争分夺秒（2015）

Critical S01E04

Part 5 Jan. 6, 2021, 2:20 p.m.

I've got Dr Howe on Skype.
谢谢你戴上帽子进来
Thank you. Put on a hat and come through.
能够试着把他接到显示屏上去吗
Can we try and patch him up to one of the monitors, please?
好的
Yep.
我叫菲奥娜·罗马斯
My name is Fiona Lomas.
你知道我们在哪里吗豪医生
Do you know where we're at, Dr Howe?
请叫我维斯希克林夫人已经告诉我大致情况了
Wes. Mrs Hicklin has given me the basics.
抱歉只能视频出席我目前不在院内
Apologies for the virtual presence, I'm off site.
如果能听听你的意见就再好不过了
It would be really great to get your take.
让我看看皮疹
Let me have a look at the rash.
发展得很快
It's evolving quickly.
请近一点
Closer, please.
好的嗯
OK, yep.
病人休克了白细胞增多血小板减少
Patient is shocked, has leukocytosis and thrombocytopenia.
好了能让我看一下血栓弹力图吗
OK. Can I see the teg?
好的应该已经放上去了
Yeah, it should be up now.
嗯
Yeah.
好的菲奥娜在
OK, Fiona? Yes?
你们采取屏障预防措施了吗
Have you taken barrier precautions?
是的很好
Yes. Good.
最坏情况这是出血热病毒
Worst case scenario, it's a haemorrhagic virus.
有可能是金葡菌败血症或者肺炎球菌
Could be a staph sepsis or pneumococcus.
(金葡菌败血症: 多见于男性原发炎性病灶以皮肤疖等为多见
临床表现较典型急起发病
肺炎球菌: 链球菌属学名为肺炎链球菌常寄居于正常人的鼻咽腔中
仅少数有致病力是细菌性肺炎的主要病原菌)
如果有样本我就能快速判断了
I can short cut with a sample.
好的你需要什么
OK, what do you need?
我需要你用无菌针刮擦皮肤损伤
I need you to scrape a skin lesion with the point of a sterile needle
直到血渗出然后将血吸到
until blood starts to appear, then blot the blood
一片显微镜载玻片上任其自然放干
onto a microscopic slide and allow it to dry.
无菌针和载玻片
Sterile needle and slide, please.
载玻片这里有谢谢
We've got slides. Thank you.
立刻送到化验室去
Get it straight up to the lab
我一到就去审查
and I'll process it as soon as I get there.
我们还要做什么
What else should we be doing?
普通的配套措施
Usual supportive measures.
给他两克头孢曲松(抗生素) 静脉滴注
Give him ceftriaxone and two grams IV stat.
我还不确定是什么
And I can't be sure what it is yet,
所以再给他一剂万古霉素
so give him a slug of vancomycin as well.
(万古霉素是一种糖肽类抗生素用来预防和治疗
革兰氏阳性菌所造成的感染传统上被用作"最后一线药物"
用来治疗所有抗生素均无效的严重感染)
请给他静脉滴注两克头孢曲松
Let's get two grams ceftriaxone IV stat
静脉滴注一克万古霉素
and one gram vancomycin IV, please.
生理盐水呢照常滴注不要停
What about fluids? Fluids as usual. Keep them coming.
血液制品也是一样
Same with the blood products.
但如果输液不起作用
But we will need to start inotropes
就需要使用心肌收缩力增强剂了
if fluids don't pick things up.
晾干
Let that dry.
哪些人需要注射预防性抗生素
Which personnel should we list for prophylactic antibiotics?
抱歉我没听清
Sorry, I didn't catch that.
还有谁需要注射预防性抗生素吗
Who else needs prophylactic antibiotics?
任何没有穿戴个人防护设备并直接
Anyone exposed to body fluids or aerosols directly
接触过体液或者他周围空气的
who wasn't wearing personal protection equipment.
给他们500毫克环丙沙星一次就行
Give them ciprofloxacin, 500 milligrams. One dose.
(环丙沙星: 为合成的第三代喹诺酮类抗菌药物
具广谱抗菌活性杀菌效果好)
不算对症但有帮助
Not perfect, but it helps.
我已经通知急救人员了
I've called the paramedics in.
心胸外科和普外科医生
The cardiothoracic and general surgeons
在复苏室都接触过空气
were both exposed to aerosols in resus.
还有丽贝卡
And Rebecca.
我去联♥系♥他们耐莉丝会发给他们环丙沙星的
I'll contact them. Nerys will distribute the cipro.
好的听起来不错我们下一阶段见
OK, all sounds good. Let's see at the next stage.
我去向卫生保监局汇报
And I'll report this to the Health Protection Unit, OK?
谢谢
Thank you.
脉搏120 血压80/60 高烧超过40度
Pulse is 120, BP 80 over 60. He's pyrexial, over 40.
贾斯汀
Justin.
你好维斯我是格伦·博伊尔
Hi, Wes. I'm Glen Boyle.
病人骨盆骨折并带有大出血
The patient has a pelvic fracture with contained haemorrhage
需要立即手术我们正要开始
requiring urgent surgery and we were just about to get started.
凝血障碍症状表明任何出血点
Well, the coagulopathy means that any bleed
会导致流血不止是的
could lead to exsanguination. Yep.
我来看看到底是什么原因然后再来告诉你好吗
Let me see what bugs I can find, I'll get back to you, OK?
好的多谢
OK. I appreciate it.
他一旦给你回电♥话♥
The minute you hear anything back from him,
立刻回来报告没问题
you bring the news straight in here. Sure.
他高烧不止没有任何措施有效
He's burning up. Nothing is improving it.
请把C型臂X光机搬来
OK, let's get the C-Arm in, please.
你怎么看
What do you think?
不做外支撑架他就会死
It's the ex-fix or we lose him.
请对准
Can we arc it, please?
很好
That's good.
可以放射了吗好的
OK to rays? Yep.
放射
Rays.
放射结束
Rays off.
谢谢
Thank you.
手术刀
Blade, please.
格伦能稍微停一下吗不行
Glen, you got a sec? No.
不是埃博拉对吧
It's not Ebola, is it?
可能是可能不是
Might be. Might not be...
呃大多数感染我都可以抵抗但那个
Well, I can fight most infections, but that...
去找耐莉丝要预防性抗生素赶紧滚鲍勃
Talk to Nerys about prophylactic antibiotics. Now piss off, Bob.
集中注意力
And focus.
止血钳
The Spencer Wells, please.
谢谢
Thank you.
我需要带150毫米钉子的电钻
OK, I'll need a drill with a 150 pin
以及冲钻套筒帮我一把
and a drill sleeve, please. Give me a hand.
就在这
Just there.
谢谢
Thank you.
请拍一张照片
Take a shot, please.
放射
Rays.
放射结束
Rays off.
好的谢谢
OK. Thank you.
请给我T型手柄
Let's get the T-handle, please.
谢谢
Thank you.
再拍一张照
Let's have another shot.
好的放射
OK. Rays.
放射结束
Rays off.
很好再给我一根钉子
Good. I'm going to need another pin.
好再帮我一下
OK, need you again.
打开就在那里
Open, just there.
谢谢
Thank you.
再拍一张照片
Let's have another shot.
放射
Rays.
放射结束
Rays off.
谢谢
Thank you.
请给我T型手柄
Let's have the T-handle, please.
脉搏加快
Pulse is rising.
血压下降
BP dropping.
再拍一张
Another shot.
放射
Rays.
推一下加温快速输注器好的
Push the Belmont, please. Yep.
他快不行了
OK, he's crashing.
是因为失血吗对他在快速失血
Is it blood loss? Yes, we're losing lots of blood fast.
你能去问一下交叉配血到哪儿了吗
Can you see where these crossmatch bloods have got to, please?
好我们再做一次血栓弹力图
OK, let's repeat the teg.
我们需要给他开膛
We need to open him up.
血库吗
Blood Bank?
我是创伤手术室的手术部医生快
This is the ODP in trauma theatre. Come on.
请立刻送C组合血包来
We need Pack C, ASAP.
还是不行
Still crashing.
为血浆中血小板缺乏做剖腹手术准备
Let's prep for a full laparotomy for PPP.
加油啊
Come on!