芝加哥急救

Chicago Med S07E09

Part 6 March 23, 2022, 8:46 a.m.

心率120.血氧量下降到86.
Heartrate 130. Sats are down to 86.
凯浦瑞丝，给她上气袋
Caprice, bag her.
我要给她插管。插管？
I'll set her up to intubate. Intubate?
莉莉现在无法保护的气道。
Lily can't protect her airway right now.
而插管对她来说是最安全的。
But intubation is the safest thing for her.
-哦，天呐。-条尺带是粉色的。
-Oh, my God. -Broselow was in the pink.
给我2毫克依托咪酯和13毫克司可林。
Give me 2 mg of etomidate and 13 mg of sux.
-血氧现在是94. -怎么会这样
-Satting now at 94. -Why is this happening?
我保证我们会检查清楚是怎么回事的，好吗？
I promise we're gonna find out, okay?
用药后告诉我一声。
Now, let me know when those drugs are in.
♪
好了，你要同意的话，
Okay, so with your permission,
我们让莉莉去做头部CT。
we'd like to send Lily for a CT of her head.
只要让她好起来都行。
Anything. Just make her well.
扫描没有发现任何肿瘤，肿块，
Scans didn't reveal any tumors, masses,
或者明显的感染。
or obvious infections.
有什么想法？
Any ideas?
有一点，但是有点牵强。
One. Kind of a stretch.
我当时无家可归时看到的东西。
Something I saw when I was homeless.
这对夫妇可不是无家可归。
This couple isn't experiencing homelessness.
是的。
No.
不，一定发生了什么事。
No, there's something going on.
我需要对她进行更彻底的检查。
I need to give her a more thorough physical exam.
♪
败血症？可能是的。
Sepsis?
Yeah, possibly.
但是她没有发热啊。
But she's not running a fever.
所以是中风。颅内出血？
Okay, so stroke. Intracranial hemorrhage?
是的，我想CT能告诉我们些什么。
Yeah, I mean, CT should tell us something.
可怜的女孩。
Poor little girl.
她做了什么，要经历这些？
What'd she ever do to deserve this?
♪
转过头来。
Just turn your head.
这里，来，看一看
Here. Here, take a look.
这是什么？ --一个结痂
What is it? A scab.
是被虫子咬的。
It's from an insect bite.
怎么了？
What does that mean?
我有思路了，但是不太确定。
I have an idea, but I'm not sure.
我需要再做些试验。
I need to run one more test.
免疫印迹分♥析♥？--是的。
-Western blot analysis? -Yeah.
我们马上就知道原因了。
We should have an answer very soon.
所以我打电♥话♥给你的健康食品店，
So I called your health food store,
并且我拿到了你喝的
and I got the ingredients
那个茶的配方。
to that tea you've been drinking.
里面有很多东西。
Lot of stuff in there.
我认为马黛茶，留兰香提取物。
I think yerba mate, spearmint extract.
最主要的成分是圣约翰草。
But the main ingredient is St. John's wort.
你看，圣约翰草
Now, listen, nothing wrong
它本身没问题，对吧
with St. John's wort, per se, right?
并且它实际上对人是有益的。
Actually helpful to-- to some people.
但它也可以增加某些
But it has also been known to increase the metabolism
抗精神病药物的新陈代谢。
of certain antipsychotic medications.
增加新陈代谢？- 是的
-Increase the metabolism? -Yeah.
它加快了你的身体处理它们的速度。
It speeds up how your body processes them, right?
使药的效力大大降低。
Rendering them considerably less effective.
所以我会好的吗？
So I'm gonna be okay?
你把茶停掉，我相信你会好的。
You switch out that tea,yeah, I believe you will be.
我是说，你对我给你
I mean, look, you responded really well
额外的利培酮反应很好，对不对？
to the extra risperidone I gave you, right?
圣约翰草的半衰期大概是24小时，
Half-life of St. John's wort is, like, 24 hours,
所以到明天这个时候，
so by this time tomorrow,
你就应该感觉好多了。
you should be feeling a whole lot better.
-谢谢。-不客气。
-Thank you. -You're welcome.
♪
-好的，夹好了。-开始静脉搭桥。
-Okay, done clamping. Initiate VV bypass.
颅内压上升到70左右了。
ICP's up in the 70s.
我们必须让它低于20
We gotta get that ICP below 20.
在产生脑疝之前我先做个偏侧颅骨切除术。
Let me do a hemicraniectomy now, before he herniates.
不，我们需要先完成移植。
No, we need to complete the transplant first.
有了新的肝脏，随着时间过去事情就会好转。
With a new liver, things will correct with time.
否则就是一个脑死亡病人拥有健康肝脏。
Or you'll have a working liver in a braindead patient.
手术期间对他进行治疗。
Treat him medically while we operate.
艾布拉姆斯医生？
Dr. Abrams?
1g/kg甘露醇，增加异丙酚使其爆发性抑制，
1 g/kg mannitol, increase propofol to burst suppress,
并取代凝血因子。
and replace clotting factors.
-好的 -最后一步。
-Good. -Last one.
把这个肝脏取出来吧。
Let's get this liver out.
很抱歉，我们认为莉莉患有一种叫做
I'm sorry, but we believe Lily has a genetic condition
OTC缺乏症的遗传病
called OTC deficiency,
这会导致氨在血液中积聚。
which causes ammonia to build up in the blood.
我们安排了一个特殊实验室来确认。
We're ordering a specific lab to confirm.
如果是遗传的，为什么她现在才生病？
If it's genetic, why is she just getting sick now?
这种疾病会在出生后几天
The disease can present anywhere
或几个月都有可能发生。
from a few days after birth to several months.
现在有多严重？
How serious is it?
很不幸，非常严重。
Unfortunately, very.
我们必须立即开始治疗。
We need to start treatment immediately.
我们的女儿会死吗？
Is our little girl gonna die?
我们将尽一切努力确保
We're gonna do everything we can
这种情况不会发生。
to make sure that doesn't happen.
我们送莉莉去儿童重症监护室，给她开始血液透析
Let's get Lily up to PICU,get her on hemodialysis.
♪
嘿，我们得到了检验结果。
Hey. So we got your test results.
你感染了一种叫做斑疹伤寒的疾病。
You contracted a disease called typhus.
斑疹伤寒
Typhus.
在美国？
In the United States?
没错，而我们可以治疗它
It does occur, and we can treat it.
强力霉素500毫克
Doxycycline 500 mg.
她到底是怎么得斑疹伤寒的？
How the hell did she get typhus?
跳蚤咬的。
From a flea bite.
我们发现了疥疮。
That was the scab that we found.
很可能是被感染的老鼠身上的跳蚤
Most likely it was a flea that
had been on an infected rat.
我怎么得病的很重要吗？
What does it matter how I got it?
重要，这是公共卫生问题。
It matters.It's a public health issue.
很抱歉，我不知道
I'm sorry, I have no idea.
伊芙，够了。
Eve, enough.
我想知道怎么回事。
I want to know what's going on.
你是什么意思。
What do you mean?
你的医疗保险是无效的，
Your health insurance isn't valid,
我们的信♥用♥卡♥刷爆了，
our credit cards are maxed out,
而且你还被老鼠传得了染斑疹伤寒。
and you've come down with typhus from a rat.
伊芙，告诉我。
Eve, tell me.
我没有--
I haven't--
我已经三个月
I haven't been going into the office
没有去上班了。
for the past three months.
我每天都在我们的储物柜里度过。
I spend my days in our storage locker.
我们的储物柜？
Our storage locker?
我的公♥司♥重组了。
My company's restructuring.
我被解雇了。
They fired me.
我尝试去找新工作，结果....
I've been trying to find another job, and there's...
什么也没有，都没有。
There's nothing. Nothing.
-你为什么不告诉我？-因为我做不到！！
-Why didn't you just tell me? -Because I couldn't!
所有人都认为我很成功。
Everybody thinks I'm this huge success.
你也是这样想的。
You think I am.
-亲爱的。 -我很抱歉。我觉得很丢人。
-Honey. -I'm sorry. I'm so ashamed.
不是的。
No.
对不起。
I'm sorry.
我很抱歉。
I'm so--I'm so sorry.
.
我在想你去哪了。
I was wondering where you got to.
这真是令人不安啊，你知道吗？
It was unsettling, you know?
是的。
Yeah.
他是怎么---
How does he--