芝加哥急救

Chicago Med S02E23

Part 2 Jan. 23, 2020, 12:13 p.m.

He may not be checking his messages.
他家里有急事
He had a family emergency.
他告诉我我随时可以来找他他保证过的
He told me that I could see him any time. He promised.
不好意思我可以找他的住院医师来看你
I'm sorry. But I can have one of his residents see you.
我不和半吊子谈
I'm not talking to some underling.
查尔斯医生在吗
Is Dr. Charles here?
在但我想他没空
Yes, but I don't think he's going to be available.
你告诉他我不接受这种待遇
You tell him that I'm not gonna be treated this way.
我就待在这里等他出来
I'm gonna stay right here and wait until he comes out.
好
Okay.
给我一杯咖啡
Hey, get me a cup of coffee.
自动贩卖♥♥机就在那里
The vending machine's right there.
艾普尔昨晚...
April, about last night--
不我自己也有错
No. It's just as much my fault.
就当没发生过吧
It never happened.
崔医生艾普尔你们上
Dr. Choi, April, you're up.
塞萨尔
Cesar?
唐·克罗克 47岁男性
Don Crocker, 47-year-old male,
呼吸困难胸部疼痛
shortness of breath, chest pains.
你们去4号♥治疗室
You're going to Treatment 4.
在楼梯间晕倒了邻居发现他的
Passed out on the stairs. Neighbor found him.
-太走运了 -血压90/70
- Lucky. - BP 90/70.
心率110 在救护车上做了12导联心电图
Heart rate's at 110. 12 lead in the ambo.
好了克罗克先生我是崔医生
All right, Mr. Crocker, I'm Dr. Choi.
我们会照顾好你好吗
We're gonna take good care of you, all right?
好了
Okay.
听我口令转移病人预备一二三
Let's transfer on my count. Ready? One, two, three.
心电图显示是急性心梗找心脏病团队来
12 lead shows a stemi. Activate the team.
克罗克先生你心脏病发作
Mr. Crocker, you're having a heart attack.
-阿司匹林 -81毫克和4单位吗♥啡♥
- Aspirin? - Yeah. 81 milligrams and 4 of morphine.
克罗克先生你有什么联♥系♥人吗
Mr. Crocker, is there anyone we should call?
朋友家人
Friends? Family?
-没有 -同事呢
- No. - Someone at work?
我在家工作一般基本不出门
Work from home. Most days don't even leave the apartment.
-那就是没有人 -是的
- So, no one? - No.
好了克罗克先生你的心脏和肺部
All right, Mr. Crocker, you've got fluid backing up
有液体回流
into your heart and lungs--
所以你才呼吸困难
that's why you're having difficulty breathing.
艾普尔注射十毫克呋♥塞♥米♥ 插入弗利导尿管
April, let's give him 10 milligrams of Lasix and place a Foley--
我们会帮助你排出多余液体
we're gonna get the excess water out of your system.
好
Okay.
-克罗克先生 -他晕过去了
- Mr. Crocker? - He's lost consciousness.
脉搏还在带他去导管室
All right, I've got a pulse. Take him up to the Cath Lab.
在那儿插管吧叫心脏科医生来
I'll intubate him there. Page Cardiology.
-准备好了吗 -好的
- Ready? - Yep.
她怎么会突然剪头发
Why'd she do it? Cut her hair.
一个女人这样换发型肯定是有事吧
A woman changes her hair like that, it's a big deal, right?
绝对发生了什么
It means something.
肯定的
Absolutely.
所以呢
Yeah. So?
你别问我啊
Well, don't ask me.
吓死我了干什么
Oh, my God. What?
你今晚会来参加我的派对吗
Are you coming to my party tonight?
不知道我还没考虑过
I don't know. I haven't thought about it.
好吧要是你去了肯定不一样
Okay. Well, it won't be the same without you.
行我现在很忙好吗
All right. Look, I'm busy, okay?
好不过你...
Okay. But you are...
一定要来派对
coming to my party.
谢谢你听了我的建议
Glad you took my advice.
她在睡觉至少让我帮你买♥♥份早餐吧
She's sleeping. At least let me buy you some breakfast.
不如来杯咖啡
Cup of coffee, maybe.
查尔斯医生
Dr. Charles?
我最近一直在看罗宾的病历
I have been reviewing Robin's history
想看看有没有漏掉什么情况
just to make sure we haven't missed anything,
她的一些症状
and, well, some of her symptoms--
与精神疾病不符
they're not consistent with a psychiatric disorder.
-里斯医生 -听她说完
- Dr. Reese... - Let her finish.
两天前罗宾来到医院时
Two days ago when Robin came to the hospital,
出现了轻微发烧 37.8度
she was running a mild fever, 100.2,
血压也有所升高
and her BP was elevated.
当时我们并没有多想
Now, at the time, we didn't think anything of it--
因为只是低烧
That's 'cause it's a very mild fever.
血压升高也很正常
And of course her BP was elevated.
当时被强行控制她很焦虑
She was on a forced hold. She was agitated.
但罗宾今天来的时候
But when Robin was brought in today,
似乎出现了幻视
it seemed she was experiencing visual hallucinations.
幻听代表精神失常
Now, auditory hallucinations indicate a mental disorder,
但是幻视应该考虑为机体异常
but visual hallucinations should be considered organic
除非有其他证据
until proven otherwise.
我们都希望罗宾所患的是
I think we all wish that Robin had a treatable
可以治疗的生理疾病而不是...
physical condition rather than--
我想查她的血浆铜蓝蛋白水平
I want to check her ceruloplasmin levels
做荧光螺旋体抗体吸收试验核磁共振脑电图
and run an FTA-ABS as well as an MRI and EEG
排除硬化症和癫痫的可能
to rule out sclerosis and epilepsy.
当然可以做吧
Of course. Do it.
你是怎么了
What's the matter with you?
她这是在安慰我
She's trying to make me feel better.
我很感激但她这是侥幸心理对吧
And bless her, but she's grasping at straws. Come on.
你被恐惧蒙住了双眼
Are you so blinded by your fear
你太害怕罗宾的问题是由于遗传
that Robin inherited her problems from you
你连其他可能性都不考虑吗
that you won't even entertain an alternative?
这是空欢喜莎伦我不需要
False hope, Sharon. Come on. I don't need any.
你无法肯定这一点
You don't know that.
曾经在诊断时不放过任何疑点的丹尼尔
Where's the Daniel who leaves no stone unturned
去哪里了
when diagnosing a patient?
那个从不放弃的丹尼尔去哪儿了
Where's the Daniel who never gives up?
你不觉得对待亲女儿更应该做到这些吗
Don't you think your own daughter deserves that much?
谢了
Thanks.
-情况如何 -他需要新瓣膜
- Hey, what are we looking at? - He needs a new valve.
艾娃·贝克扫描部同事
Ava Bekker, CT fellow,
伊森·崔急救室住院医师主任
Ethan Choi, Chief Resident of the ED.
那就开胸换瓣膜
So, we crack his chest, replace the valve.
其实不用开胸
Well, we don't need to crack his chest.
克罗克先生被定义为中度危险患者
Mr. Crocker's been assessed as intermediate risk,
经过药监局审核这样级别的患者
and transcatheter aortic valve replacement, TAVR,
可以进行输导管主动脉瓣膜更换手术 TAVR
is now FDA approved for patients at that level.
开胸主动脉瓣膜更换手术效果非常好
We get excellent results with open aortic valve replacement.
用TAVR 会带来很多不确定因素
With TAVR, you're just inviting complications.
我不同意为何要让患者
I don't agree. Why put the patient
经历长时间手术和机器连接的折磨
through a long operation and a long pump run?
不到两小时就可以让他心脏恢复正常
He can have a functional heart again in under two hours.
-侵入性越小越好 -没错
- The less invasive, the better. - Exactly.
不好意思你是急救室住院医师
Excuse me. You're an emergency medicine resident.
-你为什么在这说话 -你说什么
- Why are you even talking? - Excuse you?
因为我很尊重崔医生的意见
Because I value Dr. Choi's opinion.
我认为莱瑟医生
And I think you'll find that
也会支持TAVR的做法
Dr. Latham will back me on the TAVR.
好吧
Fine.
很抱歉把你扯进来
I'm sorry you got brought into this.
我之前不知道罗宾的事你肯定很想去陪她
I didn't know about Robin. I'm sure you want to be with her.
没事不过谢谢你
Yeah, I'm all right, but thanks.
这事也不会太久
This won't take long.
我会告诉你他的情况的
I'll let you know how he does.
谢了
Thanks, man.
-他的氧水平怎么样 -百分之百
- What level of oxygen is he on? - 100%.
左上叶分段萎陷
Left upper lobe is segmentally collapsed.
可能被他气道中的血块堵塞了
Probably plugged up from a clot in his airway.
做个支气管镜检查
Yeah. Let's get a bronchoscopy.
好的清除任何障碍
Yeah, clear out any obstructions.
我一直没问
Hey, I never asked,
你为什么决定要剪头发