sorry it's taking so-- - I want to call Daddy.
-我跟你说了 -有事吗
- I told you. - Is everything okay?
-什么时候才能打给他 -他在旅游 菲比
- When can I call him? - He's traveling, Phoebes.
你知道的
You know that.
我想回家
I want to go home.
菲比 我保证做CT不疼的 好吗
Hey, Phoebe, I promise the CT is not gonna hurt, okay?
就像是给你拍张照
It's just like getting your picture taken,
但同时 你可以帮我个忙吗
but in the meantime, will you do me a favor?
你可以为医生休息室的图上色吗
Can you color a picture for the doctors' lounge?
好吗
Yeah?
因为马拉松 医院比平时忙多了
芝加哥急救
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