急诊室的故事

ER S01E19

Part 6 Nov. 22, 2019, 11:58 a.m.

It's going. 100!
-帮我换下衣服 -他在恢复血色
- Re-gown me. - He's pinking up!
-她用了3个单位两升的盐水 -好
- sShe's had three units, two liters, normal saline. - Yeah.
-生命体征如何 -血压80/50 脉搏112
- Vitals? - BP's 80 over 50. Pulse, 112.
这个血压我接受她也没问题
I can live with that and so can she.
婴儿的五分钟阿普加评分有改善八分
Baby's five-minute Apgar's much better. Eight.
很好
That's good.
-去换件衣服苏珊 -看谁来了
- Go ahead. Re-gown, Susan. - Look who's here.
这里发生什么事了
What's going on in here?
我插了管婴儿的情况不乐观
I intubated. Baby went bad.
我试过产钳但赶上了肩难产然后她发病了
I tried forceps and got a shoulder dystocia. She seized.
于是我将她麻醉做了紧急剖腹产
I paralyzed and did a crash section.
开腹后发现她的子♥宫♥中有两升血
Got in there and there were two liters of blood in her uterus.
-你知道她胎盘早剥吗 -不开腹后才知道
- You knew she'd abrupted? - No. Once I got in there.
胎儿差点死了
Baby nearly died.
他是谁他把手伸进去做什么
Who's this? And what's he doing in there?
我是约翰·卡特医学院学生我正按压着主动脉
John Carter, med student. And I'm pressing on the aorta.
真是一团糟你用的什么链锯吗
It's a damn mess! What'd you use, a chain saw?
我只是没法坐视不管看着婴儿死去
Well I couldn't stand around waiting while that baby died.
叫新生儿重症监护运输队过来
Get an NICU transport team over here
并让产科医生做好准备
and the OB resident on call.
你冒然把她切开前应该通知我
You should've let me know you were in over your head.
血已经止住了
We've got hemostasis.
谁呼叫一下呼吸科
Someone call Respiratory.
好了卡尔森你可以放开主动脉了
Okay, Carson. You can let go of the aorta.
等等等等
Wait! Wait!
停一下停
Just stop, stop.
状态不错出血已经止住了
Looks good. Bleeding's stopped.
你去和孩子的父亲聊一下
Go talk to the father.
抽吸
Suction.
我的宝宝还好吗
Is my baby alright?
他一开始发生了窒息
He was apneic at first.
但他的五分钟阿普加评分很乐观
But his five-minute Apgar's very encouraging...
别再用那些医学术语糊弄我了
Stop hiding behind that medical crap!
我觉得你的宝宝没事
I think your baby's gonna be fine.
别别把我儿子带走
Don't! Don't take my son!
那朱呢
And Jodi?
她失了一些血
There was bleeding.
我们为她输了血她的情况已经稳定了
She's had transfusions, but she's stabilized now.
柯博恩医生一位产科专家正在为她治疗
Dr. Coburn, the OB specialist, is in there with her now.
-她正在缝合切口 -怎么会发生这种事
- She's closing the incision. - How can this happen?
我们现在需要把你儿子送到楼上
What we need to do right now is to get your son upstairs.
就是现在快去去
Now! Go! Go!
已经没事了对吗
Everything's okay, right?
去照顾你的孩子吧你在这里帮不上忙
Go be with your baby. There's nothing you can do down here.
她会没事的对吗
She's gonna be okay, right?
她的情况已经稳定了去陪你儿子吧
She's stabilized. Go with your son.
我从没见过这样一连串的判断失误
I've never seen such a chain of errors in judgement.
但我按你说的做了
I mean I did what you said.
你没注意到先兆子痫
You missed a preeclampsia!
你低估了胎儿的体重
You underestimated the fetal weight.
我一直在等产科接手
I was expecting OB backup!
-你也没诊断出胎盘早剥 -什么
- You missed a placental abruption! - What?
血块就写在那
Blood clot. Right there!
对于一个体积过大的胎儿
You do an ill-advised forceps delivery
你不明智地采用了产钳助产
on a baby that's too big.
然后你
And then you...
然后你胡乱做了剖腹产
Then you do a hack job of a C-section!
是我把那个濒死的婴儿抢救活了
It was me in the barrel with a baby going down the tubes.
你没出事故纯属走运
The only thing that saved you from disaster was dumb luck.
对但要不是我
Yeah. But if it wasn't for me,
产妇已经死了婴儿会变成植物人
the mother'd be dead and the baby a vegetable!
-产科谁在值班 -德雷克
- Who's on OB call? - Drake.
来过来
Come on. Come on!
她只是在为自己开脱而已
She's just covering herself.
她是对的是我搞砸了
She was right. It was my screwup.
-你刚才做得很棒马克 -是吗
- You were great in there Mark. - Yeah.
我根本办不到
I couldn't have done that.
是我的错
It was my fault.
她病情恶化是我的错
You know that it was my fault she went sour.
她是我的病人
She's my patient.
-没有人会怪你 -对他们没必要
- No one is going to blame you. - No, they don't have to.
格林医生
Dr. Greene!
她要不行了
She's crashing!
-她用了多少单位 -血压在下降 70/40
- How many units has she had? - BP's falling. 70 over 40.
我没法做血气分♥析♥
I can't get a blood gas.
你开始抢救流程
You run a resuscitation.
-毛细血管再充盈情况不佳 -我来搭一段动脉导管
- Cap refill's bad. - I'll throw in an arterial line.
-把血袋接到快速输液器上 -把工具盘拿来
- Put the blood bags on a rapid infuser. - Get the kit!
连上传感器
Hook up the transducer.
给她用1毫克阿托品手动测量血压
Give her a mig of atropine. Check a manual BP.
她的针孔都在出血
She's really bleeding from the puncture sac.
-谁来按压一下 -我来
- Somebody put pressure on it. - I got it.
-输液处也在渗血 -我听不到血压65
- IV site's oozing too. - I don't hear it. 65 palp.
挂上多巴胺点滴
Hang a dopamine drip.
撤掉呼吸机改用气囊
Pull her off that respirator and bag her.
凝血停止了她出现了弥漫性血管内凝血
Blood's stopped clotting. She's going into DIC!
该死用10个单位冷沉淀血小板
Oh, damn! Order 10 units, cryoprecipitated platelets.
-多源性心室早搏 -又怎么了
- Multifocal PVCs! - What now?
利多卡因 100毫克静脉注射开始点滴
Lidocaine, 100 migs, IV push. Start a drip.
记下时间 5:42 充电至260焦
Mark the time: 05:42. Charging 260.
离手
Clear!
300 离手
300. Clear!
她的每个刀口都在渗血
She's oozing from every cut surface.
我们只是在原地打转
We're chasing our tails in here.
-多长时间了 -33分钟
- Time down? - 33 minutes.
又有几次心室早搏已经用了最大剂量的利多卡因
More PVC. She's maxed out on lidocaine.
加点普鲁卡因胺每分钟30毫克最多200
Add Pronestyl, 30 migs a minute, up to 200.
-没有脉搏她快不行了 -进行多巴胺滴注
- No pulse. We're losing her! - Get a dopamine drip.
-充电至300 -让开
- Charging to 300. - Out of the way!
再来一次 360
Again. 360.
给她300单位静脉注射
Give her 300, IV push.
血气结果不好 302/50
Blood gas is bad, 302 over 50.
离上次用肾上腺素已经五分钟了
It's been five minutes since her last dose of epi.
再来7个单位
Another seven.
马克她已经死了
Mark, she's gone.
已经过了三十分钟太迟了
It's thirty minutes past too late.
我要宣布了
I'm calling it.
死亡时间
Time of death:
6:46
06:46.
还没变成直线只是室颤再来7毫克肾上腺素
It's not flatlined. It's fine V-fib. Another 7 migs epi.
格林医生
Dr. Greene.
格林医生
Dr. Greene.
我
I...
只是想跟你说
just wanted to say to or to tell you that...
我认为你的行为是英雄行为
I thought what you did was a heroic thing.
只需要向另一个方向坐一站就在火车站旁
It's just one stop the other way, right by the train station.
-我得走了 -拜托
- I gotta get going. - Come on!
肖蒂餐厅不仅有全市最油腻的鸡蛋
Not only does Shorty's have the greasiest eggs in town...
每次火车经过都会有东西从天花板掉下来
stuff falls from the ceiling every time the El goes by.
听着很棒苏珊
Sounds attractive, Susan.
我只是还有很多事要做
I just got a million things I gotta to do.
你确定自己真的没事吗
Are you sure you're okay?
我没事
I'm fine.
童子军的荣誉
Scout's honor.
珍在家吗
Is Jen home?