芝加哥急救

Chicago Med S07E04

Part 4 Oct. 25, 2021, 3:53 p.m.

间变性星形细胞瘤是致命的
A.A. is fatal.
诊断后的预期寿命最多只能活几年
Life expectancy post-diagnosis is a few years at best.
阿什莉活了30年
Ashley has survived 30.
你觉得她没得这个病
You don't think she has it.
我也不知道是怎么了
I don't know what's going on.
但不管发生了什么，都和91
But whatever's happening, it started in 1991
年那个最初的肿瘤有关系
with that original tumor.
90年
30 years.
我是说，组织样本还有存在的可能性吗？
I mean, any chance a tissue sample still exists?
不，我很怀疑
Oh, no, I doubt it.
但也许病理报告还在
But maybe the pathology report still does.
在2000年之前，所以病理报告
Pre-dates 2000, so it won't be
不在她的电子档案里
in her electronic file,
但它一定要写在纸上
but it has to be on paper somewhere.
是
Yep.
让我们找找看。好
Let's start looking. Okay.
罗兰已经睡了
Roland's sleeping now.
当他醒的时候
When he wakes up,
查尔斯医生会带他做另一个检查
Dr. Charles will come do another exam.
断药的时候我们在公交车上
We were on the bus when the break happened.
去参观哈罗德·华盛顿
To visit Harold Washington.
嗯，城市大学？
Hmm. City College?
Since the diagnosis, Roland hasn't left the apartment.
但昨天，他说他想再去学校试试
But yesterday, he said he wanted to try again at school.
我是那么希望这是…
I was so hopeful it was...
对他来说是一个新的开始
The beginning of something for him.
但是公交车上人太多了
But the bus was crowded.
而且还堵车
And there was traffic.
今天多亏了你来，你今天几乎就是我的家人
If you hadn't come, it was almost my family today.
罗兰是个可爱的男孩，善良
Roland is a sweet boy. Kind.
确实
He is.
真希望我们不是唯一一个知道这一点的人
I wish we weren't the only ones who knew that.
你的腹部病人皮特，化验结果出来了
Labs are back on Pete, your belly patient.
白细胞计数21000
White count's 21,000.
这也太高了。看看X光片
That's high. Let me see the chest X-ray?
有运动伪影，很难看出来结果
Motion artifact. Tough to read.
就在拍这个片子之前他呕吐了
He vomited just before the image was taken.
他很难保持不动
He had a hard time staying still.
好吧
All right.
哦，医生，谢天谢地你回来了
Oh, Doc, thank God you're back.
我的胃快疼死我了
My stomach is killing me.
是的，你的化验结果显示
Yeah, your labs show you're fighting
你不只是在对抗宿醉
more than just a hangover.
让我再检查一下
Let me take another look.
啊
Ahh!
这比以前更疼了
That hurts way worse than before.
好吧，特里尼，去叫迈克
Okay, Trini, grab Mike.
对不起，我得继续检查
Sorry, I gotta keep checking.
哦。这太糟糕了，不是吗？
Oh, this is bad isn't it?
哦，上帝，我再也不吃垃圾食品了
Oh, God, okay, no more crap food.
只吃沙拉和蔬菜
Just give me salads and vegetables.
不，从现在开始我要全素食，我发誓
No, no, full vegan from now on. I promise.
在你做人生重大决定前我们再拍一张X光片
Let's get another X-ray before you make any huge life decisions.
挺胸，保持90度
Upright chest, 90 degrees.
皮特，我知道你很疼
And Pete, I know you're in a lot of pain,
但你得保持不动，好吗？
but you gotta stay really still, okay?
离手
Clear.
右边隔膜下面有自♥由♥空气。
Yep, free air under the right diaphragm.
特里尼，帮我找到阿彻医生
Trini, find me Dr. Archer.
怎么回事？
What's going on?
你需要做手术
So you need surgery.
你的胃痛是因为你的胃肠道撕裂
Your stomach pain is from a tear in your GI tract.
空气渗进了你的肚子
Air is leaking into your belly.
渗进来了？怎么会这样？
Leaking? How does that happen?
在这附近，我通常会看到穿透性创伤
Well, around here, typically I see it
，子弹，刺伤…
from penetrative trauma, uh, bullets, stab wounds...
刀和枪？
Guns and knives?
但我玩的是桶倒立和同伴乒乓（均为派对游戏）
But I'm keg stands and peer pong.
我想我又要吐了
I think I'm gonna puke again.
我需要我的饮料
I need my drink.
不行，手术前不能喝液体
Sorry, man, no liquids before surgery
嘿，你的灵丹妙药，我看到你在吃冰
Hey, your elixir. I saw you eating ice.
这是过程的一部分吗？
Is that always part of the process?
是啊，嚼块冰很让人满足
Yeah, chewing on a cold cube is just satisfying.
我觉得可能是一块冰导致了撕裂
Well, I think one might have caused the tear.
是的，从那之后你每吞下一块冰
Yeah, it's likely been getting bigger
撕裂就在变大
with each cube you've swallowed since.
真的吗？一块冰？
Seriously? An ice cube?
看起来是这样。什么事？
It's looking that way. What's up?
这是位外科医生。我会把情况告诉他
Hey, so this is the surgeon. I'm gonna fill him in,
然后他来接手，好吗？
then he's gonna take over, okay?
气腹
Pneumoperitoneum.
我怀疑撕裂伤在
I suspect the tear's somewhere near
胃食管交界处附近
the gastro-esophageal junction.
是的，没有流血
Yeah, there's no blood.
也不是被枪击和刺伤的
Ah, wasn't shot or stabbed.
我怀疑是冰块掉错了地方
I think an ice cube went down the wrong way.
我天，真的吗？是的
Get out, really? All right, cool.
好吧，现在我来接手
All right, I'll take it from here.
你知道，迪恩，这孩子神经过敏
You know, Dean, kid's a nervous wreck.
状态也不是太好。
Not in the greatest shape, either.
手术后，我觉得心脏监护比较合适
Post-surgery, I think cardiac monitoring would be appropriate.
啊，我猜，是要用瓦西克监护仪吧？
Uh, let me guess, uh, use the 瓦西监视仪?
我知道你喜欢你那老派的中心静脉压监测
I know you like your old-school CVP,
但我的确认为瓦西克监视仪更适合这位患者
but I do think the 瓦西监视仪 might be better suited for this patient.
好吧，我会考虑使用它的
Well, I'll consider it.
谢谢你
Thank you.
好吧，我考虑过了
Okay, I've considered it.
不，我还是坚持用我的设备
No. I'll stick with my device.
嗯，阿彻真是个混♥蛋♥
Archer's a real ball buster, huh?
是，他还挺享受
Yeah, he enjoys it, too.
但我还有点希望
But still, part of me hoped
他至少考虑了一下用瓦西克监视仪
he would at least consider the 瓦西监视仪.
你介意我给你提一个小小的建议吗？
You mind if I offer you a little advice?
但说无妨
Please.
听着，你把重点放在了
Look, you nailed highlighting
瓦西监视仪的优势上。你搞定了
the 瓦西监视仪's positives. You nailed it.
但你指出了中心静脉压监视器的缺点
But you whiffed on pointing out the CVP's negatives.
每次使用前监视仪都需要
That monitor has to be leveled and calibrated
调平和校准。对
before each use. Right.
但如果操作的不恰当呢？
But what if that's not done appropriately?
所有的数字都会不对
All the numbers are off.
所有的数据都不能被信服
None of that data can be trusted.
这是一时的错误校准
A bad calibration in the moment.
之前发生过吗？
That's happened before?
这不会发生在我身上，因为我用的是瓦西监视仪
Not to me. Because I use a 瓦西监视仪.
总之，发人深省
Anyway, food for thought.
你知道，在我们去研讨会的时候
You know, as we move toward Grand Rounds.
看见了吗？就在那
See? Right there.
CT显示主动脉壁增厚。
CT shows the wall of the aorta has thickened.
我想是主动脉肿瘤
I think it's an aortic tumor.
不对
No way.
是胸腹动脉瘤
Thoracoabdominal aortic aneurysm.
我不知道，动脉壁的形状不正常
I don't know, the walls are abnormally shaped.
动脉瘤是对称的
Aneurysms are symmetrical.
这不是一个经典的形状
It isn't a classic presentation,
我承认，但主动脉肿瘤非常罕见，
I'll give you that, but aortic tumors
动脉瘤则不然
are super rare, aortic aneurysms are not.
好吧，听着，贝克曼医生，我都明白
Okay, look, I get it, Dr. Bickman.
普遍的事物是普遍的
Common things are common,
但并不能排除曲线球的可能性