芝加哥急救

Chicago Med S07E06

Part 4 Nov. 13, 2021, 1:10 p.m.

Heard you're being discharged today.
感觉怎么样？
How you feeling?
如果我用双脚走出医院感觉会更好
I'd feel better if I were walking out of here on my own two feet.
但我妈要送我回家并且坚持让我坐轮椅
But my mother is taking me home and insisting on the wheelchair.
要让我说，有点太在意医院的规定了
A little overly concerned about adhering to hospital policy, if you ask me.
如果有机会，恐怕你会起诉医院
I am afraid you'd sue the hospital if given the chance.
哎呦
Uh-oh.
马塞尔医生，我想再谢谢你
I wanted to thank you again, Dr. Marcel.
是的，这是我的荣幸。很高兴一切都解决了
Yeah, it was my pleasure. Just happy it all worked out.
那是我听说的那个无名氏吗？
Is that the John Doe that I heard about?
是啊
Yeah.
他情况怎么样？不太好
How's he doing? Not good.
他遭受了一段时间的严重缺氧
He suffered major oxygen deprivation for an extended period of time.
所以现在看来可能是不可逆的脑损伤
So likely looking at irreversible brain damage at this point.
艾弗里，我给你叫辆滴滴
Avery, I'm gonna call you an Uber.
一分钟以前你还坚持让我呆在轮椅上
A minute ago you're insisting I stay in the wheelchair.
亲爱的，我很抱歉
I'm sorry, sweetie.
我刚想起来我还有图表要做
I just remembered I have some charting to do.
我马上回来
I'm gonna circle back.
我很想看看这个病人的情况
I'm interested in seeing what happens with this patient.
麦基，怎么了
What's going on, Mags?
儿童和家庭服务部。在做涉嫌虐待儿童的调查
DCFS. Suspicion of child abuse.
是的，这总是很难
Yeah, that is always hard.
我只是不想看到家人经历这些
I just hate seeing families go through this.
来人啊
Somebody help!
情况不太对
Something's wrong.
给我们腾个地方
Give us some space.
血氧饱和度降到6♥4♥了，无反应
Sats down to 6♥4♥, not responsive.
开始上气囊，我们必须插管
Start bagging. We have to intubate.
他怎么了？
What's happening to him?
他没有保护自己的呼吸道
He's not protecting his airway.
他无法呼吸了
He can't breathe.
为什么—为什么？
Why--why?
我暂时还不知道。20毫克依托咪酯，100毫克磺
I don't know yet. 20 of etomidate, 100 of sux.
哦，天哪，你一定要救救他
Oh, God. You've got to save him.
我保证，我会尽全力
Hey, I promise. I'll do everything I can.
戈登是我的一切，拜托了
Gordon is all I have, please.
凡妮莎，过来
Vanessa, come here.
你记得我说过我妈妈不吃药吗？
You remember how I said my mom won't take her pills?
嗯嗯。看看这个
Mm-hmm. Check this out.
我看的是什么？
What am I looking at?
一种叫做纳米药物的新技术
New technology called a nanodrug.
这是一种智能的药物，可以用数字反馈系统
It's a smart drug that works with the digital feedback system.
我不太懂
I don't understand.
是给忘记吃药的病人用的
It's for patients that forget to take their medicine.
他们的护理人员可以通过手♥机♥应用
Their caregivers can track the exact date and time
追踪患者服用药物的确切日期和时间
that a patient ingest their pills on a phone app.
怎么做到的？看着点
How? Watch.
每个药丸都嵌入了一个微型纳米传感器
Each pill is embedded with a microscopic nanosensor.
当它在胃酸中溶解时，
When it dissolves in the stomach acid,
传感器就会向病人身体上的贴片发送信♥号♥♥
the sensor then sends a signal to a patch on the patient's body.
这个补丁会反馈给手♥机♥应用。
And that patch tells the phone app.
我就可以追踪我妈妈吃没吃药
I could track whether my mom's taking them or not.
但她的抗生素没有纳米传感器
But her antibiotics don't have nanosensors.
医院的研究人员正在研究他们的版本
Well, researchers at Med are working on their version of this.
他们说他们可以把纳米传感器装到任何药里
They said they can add nanosensors to any pills.
等我妈在药房♥准备好了，
So when my mom's are ready at the pharmacy,
告诉我一声
let me know, okay?
这，这很酷，我承认
It's--it's cool, I admit it.
但你要怎么让她同意呢?
But how are you gonna get her to sign off on this?
我是说，她一定要知道吗？
I mean, does she have to know?
这是什么？出什么事了？
What is it? What's wrong?
我给他充氧有困难
I'm having trouble oxygenating him.
你好，我是库珀医生
Hi, there. I'm Dr. Cooper.
马特，一定是搞错了
Matt, there must've been a mistake.
我找了随叫随到的肺科医生
I asked for the pulmonologist on call.
你的请求传到了我的单位，
Your request came to my unit,
作为待命的重症监护医生，我就来了
and as the critical care doctor on call, you got me.
打扰一下，你是病人的夫人吗？
Excuse me. Are you the patient's wife?
叫我玛丽尔
Marielle.
玛丽尔，我就是干这个的
Marielle, this is what I do. Okay.
我相信我能解决你丈夫的问题
I'm--I'm confident I can address your husband's issues.
好吧
All right.
戈登入院的时候得了严重的肺炎
Gordon came in with a bad case of pneumonia.
我不得不给他插管
I had to intubate him.
但我无法实现足够的气体交换
But I'm having difficulty achieving adequate gas exchange.
我以为他在和呼吸机抗争，
I thought he was fighting the ventilator,
所以我用异丙酚给他打了镇定剂但他的气道压力还是很高
so I sedated him with propofol but his airway pressures are still up.
不，不确定是什么问题
Not--not exactly sure what the problem is.
我认为是早期急性呼吸窘迫综合征
I think an early ARDS.
已经开始给他做急性呼吸窘迫综合征治疗了
Already started him on the ARDS net protocol.
急呼窘迫征？
ARDS?
急性呼吸窘迫综合征
Acute Respiratory Distress Syndrome.
在肺的底部有微小的弹性囊。
There are tiny elastic sacs at the base of the lungs.
戈登的肺似乎不能正常地交换氧气
It seems Gordon's are not properly exchanging oxygen.
为了改善他的气体交换，我们需要
So to improve his gas exchange, we need
给他打更大剂量的镇定剂然后麻痹他
to sedate him more deeply and then paralyze him.
麻痹他？
Paralyze him?
是的，我知道这听起来很极端。
Yeah, I know that sounds extreme.
在这种情况下，有必要降低胸腔内的压力
In this case, it's necessary to reduce the pressures inside his chest.
就为了这个，你就需要麻痹他？
And to do that, you need to paralyze him?
咱俩出去说几句话
Hey, can I talk to you outside for a second?
好
Sure, yeah.
玛丽尔，我们就回来
Marielle, we'll--we'll be right back
在这种情况下麻痹病人
Paralyzing people in this context often leads
往往会导致发病率和死亡率的增加
to increased morbidity and mortality.
我的意思是，一定还有别的办法
I mean, there must be something else we can do.
威尔，相信我，我也希望有别的办法
Believe me, Will, I wish there were another way.
但如果不麻痹他给他输氧，他会死的
But unless we paralyze him and get him oxygenated, he'll die.
给他打阿曲库铵点滴。
Put him on an atracurium drip.
用右美托咪定代替异丙酚，
Use dexmedetomidine instead of propofol
呃，我一会儿就回来
and, uh, I'll be back in a little bit, okay?
什么情况？心率30，还在降
What do we got? Heart rate's 30. Dropping.
1毫克阿托品，快点
Milligram of Atropine. Let's go.
我感觉不到脉搏
I don't feel a pulse.
注射完了吗？
Are you in?
阿托品注射完成。好
Atropine's in. Okay.
好了，我感觉到脉搏了
Okay, we got a pulse.
心率60
Heart rate's 60.
80.
稳定在84
Holding at 84.
好，好啊
Good, good.
干得漂亮
Nice work.
你知道，我能从他的化验结果来看
You know, I can see from his labs
他的胆红素水平很好
that his bilirubin levels are good.
这对他的肝脏来说是个好消息。
That's good news for his liver.
你应该检查一下他的血型
You should check his blood type.
南茜。好
Nancy. Yeah.
听着，我还不是十分确定
Look, I'm not so sure about that.
克罗特，我们得想想谢尔顿
Crockett, we gotta think about Sheldon.
布雷克医生，你知道，布雷克医生，除非这个病人
Dr. Blake, you know, unless this patient
有相对合法的代表来为他说话，
has a relatively legal representative
否则他的器官是禁区
to speak on his behalf, his organs are off-limits.
所以我们得去找他的亲戚
Which is why we got to track down a relative
或者法定代表人
or a legal representative.
帕梅拉，我不相信这是你的病人
Pamela, I don't believe this is your patient.
不是，迪恩，我只是路过
He isn't, Dean. I'm just passing by.
这样的话，我希望你赶快走
Oh, in that case, I'd prefer you keep passing as Dr. Marcel
因为马塞尔医生正忙着让这个人活下去呢
is very busy keeping this man alive.
我会打给你的，克罗克特
I'll be in touch, Crockett.
天啊，我不知道你和著名的布雷克医生这么亲密
Boy, I had no idea you and the renowned Dr. Blake were so chummy.