芝加哥急救

Chicago Med S08E02

Part 5 April 5, 2023, 10:17 a.m.

You know, truthfully, I'm not completely comfortable
我们的病人
making the case that our patient
比马素医生的病人更需要帮助
is of any greater need than Dr. Marcel's.
但我是这么认为的，莎伦
Well, I am. Look, Sharon.
如果我被要求追踪
If I'm being asked to follow the breadcrumbs
米曹女士的症状
of Ms. Mitchell's symptomology,
我怀疑她可能患有星形细胞瘤
I'm suspecting she might have an astrocytoma
或者动脉瘤渗漏
or maybe a leaking aneurysm.
但如果没有用电脑断层扫描检查
Now, there's no way of knowing for certain, however,
我们就没办法确定
without a CT with contrast.
但我可以向你保证，如果有上述情况
But I can assure you, if those are the possibilities,
又不进行治疗，她的结果会比
without intervention, her outcome is gonna be
跛脚几个月来得更糟
a whole lot worse than a limp for a few months.
不好意思，但这种说法太模棱两可了
I'm sorry, but that sounds so nebulous.
我是说，我们很清楚
I mean, we know precisely
做断层扫描能够得到什么结果
what we have to lose or gain with our patient.
但你只是在调查
You're just on a fishing expedition.
-这家伙是谁？-凯田中里德
-Who's this guy? -Kai Tanaka-Reed.
第一年的外科住院医师，很高兴认识你
First year surgical resident. It's a pleasure to meet you.
你是实习生，凯
You're a intern, Kai.
除非别人和你说话，否则就别说话
Learn not to speak unless spoken to.
我们就不能稀释显影剂做两次扫描吗？
Okay, can't we just dilute the dye enough for two procedures?
是可以，但我们得冒着两次扫描
We could, but we risk the chance
都不充分的风险
of neither scan being adequate.
听好了，没有最理想的选择
Look, there's no ideal option here,
但就这个情况来说，头比腿重要
but for now, head over leg.
医院会优先
The hospital is going to prioritize
替米曹女士做电脑断层扫描
the CT scan for Ms. Mitchell.
莎伦，你再一次证明了
Once again, Sharon, you've proven yourself
你的智慧超越了你的年龄
wise beyond your years.
我们在放射科见
I'll see you up in radiology.
-太烂了吧 -也只能这样了
-Well, this sucks. -It is what it is.
叫玛姬准备手术室
Have Maggie prep an OR.
-现在情况如何？-刚拿到劳肌损伤的药
-Where are we? -Just getting the RSI drugs.
好吧，来插管吧
All right. Let's tube him.
遵命，那就来吧…
Yes, sirree. Let's... let's do that.
你还好吗？你的手看起来有点抖
You all right? Your hands look a bit shaky.
我只是觉得我好像在试镜
Just feel like I'm auditioning here.
那不是气管
That's not the trachea.
那也不是
Neither is that.
怎么这么久？
What's taking so long?
硕克遇到了一点问题
Zach is having a little difficulty.
不知道为什么没办法对齐
It's just not lining up for some reason.
怎么回事？你以前没有插过管吗？
What's the matter? You've never done one of these before?
没有
No, I haven't.
你在开玩笑吧？
Are you kidding?
疫情期间我的医学院几乎都在停课
My med school all but shut down during the pandemic.
他说让我们
Said it was too big a liability
和病人互动太麻烦了
to have us interact with patients,
所以我们都在网上做
so we did everything online.
但我学得很快
But I'm a fast learner.
我没时间手把手教你
Yeah, I don't have time for handholding.
我自己来，别挡路
I'll do it myself. Get out of the way.
不行，我需要用影像式喉头镜
No, I'm gonna need to use a GlideScope.
在我回来之前，继续给他输氧
Keep bagging him until I get back.
输氧，动作快
Bag him! Bag, go!
-这些孩子真是够了 -是啊
-These kids, I swear. -Yeah.
嘿，在你动手之前
Hey, before you get started,
我想告诉你我在海滩上捡到的一本书
I wanted to tell you about a book I picked up on the beach.
是关于一个临终陪伴的故事
It's about a death doula.
南茜，影像式喉头镜的刀片去哪了？
Nancy, where'd that GlideScope blade go?
在那边的柜子里
It's over there in the cabinet.
这一切都是为了帮助大家
It's all about helping people transition
从一个层面过渡到另一个层面
from one plane of existence to the next.
好
Uh-huh.
我在想我们要不要和欧拔一起
I'm wondering if we're doing that with Al.
一起什么？
What?
纪念他的旅程
Honoring his journey.
你能解释得清楚一点吗？
You want to translate that into English for me?
我觉得我们不应该做支气管镜检查
I don't think we should be doing this bronchoscopy.
等等，你不觉得我们应该
Wait, you don't think we should be doing
尽一切努力让他活下去吗？
everything we can to keep him alive?
除非他不希望我们这么做
Not if he doesn't want us to.
现在是怎样，你冲了几次浪
So what, you catch a few juicy waves,
然后就突然开始鼓吹安宁缓和医疗了吗？
and all of a sudden, you're preaching palliative care now?
也许吧，如果需要的话
Maybe. When it's appropriate.
这里是急症室，伊芬，我们在这里救人
This is an ED, Ethan. We save lives here.
不是在这里杀人，至少不会故意为之
We don't end them, at least not on purpose.
也许你应该待在海滩上别回来
Maybe you should have stayed on that beach.
别动
Hm. Hm, hm, hm.
什么都别动，因为你现在看起来很美
Don't change a thing, 'cause you look fine as you is.
-班，你怎么会在这里？-你不记得了吗？
-Ben, what are you doing here? -You remember?
我一年要检查两次血液标记
My biannual to check my blood markers.
-对 -没错
-Right. -Yeah.
我本来打算速战速决
I was supposed to get in and out,
但他们说没有针筒了
but they said something about a shortage on syringes.
要下午晚一点才能轮到我
Can't get to me till later this afternoon.
这样啊
Oh.
但好消息是我有时间吃午餐了
But the good news is that I am free for lunch.
-你想去吃个三文治吗？-好啊
-You want to grab a sandwich? -Uh-huh.
你知道吗？我厌倦了一成不变的生活
You know what, I am tired of the same old, same old.
外面有辆我想吃看看的餐车
There is a food truck out there that I'd like to try.
好啊
Okay.
我的血管造影病人呢？
Where's my angio patient?
都准备好了吗？
Are we all good?
好，动手吧
Okay, let's do a run.
这是怎么回事？
What's going on here?
我在做血管造影
Trying to get an angio done.
我想我们都知道没有显影剂就不能做血管造影
I thought we already established we can't do that without contrast.
我找到了一个用二氧化碳替代的变通办法
I found a workaround using CO2 instead.
二氧化碳？
CO2?
就跟显影剂一样
It works a lot like a contrast.
我知道，但那有十倍的风险
Yes, I'm aware, but it's ten times as dangerous.
如果有气泡进到他的心脏…
If a gas bubble finds its way up to his heart...
我们要往动脉系统注射，哥罗基
We're injecting into the arterial system, Crockett,
在横膈膜下面
below the diaphragm.
一切都很顺利
We're all good.
-等一下 -已经注入二氧化碳
-Hold on. -CO2 has been delivered.
你看，就在这里，伤口在这里
Look, right there. That's the injury.
我们应该植入支架还是直接切开？
Should we stent or go and open?
该死，把头放下来
Damn it, drop the head.
血氧饱和度直线下降，各位
Sats are plummeting here, guys.
-80，还在下降 -怎么回事？
-80 and falling. -What's going on?
气塞，把C型臂移开
Vapor lock. Move the C-arm.
动作快…
Move it. Move it.
气泡阻塞了回流心脏的静脉
A gas bubble is occluding the venous return to the heart.
但这不可能啊
But that's impossible.
-现在就发生了 -血氧降到79
-Well, clearly not. -Now down to 79.
他的心跳超快
He's getting super tachy.
把导管插入他的心脏
Let's wire a catheter up to his heart.
不行，没时间了，我们得改变他的位置
No, no time. We have to change his position.
看能不能让血液通过气泡
See if we can get the blood past the bubble.
希望二氧化碳能重新吸收
Hope the CO2 reabsorbs.
把你的手放在他背上，拍他几下
Put your hand on his back. Give him a couple of pats.
这边
Right there.
就是这样
That's it.
加油，祖利安
Come on, Juli�an.
加油，祖利安，不要放弃
Come on, Juli�an. Stay with me.
血氧饱和度恢复了，91，还在上升
Sats are back up. 91 and climbing.
气塞没了
Vapor lock cleared.
天啊