争分夺秒（2015）

Critical S01E12

Part 4 Jan. 6, 2021, 2:22 p.m.

(胰岛素可诱发葡萄糖进入脂肪细胞和肌肉细胞葡萄糖进入细胞时会携带钾离子一同进入实现了钾离子向细胞内转入达到降低细胞外钾离子浓度的目的摘自《中国社区医师》杂♥志♥ 作者李春昌)
然后是镁和胰岛素-葡萄糖溶液
then magnesium and insulin dextrose.
她还是室性心动过速有心排
She's still in VT with output.
能帮我一起通一下气道吗
Can I have help with her airway?
我忙着照顾你另一个病人呢
I'm busy with your other patient.
注射10毫升氯化钙
Calcium chloride, 10ml going in.
好我们再来一次同步电击吧
OK, can we have another synchronised shot, please?
不应该等到输完胺碘酮吗
Shouldn't we wait until the amiodarone's gone through?
差不多快完了
You know, eh, it's nearly run through
而钙离子能暂时稳住她的心脏
and the calcium should stabilise her heart temporarily.
喂我是创伤科主任医师格伦·博伊尔
Yes, this is Glen Boyle, Trauma Consultant.
我需要一间手术室做紧急剖腹手术
I need a theatre for an emergency laparotomy, please.
重大事故编号♥0005
Maj Acc. MO 0005.
因为事态紧急所以是的我现在就要
Well, it's an emergency so, yes, I need it now.
好吧明白
OK, understood.
怎样
News?
最多还要15分钟但斯特里特已经知道了
Another 15 minutes at best, but Street knows about him
而且妮可拉在楼上找手术室
and Nicola's trying to find a theatre upstairs.
血压依旧不可测
BP's still abysmal.
好吧继续给他输血目标是收缩压90
OK, let's keep transfusing him. Aim for 90 systolic.
CT和手术室都没空
CT and theatre are busy,
所以我们叫雪莉来这里重新给他照X光
so let's get Shelley down here to redo the x-rays.
贾斯汀你来打电♥话♥给X光科
Justin, you can do that. Call up to X-ray, please.
嗯比利可不可以...? 我忙着呢
Em, Billy can you...? I'm busy.
谢谢
Thank you.
由于发生重大事故各科室的工作均出现严重延迟
'Due to a major incident, we're experiencing severe delays.
我们对因此给您造成的一切不便与苦恼...
'We apologise for any inconvenience or distress...'
我是贾斯汀能...你好雪莉
Justin here. Can...Hi, Shelley.
嗯很好能请你再到复苏室C病位来做一次X光吗
Yeah, fine. Can we get more x-rays in Resus Bay C, please?
谢谢
Thanks.
格伦
Glen?
有个长时间受困的人正在过来低昏迷指数
We have a prolonged entrapment on its way. Low GCS.
他们在现场就给他插管了
They intubated him on scene.
我腾出了一个急诊室小单间
I've cleared an ED cubicle
并按照复苏室要求做了准备
and stocked it to the Resus requiement.
所以我们可以将它作为额外的复苏病位
So we can use it for an extra Resus bay.
额外的帮手呢
And what about those extra hands?
克莱夫不肯调遣现场员工克莱夫?
Clive won't reallocate onsite staff. Clive?
他被上调到管理部门去了
He's been moved up to management.
我知道我需要你撑到帮手来为止
I know. What I need is for you to cope until people start arriving.
我已经叫值班外科住院医师来了
I've got the on-call surgical SHO coming
多米尼克把手上那个哮喘病人
and we can ask Dominic to help
移交出去以后也可以叫他帮忙
after he hands over the asthma patient.
你这边能腾出谁来吗
So can you spare anyone?
哦该死我还有选择吗
Oh, shit. Do I have a choice?
多谢了格伦
Thanks, Glen.
血压又下降了 68/34
BP's dropping again. It's 68 over 34...
该死输液线渗血了
Shit! He's oozing from his lines.
给他注射钙以及更多的凝血因子
Give him calcium and more clotting factors, please.
他很冷请拿保温毯来好的
He's cold. Can we have a Bair Hugger, please! Yeah!
喂总台请接手术室
Yeah, switch, give me theatres, please.
我是格伦·博伊尔重大事故编号♥0005
OK, this is Glen Boyle. Maj Acc MO 0005.
自我上次打过电♥话♥以后他又恶化了
He's deteriorated since the last time I called.
我真的需要马上送他过去
I really need to bring him up now.
凝血障碍是的输血是的
Coagulopathic, yes. Transfusing, yes.
好的谢谢好的准备移送
OK, thank you. OK, let's prep for transfer.
还需要五分钟我们一边走一边给他输血
They'll be another five. We'll continue transfusions as we go.
我需要查一下其他病位
I need to check the other bays.
但如果有变请叫我
But give me the shout if anything changes.
你要我继续照X光吗?
Do you want me to carry on with x-rays?
是的请继续好的
Yes, please. OK.
哈莉请告诉我最新情况
Harry? Update, please.
呃好的这个要转去内科
Er, yeah. This one is medical
这位女士恢复窦率急救人员会带走她
and this lady's back on sinus, the medics are taking her.
很好
Good.
我听到你的消息了祝贺你
I heard your news. Well done.
我希望你比我运气好选对了人
I hope you have more luck than I did choosing the right one.
谢谢
Thank you.
哈莉康斯坦丝跟我走安娜来
Harry, Constance, with me, please. Anna, here.
我需要你跟哈莉和康斯坦丝去急救部监护病位
I need you to go with Harry and Constance to the ED monitor bay.
我会派外科医生去
There'll be a surgeon there
我也会尽快送多米尼克过去去吧
and I'll send Dominic over ASAP. Go.
嗯我叫阿尼娅
Em...it's Ania.
好吧
Right.
哈莉嗯?
Harry? Hm?
那个长时间受困病人我要你主导
I need you to take the lead on the prolonged entrapment.
不我...
No, I...
听着如果有问题你可以来叫我好吗
Listen, if there's a problem, you know you can call me. Yes?
好的谢谢你
Yes. And thank you.
准备好照X光了谢谢
I'm ready for rays. Thanks.
数到三放射
Rays in three.
一二三放射
One, two, three, rays.
请去四号♥隔间
Cubicle four, please.
你们好先做交接然后把他放到手推车上
Hi. Handover first, then we'll put him on the trolley.
不应该先等创伤急救队长来吗
Shouldn't we wait for the Trauma Team leader?
就是我哦
That's me. Oh.
好吧年近40的男性
OK, I've got a male in his late-30s,
在重大事故中从摩托车上摔下来
came off his motorbike during the major incident.
他在两辆车辆之间
He was trapped in a lateral position
以侧卧位被夹了一小时
between two vehicles for an hour.
他当时还能告诉我他还没挂
He was able to tell me he hadn't been KO'd
而且胸部疼痛
and he had a pain in his chest.
因为呼吸困难在现场就插管了
Tubed at the scene as he had difficulty breathing.
我们做了很多呼气末正压通气并大量输氧
We needed lots of peep and a high flow of oxygen
(PEEP(positive end-expiratory pressure)即呼气终末正压为机械呼吸机在吸气相产生正压气体进入肺部在呼气末气道开放时气道压力仍保持高于大气压以防止肺泡萎缩塌陷在治疗呼吸窘迫综合征ARDS 非心源性肺水肿肺出血时起重要作用)
才将他的血氧度维持在可接受的程度
to keep his sats acceptable.
入气量相等但是有双侧外科性气肿和肋骨骨折
Equal air entry, but bilateral surgical emphysema and rib fractures.
(外科性气肿是皮下气肿的一种是术后或创伤后皮下组织积气)
外科性气肿自插管以来
Surgical emphysema has extended
已经延展到上胸腔和颈部
to his upper chest and neck since intubation.
他做了双侧胸廓造口术循环稳定
He had bilateral thoracostomies. Circulation is stable.
骨盆和腿部似乎没有重大损伤
Pelvis and leg seemed to escape major damage.
好极了谢谢把他搬过来
OK, great, thanks. Move him across
然后我会帮他通气直到麻醉师来
and I'll manage him on vent until the anaesthetist arrives.
抱歉能帮我们抬一下担架吗
Sorry. Can you help us with the scoop?
是的当然
Yeah. Sure.
数到三一二三
On three. One, two, three.
知道了是创伤手术室打来的
I've got it. That was trauma theatre.
斯特里特会晚来你得自己先开始
Street's been delayed. You'll have to start on your own.
你不来吗不行复苏室需要我
You're not coming? I can't. I'm needed in Resus.
你从这里接手可以吗好的
You'll be OK from here, yes? I will.
关于延长合同的事嗯
About extending your contract. Yeah.
确保你这样做是对的
Make sure it's the right move.
不要毁了你的军医事业需要走了
Don't mess up your army career. Need to go.
来了
Yeah.
电梯门关闭
Door closing.
双侧入气量相等
Equal bilateral air entry.
摸上去好奇怪呃我是说外科性气肿和
That feels weird. Er...I mean surgical emphysema and...
双侧肋骨骨折
...bilateral rib fractures.
无腹胀
The abdomen is not distended.
为什么他的血氧饱和度下降了
Why are his sats dropping?!
哦该死内管出来了把固定块拿掉
Oh, shit! The tube's come out. Come get blocks off.
我去找人帮忙
I'll go get help!
好了吗中立位固定
Got it? C-spine immobilisation here.
好的请给我气囊和面罩
OK. Bag and mask, please.
加油
Come on...
口咽插管
Guedel!
加油啊
Come on...
他的胸部不动血氧也没有上去
His chest's not moving and his sats aren't going up.
查一下胸廓造口看看是不是还开着
Check the thoracostomies, see if they're open.
然后请准备喉镜和内管该死
And then a laryngoscope and a tube, please. ..Shit.
快快血氧在下降