芝加哥急救

Chicago Med S06E11

Part 5 April 13, 2021, 9:24 a.m.

Since Terri died,
我反正也是心如死灰
I haven't really been living anyway.
我想回家
I want to go home.
麦金太尔先生不制定治疗方案
Mr. McIntyre, I can't in good conscience
就让你出院我良心不安
discharge you without a treatment plan.
要我签什么我都签
I'll sign whatever I have to.
我只想和我妻子待在一起
I just want to be with my wife.
我们去
Uh, you know, we will, um--
我们去准备好材料好吗
we will get the paperwork going, okay?
谢谢你利亚姆
Thank you, Liam.
我们不能让他回家
We're not letting him go home.
-我同意 -好吧
- I agree. - Okay.
留院做精神观察吗
Psych hold, then?
威尔他不是心理疾病他只是伤心
Will, he's not mentally ill. He's grieving.
我们在逼他和自己的妻子永别
I mean, we're asking him to say goodbye to his wife.
而且是再一次永别
You know, again.
那我们能用什么招呢
So what's our play?
说实话我也不知道
Honestly, I don't know.
你能帮我争取一点时间吗
Can you buy me a little time?
可以我可以慢点处理他的美国医学会文件
Yeah, I can slow-roll his AMA paperwork.
-谢谢 -没事
- Thank you. - All right.
你让维诺尼医生参与了你的病例诊断
You brought Dr. Virani in on your case.
我需要一位顾问
I needed a consult.
我们需要顾问的时候一般都打给心脏内科
Usually we call Cardiology for consults.
楼上可没人在伦敦中心医院就职过
No one upstairs has London Heart Hospital on their resume.
所以我相信心脏内科本该派下来的住院医师
So I'm sure the resident Cardiology would've sent down
会理解的
will understand.
拉尼克医生
Dr. Lanik?
3号♥的吉娜·凯恩
Gina Caine in 3--
那位不信新冠的女士
Ms. COVID is a hoax?
我给她加了高流量的氧气
I upped her high flow O2
放射科的人也准备换呼吸机了
and RT is ready to convert to a BiPAP,
但也只是在拖时间罢了
but it's just delaying the inevitable.
她得插管了
She'll need to be intubated.
是的但是她会同意吗
Yeah, but is she gonna give consent?
给她插鼻管就已经够费劲了
It's been tough just keeping her on the cannula, so...
所以也不能确定
it's doubtful.
那你最好让她改变主意
Well, you better change her mind.
看起来有轻微的小肠循环扩张
It looks like there's mildly distended loops of small bowel.
-也可能是局部肠阻梗 -我不确定
- Could be a partial obstruction. - I'm not sure.
如果是肠阻梗的话
If it were an obstruction,
我觉得肠道得比现在扩张得更大才对
I'd expect the bowel to be a lot more dilated than it is.
那又怎样我们就各持己见吗
So what? We just agree to disagree?
-这能对她有什么帮助呢 -该死的
- I mean, that doesn't help her. - Damn it.
我知道肯定有什么导致了她的疼痛
I know something's causing her pain,
如果就在她的体内
and if it's in there,
我们就是不知道病因也无法看到
we just don't know what it is. Can't see it.
卡拉建立一个高分辨率的三维渲染扫描
Uh, Kara, build the scan into a high-res 3D rendering.
集中在左侧在她疼得最厉害的地方
Focus on the left flank, where her pain is the worst.
-没想到啊 -肾静脉被压♥迫♥了
- Well, how about that? - Renal vein is compressed.
看起来就是它造成了
I mean, it looks like it's causing
严重的左侧静脉充血
significant left-sided venous congestion.
那可不仅仅是疼痛了
That isn't just painful--
那可以说是酷刑了
It's excruciating.
和以前一样的疗法
Same drill as before.
准备好起搏器注射200毫克胺碘酮
Set up to cardiovert, then 200 milligrams of amio
然后上点滴
followed by a drip.
心房♥纤颤及心室重复反应重复他的摄入
A-fib with RVR. Replay on his intake.
-好的已同步 -离手电击
- Okay. Synced. - Clear. Hit it.
血压回升 122/73
BP's coming back up. 122/73.
心率稳定 140
Heart rate's settling. 140.
心率还是太快增加艾司洛尔点滴
Still too high. Add an esmolol drip.
又发生了吗
It happened again?
-是我的心脏吗 -是的
- My heart? - Yeah.
这说不通他的心脏跳动不规律
Doesn't make sense--his heart's beating irregularly,
但是没有证据表明他到底有什么病症
but there's no evidence anything's actually wrong with him.
我看了他的病例
I looked at his chart.
除了心率之外唯一反常的就是流鼻血
The only other anomaly is the nosebleed.
你觉得流鼻血和这个有关系吗
And you think the nosebleed's connected then?
有可能
Could be.
我之前治疗过一个人他在浴室滑倒了
I once treated a guy who slipped in the shower
肩膀脱臼
and dislocated his shoulder.
看起来就是普通的意外吧
Random accident, right?
结果是他有未诊断出的严重慢性腹泻症
It turns out, he had undiagnosed celiac disease.
维生素B12无法♥正♥常吸收导致贫血
A poor B12 absorption leads to anemia--
导致他腿脚无力
Leads to weakness in his feet,
最终发生了浴室滑倒这件事
leads to falling in the shower.
一切绝非偶然
Nothing random about it.
特丽妮再做一次血常规血液生化
Trini, repeat CBC, BMP,
心脏检查心超
cardiac labs, echo.
心电图先不用做
Leave the EKG.
我们从头再来
We're starting over.
这就是病因吗
This is the reason?
肾静脉被压♥迫♥
The renal vein is being compressed?
这被称为胡桃夹综合征
It's called nutcracker syndrome.
因为这种疼痛就像是
Because the pain feels like
你被一个胡桃钳狠狠挤压着一样
you're being squeezed by a nutcracker.
这么长时间
All this time.
就在这儿
Right there.
其他医生为什么看不到呢
How'd all the other doctors miss it?
它很会躲藏
It hides.
只有先排除其它一切因素才能找到它
Only get to it by ruling out everything else first.
能最终得到个答案我能够放心了
I'm relieved to finally have an answer,
但我的疼痛可不只是挤压那么轻松
but my pain, it's more than a squeeze.
我就像被压土机狠狠碾过一样
I'm being crushed by a car compactor.
是的我们怀疑有并发症
Yes, we suspect a compounding issue,
第二种失调感染了尿管
a second disorder affecting the ureter.
腰痛血尿综合征
Loin pain hematuria syndrome.
真是痛上加痛
So misery on top of agony.
-该怎么治疗 -手术
- What's the fix? - Surgery.
有两个选择
There are two options.
第一个是肾静脉转位
First is a renal vein transposition.
这样能够缓解胡桃夹综合征
It'll relieve the nutcracker syndrome,
但是不幸的是不能解决腰痛
but unfortunately, it may not do anything for the loin pain.
第二个选项呢
Option two?
栓塞肾动脉
Embolize the renal artery.
这样能够解决腰痛
This will help with the loin pain,
但可能使胡桃夹综合征恶化
but may aggravate the nutcracker.
那我们就两个一起做
So let's do both.
问题是你没办法两个一起做
The thing is, you can't do both.
一起做的话会使肾脏供血
Together, they would put too much stress
受到过大的压力
on the kidney's blood supply.
你的脏器会发生衰竭
The organ would fail.
那就算了
Then, no.
两个都不做了
To both options.
两者都不能解决我的痛苦那还有什么必要
Neither ends my pain, so what's the point?
减少部分疼痛就能让你的生活完全不同了
Less pain could make a huge difference in your life.
没有疼痛才会完全不同
Zero pain is something.
不然就只是不断地重复历史
Everything else is just history repeating itself.
一次又一次的诊断
Procedure after procedure,
所有的痛苦巨大的失败
all of them, colossal failures.
我再也无法承受了
I can't take another one.
我会疯掉的
I will lose my mind.
我这一生都将活在痛苦之中
I am always going to live in pain.
我是时候接受这个事实了
It's just time that I accept that.
如果你很忙我就一会儿再来
If you're busy, I could come back later.
千万别
Oh, hell no.
这个病例让我一直在兜圈子
This case had me going in circles.
非常感谢你
Thank you very much.
别客气
You're welcome.
怎么样