芝加哥急救

Chicago Med S05E10

Part 3 Jan. 21, 2020, 1:05 p.m.

She's been diagnosed with panic disorder?
是的给她开过百忧解
Mm-hmm, she was prescribed fluoxetine.
吃了近两周了
Been on it for about two weeks.
那她的恐慌症又发作了
So she had another panic attack.
可我们怎么知道她的药物是有效的呢
But how do we know if her regimen is effective?
我想也许您能和她谈谈
I--I guess I thought that maybe you could speak with her.
库里小姐抗抑郁药物通常要几周时间
Ms. Curry, antidepressants often take several weeks
才见效对不对
to kick in, right?
换作我我会告知帕特尔太太我了解她的焦虑
So I would tell Ms. Patel that you understand her frustration,
要有耐心继续按处方吃药
to be patient, and stick with the prescription.
还有别的事吗
Anything else?
有恐惧症发作是有触发因素的对吧
Yes, um, panic attacks have triggers, right?
负面的对话或者想法
Negative words or--or thoughts.
对
Yep.
有一种理论说通过不断地重复
Well, there's this theory that by repeatedly vocalizing
这些触发词汇就能让它们失去作用
those triggers, you can decouple them from their power.
-就像认知解离 -有一个程序
- Like cognitive defusion. - There's an app.
基本上把你的焦虑记录下来
Basically, you record your anxieties,
这个程序会把它们录成歌♥
and the app then turns them into songs.
我觉得你想要尽全力
I think it's admirable that you want to
去帮助你的病人这种态度非常令人尊敬
do everything you can to help your patients,
但在紧急情况下推荐这种噱头
but offering up gimmicks in an emergency setting--
我真的看不出有什么好处
I just--I really don't see the benefit.
对帕特尔太太最好的治疗
You know, the best care for Ms. Patel
还是要通过她的私人心理医生
is with her regular psychiatrist.
所以我建议你让她出院
So I suggest that you discharge her,
然后你和那位医生进行跟踪回访
and that you follow up with whoever that might be.
好吗就这样
Okay? Okay.
他怎么样
How's he doing?
内脏器官没有贯入伤
Yeah, well, no solid organ entry,
但我觉得他腹部的积液不是好现象
but I'm not liking this free fluid in his abdomen.
他的血压稳定
Hmm, well, his blood pressure's steady.
不像是在出血
Doesn't seem like he's actively bleeding.
也许没什么事
Could be nothing,
也可能是我们无法通过CT扫描发现的出血
or it could be a bleed we can't see on CAT scan.
我们给明格斯先生做个诊断性腹腔镜检查吧
Let's get Mr. Minguez in for a diagnostic laparoscopy.
看看我们能否发现哪里在出血有多严重
See if we can find out what's bleeding and how badly.
我们不能边等待边观察吗
Well, couldn't we just watch and wait?
如果他情况恶化就要冒开放手术的风险吗
And risk an open procedure if he goes downhill?
我不同意手术检查是唯一的方法
I don't think so. Surgery's the only play.
等等你不告诉他其他的选择吗
Wait, you're not gonna lay out his options?
他也许不需要手术检查
He might not need surgery.
你看见他刚才的反应了
Well, you saw how he acted earlier.
他很害怕做手术
He's afraid of going under,
如果我们给他别的选择他肯定会选的
We give him an out and he'll take it.
不他需要手术检查
No, he needs this.
我们并不知道他需要什么
We don't know what he needs.
这是用手术来决定他是否需要手术
It's a surgery to see if he needs surgery.
虽然我很尊重你的意见塞克斯顿护士
As much as I value your input, Nurse Sexton,
我是外科医生方案就是这样
I am the surgeon, and this is the plan.
好吧失陪了
All right, if you'll excuse me.
等等你要把我的孩子留在这
Wait, you--you want to keep my kid here?
不行不行
No, no, no, no.
她说我可以把他接回家了
She said that I could take him home.
我现在就要接他走
So that's what I'm gonna do. I'm doing that.
情况是这样的
Whoa, whoa-h-here's the story, um...
如果你坚持要你儿子出院
If you insist on discharging your son,
我们就只能
we're gonna be left with no other option
通知儿童保护组织了
than to call Child Protective Services.
儿童组... 为什么
Child ser--why?
你现在无法照顾你的孩子
You're not currently capable of taking care of your child.
我告诉你了这种情况
I told you, this was the only time
以前从没发生过
that this has ever happened.
琳恩你知道我说的是对的
Lynne, you know I'm right.
我们还能联♥系♥其他人吗
Is there anyone else we can call?
杰西的父亲姨妈或者舅舅
Jesse's father? An aunt or uncle?
-没有 -好吧
- No! - Okay.
就我们俩
It's just us.
-那... -我的天
- Well... - Oh, my God.
我的孩子要离开我了
My baby's gonna be taken away from me.
如果能改善你的情况就不会了
Not if we get you in a better place.
你说过你以前曾试着戒过毒瘾
You said you've attempted to get clean before.
你都试过什么治疗方法
What treatments have you tried?
美♥沙♥酮♥ 戒毒互助所
Uh, methadone and--and NA,
还有立即戒断
and, uh, cold turkey.
-都没用 -尝试过戒毒方案吗
- Nothing works. - Ever tried a detox protocol?
那要去机构里待一个月
That's a month in a facility.
谁来照顾我的孩子呢
Who's gonna take care of my kid?
如果我们加快速度呢
What if we sped things up?
这叫快速戒断治疗
It's called rapid detox.
通常来说我不会推荐这个方案
Yeah, now, I normally wouldn't suggest it,
可我们时间太紧了
but we don't have much time.
在你摆脱依赖时我们会对你进行麻醉
We push you through withdrawal under sedation
以控制戒毒的反应 24到48小时
to manage the symptoms, and in 24 to 48 hours,
你就会正式开始戒除毒瘾了
you'll be down the road to treating your addiction.
摆脱依赖
Withdrawal.
我上次摆脱依赖的时候
The last time I went through that,
差点就没命了
it almost killed me.
这确实有风险
It is not without risk,
可我想不出别的方法能让你们不分开
but I don't know what I can do to keep you together.
-我能去和儿子告个别吗 -当然
- Can I say good-bye to my son? - Of course.
等一下
Hold up.
看来我们要在这待上几天了
Looks like we're gonna stay here for a couple days.
什么我不要
What? No!
会很有意思的
It'll be fun.
还记得吗就像
Remember, like...
就像我们的卫生间漏水那次
When we had that leak in the bathroom?
我们只能住到旅馆里面
We had to go stay in that hotel.
还记得我们的秘密击掌吗
What was that secret handshake we -- we made up?
就是这样好了
That's it. Okay.
乖乖听医生的话好吗
Well, you be good for the doctors, okay?
好吗
Okay?
他们真要拿个镜头插到我身体里吗
So they're really gonna stick a camera inside me?
听起来很夸张实际上没这么夸张
It's a lot less dramatic than it sounds.
我爸爸要替换心脏瓣膜的时候
That's what they told my dad
医生们就是这么跟他解释的
when he needed a new heart valve.
结果他在被麻醉后中风发作
He had a stroke under anesthesia.
再也没能醒过来
Never woke up.
亚历克斯我很抱歉
Alex, I am so sorry.
这台手术是微创的非常安全
You know, this procedure is minimally invasive,
而且马塞尔医生是很厉害的外科医生
very safe, and Dr. Marcel is a great surgeon.
我相信他但是
I'm sure he is, but it's --
但是我很难不去考虑风险
it's just hard not to think about.
如果你还有疑问我可以去找他
If you have any questions, I can track him down.
我只是手术真的是我唯一的选择吗
I just-- is this really my only option?
她现在情况如何
How--how's she doing?
暂时没问题
Okay for now.
已经开始输注右美托咪定
Got the dexmedetomidine flowing.
劳拉西泮也备好了
Ativan at the ready.
现在还能唤醒她吗
She still arousable?
琳恩
Hi, Lynne.
我要你把这片药吞下去
I need you to swallow this pill.
这是什么药
What is it?
纳曲酮防止你复吸的药
Naltrexone, to prevent you from relapsing.
威尔你在做什么
Will, what are you doing?
我要对她开始进行快速戒断治疗
Starting her on a rapid detox protocol.
有人批准你这样做吗
Has this been authorized?
你说过我们做的事都是没问题的
You said we were all kosher here.
别担心埃莎确实没问题
Asha, don't worry -- we are.
真的吗威尔快速戒断治疗
Really, Will? Rapid detox?
有很多诊所都在这么治疗小娜