芝加哥急救

Chicago Med S05E08

Part 3 Nov. 18, 2019, 10:06 a.m.

No, injuries like this, looks more like a beating.
有人看见他去哪里了吗
Did anyone see where he was going?
他刚才说去见个朋友
He just said he was meeting a friend.
你不是说他去办事了吗
Thought you said he was running an errand.
血压下降到92了挂一个单位O型阴性血
BP's down to 92. Hang a unit of O-negative.
拍X光
X-rays!
大家离手
Everybody, clear!
左侧有严重的血气胸
Massive hemopneumothorax on the left side.
-他需要插胸管 -推5个单位吗♥啡♥
- He needs a chest tube. - Push 5 of morphine.
胸管快给我
Chest tube, give it to me!
血压降到70了
BP's down to 70.
进去了
I'm in.
血压好些了但心率还很高
Pressure's better, but his heart rate's still up.
他还在失血
He's still losing blood.
通知CT部门我们马上带他上去做平面扫描
Call CT, tell them we're bringing him up to a pan-scan now.
别担心伙计有我们在
Don't worry, buddy. We got you.
艾普尔他怎么样
April, how is he?
暂时稳定了
He's stable for now.
我们还在找出血的源头
We're still trying to find the source of the bleed.
我能和你还有崔医生说句话吗拜托
Uh, can I have a word with you and Dr. Choi, please?
我想让拉尼克医生做他的主治医师
I want Dr. Lanik running point on this.
-古德温女士 -你跟我一样清楚
- Ms. Goodwin-- - You know as well as I do,
你们都跟塞克斯顿医生太亲近了
you're too close to Dr. Sexton.
我可以把个人感情从...
I can separate my personal feelings from--
不拉尼克医生会随时通知你们最新情况
No, Dr. Lanik will keep you updated,
而且急诊室需要你们
and you're needed in the ED.
遵命
Yes, ma'am.
我会尽快回来看看好吗
I'll check back as soon as I can, okay?
扫描结果出来了吗
We're able to get the scans yet?
没有
No.
你之前说诺亚去见朋友
Hey, what were you saying earlier
是怎么回事
about Noah meeting a friend?
他只说他必须去帮一个人
He just said he had to help someone.
帮谁
Who?
扫描结果出来了
Scans are up.
他有三♥级♥脾裂伤中间有出血
He's got a grade-3 splenic laceration with a central blush.
血液正流入他的腹腔
He's bleeding into his abdomen.
我去联♥系♥手术室告诉他们我们要带他上去
I'll call the OR and tell them we're bringing him up.
血压稳定
Well, pressure's stable.
没理由不用栓塞疗法
No reason why we can't embolize the bleed.
但是如果血压突降...
But if the pressure drops...
等真降了我们再去担心也不迟
Well, we can worry about that when the time comes.
介入放射创伤更小
IR is less invasive.
我同意拉尼克医生
I agree with Dr. Lanik.
我不想给我弟弟开刀
I don't want to cut my brother open
除非万不得已
unless it's absolutely necessary.
-这由不到你决定 -确实由我决定
- It's not really your call. - No, it's mine.
去介入放射科我们走
We're going to IR. Let's move.
我刚刚检查了洛丽·谢尔顿的血样
I just checked on Lori Shelton's blood work.
检验科很快就会有结果
The lab should have it up soon.
-很好谢谢 -好
- Great. Thanks. - Yeah.
你知道斐波那契今晚演出吗
Did you know that Fibonacci is performing tonight?
那个数学家吗
The mathematician?
他不是都死了一千多年了吗
Hasn't he been dead for about 1,000 years?
是个摇滚乐队
Uh, it's a--it's a rock band.
他们用斐波那契数列作曲写歌♥
They--they write all their songs using Fibonacci's sequence.
每个音调都是前两个音调的加和
So, uh, every note is the sum total of the two notes before it,
他们的音乐实际上很动听
and, uh, their--their music is actually quite elegant.
听起来很有趣
Oh, that sounds interesting.
其实票还没买♥♥完
There--there are still tickets available.
要是你想问你能不能早点下班那就问
Oh, if you're asking if you can take off early, go ahead.
好吧
Oh, okay.
好谢谢谢了
Okay, thank you. Thanks.
救人这里需要帮助
Help! We need help in here!
让一下爸爸
Watch out, Dad.
我的肚子好痛
My stomach hurts so bad.
-超声波 -在这
- Ultrasound. - I got it.
发生什么了怎么了
What is it? What's wrong?
我们马上就知道
We're gonna find out.
有一个血块阻塞血液从肾脏流出
There's a clot blocking blood flow out of the kidney.
应该是它让她今早昏倒
It's likely what made her collapse this morning.
我以为是感染
I thought it was an infection.
肾功能损害症状与感染很像
Kidney dysfunction can mimic signs of an infection.
那我们怎么办
Okay, so what do we do?
组织型纤溶酶原激活剂抗凝血药
有种药叫TPA可以溶解血块
There's a drug called TPA that should break up the clot,
但是我们要先做CT确定血块位置
but we'll need a CT first to pinpoint its location.
告诉放射科我们要把她带上去
Tell radiology we're bringing her up.
不等等你不能给她做CT检查
No, wait! You cannot give her a CT scan.
她会对造影剂过敏
She's allergic to the contrast.
你确定她过敏
You're sure she's allergic?
移植前她做过一次CT
She had a CT scan before her transplant
有很严重的反应
and had a really bad reaction.
几乎要了她的命
It almost killed her.
移植中心一定没把过敏史写在表格里
Her transplant center must have not put that in her chart.
你有超声波
You have the ultrasound.
你不能用这个定位血块吗
Can't you use that to locate the clot?
超声波不能提供足够详细的图像
An ultrasound doesn't give us a detailed enough view.
我们不能注射药物
We can't inject the medication
除非在CT上有精确的位置
without a precise location on CT.
请让它别疼了
Please make it stop!
你还有别的方法吗
Isn't there something else you can do?
我们可以用大剂量的类固醇来做CT检查
We could try to get the CT by using a high dose of steroids
来抑制她的过敏
to suppress her allergy.
但是她可能会过敏性休克
Yeah, but she could go into anaphylactic shock.
不我不会让她再经历那个
No, I'm not putting her through that again.
我们还有别的选择吗
Do we have an alternative?
好吧我们会给她输入肝素
All right, we'll put her on heparin.
等待观察血块是否自己溶解
Wait to see if the clot resolves on its own.
在这种情况下是最好的选择
At this point, it's our best option.
剂量 1000单位肝素
Bolus 1,000 units of heparin,
50毫升芬太尼止痛重新化验
50 mics of fentanyl for the pain, and repeat her labs.
洛丽坚持住
Lori, hang in there.
我们会帮你度过困难
We're gonna get you through this.
你的检查结果来了
Hey. Your scans came back.
结果你没有食物中毒
Turns out you didn't have food poisoning.
你得了阑尾炎
You have appendicitis.
我和你们说了真的很痛
I told you guys this pain was real!
幸好我们发现及时
Luckily, we caught it in time.
我们会把你送到手术室
We can get you up to an operating room
摘除阑尾防止它破裂
to remove it before it bursts.
一个叫姆布达的网友问
@Mewbuddar is asking,
"除了手术还有别的方法吗"
"Is there's an alternative to surgery?"
有时抗生素可以治疗
In some cases, it can be managed with antibiotics,
但是手术是标准治疗手段
but surgery is the standard.
宝贝弹幕都是在说
Babe, the chat is all worked up
手术的利弊
over the pros and cons of surgery.
给我摄像头
Give me the camera.
好吧兄弟们这是个重要决定
All right, team, this is a big one,
所以别折腾我
so don't do me dirty
因为我真的快疼死了
'cause my side is literally killing me.
你们会让我做手术吗
Will you let me have surgery?
不能这样来选治疗方法
This is no way to determine treatment.
你们听到他了伙伴们我现在发起投票
You heard him, peeps. I'm setting up a vote.
手术还是抗生素发起
Surgery versus antibiotics. Go!
这太离谱了
This is ridiculous.
投票在计算
Vote are tallying.
好的结果出来了
Okay, the votes are in.
宝贝呃...
Oh, babe, uh...
否 85%
手术的投票结果是否
Surgery is a no-go.
这是严肃的医疗决策