急诊室的故事

ER S01E19

Part 5 Nov. 22, 2019, 11:58 a.m.

看下本顿在不在需要做紧急剖腹产手术
Find out if Benton's still here. Splash and crash.
你要把她带到哪去
Where are you taking her?
我们要做紧急剖腹产我需要你的同意
We gotta do an emergency C-section. I need your consent.
你看你干的好事你之前做过吗
Look how you are doing! Have you done this before?
我做过很多次
I've scrubbed in many times.
我要换别人来
I want somebody else here!
我们等不了了
We can't wait.
再等五分钟你的孩子就要脑死亡了
If we wait five more minutes, your baby's brain dead.
天啊那快啊快去啊
Oh, my God. Go, go!
快做
Do it!
继续走请让出过道让医生工作
Keep moving! Please get out of the way. Let them work.
我很爱你
I love you so much.
马上就能回家了马上就能离开这里了
We're almost home. We're almost out of here.
呼叫呼吸科
Call Respiratory.
奥布莱恩先生请在外面等
Come on, Mr. O'Brian, wait outside.
我爱你
I love you!
我在这里我就在这里陪你
I'm right here. I'm right here.
血压非常高 170/120
BP's sky high. 170 over 120.
-怎么麻醉 -没时间了
- What about anesthesia? - There's no time.
直接做局部麻醉吧
I'll throw in a local.
-她在抽搐 -拿个牙垫过来
- She's seizing! - Grab the bite block.
做麻醉和插管
Let's paralyze and intubate.
4毫克镇静剂 10毫克万可松[常用麻醉剂]
Versed, four migs. Norcuron, 10.
插管盘
Intubation tray.
-让呼吸科的人来这 -7.5号♥
- Get Respiratory down here. - 7.5.
已准备好抽吸
Suction standing by.
15升氧气
O-2 at 15.
卡特试着进到里面去
Carter, try and get in here.
我们得给她用呼吸气囊
We're just gonna bag her for now.
把交叉配型后的血拿过来
Get that typed blood cross-matched and down here.
-血凝操作盘在哪 -准备好呼吸机
- Where's that coag panel? - Get a vent ready.
血压已经是200/130了
BP's 200 over 130!
所有人深呼吸冷静一下好吗
Everybody just take a deep breath, all right?
10毫克肼屈嗪[妊娠高血压急症药]
Hydralazine, 10 migs.
再注射一袋硫酸镁
Another bolus of mag sulfate.
呼叫新生儿重症监护室找人过来
Somebody call NICU and get somebody down here...
照顾婴儿
...for the baby.
来个人直接去产科
Somebody physically go up to the OB...
必须拉一个医生过来马上就去
...and drag somebody down here, okay? Go!
开始抽吸
Get the suction in.
手术刀
Scalpel.
来看下
Let's see.
那是筋膜吗
Is that the fascia?
看起来没错
Yeah, that looks right.
-用夹子夹住 -肼屈嗪已注射
- Grab with those clippies. - Hydralazine's in.
拿好装备大兵
Grab an army, navy.
-吸血 -组织剪
- Suction. - Metz.
那把长的剪子
The long scissors.
再拉一下那里
Retract there.
-进来了 -膀胱瓣是不是有问题
- I'm in. - Isn't there something about a bladder flap?
-镊子 -吸血
- Pickups. - Suction.
-我打开腹膜了 -止血钳
- I'm dividing the peritoneum. - Hemostat.
进来了
Okay, we're in.
拿住那一边然后拉
Grab that side and pull.
拿一只牵开器过来
Get a retractor in there.
开口还要再大继续拉
We need exposure. Pull!
天啊
Oh, man!
现在开口够大了
That's wide enough.
好了现在给我手术刀
All right. Now, scalpel.
横切子♥宫♥的下半段
Cut across the lower segment of the uterus.
你是在问我吗
You're asking me?
我在问上帝
I'm asking God.
吸血不是吸这里
Suction. No, here.
-你切得不够深 -我怕切到婴儿
- You're not all the way through. - I don't wanna cut the baby.
开一包止血棉
Open a pack of lap pads.
-这边再拉一些 -好的
- Retract this way, more. - OK.
-我进去了 -天啊
- There, I think I'm in. - Oh, my God.
这里有两升血
There's two liters in there.
-她出现胎盘早剥了 -她失血过多
- She's got an abruption! - She's bleeding out!
-卡特换上手术隔离服 -取出婴儿
- Carter, change, gown up! - Get the baby out there!
打开静脉导管
Open those IV lines.
快点马克把婴儿取出来
Hurry, Mark. Get him out!
-取出婴儿 -注射生理盐水
- Get the baby. - Pump in saline.
别管配型了 8个单位的O型阴性血要快
Forget that cross-match! Eight units O-neg down here, stat!
-快一点 -我抓住他了他很大
- Hurry up. - I've got him. He's big.
快点吸血保证他呼吸畅通
Hurry up. Suction his airway.
血压还好 120/80
BP's okay, 120 over 80.
-出来了 -快啊
- Come out. - Hurry up.
脐带出来了
The cord's free.
给他的鼻腔吸一下
Suction his nose.
脐带夹
Umbilical clamp.
他没有呼吸了
He's not breathing.
夹子
Okay, clamp.
给他用呼吸气囊
All right, bag him.
卡特过来
Carter, get in here.
卡特
Carter.
过来顺着我的手下去
Get in here. Follow my hand down.
-感觉到主动脉了吗 -我不知道
- Feel the aorta? - I don't know.
-在跳动 -感觉到了
- It's pulsing. - Yeah, I do.
-往下推不要放手明白吗 -应该可以
- OK. Push down on it. Don't let go. You got it? - I think so.
-不要应该要确定 -好的
- Don't think, do. - I got it.
-他还活着吗 -血压还撑得住 110/70
- Is he alive? - BP's holding. 110 over 70.
快快点
Move, move!
开始做心肺复苏
Start CPR.
我准备插管了
I'm gonna intubate.
-足跟采血测下血糖 -肌肉无力
- Heel stick a glucose. - Tone is flaccid.
需要做血气分♥析♥
We need a blood gas.
-我看不到吸一下 -O型阴性血拿来了
- I can't see. Suction! - O-neg's here.
好的输血吧
All right, pump it in.
进去了
I think I'm in.
给他用呼吸气囊
Bag him.
快速听一下
Quick listen.
-用气囊时胸部有扩张 -好的可以了
- Chest expands while we're bagging. - Okay, we got it.
包扎一下继续用气囊
Tape it and keep bagging.
血糖20
Blood sugar's 20.
注射10%葡萄糖水
Give him D-10.
-找不到他的血管 -加强换气
- He's got no veins. - Hyperventilate him.
我试试通过脐带线注射
I'm gonna try an umbilical line.
脐带线是插入两条动脉之一或脐带静脉的导管可以快速进入早产儿的中枢循环
用肾上腺素吧
What about some epi?
通过导管注射0.04单位的肾上腺素
0.04 epi down the tube.
肾上腺素在这里
Here's the epi.
我绑好这里再放开夹子
Release that clamp after I tie this off.
放开夹子
Release the clamp.
天啊你是怎么看到的
Oh, my God. How can you see?
我也不知道
I don't know.
拿一袋O型阴性血
Grab a bag of O-neg.
注射量要按照公斤数来
Stick the pins per kilo.
40毫升
40cc's.
快
Come on.
快点
Come on.
这是脐静脉
That's the umbilical vein.
好插管时帮我把它钩起来
Okay. Hook it up while I advance it.
好的开始注射葡萄糖
Okay, it's going. Glucose at...
每千克5毫升
5 mil per kilo.
跟我一起向下
Follow me down.
20毫升
20 mils.
加油小家伙
Come on, little guy.
加油
Come on.
他动了我感觉到了他动了
He moved! That's what I got. He moved.
继续注入 100