芝加哥急救

Chicago Med S02E06

Part 1 Jan. 23, 2020, 12:09 p.m.

所以我拿的样本上标着"左髋关节滑液"
So I get this specimen labeled "Synovial fluid, left hip."
我看着它
And I'm looking at it,
不是非常粘稠
and it's not very viscous.
很明显我在想也许是痛风
Obviously, I'm thinking maybe it's gout,
但在显微镜下没有任何尿酸结晶
but there aren't any crystals under the microscope,
只有细胞所以我联♥系♥取液的实习生
just cells, so I call the intern who drew it,
他告诉我他在排除肝硬化的可能
and he tells me he's trying to rule out cirrhosis,
一点道理都没有
which doesn't make any sense,
直到我突然明白
until I suddenly realize,
我看到的那些不是单核细胞
those weren't monocytes I was seeing,
而是早幼粒细胞白血病蛋白
they were PMLs.
那家伙从他左髋关节采集的
The guy had drawn it from the left hip,
但那是腹膜液
but it was peritoneal fluid.
你怎么了
What is the matter with you?
下公交后你看到有人在跟着我们吗
Did you see someone following us when we got off the bus?
没有
No.
我很肯定我看到了
I'm pretty sure I did.
-谁 -我不知道
- Who? - I don't know.
我一直有种被跟踪的感觉
I just can't shake this feeling I'm being followed.
-被跟踪 -没错
- Followed? - Mm-hmm.
我明白了
Oh, I get it.
别担心不是真的
Don't worry, it's not real.
什么
What?
你第一年当精神科实习医生
You're a first year psych resident.
那是什么意思
But what does that mean?
你花整天时间治疗精神问题严重的病人
You spend all day treating very disturbed people.
那些人精神紊乱的行为反映在你身上
It's only natural that you'd start mirroring
是很自然的比如妄想症
some of their disorders. For example, paranoia.
我不知道
I don't know.
你的语气有点居高临下
That sounds kind of condescending.
这太忙了麦基你得让这些病人
Stacking up here, Maggie, you need to get these patients
去医疗楼
to the medical floors.
真的吗抱歉崔医生我没注意
Oh, really? Sorry, Dr. Choi, I didn't notice.
曼宁医生海莉·克莱恩来了
Dr. Manning, Hayley Kline, incoming.
女性青少年患非霍奇金淋巴瘤在接受化疗
Adolescent female, on chemo for non-Hodgkin's lymphoma.
-不不不去急救室 -好的
- No, no, no, Baghdad. - Oh, okay.
曼宁医生幸亏你在这
Dr. Manning, thank God you're here.
阻止那些鞋不要鞋
Stop the shoes. No shoes.
-亲爱的我不明白 -她在胡言乱语
- Honey, I don't understand. - She's been talking nonsense.
昏迷指数10 精神状态改变语无伦次
GCS 10, altered mental status, mostly incoherent.
新出现黄疸现象
New onset of jaundice.
-艾普尔 -交给我
- April? - Got it.
她的眼睛变黄了
Her eyes, they're-- they're yellow.
海莉亲爱的我是曼宁医生
Hayley, honey, it's Dr. Manning.
你记得我吗
Do you remember me?
我找不到我的...
I can't find my--
-她怎么了 -我们会查出来的
- What's wrong with her? - We're gonna find out.
不要下雨不不
No rain. No. No.
挂一升生理盐水
Let's hang a liter of NS
做血常规血液生化肝功能还有电解质检测
and draw a CBC, BMP, LFT, and lytes.
好的
On it.
她上一次化疗是什么时候
When was her last dose of chemo?
几天前我觉得
Few days ago, I think.
实际上有一周了
A week, actually.
亲爱的亲爱的
Oh! Sweetie, honey.
她可能肝功能衰竭
She could be in liver failure,
可能导致她的大脑膨胀
which could be causing her brain to swell.
不
Oh, no.
昏迷指数恶化我们得插管来保护气管
GCS is worsening. We need to intubate, protect her airway.
我来
I got it.
做你们该做的就好了
Do what you gotta do.
注射10毫克依托咪酯和75毫克琥珀胆碱
10 of etomidate and a 75 of sux.
好的
Yup.
百分之九
Nine percent.
插♥进♥去了
I'm in.
去预约头和腹部CT 呼吸机
Let's get a head CT and belly, hyperventilate
让实验室检测对乙酰氨基酚含量
and get labs now with an acetaminophen level.
-明白 -联♥系♥告知他们
- Got it. - Call 'em and tell 'em
我们马上就上去没有时间了
we're on our way up, we don't have time.
你们可以一起走吧
You can come with us. Let's go.
坚持住海莉
Hang in there, Hayley.
你能快点卸货吗
Can't you rush those discharges?
-我需要那些药 -你整理成页了吗
- I need those meds. - You paged?
对好好好
Yeah. Yeah, yeah, yeah, yeah.
我们已经爆满了楼上没有床位了
We're jammed and there's no beds upstairs.
我很讨厌这么说但也许我们应该...
I hate to say it, but maybe we should--
我们不会把病人转到其它医院的
We're not diverting patients to other hospitals.
我的意思是...
I'm just saying--
麦基我们不会无视规章制度的
Maggie, we're not going on bypass.
如果医疗楼满了就联♥系♥加护病房♥
If the medical floors are filled, call the ICUs,
把病人安排在那直到有床位空出来
put patients there until beds are available.
我会试试的
I'll try.
很抱歉不能保证隐私
Sorry for the lack of privacy.
没事我就想快点出院
Oh, no problem. I just want to get outta here.
什么时候开始疼的
When did the pain start?
半小时之前
About a half hour ago.
我打算忍♥忍♥就过去了
I was gonna ignore it,
但我的邻居他是个护士
but my neighbor, he's a nurse,
所以他让我应该来检查一下
and so he said I should get it checked out.
我不喜欢医院
I don't like hospitals.
我明白到底是哪个位置疼
I hear ya. Where exactly is the pain?
这肚脐这
Here. Uh, the belly button.
霍斯特德医生
Dr. Halstead?
洛根先生你有心房♥纤颤史吗
Mr. Logan, do you have a history of A-fib?
那是什么
What's that?
心率不齐
An irregular heartbeat.
没有很严重吗
No. Is it serious?
很常见但我们得检查一下
Oh, very common, but something we should look into.
这里如何疼吗
What about this? This hurt?
不疼
No.
-这呢 -对就是那
- This? - Yeah, there.
好消息你的肚子是软的你没有防备
Well, good news, your belly's soft and you're not guarding,
意味着我碰你时候并不紧张
meaning you're not tensing when I touch you.
所以我没事对吗
Oh, so it's probably nothing, right?
可能是我吃了什么东西引起的
I mean, it's probably something I ate.
希望如此但保险起见
I hope so, but let's just-- let's just be safe.
预约做一次胸部X光腹部平片血液乳酸检测
Let's order a chest x-ray, KUB and lactate,
血液生化淀粉脂肪酶检测还有基本指标
CBC, amylase lipase, check his basic chemistry.
好的
Right.
做那些要多久
How long is that all gonna take?
不会太久
Uh, do you know, not long.
我们会尽快让你出院
We'll get you outta here as soon as possible.
手术耐受度不错柯林斯先生
Tolerated the surgery well, Mr. Collins.
胸音正常
Your chest sounds good.
太好了
That's great.
我来听一下
Let me.
柯林斯先生我们要重做您的
Mr. Collins, we're gonna have to redo
主动脉瓣置换手术
your aortic valve replacement.
-什么 -莱瑟医生
- What? - Dr. Latham?
心尖收缩期杂音
Apical systolic murmur.
我没有听到
I didn't hear it.
很微弱
It's subtle.
很抱歉我还是没有听到
I'm sorry, I still don't hear it.
叫手术室安排
Call the OR, have them set up
重做一场主动脉瓣置换手术
for an emergent aortic valve take back.
马上去
Right away.
你还要做一次手术真的吗
You're gonna have to operate again, really?
莱瑟医生我想和你谈谈先失陪了
Dr. Latham, if I may. Excuse us.
我们还要让他再经历一次吗
We're gonna put him through it again?
我们至少先做个超声确认一下吧
Shouldn't we at least get an echo to confirm?