急诊室的故事

ER S01E21

Part 4 Nov. 22, 2019, 11:58 a.m.

abdominal pain or fetal distress.
手术性阴♥道♥分娩的条件是什么
What are the criteria for operative vaginal delivery?
胎位正婴儿体重在4千克以下
Mainly favorable fetal lie and a small baby under 4,000 grams.
婴儿体重4.2公斤巨大胎儿
The baby was 9 lbs, 3 ounces. Macrosomic.
我用了利奥波德手法
I used the Leopold maneuver
和子♥宫♥高度来估计婴儿的体重和大小
and fundal height to estimate baby weight and size.
我认为没问题
I was off.
对巨大胎儿使用产钳时你所冒的险是什么
What risks do you run using forceps on the macrosomic baby?
23%的概率导致肩难产
A 23% chance of shoulder dystocia.
-且真的发生了 -没错
- Which happened. - Yes
你有什么资格在急诊室做高风险产科手术
What qualifies you to manage high risk OB in an ER?
我们不是来质问格林医生的培训过程的
We're not here to question Dr. Greene's training.
为什么在急诊室进行剖腹产
Why a C-section in the ER?
婴儿缺氧且心动过缓
Baby was hypoxic and bradycardic.
不马上行动就有可能损伤大脑
Had to do it in minutes or we ran a risk of brain damage.
你做过几次紧急剖腹产
How many crash C-sections have you done?
我参与过好多次
I've scrubbed in on several.
那你就有资格了吗
When that qualified you?
格林医生的手术我同意了
I give Dr. Greene credit for crashing her when he did.
如果预先知道结果你会做什么改变吗
Knowing the outcome, what would you have done differently?
我应该亲自带她去产科立刻马上
I should've taken her up to OB myself. Immediately.
我之前引产过也接生过
I've induced before, delivered babies before.
我以为我可以控制住局面但我错了
I assumed I could handle the situation. I was wrong.
还有人提问吗
Anyone else?
谢谢你格林医生
Thank you, Dr. Greene.
不算很差
That wasn't too bad.
我知道你把这件事情讲出来会好受些
I knew once you had a chance to talk it through you'd feel fine.
我应该感到轻松吗
I'm supposed to feel some sense of relief?
我得回去工作了
I gotta get back to work.
顺便一提今早肠胃感冒的病例
By the way, that stomach flu this morning.
下次你不同意我的诊断时
The next time you disagree with my diagnoses
别在病人面前说
don't do it in front of the patient.
我们去哪
Where are we going?
跟我来
Follow me.
扶一下
Hold that a second.
你觉得怎么样
What do you think?
对你来说有点小
It's a little small for you.
- 那是谁的帽子 -你的
- Whose is it? - Yours.
-我的吗 -道格
- Mine? - Doug...
和你的一样
It's the same as yours.
18档变速器
Eighteen-speed grip twist-shifter.
超级链齿轮驱动还有些我不懂的性能
Hyper-sprocket drive and stuff I know nothing about.
过来过来
Hey, come here. Come here.
如果要骑就戴上头盔
You ride bike, you wear helmet.
你头盔哪去了
Where's your helmet?
我明白你是好意道格但是
I know you mean well Doug, but...
-快点道格跟你比赛呢 -来了
- Come on, Doug. Race you. - You're on.
你应该提前跟我说的
You should've talked to me about this.
我等会就回来
I'll be back.
安妮塔·萨拉查在哪
Where's Anita Salazar?
-跑了找不到她 -该死
- Eloped. Can't find her. - Damn it!
需要我派出公共卫♥生♥部♥的人去找吗
Want me to send Public Health out together?
可以试试地址可能是假的
You can give it a try. It is probably a fake address.
马克我们需要你的帮助车祸伤员即将到达
Mark, we could need your help. We've got an MVA coming in.
翻车甩出20米重度醉酒
Rollover TC, thrown 20. Heavy ETOH.
他右腿有撕裂伤无挡开性骨折
Lac on his right leg, no parry fracture.
扎了两根液他不想别人碰他
He's in two IVs. He doesn't want to be touched.
他自称为斯迈利无身份证明
Calls himself Smiley. No I.D.
我不要在这里
I'm in the wrong place.
拿个便携式胸透机下来
Get a portable down here.
做下血常规生化七项测一下血液酒精含量
Get CBC, Chem-7, blood alcohol.
注意脖子
Watch his neck.
转移一二三
Transfer, one, two, three.
好了
All right.
-血压90/50 -把他衣服脱了
- BP 90 over 50. - Get him undressed.
撞到头了吗疼吗
Hit your head? Does it hurt?
我怎么知道
How should I know?
-全速输盐水 -烂醉如泥
- Run the saline wide open. - Drunk as a skunk.
毛细血管再充盈很慢他低血容量了
Cap refill's slow. He's hypovolemic.
你觉得是脾脏的问题吗
Do you think it's the spleen?
不清楚
Don't know.
给他的颈椎做个仰卧水平投照
Shoot a cross-table C-spine.
血常规
CBC, type and cross for four.
保持别动斯迈利先生
Stay still, Mr. Smiley.
-X光准备好了 -肺部没声音
- X-ray's ready. - Lung's clear.
拍片
Shooting.
往后站
Stand back.
屏住呼吸
Hold your breath.
离手
Clear.
氧气好了
O-2 is here.
别碰我
Get your hands off me!
腹部僵硬了我觉得是脾脏问题
Abdomen's rigid. I think it's the spleen.
准备灌洗
Let's prep for a lavage.
斯迈利我们很担心你
Smiley, we're very concerned about you,
只想确认一下你不是内出血
only need to make sure you're not bleeding internally.
我们要把这根管子
We're gonna take this tube
插♥进♥你鼻孔里然后伸到你的胃去
and put it in your nose and then go down there into your stomach.
-过程不会很好受 -去死吧
- OK? It's not very pleasant. - Go to hell!
我今天也不好过
It's not the highlight of my day either.
别拿着管子靠近我
Don't come near me with no tube.
1%利多卡因和肾上腺素
One percent xylocaine with epi.
你已经喝得不省人事了
You're drunk out of your mind.
我们得给你治疗
We need to take care of you.
这是我们的决定你说了不算
This is our decision, not yours.
保持呼吸
Just keep breathing.
我在手术室协助了一场剖腹手术并缝合了切口
I assisted on a laparotomy and closed the incision in the OR.
两场新手术我终于有机会了
Two new procedures. Finally I have a chance.
需要我给你拿点什么吗哈蕾咖啡蛋糕
Can I get you anything, Haleh? Coffee? Cake?
-你想给我拿咖啡吗 -是的
- You wanna get me coffee? - Sure.
加奶油和糖
Cream and sugar.
-法罗在哪间房♥ -诊查二室
- Where are we putting Fareau? - Exam 2.
如果可以的话这是我还需要的操作清单
And if you could, here's a list of procedures I still need.
-如果有清单上的人进来直接送到我这里 -好
- So if any of them come in throw them my way? - Sure.
你能顺路帮温蒂给我们二室的
You can stop by help Wendy get an IV
瘾君子朋友做个静脉滴注吗
going on our junkie friend in Two.
-我的清单上没有静脉滴注 -现在有了
- IV is not on my list. - It is now.
也许我们应该去找个医生
Maybe we should get a doctor.
我会找到血管的我总能找到
I'll find a vein. I always do.
这里有一条
There's one.
不好
No good.
-我去找刘易斯医生 -为什么
- I'll get Dr. Lewis. - What for?
他全身上下都没有可用的血管
He hasn't got a vein left anywhere.
得给他开中心线注射
He's gonna need a central line.
他的血都要流光了得赶紧找到出血点
He's bleeding out. We've gotta find out where the source is.
-灌洗怎么样了 -快好了
- How's that lavage come in? - Almost there.
胸片正常
The chest is normal.
快找到出血点了可能在腹膜后面
Gotta find the bleeder. It could be retroperitoneal.
他觉得疼了多打点利多卡因
He's feeling it. Give him some more lidocaine.
到底哪里在出血
Where's he bleeding?
-有输出吗 -还没有
- Any output? - Nothing yet.
马上挂两个单位的血
Hang two units now.
这里都浸透了
This is soaked through.
-四个单位够吗 -再加四个单位
- Will four units be enough? - Get four more.
找到了
Found it!
-股动脉 -是动脉
- Femoral artery. - It's a pumper.
联♥系♥血管科做个血管造影然后送他去楼上
Get Vascular on the line, get an angiogram and let's get him up.
-我在这按着 -给导管室打电♥话♥
- I'll keep pressuring. - Call the Cath Lab.
我们走
Let's move!
黛比
Deb?
快好了
Almost done...
好了