芝加哥急救

Chicago Med S06E16

Part 3 Oct. 4, 2021, 6:16 p.m.

We have left side hemothorax.
我插根管子进去
I'll put in a tube.
不我来
No, I'll do it.
好
Okay,
在快速输血仪上再挂两单位血
hang two more units on the rapid transfuser.
血压100/70 心率110
BP 100 over 70. Heart rate, 110.
好些了带他去做CT
Better. Let's take him to CT.
天哪怎么回事
Oh, my-- what happened?
那家伙朝他开了枪
He got shot by this guy.
我没问题创伤二室
Right with me, trauma two.
-尼尔·迪特里希 25岁 -走开
- Neil Dietrich, 25-- - Go away.
昏迷指数13 疑似脑震荡
GCS 13. Suspected concussion.
他拿走了红色药片删掉
He took the red pill away. Delete.
你知道他几周前来过对吗
You know he was here a couple weeks ago, right?
是阿彻医生的病人我给他做过顾问
Patient of Dr. Archer's. I consulted on the case.
彻底的妄想症
Completely delusional,
以为自己生活在电脑游戏里
thinks he's living in some kind of computer simulation.
他拿走了红色药片
He took the red pill away!
影像看上去很糟糕子弹碎得太厉害了
Image is lousy, too much scatter from the bullet.
我们得做核磁共振
We need an MRI.
-不行 -子弹是假亚铁
- No, can't. The bullet is pseudoferrous.
它会升温好吗
It will heat it up. All right.
我们可以假设他有脊髓血肿
We can assume he's got a cord hematoma.
-需要做手术 -等等
- He needs surgery. - Well, hold on.
血肿可能是也可能不是问题
The hematoma may or may not be a problem.
好你看子弹靠近脊髓
All right, look. The bullet is near the cord.
这可能不仅仅是脊髓休克
All right? This can be more than just spinal shock.
早期减压是这种情况下的正确疗法
Early decompression is the right course of action here.
好吧如果伤到脊髓造成脑脊液泄漏了呢
Well, what if you injure the cord, create a CSF leak?
他会瘫痪的
Then he's paralyzed.
重症监护室里有大量预防措施
Profusion precautions in the ICU,
血肿很可能会自行消失
hematoma could very well resolve on its own.
不太可能好吗
Yeah, unlikely. All right.
而且我的整个职业生涯都在治疗枪伤
And I've spent a career treating gunshot wounds.
我觉得我在芝加哥医院急诊室的工作
I think my tenure in the ED in Chicago
让我对枪伤是比较熟悉的
gives me some insight into GSW.
你对崔医生的敌意众所周知
Your animosity towards Dr. Choi is well-known.
自从他当上急诊室主任你就憎恨他的权威
You've resented his authority ever since he was made chief.
我觉得你没有能力
I don't think you're capable
做出公正的临床评估
of making an impartial clinical assessment.
不管我跟伊森之间有什么问题...
Whatever my issues with Ethan might be...
都不会影响他的临床判断
They aren't affecting his clinical judgement.
好像你有资格评判似的
As if you're in a position to judge.
我要给他做手术
I am taking him into surgery.
是否手术应该由神经外科医生决定
Hey, surgery is a neurosurgeon's decision,
-而不是你 -没错
- not yours. - That's right.
好
Okay.
好行
Okay. Fine.
打给神经外科但你们俩别忘了
Call neurosurgery, but know this, both of you,
手术每拖延一分钟
that every minute we delay surgery
都会让崔医生的风险更大
puts Dr. Choi at greater risk.
米沙我很抱歉
Mischa, I am so sorry.
马塞尔医生我的病人在做搭桥手术
Dr. Marcel, I have a patient on bypass.
她的胸腔已经打开心脏在哪里
Her chest is open. Where is my heart?
莱瑟医生我以为我提过粘液瘤已经侵入
Dr. Latham, I thought I mentioned the myxoma invaded
内二尖瓣小叶
the interior mitral leaflet.
对但时间紧迫
Yes, but the clock is ticking.
-还要多久 -稍等
- How much longer? - Hold on.
马塞尔医生
Dr. Marcel?
我还在修补小叶
I'm still repairing the leaflet.
好了给你
Okay. Here we go.
交给你了
It's all yours.
-我们继续 -好
- Let's proceed. - Okay.
谢谢
Thank you.
你想从哪里开始
Where would you like to begin?
-肾脏 -好
- On the kidney. - Okay.
好减少镇静剂
All right, lighten the sedation.
伊森能听到我说话吗
Ethan, can you hear me?
伊森
Ethan?
伊森我是萨姆你能眨眨眼睛吗
Ethan, this is Sam. Can you blink your eyes?
伊森你能眨眼吗
Ethan, can you blink?
好很好
Okay, good.
你能动动脚趾吗
Can you wiggle your toes?
伊森加油尽量动动脚趾
Ethan, come on. Try to wiggle your toes.
好
Okay.
很明显他下肢无力
It's clear there's a weakness in his lower extremities.
也许已经不需要我的意见了
Perhaps my input's not needed.
萨姆你有什么建议
Sam, what do you suggest?
如果我们不尽快给他做手术
Well, if we don't take him to be operated on
情况只会越来越糟
as soon as possible, then it will only get worse.
-我还是回家吧 -椎板切除术对吗
- Why don't I just go home? - Laminectomy, right?
对椎板切除术
Yes, laminectomy.
麦基能麻烦你打开混合手术室吗
Maggie, would you please open the hybrid OR?
除非你想带他上楼
Unless you want to take him upstairs.
病人最好避免移♥动♥
It's better for the patient to avoid the trip.
混合手术室就行
Hybrid OR will do.
-他在哪里 -五号♥诊疗室
- Where is he? - Treatment five.
米沙
Mischa?
我们在停车场发现他的
He was found in the parking garage,
好像从楼梯上摔下来了
seems to have fallen down the stairs.
呼吸率10 一股酒味
Respiration is 10, smells of alcohol.
他失去知觉了吗
He lose consciousness?
不好说但你看到他头部受伤了
Can't say, but you see the head injury.
米沙你能告诉我出什么事了吗
Mischa, can you tell me what happened?
米沙能听到我说话吗知道这是哪吗
Mischa, can you hear me? Do you know where you are?
-要给他检查颈椎 -护颈别取
- We need to clear a C Spine. - Leave the collar on.
带他上去做头部和颈部CT
Send him up for head and neck CT.
坚持一下
Hang in there, buddy.
我们会把你治好的好吗
We'll get you all fixed up, okay?
子弹能取出
Bullet's accessible.
我刚刚听说伊森的事他怎么样
I just heard about Ethan. How's he doing?
他们取出子弹了
They got the bullet.
血肿极小可以缝合了
Hematoma is minimal. You can close.
等等还有椎后骨碎片
Hold on, there are retropulsed bone fragments.
-是我知道 -我们应该取出来
- Yeah, I'm aware of that. - But we need to extract them.
已经给他的脊椎减压了这就够了
His spine is decompressed. That's all we need to do.
碎片能造成的伤害已经造成了
Any damage from the fragments already been done,
再去找碎片只会让情况恶化
and we'll only make things worse, going after them.
不行既然做了手术开了刀
No, listen, we're here. We're open.
我们就找到碎片然后做脊柱融合
Let's find the fragments, and then we'll fuse the spine.
这样手术时间风险和侵入性都会增加
That's a longer, riskier, more invasive surgery.
但是这样的话
But it will allow Ethan
伊森能马上进入术后恢复期
to begin the recovery process immediately.
对前提是他没瘫痪
Yeah, if he isn't paralyzed.
找骨碎片的风险大于收益
Chasing bone fragments is more dangerous than it's worth.
艾布拉姆斯医生说得没错
Dr. Abrams makes a good point.
太吵了能请你关掉吗
That is so distracting. Would you turn that off please?
你们该缝合伤口了
You should close him and start sewing--
该死
Damn it.
也许伊森需要一个对自己能力
Maybe Ethan needs a neurosurgeon
更有信心的神经外科医生
who's more confident in his abilities.
这样的人不存在
That person doesn't exist.
这不就对了
Well, then.
崔医生的情况怎么样了
What do we know about Dr. Choi?
还在手术当中
He's still in surgery.
好是这样他昨晚给我发邮件
Okay, listen. He e-mailed me last night
说在考核期内的这些医学生之中
and said, from among the med students auditioning,
他决定让凡妮莎·泰勒
he decided to go with Vanessa Taylor
回到急诊科轮值
to come back and rotate in the ED.
我本来想撤销这个决定
At first I thought about quashing it,
但是这样对泰勒小姐不公平