急诊室的故事
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急诊室的故事
ER S01E19
Part 4
Nov. 22, 2019, 11:58 a.m.
杰罗德
Jared.
-希望你好起来 -谢谢你
- Hope you feel better. - Thank you.
不客气
You're welcome.
马克 产科的那个病人怎么还在这
Hey, Mark. How come the OB case is still here?
他们还在楼上忙 我再打次电♥话♥
They're still busy upstairs. I gotta call again.
格林医生 出事了
Dr. Greene! Something's wrong.
婴儿的心脏 显示器上数值降到90了
The baby's heart... The monitor's down to 90.
不对啊 不应降到那么低啊
So, it's not right. It's not supposed to go that low.
妈 坚持住
Hey, Ma. Hanging in there?
你还好吗
Hey, how are you doing?
-怎么那么久才醒过来 -她76岁了
- Why so long in the recovery? - She's 76.
-估计失血多少 -500毫升
- Estimated blood loss? - 500cc's.
术后医嘱呢
Post-op orders?
虽然她是你妈妈 但她是我的病人
She may be your mother, but she's my patient.
我们要乘手术电梯了
We're taking the O.R. elevator.
她会被送到604
She's going to 604.
这迟早会发生的 皮特
It was bound to happen sooner or later, Peter.
宝贝 试着深呼吸
Sweetie, let's try a deep cleansing breath.
-然后在倒数后呼气 -闭嘴 肖恩
- Let's exhale on the count of... - Shut up, Sean!
呼叫产科 准备功能性内窥镜手术
Call OB and get the FESS in here.
你怎么样了 奥布莱恩太太
How are we doing, Mrs. O'Brian.
我觉得我该打一针局麻
I believe I'll have an epidural.
宫缩间隔缩短到两三分钟了
Contractions are two to three minutes apart.
-我认真的 -追踪波形显示活性降低
- No kidding! - Tracing showing decreased activity.
那是什么
What's that?
婴儿的心率比正常值低很多
The baby's heart rate is reacting very less than it should.
但婴儿的睡眠周期是二十分钟 我们要做的是
But babies sleep in 20-minute cycles, so what we want to do
叫醒他 该起床啦
is wake him up. Rise and shine!
好了 他刚刚只是在睡觉
There we go. He was just sleeping.
心率回升了 问一下柯博恩要多久能到
The heart rate's back up. Get an ETA on Coburn.
我是尤拉米医生 麻醉科 我来给你做硬膜外麻醉
I'm Dr. Urami, anesthesiology. I'm here to do your epidural.
太好了 拜托了 快打麻醉吧
Oh, yes, please. Let's do that.
-硬膜外麻醉怎么样 -棒极了
- How's that epidural? - Wonderful.
这些照片太赞了
These are great.
我要把杰罗德的这些照片给我的学生们看
I'm gonna show these pictures of Jared to my students.
-八年级学生吗 -没错 做"展示说明"
- Eighth graders? - Yeah, you know, like "show and tell."
在数学课吗
In math class?
现在我们能得到子♥宫♥内的压力读数
Now we can get a pressure reading inside the uterus.
这个头皮电极
This scalp electrode
可以更精确地监测脉搏
monitors the pulse rate more exactly.
看得开心吗
Enjoying the show?
是啊 我是说
Yeah. I mean
不
no.
她的宫口扩张了八厘米 子♥宫♥颈完全消失了
She's eight centimeters dilated, completely effaced.
-时间不多了 -心率又降低了
- Won't be long. - There's another decel.
晚期成分多变
Variable with a late component.
从子♥宫♥导管注射500毫升生理盐水
Let's infuse 500cc's normal saline through the uterine catheter.
-像正常静脉注射一样吗 -没错
- Like a regular IV? - Yeah.
我们得把她送去楼上产科
And we need to get her up to OB.
我看看能不能催谁一下
I'll see if I can light a fire under someone's butt.
-出什么事了吗 -不 没事
- Is something wrong? - No, we're okay.
-再呼叫一次柯博恩 -好的
- Page Coburn again. - Okay.
我为什么不能把她送上去
Why can't just I send her up?
她宫口扩张了几英寸 硬膜外麻醉快失效了
She's inches away and the epidural's wearing off.
那就去找德雷克 快点
Well, then find Drake! Hurry up.
呼吸 呼吸 呼吸 试试别的呼吸方式
Breathe. Breathe. Breathe. Wanna try some of the breathing?
当你像我一样放弃工作待在家里
You don't have fantasy you have about me quitting work
只为孩子打算时幻想就破灭了
and staying home to have a budget for kids?
拉倒吧 就这一个了
Forget it! This is it.
重复性晚期成分 我们得接生了
Repetitive lates. We need to deliver.
好了 我需要检查一下 试着单次呼吸几下
OK. I need to take a look. Try some single breaths.
宫口完全扩张了 子♥宫♥颈完全消失了 该用力了
Fully dilated, 100% effaced. It's time to start to push.
-现在吗 -是的
- Already? - Yes.
-在这吗 -是的 卡特
- Here? - Here. Carter.
跑去找卡萝来
Run and get Carol.
呼吸
Try some breathing!
我超级爱你宝贝 非常爱你 无敌爱你
I love you so much, babe. So much! So much!
闭嘴
Shut up!
拿婴儿取暖器和新生儿复苏推车到三号♥床 立刻
Get a baby warmer and a newborn resuscitation tray in 3, stat!
九 十
Nine, ten!
呼吸 呼吸
Take a breath, take a breath.
-欢迎回来 -我回家了吗
- Welcome back. - Did I go home?
用力 一 二 三 四 五 六 七
Push! One, two, three, four, five, six, seven,
八 九 十
eight, nine, ten!
我没准备好做母亲
I'm not ready to be a mother.
-忍♥耐一下 -做不到 我要被撕裂了
- Bear down. - I can't! It's gonna rip me apart.
一 二 三 四 五 六
One, two, three, four, five, six...
我不行 我做不到 把他取出来
I can't! I can't! Get it out!
卡特 去楼上产科把德雷克拽下来
Carter! Go up to OB and drag Drake down.
告诉他带产钳来 快去
Tell him to bring some forceps. Go!
她的生产没有进展
She's not progressing.
婴儿的心率低得危险了
The baby's heart rate is dangerously low.
我要开始阴♥部♥阻断了
I'm gonna start the pudendal block.
好的 我去穿上手术隔离衣
Okay, I'll gown up.
产科要做两个剖腹产和三个接生
OB's got two C-sections and three deliveries.
如果你再等等 没人会责怪你的
No one will blame you if you wait for a be.
但婴儿监视器显示现在不做就等死了
But the baby's monitor says now or never.
你为什么要冒这么大风险呢
Why put your ass on the line?
已经到了这一步 我就要让她顺利生产
'Cause I've come this far, and I'm gonna see it through.
-柯博恩在哪 -在来的路上
- Where's Coburn? - In transit.
怎么 她坐骆驼来的吗
What, is she coming by camel?
测她血压
Get her BP.
血压仍在上升 150/100
BP's still climbing. 150 over 100.
快点 马克 婴儿心跳过缓
Go, Mark. Baby's bradying down.
现在不要用力 别用力
Now don't push. Don't push.
在我打开产钳之前 做会阴正中切开术
Before I break the plates, cut a median episiotomy.
头出来了
Here comes the head.
-准备好篮子 -操
- Get a blanket ready. - Damn!
-拽他出来 -他卡住了
- Get him out! - He's stuck.
-肩部难产 -那是什么
- Shoulder dystocia. - What's that?
肩膀挂在阴♥部♥骨头上了
Shoulder's hung up on the pubic bone.
天啊
Oh, my God!
关掉导联
Lead's off.
用屈大腿助产法
McRobert's maneuver.
-把她的腿举向头部 -抬起腿
- Push her legs up towards her head. - Lift your legs.
悬在空中
Straight up in the air.
谁推一下她肚子
Somebody push on the abdomen.
-你在做什么 -试着把他肩膀归位
- What are you doing? - Trying to free his shoulders.
卡特 不是子♥宫♥底施压 往我这边点压
Carter, not fundal pressure. Down here. Down here.
婴儿卡住了 离开呼叫产科
It's jammed! Stat page OB!
天啊 做点什么啊
Oh, my God, do something!
我们试试沃兹转动法
Let's try a Woods.
我需要扩大外阴切开范围
I need to extend the episiotomy.
如果我能转动后肩
If I can rotate the posterior shoulder
我爱你 宝贝
I love you, baby.
试着把后肩解救出来
Try to deliver the posterior shoulder.
他被卡住了 加油
He's jammed in. Come on.
拜托 给点力啊
Come on! Come on!
怎么就生不出来
Why can't you deliver this baby?
奥布莱恩先生 拜托
Mr. O'Brian, please.
不起作用 放开她
It's not working. Let her go.
放开她 完全没用
Let her go. It's not working.
用扎文那利法
Zavenelli.
你在干什么
What are you doing?
我们得把婴儿推回去
We gotta push the baby back in.
然后呢
Then what?
我们马上就熬过去了
We're almost through.
苏珊 手伸进来 拿一套剖腹产手术盘 要快
Susan, get your hand in here. Grab a cesarean tray. Run!
抬起来 头部垫高 身上盖床单
Climb on up, hold her head in. Throw a sheet over her.
带她去创伤一室
Get her into Trauma 1.
急诊室的故事
ER
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