争分夺秒（2015）

Critical S01E04

Part 2 Jan. 6, 2021, 2:20 p.m.

血氧饱和度低于90% 请做双侧胸腔闭式引流术
Sats are below 90%. Let's get bilateral chest drains in, please.
我来
Me.
另一边我来
I'll do the other.
慢而稳事必成
Slow and steady wins the race.
丽贝卡能来帮把手吗
Rebecca, can I have a hand, please?
就只要
Just...
他的气道情况不乐观
I'm not happy with his airway.
我要做快速诱导插管好的
I need to RSI. OK.
硫喷妥钠-司可林 250-100 好的
Thio-Sux, 250-100. Yep.
亲爱的请你帮我弄好那一边好吗
Can you sort that side for me, please, love?
硫喷妥钠250毫克司可林100毫克
Thiopentone, 250 milligrams, suxamethonium, 100 milligrams.
请帮我系上
Tie us, please.
稍等
One second.
250毫克硫喷妥钠
250 thio.
贾斯汀
Justin?
请系上
Ties, please.
冲洗
Flush.
100毫克司可林
Sux, 100.
冲洗谢谢
Flush. Thanks.
还有多久可以插管
How long before we can intubate?
一分钟左右
About a minute.
所有人准备
Everyone, stand by.
我想要看一下他的盆骨听起来像是骨折
I'd like imaging of his pelvis. It sounds like a fracture.
我们这边一好就送他去做CT
We will get straight to CT as soon as.
所以
So...
你和她你是怎么做到的
you and her - how'd you pull that off?
闭嘴
Shut up.
准备好视频喉镜以防万一好这就准备
Get the GlideScope ready in case we need it. Yep, on it.
(视频喉镜镜片前端安装高清晰度防雾摄像头
并由两个发光二极管提供光线和对比度
通过光缆将图像传递并放大至液晶显示器上)
我先用普通喉镜试一下
I'll try the laryngoscope first.
好了时间到了
OK. That's time.
好的
OK.
血氧还在降低
Sats are still falling.
不起作用请试一下视频喉镜
That's not working. We'll try the GlideScope, please.
水肿太厉害
There's loads of oedema.
看不清
Can't get a view.
看不到完整的会厌
Can't see much of the epiglottis.
(会厌: 覆盖了一层黏膜组织的软骨
和舌根部相连位于舌头及舌骨稍微偏上的后方)
我们来试一下盲探插管
Let's try a blind bougie.
(指盲探气管插管一般经鼻插入此处经口
但用的是管径小而细长的经鼻插管)
谢谢
Thank you.
请让一下
Excuse me.
塞不进气管里去
It's not going in the trachea.
不行塞不进气管里去
No, it's not going in the trachea.
接下来准备如何人工通气
Course of action? Bagging.
胸腔闭式引流术怎样了
Tell me how the chest drains are.
水柱波动并有气泡排出
Swinging and bubbling.
(水柱波动可以观察胸闭引流的通畅性并反映肺膨胀的程度)
水柱波动和有气泡排出都是引流瓶密封良好的证明)
血氧饱和度低于60%
Sats are below 60%.
来两个人试一下好的
Let's try two person. Yep.
可以吗
Anything?
不行插不进去
No, it's not going in.
来试一下口咽通气道
OK. Let's try a Guedel airway, please.
(口咽通气道: 用于治疗或预防舌抵至腭部
或附着至咽后壁所致的上呼吸道梗阻
亦可协助进行口咽部吸引便于插管)
进去啊
Come on!
给我一件手术服好吗
Can I have a gown, please?
好了插插
OK, go, go.
血氧低于50% 进去啊
Sats below 50%. Come on.
也不行好吧
It's also not happening. OK.
我觉得你没有挤进去任何空气
I don't think you're moving any air.
无法插管无法通气
Can't intubate. Can't ventilate.
他需要做环甲膜切开术
He needs a crike.
是的请立刻给我准备环甲膜切开套件
Yep. I need a crike kit now, please.
(crike 全称Cricothyrotomy 即环甲膜切开术适用于需立即抢救者
于甲状软骨和环状软骨间作一长约2~4厘米的横行皮肤切口
于接近环状软骨处切开环甲膜以弯血管钳扩大切口
插入气管套管或橡胶管或塑料管并妥善固定)
太好了
Yes!
哈莉请帮我系上
Harry? Ties, please.
谢谢
Thank you.
肿胀和青紫的地方还真多
There's lots of swelling and bruising.
没关系我来处理
It's OK. I've got it.
请给我手术刀
Let's have the blade.
镊子
The forceps.
好了
There we go.
请给我经鼻插管
Let's have the bougie.
谢谢
Thank you.
人工气管
Trach.
好拿出经鼻插管
OK, bougie out.
好的我来
OK, I've got it.
好扶稳我们来固定
OK, hold till we secure.
没问题去冲管吧谢谢
Safe hands. Cuff up. Thanks.
冲管
Cuff.
好了
Yep.
呼吸
Breath.
呼吸
Breath.
病人气息顺畅了
Patient's ventilated.
血氧上升很好
Sats are rising. Good.
我来做锁骨下静脉穿刺插管术谢谢
I'll do a subclavian line. Thank you.
(适用于需持续补液的病人以使病人免遭频繁穿刺浅静脉之苦
必要时也可作采血化验插管加压输液或中心静脉压测定)
请缝合
Suture, please.
请帮下忙好吗好的
Could you? Yep.
他体温升高了
He's warmed up.
真快
That was fast.
把充气式保温毯拿掉
Let's get the Bair Hugger off
然后给他输250毫升的生理盐水
and give him a 250ml bolus of saline, please.
好的
Yep.
当锁骨下静脉穿刺插管好了以后
And when the subclavian line is ready,
和往常一样检查血液
let's do the usual bloods.
所以是全血细胞计数尿素与电解质
So that's FBC, U&E,
(全血细胞计数:即血常规提供关于病人血液细胞的信息
尿素与电解质: 检测肾功能)
血液酒精浓度
EtOH,
交叉配血血栓弹力图肝功能和静脉血气检测
crossmatch, teg, LFTs and VBGs.
毯子上血真多
Lots of blood on that blanket.
我们来清理一下这些划伤并且包上止血敷布
Let's clean up these lacerations and compress.
脉搏113 血压88/58 下降中
Pulse 113, BP 88 over 58. Falling.
好我们需要给他输血
OK. We need to get blood in.
清理完毕后通过锁骨下静脉滴注
We will transfuse through the subclavian line when it's clear.
输入血小板新鲜冰冻血浆和一克的氨甲环酸
So, that's platelets, FFP and let's get in one gram of TXA.
请各位
And, please...
动作快点
let's move on this.
静脉血气和样本已经抽取完毕
VBGs and samples ready to go.
耐莉丝我会处理好的
Nerys. I'll sort it.
哈莉能请你帮我把血挂上去吗
Harry, will you put the blood in for me, please?
好的这些已经冲洗完毕
Er, yep. These are flushed.
通过静脉留置针注射氨甲环酸
TXA going in through the Venflon.
心动过速血压80/50
Tachycardic. BP 80 over 50.
太低了
It's too low.
而且他身上很滑腻
And he's clammy.
请告诉我体温
Tell me his temperature, please?
39.7度
39.7.
他在发高烧
He's cooking.
是啊该死
Yeah. Bollocks.
看起来他受感染了
Looks like he's septic.
你的直觉是什么是他受感染了还是内出血
What's your instinct? Is he septic or is it internal haemorrhaging?
很可能两者都有
Probably both,
但我只是往坏处想罢了
but that'll be me being pessimistic.
那还真不像你啊
Not like you, then.
所以你是怎么把她哄回来的
So, er... how'd you get her back then?
商业机密比利
Trade secrets, Billy.
好吧
Right.