芝加哥急救

Chicago Med S02E22

Part 3 Jan. 23, 2020, 12:13 p.m.

but her fever's rising, and she's disinhibited
意识水平降低
with a decreased level of consciousness.
-吸毒过量 -毒理检测结果为阴性
- Drug overdose? - Tox screen was negative,
其他检测也是
as was every other test--
孕检尿检胸透 CT
pregnancy, urinalysis, chest X-ray, CT,
盆腔超声
pelvic ultrasound.
神经系统感染
Neurologic infection?
脑膜炎脑炎做腰椎穿刺了吗
Meningitis? Encephalitis? You get an LP?
刚做了脑脊液正常
Just did. CSF was clear.
无论这是什么都是病毒性的
Whatever this is, it's viral.
实验室正在检测聚合酶联锁反应
The lab's running a PCR.
好有消息通知我
Okay. Keep me posted.
多丽丝告诉我你被急诊科录取了
Hey. Doris told me you matched in Emergency Medicine.
太棒了
That's awesome.
恭喜克拉克很高兴有你的加入
Way to go, Clarke. Good to have you.
谢了对了
Thanks. Hey, um,
有件事我一直想说
there is something that I've been meaning to talk--
娜塔莉
Natalie!
-她在抽搐 -天呐快救她
- She's seizing. - Oh, my God, make it stop!
-两单位安定 -收到
- Two of ativan. - Got it.
血氧饱和度在下降 77 76
Sats are dropping. 77. 76.
艾莉森有感觉吗
Allison, can you feel this?
我得插管了
I need to intubate.
没嗑药她的下巴脱落了
No drugs. Her jaw is loose.
我们会处理好的
We're gonna fix this.
-好了差不多了 -好
- Okay, almost. - Yeah.
不不不不不行你们会呛住她的
No, no, no, no, no-- you're gonna choke her!
不这样的话她没办法呼吸
She won't be able to breathe otherwise.
-我进去了 -好了我来我来
- I'm in. - Okay. I got it. I got it.
注意管子开始泵氧
Secure the tube and start bagging.
做胸部X光打给儿科重症监护室要一个床位
Stat chest X-ray and call up to the pediatric ICU for a bed.
等等重症监护室她怎么了
Wait, ICU? What's going on with her?
哥们我拿到你的检查结果了
Hey, man. I got your labs.
希望只有好消息
Good news only, please.
我能坐下吗
Can I sit?
除了你的血糖以外一切正常
Everything's normal except your blood glucose.
血糖特别高
It's extremely high.
-糖尿病 -是的
- Diabetes. - Yes.
我准备开始给你输液输胰岛素
I'm gonna start you on IV fluids and insulin
还有血红蛋白和糖化血红蛋白
and order hemoglobin A1C,
控制你的血糖
Get a better reading on your sugar levels.
糖尿病会使你的脚变麻木
Diabetes can make your feet numb.
所以我不知道我的脚上有个钉子是吗
That's why I didn't realize I had a nail in my foot, isn't it?
是的
Yeah.
我病了一段时间了
I've been sick for a while.
重要的是我们发现了
Look. The important thing: we caught it.
做一些生活方式的调整
Some lifestyle adjustments,
你就能好起来了
and you'll get way out ahead of this thing.
是啊
Yeah, sure.
我知道改变并不容易
Look, I get it. Change isn't easy,
但从长远来看这是唯一的办法
but in the long run, it's the only way.
我叫内分泌科来
I'm gonna page Endocrinology,
让他们下来会诊
have them come down for a consult.
他们应该能回答你的所有问题
They should be able to answer all your questions.
艾莉森的腰椎穿刺结果
Allison's LP results.
脑炎
Encephalitis.
天呐 HSE
Oh, my God. HSE?
是的发烧神经问题抽搐现在的昏迷
Yeah. Fever, neuro issues, seizures, now the coma--
病毒符合这些症状
virus fits the symptoms.
是的
Yeah.
我只是没想到她才13岁
I just didn't see it coming. I mean, she's 13.
疱疹病毒
Herpes?
艾普尔
April!
血压在下降高压94 低压66
BP's falling. 94/66.
心跳加快脉搏120
Heart's racing. Pulse is 120.
肺部积水血氧饱和度
All right, lungs are wet. Sats?
没有读数
Can't get a reading.
手指都肿了发紫脉搏监视器测不到脉搏
Fingers are swollen, purple. Pulse ox monitor can't register.
做个血气分♥析♥
Get a blood gas.
脚趾也发紫了耳垂也是
Toes are purple. Earlobes, too.
眼睛和鼻孔有血
Blood in the eyes, nasal passage.
-发生什么了 -你的血液循环被切断了
- What's happening? - Your circulation's being cut off--
不能很好地为你的全身供氧
oxygen's not moving well through your body.
-为什么 -我不清楚
- Why? - I'm not sure.
二氧化碳分压256 动脉血氧分压255
pco 256, pao 255.
好了供氧加到10升
All right, let's increase the oxygen to 10 liters.
艾普尔
April?
他还要被转送到重症监护室吗
Is he still being transferred to the ICU?
推迟一下
Hold off for now.
做一下弥漫性血管内凝血测试
Let's test for DIC.
如果和我们看到的一样的话
If that's what we're seeing,
我想可能有办法说服加里
I think there may be a way to convince Gary
治疗他的脑出血
to fix his brain bleed.
你在找我吗
Oh, hey, were you looking for me?
请加入我们吧查尔斯医生
Please join us, Dr. Charles.
这位是妮可·詹森是希普利...
This is Nicole Jansen of Shipley--
希普利·奥斯汀·谢伊
Shipley Austin & Shea.
我是罗宾·查尔斯的代表律师
I'm representing the interests of Robin Charles.
律师
Lawyers?
我希望你能帮我们弄清楚
I'm hoping you can provide some clarity
查尔斯小姐的非自愿入院情况
on the circumstances surrounding Ms. Charles's involuntary hold.
我不知道哪里不清楚
I don't see how it's not clear.
申请书是按照州法律提出的
A petition was filed in accordance with state law.
24小时内权医生签署了...
And within 24 hours, Dr. Kwon here signed--
我会问到权医生的首先我想聊聊
I will get to Dr. Kwon. First, I want to talk
原始的查尔斯医生提出的
about the filing of the original petition
申请
by Dr. Charles,
医院的精神科主任
the hospital's Chief of Psychiatry,
但同时还是我客户的父亲
but also my client's father.
多有意思
Interesting.
艾莉森有2型单纯疱疹病毒
Allison has HSV type 2,
这种疱疹相更常见于生殖器疱疹
which is more commonly associated
而非口腔疱疹
with genital herpes than oral.
生殖器不会的
Genital? No.
小艾不会那么做的什么时候在哪
Ali doesn't do that. And when? Where?
她不是在学校
She's either at school
就是和我们俩中的其中一个在家是吗凯文
or at home with one of us-- right, Kevin?
我在家办公在家里并没有发生什么
Yeah, look, I work from home. Nothing's going on at the house.
没有男生来过从来没有
Okay, no boys come over, ever.
我知道女孩们不会告诉她们妈妈所有事
I know girls don't tell their mothers everything--
反正我没有但是...
God knows I didn't, but--
但小艾和我我们会谈的
but Ali and me--we talk.
你注意到艾莉森的心情
Have you noticed any change in Allison's mood
或个性在近期有什么变化吗
or personality in the last few days?
没有除了生病她还是和平常一样开心
No. Besides being sick, she's been her usual happy self.
为什么
Why?
艾莉森的腹痛和
Allison's abdominal pain is inconsistent
疱疹的诊断一致
with the HSE diagnosis,
可能是性侵犯的迹象
and it may be a sign of sexual assault.
我们想做一个范围更大的盆腔检查
We'd like to perform a more extensive pelvic exam
保险起见
just to be sure.
那真的有必要吗我是说
Is that really necessary? I mean, come on,
这对你们的治疗并没有什么影响不是吗
it's not gonna have any effect on how you treat her, is it?
可能有内部损伤和内出血
There might be some internal damaging and bleeding
需要被修复
that needs to be repaired,
她还有可能感染了其他性传染疾病
and it is possible she may have contracted another STD.
能等一等吗能等到我们...
Look, can it just wait? Can it wait until we...
有时间弄明白...
just have a moment to figure out--
没关系
It's okay.
没关系你可以... 你们可以去做检查
It's okay. You can-- you can perform the exam.
-你确定吗 -是的