芝加哥急救

Chicago Med S06E14

Part 5 May 24, 2021, 3:13 p.m.

我要给他插管准备导管
I need to intubate him. Get a line.
预约CT 联♥系♥手术室
Order a CT. Call the OR.
确保有房♥间可用
Make sure they have a room open
以防要带他上去做手术
in case we need to bring him up to surgery.
等等尼尔不是说他不想接受治疗吗
Wait, didn't Neil say that he didn't want to be treated?
他是说过但现在他昏迷了
He did, but now he's unconscious.
所以你就打算不顾他的意愿
So you're just gonna disregard what he wanted?
当一个患者不再有能力做出医疗决定
When a patient is no longer able to make medical decisions,
又没有人出来替他做决定时
and there's no one to stand up for them,
由医院承担代理权
the hospital assumes power of attorney.
20毫克依托咪酯 100毫克司可林
20 of etomidate, 100 of sux.
我应该不给他插管吗他又没有拒绝插管
Should I not intubate him? He doesn't have a DNI.
你说
Tell me!
我得承认你妈妈今天早上来的时候
I have to admit, when your mother came in this morning,
我以为是她的心脏濒临衰竭
I assumed it was because her heart was on the brink of failure,
但是超声心动图显示不是这样
but that's not what the echo is showing.
看起来她的心跳更有力了
Looks like her heart is beating more effectively.
得了卡萝尔这种慢性病的人
I mean, when you have the kind of underlying disease Carol does,
心脏情况会有前后变化
the heart can behave inconsistently,
但是很少有恢复得这么快的
but rarely does it show this kind of improvement.
是挺奇怪的
Yeah, that is odd.
那为什么我妈经常晕倒
So why does my mom keep passing out?
这是一种叫"吸瘪"的现象
It's a phenomenon called "Suck down."
心脏收缩过度
The heart's contracting so hard
以至于心室壁也被吸入左心室辅助装置了
that the ventricle wall is getting sucked into the LVAD, too.
血液循环不良
The poor blood circulation
导致脑部供血不足
is leading to a lack of cerebral perfusion.
我们现在怎么办呢
Well, what do we do now?
等莱瑟医生做完手术
I'm going to consult with Dr. Latham
我就去咨♥询♥他
as soon as he gets out of surgery.
有可能他想缝合关闭左心室
There's a chance he'll want to sew the left ventricle shut
来让左心室辅助装置有效工作
to help the LVAD work effectively.
这是好事对吧
Well, I mean, this is good news, right?
我对这个说法持保留态度
I hesitate to call it good news
等弄清楚再下定论
until we figure out exactly what's going on.
-谢谢你杨医生 -谢谢
- Thank you, Dr. Young. - Thank you.
这种事可不常见
That's not something you see every day.
是啊
Yeah.
肯定是因为她吃了鱼油
Must be the fish oil she's taking.
你做什么
What are you doing?
你为什么翻我妈的包
Will, why are you going through my mom's bag--
你在干什么
what are you doing?
咱们看看这些神奇的保健品长什么样
Let's see what these magical supplements look like.
天哪这太... 威尔
God, this is so--Will!
不对这是β受体阻滞剂
Nope, that's the beta blocker.
停
Stop.
这是他汀那两个是呋♥塞♥米♥
That's the statin, and those two are Lasix.
-去哪了娜塔莉 -你在说什么
- Where'd they go, Natalie? - What are you talking about?
丢失的试验药物
The trial drugs that went missing?
蓝色的药我知道你拿了
The blue pills. I know you took them.
你把药怎么了
What'd you do with them?
你竟然说是我拿的
I can't believe you're accusing me of this.
你妈心室功能改善
The improved function in your mom's left ventricle.
上周你突然对这个药的副作用感兴趣
Your sudden interest in the drug's side effects last week.
现在想想你从来没告诉我
Come to think of it, you never did tell me the name
那个干咳的临床试验患者叫什么
of that trial patient with the dry cough.
-我很好奇是谁 -得了吧
- I wonder who it is. - Please, come on.
太荒谬了
This is ridiculous!
你在给你妈服用一种
You are dosing your mother
未经验证的临床试验药物娜塔莉
with an untested clinical trial drug, Natalie,
没有人指导和监督
without supervision or monitoring.
我们不知道这种药
We don't know how the drug
和左心室辅助装置的相互作用
interacts with an LVAD.
可能会害死她
It could kill her.
你必须马上坦白
You need to come clean right now.
威尔
Will...
-威尔我... -把药给我
- Will, I-- - Just give me that.
不要威尔等等等等
No, Will, wait, wait. Wait!
你听到心脏医生说的了
You heard the cardiologist.
我妈的心跳更有力了药可能有用
Mom's heart is pumping harder. The drugs could be working.
我们又不能确定
We don't know that for sure.
求你我当时走投无路了
Please, I was desperate,
你对那个药全都是正面评价
and everything you said about the drug was good.
我不知道会让我妈陷入任何危险
I didn't think I was putting Mom in any danger.
这事太恶劣了小娜
This is really bad, Nat.
威尔求你
Will, please.
求你求你
Please. Please...
-打扰到你了吗 -完全没有
- Am I interrupting? - Not at all.
我刚刚在和法官谈话
I was just talking to a judge,
请求法♥院♥指令让我们治疗尼尔
trying to get a court order so we could treat Neil,
但是没有明确证据证明他的病情
but without definitive proof of his medical condition,
他帮不了我们
he couldn't help us.
不重要了
Well, it doesn't matter
因为阿彻医生把尼尔带去了手术室
because Dr. Archer took Neil up to surgery
现在就在切除他的阑尾
and is removing his appendix right now.
等等尼尔同意了吗
Wait, Neil agreed to that?
没有但是他出现呼吸窘迫
No, but he went into respiratory distress
需要插管
and needed to be intubated.
迪恩也就有权代表他做出医疗决定
Leaving Dean to make medical decisions on his behalf?
对
Yeah.
我看见阿彻医生之前对尼尔有多懊恼
I saw how frustrated Dr. Archer was with Neil before.
没错
Definitely.
我不禁想
It got me thinking,
他会不会...
could he have...
他会不会给尼尔过度用药
could he have overmedicated Neil
让他陷入昏迷
to knock him unconscious?
天哪
Oh, God.
左心室辅助装置与肌力药的相互作用
左心室辅助装置与肌力药的相互作用
及其医疗效果
威尔
Will.
塞布丽娜
Sabeena.
我不知道你今天会过来
I didn't know you were coming in today.
只是路过
Just passing through.
想来看看你怎么样
Thought I'd see how you were doing.
我要和实验室首席技术员见个面
I have a meeting with the head lab technician.
都还挺好的
Yeah, no, everything's all good here.
我正在休息
Just taking a break.
好的
Okay.
我们现在试验的药
Hey, the drug we're testing,
你知道对装了左心室辅助装置的病人
any idea how it might affect a patient
有什么影响吗
with an LVAD?
这种药是一种肌力药
The drug's an inotrope--
本质上是药物型的左心室辅助装置
essentially, a chemical LVAD.
怎么会有人想这么做
Why would anyone do that?
只是假设而已
Just a hypothetical.
在那种情况下我想不到为什么
I can't imagine why it would ever be prescribed
会开出这样的处方
in that situation.
但是我们还有几个月就要去药监局认证了
But listen, we're a few months out from seeking FDA approval.
如果有患者发生任何不良反应
If there's a patient suffering any adverse reaction,
-这是必须要上报的 -没有
- it needs to be reported. - No.
没有这种情况
Nothing like that.
孩子的血压还是过低
The baby's still hypotensive.
我不知道她能否撑过去
I don't know if she's gonna survive this.
我还在找出血的地方
Trying to find the source of the bleed.
你想让我怎么做
What do you want me to do?
继续给她输血就行了
Just keep giving her more blood.
好的
Okay.
拜托了
Come on.
肖恩你怎么样
Hey, Shawn, how you doing?
-好多了谢谢 -我来检查一下
- Much better, thank you. - Let's check your work.
植入管看起来不错