争分夺秒（2015）

Critical S01E01

Part 2 Jan. 6, 2021, 2:19 p.m.

谢谢你康斯坦丝来一下好吗好
Thank you. Constance, could you, please? Yep.
请严密监视血压
Let's keep a close eye on the BP, please.
谢谢对于拧捏没有反应
Thank you. No response to trap pinch.
一昏迷等级?
One. GCS?
四分镇静状态下四分
Four. Four with sedation.
(GCS是格拉斯哥昏迷指数四分属重度昏迷)
抱歉
Sorry.
双侧胸廓切开完成引流时间?
Bilateral thoracostomy patent. Time for drains?
数据是88
Sats 88.
最好先把他控制住
Prefer to get him under first.
好了急救人员可以走了
OK. That's the lads off.
好的谢谢两位祝你们愉快
OK, thanks, guys, have a good one.
下次再见伙计们
See you next time, lads.
不是给他打过镇静剂了么
I thought he was sedated?
是的是的
He was. He was.
吸液好的
Suction. OK.
需要快速诱导插管比利
Need to RSI, Billy.
快速诱导插管是在应用一种强诱导剂后立即用
速效神经肌肉阻滞剂使患者神志丧失和肌肉麻痹状态
以进行气管插管的方法预防和维持病人呼吸道的畅通
这就来这就来
Yeah, I'm on it, I'm on it.
请赶快
OK, do it fast, please.
血压下降
BP's dropping.
血压严重偏低没有桡动脉脉搏
Severely hypotensive, no radial pulse.
我们需要插管
We need to get a tube in.
血压这么低我没办法插管
Yeah. I can't get a tube in with the BP down this low.
好吧赶紧拿血来直接挤进去
OK, blood straight away, just squeeze it in.
贾斯汀快
Justin! Quickly.
我们得把他的血压弄上去
We need to get this blood pressure up.
先生我们会清理你的喉咙
Sir, we're going to clear your throat.
请冷静下来这样我们才能帮你
Please try to be calm so we can help you.
数据在下降
The sats are going down,
我们得赶紧把管子插♥进♥去
we really need to get the tube in.
天啊我在试呢
...sake, I'm trying.
时间在流逝请尽快
Clock's ticking, fast as you can, please.
测到桡动脉脉搏了
I've got a radial pulse.
好吧血压够高了
OK, you've got enough pressure,
请尽快把管子插♥进♥去好来吧
you need to get the tube in, please. OK, here we go.
你是新来的住院医师?
Are you the new SHO?
是的大家都叫我哈莉
Er, yeah, everyone calls me Harry.
好能请你在我们拿走固定块时
OK, can you give me inline C-spine immobilisation
帮他做颈椎中立位固定吗
while we take the blocks off, please?
不把手放进来
No, get your hands in there!
好扶紧
OK. Hold tight.
对了
That's it.
天啊
Jesus.
你扶好了吗是的
You got him? Yeah.
谢谢
Ta.
扶紧了是
Hold tight. Yeah.
250毫克硫喷妥钠(静脉麻♥醉♥药♥) 好的
Thiopentone, 250mg. OK.
250毫克硫喷妥钠正在注射
Thio, 250. Going in.
正在注射只是让你睡一觉伙计
Going in. Just sending you off to sleep, mate.
推嗯
Push. Yeah.
终于安静下来了
Finally, some peace and quiet.
100毫克司可林正在注射
Sux 100, going in.
(司可林是筒箭毒碱合成代用品
肌肉松弛作用快可使气管插管容易进行)
我们在处理创伤时使用司可林因为起效快
We use sux in trauma cos it works fast.
但这里可不止这一种药
That's not the only thing around here.
让病人失去知觉得花上一阵子
Takes a while to paralyse the patient.
好了
Here we go.
哦好了吸液
OK, yeah. Suction.
别忘了做动脉血气检测和心电图
Make sure you do ABGs and an ECG.
(动脉血气检测是检测肺换气功能的重要项目从而判断出
有无缺氧及其程度有无酸碱失衡及其失衡的类型程度等)
是阿彻菲尔德医生
Yes, Dr Archerfield.
一个人就要那么多医护人员
All those staff to one patient.
不那是创伤急救呼叫是重伤病患
No, that's a trauma call, critical injuries.
真是疯了
It's madness.
这人有点冷有没有量过体温
This guy feels cold. Did we get a temperature?
没有人告诉过我
Not that anyone's given me.
他们过了多久才把他放上铲式担架的
How long till they scooped him?
15分钟后到达现场 25分钟后放上担架
They were there in 15 minutes, scooped after 25.
颈动脉核心体温 36.1度
Carotid core, 36.1.
对于一个30分钟内被塞入担架的人来说他体温偏低
Yeah, he's cold for someone they scooped inside 30 minutes.
15加25是40 那就算40分钟吧
15 and 25 is 40. 40 minutes then.
冰柜里还有多少血只剩三包了
How much blood is left in the fridge? We're down to three bags.
胸内出血请给我纱布
Intrathoracic haemorrhage, get me a swab, please.
好了来了病患出现突发症状
OK, here we go. I'm calling a code.
我们需要更多的血再来一个静脉留置针?
We need more blood. Another Venflon?
对还要一根大号♥导管
Yes, and a trauma line.
我可以来插静脉留置针
I can do Venflon.
我是梅里克护士复苏室病患情况危急
Sister Merrick, resus, we're coding.
请给我氨甲环酸(缓解出血) 这就来
Tranexamic acid, please. Coming up.
先止血大量输血方案
Let's stop this haemorrhage. Major transfusion protocol.
不不别给我接血库
No, no, don't put me through to blood bank.
哦我知道你们不需要我提醒各位
Oh, I know you don't need me to say this, everyone,
请利索点
but nice and fast, please.
复核
Crosscheck.
O+型已记录并核查已复核
O pos, dated and checked. Crosschecked.
不我知道我还在等
No, I know, I'm still holding.
还剩两单位的O+血
Two units of O pos remaining.
氨甲环酸静脉注射一克紧接着注射一克
TXA, 1g IV, 1g infusion to follow.
对我是拉帕波特夫人
Yes, this is Mrs Rappaport,
我是重伤待命主任医师
I'm the consultant on call for major trauma
我们刚刚启用了大量输血方案
and we have just enacted the major transfusion protocol.
立刻给我们送12单位的O+型血来
You send us 12 units of O positive immediately.
8单位新鲜冰冻血浆和四单位血小板
Eight of FFP and four of platelets.
你有授权吗什么
'Do you have authorisation?' What?
那应该是第三个单位的血包了吧
I make that the third unit of blood now.
一个单位的O+血
One unit of O pos.
那赶紧把我接过去啊
OK, then, please put me through.
不谢谢了!
No, thank you!
下个单位的O+血通过大号♥导管注射
Let's put the next unit of O pos through the trauma line
请按紧胸腔出血口
and pressure on the thoracostomy bleed.
哈莉请按紧
Harry, pressure, please.
来
Here.
好我插入大号♥导管时请去拿血
OK, let's take bloods as I do the trauma line.
你好我是罗琳·拉帕波特重伤待命主任医师
Oh, hi, yes, this is Lorraine Rappaport, consultant on call for trauma...
请从储藏室里再拿一袋O+血来
Let's have another bag of O pos from the store, please.
有名重伤病人昏迷了没有你的认可
We have a major trauma patient in recess and blood bank
血库不肯启用大量输血方案
won't enact the major transfusion protocol without your say-so.
你们测量过他的血红蛋白吗
Did you ever have a haemoglobin measurement?
不我们没有测量过病患的血红蛋白
No, we haven't measured the patient's Hb,
就算测了也一定是正常的
and if we did, it would be normal because
因为他血液里的血红蛋白浓度不会变
the concentration of haemoglobin in his blood won't have changed.
但有改变的是在他体内循环的血
But what has changed is he has a lot less blood circulating
比半小时前少了很多
than he did half an hour ago.
如果我们不给他输血他会死
And if we don't transfuse him, he will die.
打扰一下谢谢
Excuse me... Thank you.
抱歉
Sorry...
抱歉! 怎么了
Sorry! Yes.
这个胸廓切口的血止不住
This thoracostomy's really bleeding.
他失血过多了
He's bleeding out.
我们需要更多的血不然就救不了他了
We need more blood, we're losing him.
这家伙的胸腔里到底怎么了
What the hell's going on in this guy's chest?
请来一个人给他做胸腔引流
We need someone to do a chest drain, please.
我来
Me.
有人自荐了贾斯汀立刻去止血
We have a volunteer. Justin, get on that bleed now.
换掉手套护目镜罩袍两分钟内全部换好
Swap gloves, eye guards, gown. I want you ready to go in two minutes.
比利血气检测如何
Billy, where are those blood gases?
动脉血氧分压 5.3 动脉血二氧化碳分压 4.5
PaO2, 5.3. PaCO2, 4.5.
酸碱度 7.1 乳酸 8
PH, 7.1. Lactate, 8.
碱剩余 -6
Base excess, -6.