芝加哥急救

Chicago Med S02E18

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

我很快回来
I'll be back shortly.
他有点不对劲
Something's just not right with him.
-我同意 -但是是生理上还是精神上的
- I agree. - But is it physical or mental?
我的猜测跟你们一样
Your guess is as good as mine.
很遗憾我们没有理由不让他出院
Unfortunately, we have no grounds to hold him.
我去准备出院文件
I'll get the paperwork ready.
好你的病人室上性心动过速
Okay, so your patient is in SVT.
你要怎么办
What do you do?
除颤器开到七焦
Um, cardiovert at 7 joules.
对
Right.
她又恢复窦性心律了现在怎么办
So she's back in sinus rhythm. What now?
-查看她的生命体征 -对
- Check her vitals... - Mm-hmm.
准备静脉输液
Establish IV access,
如果她的收缩压低于75就进行输液
provide fluids if her BP drops below 75 systolic.
然后腺甘酸你加了吗
And? The adenosine? You got a dose?
腺甘酸被划掉了
Adenosine is scratched out.
那就自己算
Calculate then.
你的病人又要开始室上性心动过速了
Your patient's gonna revert back to SVT.
快点
Come on.
这是生死攸关的事
It's a life and death situation here.
6.5毫克的腺甘酸
6.5 milligrams of adenosine.
是0.65 不是6.5 给
It's 0.65, not 6.5. Here.
对不起
I'm sorry.
-什么情况 -他的左胳膊没有知觉了
- What happened? - He can't feel his left arm.
好了左臂血压是80/30
All right, left BP is 80 over 30.
看一下右边血氧饱和70
Check the right. Sat's at 70.
布兰登你能捏一下我的手吗
Hey, Brandon, can you squeeze my hand?
不行不行我动不了
No. No, I can't.
-好的 -右臂是150/100
- Okay. - Right arm's 150 over 100.
这是这是怎么回事
What's--what's going on?
双腿变冷我们需要马上做CT造影
All right, legs are cold. We need a CT angio now!
收到
Got it!
-爸爸 -怎么了
- Dad? - What is happening?
布兰登的左臂没有供血
Brandon's not getting blood to his left arm,
但我需要拍片看一下
but I need a picture of it to see.
有可能是我们做的移植堵塞了
It's possible that the graft we put in has become occluded.
堵塞堵塞了这是什么意思
Occlud--occluded? What does that mean?
第一场手术可能没起效
The first surgery may not have worked.
那你们得再做一次吗
So you have to do it again?
可能没那么简单
It may be more complicated than that.
她室颤了
She's in v-fib!
除颤仪开始心脏按压
Paddles. Start compressions.
-威尔她的肋骨会断 -充电至两百焦
- Will, I'll break her ribs. - Charge to 200 joules.
马上开始按压
Start compressions now!
你确定吗我...
Are you sure? I--
-让开 -别威尔
- Out of my way. - No, Will.
-充电了吗 -两百焦
- Are we charged? - 200 joules.
心肺复苏暂停离手
Holding the CPR. Clear.
一毫克肾上腺素再次充电至两百
One milligram of epi, charge to 200 again.
-两百 -好了离手
- 200. - All right, clear.
脉搏正常
Pulse is good.
霍斯特德医生决定插管
Dr. Halstead decided to intubate.
我是因为她才开始做护理的
You know, this woman is the reason I stayed in nursing.
第一年做手术室护士时
My first year as an O.R. nurse,
其实我想过放弃
I actually thought about quitting.
-你吗 -有段时间很艰难
- You? - Oh, I had a rough time.
有一场...手术是我做消毒
There was this, um, surgery I scrubbed on.
应该是血管手术
I think it was a vascular case.
医生要一把十刃手术刀
The resident asked for a ten blade scalpel.
结果手术刀从我手里滑落掉进了切口
It slipped out of my hand, dropped in the incision.
-我的天啊 -没有伤到病人
- Oh, my God. - It didn't hurt the patient,
但那个医生四处散布这事
but that resident reamed me out.
罗文医生介入了叫他过去
Dr. Rowan stepped in, called him out,
说手术室里
said everyone
每个人都应该得到尊重
in the O.R. deserved civility.
每一个人
Everyone.
贝拉·罗文
Bella Rowan.
了不起的女人
Wonderful woman.
非凡的老师
Extraordinary teacher.
肖恩我的天啊
Sean, oh, my God.
我的天啊救命来人啊
Oh, my God. Uh, help, someone!
救救我丈夫拜托了
Help my husband, please.
好的这里需要一张轮床
Okay, hey, I need a gurney here.
亚当斯先生你能听到吗
Mr. Adams, can you hear me?
-他怎么了 -没有反应
- What's wrong with him? - Unresponsive,
有脉搏我们把他送进病房♥
has a pulse. Let's get him in a room.
过来这里
Bring it over here.
听我数数转移准备一二三
Let's transfer on my count. Ready, one, two, three.
-我们走吧 -他没有呼吸了
- Here we go. - All right, he's not breathing.
-做喉镜和气管插管 -肖恩
- Get a laryngoscope and a 7.5 ET tube. - Sean!
准备创伤一室
Trauma 1 to prep.
他彻底晕厥了不需要用药
He's totally flaccid. Don't need drugs.
莫妮克你开始静脉注射
Monique, you start the IV.
好的
Okay.
-肖恩 -好你就站在这里
- Sean... - Okay, you stand right here.
他的上消化道大量出血
He's got a massive upper GI bleed.
他的胃里都是血液
His stomach's filling with blood.
进去了艾普尔听听他的肺音
I'm in. April, listen to his lungs.
好的
Yep.
两边呼吸音都不错
Good breath sounds bilaterally.
好挂两单位的血再准备四个单位的
All right, hang two units of blood and get another four ready.
怎么回事为什么为什么会这样
What's going on? Why--why is this happening?
我不知道但我们会查出来的
I don't know, but we're gonna find out.
挂盐水
Hang saline.
-盐水挂好了 -好就这样
- Saline's up. - All right, stay on it.
收到你的呼叫了
Got your page.
罗文医生最新的报告
Dr. Rowan's latest labs.
很遗憾她现在是急性肾功能衰竭
I am so sorry. She's in acute renal failure.
高钾血和酸中毒
Hyperkalemic and still acidotic.
好的我们给她做低流透析
All right, we'll start her on low flow dialysis.
这样应该能调整她的电解质和酸碱度
It should correct her electrolytes and PH.
威尔
Will...
我不会袖手旁观看着她死
I won't stand by and let her die.
让艾普尔呼叫肾脏部
Tell April to call renal.
移植物闭塞在任何血管外科手术中都可能出现
Graft occlusion is a possible outcome of any vascular surgery.
这不能怪任何人
It's nobody's fault.
好吧那现在有两个选择对吗
Okay, so there are two options, right?
-我们可以 -让我来处理好吗
- We could either-- - Just let me handle this, okay?
米奇有时间吗
Mitch, a moment?
怎么了
What is it?
CT显示我放进
So the CT revealed that the graft
布兰登胸腔的移植物扭结了
I placed in Brandon's chest kinked,
引发了再缩窄
causing re-coarctation,
或者就是主动脉收缩
or essentially a, uh-- a narrowing of his aorta.
跟以前一样
Like before?
很遗憾
I'm sorry.
那那怎么办我们又回到原点了吗
So--so what? We're just back at square one?
是的但是这次情况更加复杂了
Yes, but this time, things are more complicated.
我可以用支架修复嫁接
Now I can repair the graft by placing a stent,
这我们可以在导管室里做
and we would do that in the cath lab.
但支架会堵住
But the stent will cover
左锁骨下动脉
the opening of his left subclavian artery.
这样就会切断他左臂的血液循环
That will cut off circulation to his left arm,
也就是说布兰登会失去左臂
meaning Brandon will lose that arm.
失去左臂
Lose his arm?
不行
No.
不他不能失去他的胳膊他不能
No----he can't. He can't.
一定还有什么别的办法
It--there must be something else you can do.
很抱歉但是没有别的办法了
I'm sorry, but no.
恐怕这是我们唯一可行的选择了
I'm afraid this is our only viable option.