芝加哥急救

Chicago Med S07E07

Part 6 Nov. 21, 2021, 4:34 p.m.

为什么会这样？我也不清楚
Why is this happening? You know, I don't know.
通常是由脑部损伤引起的
It's usually caused by traumatic brain injury.
生命体征正在稳定
Vitals are stabilizing.
血压降到正常值了。心率78
BP's back to normal. Heart rate 78.
阿斯特丽德？你能听到我吗？
Astrid? You with me?
为什么她的胳膊还是那样？
Why is her arm still doing that?
阿斯特丽德，你能放松你的胳膊吗？
Can you relax your arm for me, Astrid?
让我们再做一次核磁共振，这次是对比。
Okay. Let's get another MRI, this time with contrast.
我想要一个完整的代谢基因组
And I want a full metabolic genetic panel.
没事了，我们在这
It's okay. We got you.
能再给我拿一个吗？嗯嗯
Can I get one more? Mm-hmm.
好了，补丁到了
Okay, patch is in.
切割的横膈膜现在应该可以容纳肝脏了
The cut diaphragm should accommodate the liver now.
我不应该把它割断。这是我们最后的机会
Should's not gonna cut it. This is our last chance.
好了，肝脏进去了
Okay, liver's in.
还没完呢
Not out of the woods yet.
仍然需要连接容器
Still need to attach the vessels.
让我们从肝静脉开始
Let's get started with the hepatic vein.
好
Okay.
你想试试吗，伙计？
You wanna hit some of this, buddy?
不，不用了。这对你有好处，威尔。
Nah, I'm okay. Good for you, Will.
这很好，这很好
That's good. That's good.
你…你…你一直的选择都很好
You--you--you keep making the good choices.
你把错误的选择留给我
You leave the bad choices to moi.
马特，你觉得把另一个瓦西监控仪放在埃莉诺
Matt, do you think putting another Vas-COM on Eleanor
身上是个坏的决定吗？
was a bad choice?
你觉得呢？
What do you think?
我们知道可能有禁忌症
We knew there might be contraindications.
你为什么那样做？
Why'd you do it?
你还没弄明白吗？
You still haven't figured that out yet?
天哪。这很奇怪。你没事吧？
God. That's weird. You all right?
嗯。我的胳膊…我的胳膊很紧
Yeah. My arm's--my arm's tight.
让我看看。我很好，我很好
Let me check. I'm good, I'm good.
我感觉不太好
I don't feel so good.
咱们呼吸点新鲜空气。好
Let's get you some fresh air. Yeah.
不，不，不，我带你出去
No, no, no, let's get you out--
我带你出去。好
let's get you out of here. Okay.
慢点，深呼吸
Just take it easy. Deep breaths.
就这样，就这样。我没事，我没事
There you go, you got it. I'm good. I'm good.
好了，非常好
All right. Yeah, you're good.
就坐在这，我给你倒杯水
Let's sit you down, get you a glass of water.
你会和之前一样好的
You'll be good as new.
该死的
Oh, damn it.
拜托，说话啊
Come on. Talk to me.
哦，天哪，怎么回事？打120
Oh, my God, what's happening? Call 911.
拜托
Come on.
史蒂薇，怎么回事？
Stevie, what's going on?
我又做了个创伤测试
I'm doing a second ASIA exam.
亚布拉姆斯已经做过了
Abrams already made the call.
那是在内森的脊柱被牵引之前。
That was before Nathan's spine was in traction.
你认为稳定
And you think the stabilized alignment
会加快内森的恢复吗？
will improve Nathan's score?
这是改变艾布拉姆斯想法的唯一方法，
It's the only way to change Abrams' mind,
让他去做椎板切除术。
get him to go for the decompressive laminectomy.
你看见了吗？嗯
Did you see that? Yeah.
反射性肌肉收缩。在受伤区域的下方
Reflexive muscle contraction. Way beneath the zone of injury.
他还有运动机能。
He's still got motor function.
他可能不会完全瘫痪
He might not be completely paralyzed.
亚布拉姆斯医生，我给你看样东西
Dr. Abrams, I need to show you something.
我错过什么了吗？
Am I missing something?
他的骨盆在一秒钟前就退缩了。
His pelvis just flinched a second ago.
这是一个微妙的发现
It was a subtle finding.
很高兴看到你们两个在我不在的时候在神经外科
Glad to see you two sat for your neurosurgery boards
董事会上。我知道我看到了什么。
while I was away. I know what I saw.
我认为丹尼尔斯先生有B级不完全损伤
I think that Mr. Daniels has a Grade B incomplete injury.
如果我们解开绳子，
He has motor function to salvage
他会有运动功能
if we decompress the cord.
他可以恢复双腿
He could get his legs back.
那会改变演算。
Well, that would change the calculus.
但你最好确定你看到了你所看到的
But you better be certain you saw what you saw.
因为如果你没有，而且这个人死在了我的束手台上
Because if you're not, and this man dies on my table,
你去向他儿子解释
you'll be the ones to explain why to his son.
我们确定
We're sure.
好
Okay.
做手术吧
Let's do it.
什么情况。可♥卡♥因♥诱发心肌梗死。
Talk to me. Cocaine-induced MI.
在现场休克了三次。
Shocked three times in the field.
间歇性心脏骤停
Intermittent ROSC.
伊森，过来帮帮忙
Ethan, need an extra set of hands.
这是马特·库珀吗？是
That Matt Cooper? Yeah.
好，听我口令
All right, on my count.
一、二、三
One, two, three.
给他连上监视器。一毫克肾上腺素
Get him up on the monitors. Milligram of epi.
摸到脉搏了吗？还是室颤
You got a pulse? Still in V-fib.
开始急救。桃瑞丝，按压
Let's run the code. Doris, compressions.
明白。除颤器在哪？
You got it. Where's the defibrillator?
第四治疗室
T4.
伊森，在我电击的期间插管
Ethan, intubate while I grab the paddles.
保持按压。离手
Hold compressions. Clear.
血氧饱和度降到78.等等
Sats are dropping 78. Hang on.
降到74
Sats down to 74.
崔医生？桃瑞丝…
Dr. Choi? Doris...
插♥进♥去了
I'm in.
情况怎么样
How we looking?
血氧饱和度回升了
Sats are coming back up.
还是室颤。再打一毫克肾上腺素
Still in V-fib. Another milligram of epi.
充电到200
Charge to 200.
好，离手。离手
Okay, clear. Clear.
有脉搏了
Got a pulse.
窦性心律。就像骑自行车一样，对吗？
Sinus tach. Just like riding a bike, right?
2导联心电图、胸部x光和呼叫心脏科
12-lead EKG, chest x-ray, and page cardiology.
阿斯特里德，好消息是你的幻觉
So, Astrid the good news is that your hallucinations
不是由任何
are not being caused
潜在的精神疾病引起的
by any kind of underlying mental illness.
所以我没疯?
So I'm not going crazy?
嗯，没有
Well, no.
但是在一个基因组发现你患有一种
But a genetic panel has revealed that you have
叫做异染性白质营养不良或MLD的疾病
a disorder called metachromatic leukodystrophy or MLD.
MLD导致大脑和神经系统
MLD causes the brain and nervous system
逐渐丧失其功能
to progressively lose its function.
第一个症状通常是精神病发作，
The first symptoms are often psychotic episodes,
接着是一系列其他症状，
followed by a host of others
就像我们看到的肌肉功能变差
such as poor muscle function like we witnessed.
所以病情会恶化吗？
So this is going to get worse?
希望我们能通过药物遏制其发展
Hopefully we can mitigate its progression with meds.
事实上，你直到最近才出现任何症状，
And the fact that you haven't shown any symptoms
这是一个非常非常好的迹象
until recently is a really, really good sign.
这意味着我们很早就发现了这一点，
It means we caught it early
应该指出未来会有更好的结果
and should point to a better outcome going forward.
至少我知道我到底怎么了
At least I know what's going on with me.
终于解脱了
Such a huge relief.
谢谢你
Thank you.
谢谢你
Thank you.
布雷克医生？
Dr. Blake?
噢。为这个项目筹款
Oh. Fundraiser for the program.
在手术室里呆了12个小时，他们还是希望我穿高跟鞋
12 hours in the OR, and they still expect me to wear heels.
是啊。嗯，你需要什么？
Right. Ha. What do you need?
听着，我只想说我意识到
Look, I just wanted to say that I realize
我可能让你陷入了困境
I might have painted you into a corner,
你知道，你和团队，在推进这台手术
you know, you and the team, pushing for that surgery.