芝加哥急救

Chicago Med S02E23

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

why'd you decide to cut your hair?
是时候改变一下了
Time for a change.
我找马万·哈达
I'm looking for Marwan Haddad.
-你是他的家人吗 -我们一起上学
- Oh, are you family? - We go to school together.
他现在正在进行治疗
Well, he's being treated right now.
你在大厅等他吧
Why don't you wait in the lobby,
等你能看他的时候我会告诉你的好吗
and I'll tell you when you can see him, okay?
崔医生
Oh, Dr. Choi,
看一下2号♥治疗室的那个女孩
take a look at this girl in 2.
可能是远端桡骨骨折和脑震荡
Probable distal radial fracture and concussion.
这个小天才把绳子绑在椽子上
This young genius tied a rope around a rafter
试图荡过学校食堂
and tried to swing across the school cafeteria.
-什么 -你会明白的
- What? - You'll see.
顺便说一下我找不到我的咖啡杯了
Oh, by the way, I'm missing my coffee mug.
很显然有些白♥痴♥认为
Yeah, some cretin obviously thought
偷了它会很有意思
it would be amusing to steal it.
我会帮你留意的斯托尔医生
I'll make sure to look out for it, Dr. Stohl.
谢谢
Thank you.
闭合性远端桡骨骨折
Closed distal radius fracture.
猴子装
Monkey suit.
当然了从椽子上荡过去
Of course. Swinging from the rafters,
-一定得穿猴子装 -太蠢了
- got to have a monkey suit. - So stupid.
不蠢你应该看看
No. You should've seen people's faces
人们看到你时的表情
when they saw you.
太刺♥激♥了
It was so clutch.
毕业生恶作剧我们要高中毕业了
Senior prank. We're graduating from high school.
得让骨科住院医生来看看
We'll need the Ortho resident to see her.
恐怕我们得把你的猴子装剪开来接好你的手臂
I'm afraid we're gonna have to cut this suit to set your arm.
-不行这是租的 -抱歉
- No! It's a rental. - I'm sorry.
你朋友掉下来的时候失去意识了吗
Your friend lost consciousness when she fell?
是的我有点担心
Yeah. I was kind of worried.
脑震荡的确很令人担忧
Concussion is always a concern.
做一个分层扫描头和脖子
I want to get a CAT scan, head and neck,
保险起见
just to be sure.
别担心你很快就能离开这了
Don't worry. You'll be out of here in no time.
我来联♥系♥骨科
I'll call Ortho.
崔医生你今晚会来参加我的聚会的吧
Oh, Dr. Choi, you're coming to my party tonight, right?
谢谢但是我去不了了
Thanks, but I'm not gonna be able to make it.
明天早班
Early call tomorrow.
你确定吗就喝一杯迈泰
You sure? One Mai Tai.
抱歉
Sorry.
好吧
Okay.
瓣膜已放好持开放状
The valve is in position and open.
-注射染剂检查 -氟代
- Injecting dye now to check it. - Fluoro.
左冠状动脉看起来不错但我看不到右边的
Left coronary artery looks good, but I'm not seeing the right.
可能堵塞了能放进去线吗
Could be occluded. Can you get the wire in?
我试试给右冠状动脉插管
Let me try and cannulate the right coronary artery.
不行内腔被堵塞了
Can't, the lumen's blocked.
右边没有血液流动
There's no flow on the right side.
右边的ST段有改变
Seeing right side ST changes.
旧瓣膜的钙沉淀一定中断了
Calcium deposit must have broken off
堵塞了右冠状动脉
from the old valve and occluded the RCA.
他的心脏不行了我们现在就得给他开胸
His heart is dying. We've got to open him up now.
我们一开始就应该这么做
What we should have done in the first place.
我们已经打电♥话♥给她找另一张床位了
And we're already making calls to find her another bed.
在我们能把她转到长♥期♥康复中心之前
We'll keep Robin here until we can get her transferred
罗宾就在待在这
to a long-term facility.
我们会照顾好她的
We'll take good care of her.
我会减少她的镇静剂用量
I've dialed back on her sedation.
罗宾宝贝
Robin? Honey?
离我远点离我远点
Get away from me. Get away.
离我远点离我远点
Get away from me. Get away from me!
让他走
Make him go!
丹丹丹交给我们吧
Dan, Dan, Dan, we got this.
你说得对
You were right.
我做的那些测试没有任何迹象表明
The tests I ran-- there's no indication
有任何的器官严重疾病我很抱歉
of any organic medical condition--I'm sorry.
罗宾显示出运动功能障碍你之前注意到过吗
Robin's showing dyskinesia. Did you notice that before?
那些不太顺畅的动作吗
The jerky movements?
是的我以为那是精神病治疗药物的缘故
Yeah, I assumed it's from the antipsychotics.
可能是
Yeah. It could be.
你有做肿瘤检查吗
Did you order a paraneoplastic panel?
自身免疫检测吗为什么
For auto-antibodies? Why?
-能做一个吗 -当然
- Could we just run one? - Of course.
搭桥放好了取下搭桥机
Graft is in place. Let's get him off of bypass.
松开主动脉
Unclamping the aorta.
让他的心脏自主跳动吧上除颤
Let's get his heart beating on its own. Defibrillate.
离手窦性心律
Clear. Sinus rhythm.
减到2升
Cut to 2 liters.
等等他的心脏右侧还在膨大
Hold on. His right heart is ballooning.
重新接上完全支架马蒂他上了什么药
Back on full support. Marty, what's he on?
8单位多巴酚丁胺 5单位多巴胺
Dobutamine at 8, dopamine at 5.
给他1负荷单位的米力农注射50毫克的
Give him a milrinone loading dose, epinephrine bolus
肾上腺素同时吸入一氧化氮
of 50 micrograms, and start inhaled nitric.
不会管用的他的心脏没救了
That's not gonna cut it. His heart isn't coming back.
他只能接上体外膜肺氧合了
He's not leaving this room without ECMO.
但以后不就会留下并发症的隐患吗
Won't that just set him up for complications later?
为什么这家医院的住院医生
Why do all the residents in this hospital
都觉得他们有资格提出意见
think they can offer their opinions?
不上体外膜肺氧合
No ECMO.
他的心脏足够强壮能够支撑自主跳动
His heart is strong enough to come back on its own.
我不同意
I disagree.
意见收到但这是我的病例
Noted, but this is my case.
好了减到2升
All right, cut to 2 liters.
心脏恢复跳动了
The heart's coming back.
隔膜回到中线小血管阻力可接受
Septum is midline, SVR acceptable.
-血压稳定 -做得好罗德斯医生
- Pressure's holding. - Good call, Dr. Rhodes.
是
Yeah.
移除导管吧
Let's decannulate.
他的血氧降到80了
His sats are down to 80.
这是他最新的X光片
There's his latest X-ray.
没有改善
No improvement.
给他做的吸氧量是多少
How much vent support are we giving him?
-已经最大值了 -已经打了支气管扩张剂
- Maxed out. - He's on bronchodilators,
但还是得不到足够的氧气
and he's still not getting enough oxygen.
75%
75%.
如果我们不改善他的缺氧状况
If we don't correct his hypoxia,
他的大脑就要因为缺氧损伤了
we're looking at anoxic brain injury.
把他送到重症监护室
Let's get him up to the ICU
给他上心肺支持
and put him on cardiopulmonary support.
好的
Right.
你的病人还有个朋友找来了可能是女朋友
Your patient has a friend here. Girlfriend, maybe.
-好的我去和她谈谈 -好
- Oh, good. I'll go talk to her. - Okay.
多谢了小娜
Thanks, Nat.
你等了多久了
How long you been waiting?
我不知道一个多小时了吧
I don't know, about an hour.
果不其然他们这就是一群骗子
Typical. They lie to you here.
要维护你的权利啊
Stand up for your rights.
你好你是马万的女朋友吗
Hi. Are you Marwan's girlfriend?
你是不是叫克里斯蒂娜
Is your name Christina?
是
Yes.
你怎么知道我的名字
How do you know my name?
他刚刚送进来的时候一直在叫你的名字
When he first came in, he called out for you.
你了解什么有助于治疗的情况吗
Do you know anything that may help me treat him?
比如说病史用药史之类的
Any medical history? Medications?
我们还没那么了解彼此
We haven't known each other that long.
我们要把马万送去重症监护病房♥了
Okay. We're taking Marwan up to the Intensive Care Unit.
如果你愿意的话也可以上去
If you want, you can come wait up there.
那好我叫人带你上去好吗
All right. I'll have someone come grab you, okay?
斯托尔医生
Dr. Stohl,
我找到你的杯子了