芝加哥急救

Chicago Med S08E04

Part 2 April 5, 2023, 10:18 a.m.

hit him in the chest.
好的
Okay.
好，来吧
All right. Here we go.
嗯，我要你…
All right, I want you to...
我要你抓住他的脚踝
I want you to grab him by his ankles.
纳撒尼尔，我要稍微把你抬起来一点，好吗？
Nathaniel, I'm gonna bring you up a little bit, OK?
好的
Okay.
继续走，这里
Keep going. Right here.
-好 -这里
-Yeah. -Right here.
好的…
Okay, okay.
一切都会没事的…
It's gonna be all right. It's gonna be all right.
有我在，老兄，有我在没事的
I got you, buddy. I got you.
来吧
There you go.
好的，看着我
Okay, look at me.
纳撒尼尔，你这是连枷胸
Nathaniel, you have a flailed chest
可能还有血气胸，好吗？
and likely a hemopneumothorax, okay?
那是什么意思？
What does that mean?
他两侧肋骨都断了几根
He broke several ribs on both sides,
导致里面出现浮动段
which is now causing a free-floating segment.
他的肺应该塌陷了
His lung is likely collapsed,
他的胸腔充满血和空气
and his chest is filled with blood and air.
-我们带他出去吧 -不…
-Let's get him out of here. -No, no, no, no.
听起来隧♥道♥还在继续坍塌
Sounds like the tunnel is still coming down around us.
嗯，我们动作要快一点
Yeah, then we better move quick.
-来吧 -不…
-Come on. -No, no, no.
如果我们试着移♥动♥他可能会让情况更糟
If we try to move him, we could make it worse.
好吧，那我去找人帮忙
All right, then. I'll go get some help.
不行，我进来的那条路太危险了
No, it's too dangerous the way I came in.
-好吗？-那我们要怎么办？
-All right? -So what do we do?
我们等芝加哥消防队来救我们出去
We wait until CFD comes to get us out.
这是最安全的选项，好吗？
It's the safest option, all right?
我需要控制这个出血
I need to get control of this bleed.
我需要找东西包扎这个伤口
I need to create a pressure dressing for this wound.
把你的领带给我
Give me your tie.
拜托撑住，纳撒尼尔
Hang in there for me, Nathaniel.
你会感觉到一些压力，好吗？
And you're gonna feel some pressure, okay?
好
Okay.
早安，泰勒医生
Morning, Dr. Taylor.
嘿
Hey.
萝丝，伊曼奴，这位是霍士迪医生
Rose, Emmanuel, this is Dr. Halstead.
嗨，很遗憾你人不舒服，萝丝
Hi. Sorry to hear you're feeling poorly, Rose.
泰勒医生认为我或许能帮上忙
Dr. Taylor thought I might be able to help.
人越多越好，我很习惯看医生
The more, the merrier. I'm well-accustomed to doctors.
我太太患有第一型糖尿病和高血压
My wife has type 1 diabetes and hypertension.
不过萝丝今天是因为慢性泌尿道感染来的
But Rose is here today because of a chronic UTI.
她的内科医生帮她开了几轮抗生素
Her internist prescribed her several rounds of antibiotics,
可是完全没有效
but none of them have done anything.
所以我做了尿液培养
So I sent a urine test with cultures.
嗯
Mm-hmm.
多重抗药性霉菌感染
Multi-resistant fungal infection.
“霉菌”听起来好糟，对吧？
"Fungal" is such an unpleasant word, isn't it?
很多医学名词都很…
A lot of medical words are...
痰，流脓
Phlegm, discharge.
萝丝教11年级的英文作文
Rose taught 11th grade English composition
教32年了
for 32 years.
她很擅长词汇
Words are her thing.
有些一听就很尴尬
Some are just naturally embarrassing,
像是有霉菌
like having a fungus.
这个嘛，在这里没什么好尴尬的，萝丝
Well, no need to be embarrassed here, Rose.
上面写说只对伏立康唑和两性霉素敏感
It says it's sensitive to voriconazole and amphotericin only.
那就静脉注射200毫克的伏立康唑
So voriconazole. 200 milligrams. IV.
嗯，我也是这样想，可是有个问题
Um, I had the same thought, but there's a problem.
-那个药在短缺清单上 -已经三周了
-It's on the shortage list. -For three weeks now.
那其他药呢？
What about this other medication?
让我们讨论一下，马上回来
Let us talk it over. We'll be right back.
两性霉素B太过时了
Amphotericin B is old-school.
-大家都叫它两性霉素 -我知道
-They call it amphoterrible. -I know.
而且萝丝的肾脏因为糖尿病已经出问题了
And Rose's kidneys are already compromised because of her diabetes.
她的肌酸酐从2.8起跳
Her creatinine is 2.8 to start.
两性霉素会让她的肾脏坏掉、害她洗肾
Ampho will knock them out and put her in dialysis,
也可能更糟，让她丧命
or worse, kill her.
一定要用伏立康唑
It has to be voriconazole.
那我们打电♥话♥给其他医院、药局
Let's start calling around hospitals, pharmacies,
-问问看谁有 -没有，我已经打了
-see if they have any. -No, I already did.
所有在芝加哥和我通话的人都没有
Everyone I talked to in Chicago was out.
我不知道下一步该怎么做
I'm not sure what the next move is,
所以我才找你来
which is why I dragged you into this.
我是说，如果你拿不到唯一能够治疗感染的药
I mean, what do you do if you can't get the only drug
你该怎么做？
that'll treat an infection?
疼痛只出现在她的下背
The pain is localized to her back.
上面写说她的尿酸有问题
It says here her UA is dirty.
嗯，尿液检查结果不正常
Yeah, that's not normal for a urine dip,
可是也不能排除感染
but it also doesn't scream infection either.
-嗯 -我看过短缺清单
-Mm-hmm. -I checked the shortage list,
我知道现在显影剂供应量不足
and I know that the contrast dye supply is low.
-目前它是被管控的药品 -嗯
-It's currently restricted. -Yes.
可是管理规则上也说如果患者需要做电脑断层扫描…
But protocol also states that if a patient needs a CT...
嗯，你有帮她做超音波检查有没有肾结石吗？
Okay, did you ultrasound her for a kidney stone?
-没有 -为什么不做？
-No. -Why don't you?
通常有腹膜炎或腰痛的孕妇
Kidney stones usually present in pregnant women
-才会有肾结石 -没错
-with peritonitis or flank pain. -Right.
坎迪丝只有下背痛
Candace only has low back pain.
是的，你还是可以帮她做超音波检查
Sure. You can still ultrasound her to check.
我可以，可是我们都知道
I could, but as we both know,
超音波对结石不是很灵敏
ultrasound is not very sensitive for a stone.
电脑断层扫描更能搞清楚
A CT would give me a much better picture
-问题在哪里 -嗯
-of what's actually going on. -Okay.
如果超音波上看不出什么结果
So if the ultrasound doesn't show anything conclusive,
那你再去安排电脑断层扫描，可以吗？
you'll order the CT, yeah?
-我会去做超音波 -嗯
-I'll do an ultrasound then. -Right.
你也应该开始给她经验性抗生素
And you might want to start her on empiric antibiotics too.
万一是肾盂肾炎，你最好提早治疗
In case it's pyelonephritis, you should get ahead of that.
我是说，青少年想要
I mean, like, it's perfectly natural
跟父母保持距离…
for a teenager to want distance from...
这是很自然的事，对吧？可是我不知道
From their parents, right? But I don't know.
最近，她似乎完全不想
Recently, it just seems like she doesn't want anything
跟我有任何关系
to do with me at all anymore.
这可能只是暂时的
That may only be temporary.
而且寻求这种独♥立♥
And it's healthy for your daughter
对你女儿来说是很健康的
to seek out this kind of independence.
你觉得我会不知道吗？
You think that I, of all people, wouldn't know that?
可是我真的不懂，天啊，这真的…
But I don't know, man. It's been a...
意外地让人难以接受，你知道吗？
surprisingly difficult pill to swallow, you know?
这件事跟我在工作上遇到的其他问题
And that kind of dovetails with this other issue
又相互呼应
that I'm having at work, right,
陪伴病人面对困难的时光
involving being there for patients in difficult times.
我是说，我很习惯处在那种让人不安的环境，对吧？
I mean, I'm used to living in those uncomfortable moments, right?
我是说，那就是我们的工作
I mean, it's what we do.
你懂我的意思，你做这行很久了
You know what I'm talking about. You've been doing this a long time.
-嗯 -可是最近
-Mm-hmm. -But recently,
譬如说，当我必须跟病人说
when, say, I have to give a patient,
坏消息的时候
like, a really tough diagnosis, right,
像是告诉他们或他们所爱的人
like, tell them or the people that they love
说他们患有终生精神疾病…
that they have a lifelong mental illness...
他们这辈子完了
Their lives are over.
嗯
Yeah.
这些时刻一直困扰着我，你懂吗？
And I've been haunted by these moments, right?
它们一直跟着我
They stick with me.
有时候它们会回头盯着我看
It's like sometimes they stare back at me.
有时候他们会哭泣
Sometimes they cry.
有时候他们不知道怎么办他们本来就不会知道