芝加哥急救

Chicago Med S02E10

Part 4 Jan. 23, 2020, 12:10 p.m.

我就立刻出院
and I'm getting the hell out of here.
六分钟后要去楼上做术前咨♥询♥
We have a pre-op consult upstairs in six minutes.
里斯医生艾布拉姆斯医生你们好
Dr. Reese, Dr. Abrams. How's it going?
我得帮她改掉从你那里养成的坏习惯
I need to break her of all your bad habits.
我发现我手下的住院医生大部分都自愿
I've found my most successful residents happily volunteer
延长一周80小时的工作标准
to work well past the standard 80-hour week.
查尔斯医生
Dr. Charles.
梅根·斯科特你之前评估过的待移植患者
Meghan Scott, my transplant patient you evaluated.
我记得
Yeah.
你当初说得对
Turns out that you were right about her.
她还是喝酒了
She fell off the wagon.
真的吗
Really?
我很遗憾
I'm very sorry to hear that.
我之前那样质疑你的决定
The way I put you on the spot about your decision--
我应该向你道歉
I owe you an apology.
不必
No, you don't.
谢谢你的道歉但是我的评估
I appreciate the gesture, but my evaluation--
我调查过她那是我的决定
I vetted her. It was my call.
我... 我应该去看看她
I should, um--I should probably check in with her.
移植委员会应该需要重新评估
The transplant committee's gonna want another assessment.
我先失陪了我得去一下发病率和死亡率大会
If you'll excuse me, I've got to get to the M&M.
好谢谢你告诉我
Yes. Thank you for telling me.
应该的
Of course.
由于一种未知的心包积液
The patient became unstable
病人的情况开始变得不稳定
due to an unrecognized pericardial effusion,
我使用了紧急心包穿刺术让病情稳定了下来
which was stabilized by emergent pericardiocentesis.
你展示了几张胆石病的
You presented the images of the mrcp
核磁共振胰胆管造影
demonstrating cholelithiasis
来支持你所诊断的
to support your diagnosis of pancreatitis
由胆石病引发的胰腺炎
due to choledocholithiasis,
但你没有向我们展示任何
but you aren't showing us any images
肺底或者心脏的照片
of the lung bases or heart.
那些照片并没有采集
Those images were not obtained.
为什么
Why not?
病人动来动去导致图片模糊
The patient's movement resulted in unreadable images.
你为什么不再照一次
Why didn't you repeat the scan?
因为已经捕捉到了足够多
The study captured adequate detail
想看到的细节
within the area of interest.
所以如果你在这时候足够警觉
So, had you been more vigilant at this juncture,
或许你就能发现
perhaps you would have identified
病人的心包积液
this patient's pericardial effusion
也就能避免后来的心血管爆裂了
and avoided his subsequent cardiovascular collapse.
事后而言是的
In hindsight, yes.
但在当时我认为自己已掌握需要的信息了
At the time, I believed I had what I needed.
我们继续
Let's move on.
你刚才说你给病人用了呼吸机
You mentioned placing the patient on bipap,
这加重了心脏压塞
which exacerbated cardiac tamponade.
你作何反应
How did you respond?
你感觉如何
How are you feeling?
感觉自己一下毁了两个人
Like I screwed up two lives.
你们母女马上就团聚了
Let's get you two together.
我会把这扇隔墙打开
I'll have this dividing wall opened up.
她怎么样脖子还好吗
How is she? Is her neck okay?
好消息是没有骨折
Good news is there are no fractures.
好那坏消息呢
Okay. What's the bad?
不一定是坏事可能没什么大不了的
It's not necessarily bad. It might be minor,
但CT显示布里亚的上胸椎有一块阴影
but Bria's CT showed a mass in her upper thoracic spine,
不是车祸造成的
unrelated to the accident.
天哪阴影就是肿瘤对吧
Oh, god. A mass means tumor, right?
可能有很多种
It could be a number of things.
我可怜的孩子
My poor baby.
她前几个月一直说后背疼
She's had some back pain in the last few months.
她还总安慰我说没什么事
She tried to convince me it was nothing.
我应该早带她来医院的都是我的错
I should've brought her in. This is my fault.
梅根在我们照核磁共振
Meghan, until we do an MRI
看清楚到底是什么之前
to get a better look at what we're dealing with,
你要先保持冷静
the best thing you could do is try to stay calm.
该死
Son of a bitch!
把这东西拿走
I need this damn thing out!
卡斯罗先生请您冷静
Mr. Koslow, please, you need to calm down.
把这从我的胳膊上拿走
And you need to take this out of my arm.
我已经超了两磅了
I'm two pounds over.
只是水的重量
It's just water weight.
输液是唯一让你恢复精力的办法
That IV is the only reason you're feeling stronger.
你得接受它
You need to leave it in.
去你的你不会得逞的
You know, screw this. You're not gonna do it,
我自己拿掉
I'll pull it out myself.
别别别请别那样做
No, no, no. Please don't do that.
好你想要这样
Okay. Fine. That's what you want,
那我们先回病房♥
let's get you back to your room.
才不要你别想再给我什么
Hell, no! You're gonna try to give me something.
-我不奉陪了 -不先生
- I'm done with this crap! - No! Mr--
放开...
Get off of--
-现在你流血了 -我没事
- Now you're bleeding. - I'm fine.
好了所以你才需要治疗
Okay. This is why you need to be treated.
我治疗了现在我胖得不能上马了
I did that, and now I'm too fat to ride.
你不能再用利尿剂了
You can not take diuretics again.
你是在玩一场俄♥罗♥斯♥轮盘
You are playing Russian roulette.
你走运的机会是有限的
There are only so many times you can pull that trigger.
放开我立刻
Let me go, now!
妈妈我没事
Mom, I'm fine!
-不过是条毯子 -我不需要
- Oh, it's just a blanket. - I don't need it.
你们还好吗
Everything okay?
她看着有点冷
Oh, she just seemed cold.
你不该起来的
And you shouldn't be up.
我扶你回病床吧
Can I help you back into bed?
里斯医生
Dr. Reese?
我在神经重症科轮岗
I'm doing a rotation in neurocritical care.
我们发现的阴影不是肿瘤
The mass we found is not a tumor.
谢天谢地
Oh, thank God.
是脊动脉畸形
It's a spinal AVM,
就是血管异常扭结了
which is an abnormal tangle of blood vessels.
严重吗
Is it serious?
布里亚可能一生下来就是这样
Bria's probably had it since she was born.
很常见的是我们一直要到
Quite often, we don't find it
它开始有影响才能发现它
until it starts causing problems.
什么影响
What kind of problems?
会麻木出血甚至瘫痪
Down the line, numbness, hemorrhage, even paralysis.
所以后背疼就是一个信♥号♥♥
So, the back pain was a sign.
我们本可以几个月前就发现了
We could've caught this months ago.
我们还是把重点放在我们现在发现了它上吧
Let's focus on the fact that we caught it now.
这是可以通过手术治疗的
It can be treated surgically.
里斯医生会给你们做一个神经外科咨♥询♥
Dr. Reese will do a neurosurgery consult with you,
然后我们神经外科主任艾布拉姆斯医生
and then our head of neurosurgery, Dr. Abrams,
会过来跟你们详谈
will come down and go over the details.
真的对不起布里亚
I'm so sorry, Bria.
好了不是你的错
Stop it. It's not your fault.
不是我没有关心你
No. I wasn't thinking about you.
我只想着自己
I was only thinking about myself.
动脉畸形的确不是好事
Having an AVM is unfortunate,
但现在尽早地发现
but finding it now, as early as we have,
已经是最好的结果了
is the best we could ask for.
曼宁医生之后让我去做心包穿刺术
Dr. Manning then paged me to perform a pericardiocentesis.
你有推荐去做液体分♥析♥
Did you recommend sending the fluid for analysis
并且给胸腹骨盆做CT吗
and obtaining a CT chest, abdomen, and pelvis?
我有说过
I did.
CT显示在右中肺叶上有一个肿块
The CT showed a large mass in the right middle lobe
伴有肺门肥大和纵膈淋巴结肿大
with bulky hilar and mediastinal lymphadenopathy.
那是曼宁医生要求肿瘤咨♥询♥的时候吗
And that's when Dr. Manning called for an oncology consult?
是的而且他们的建议是化疗
Yes. And their recommendation was chemotherapy.