急诊室的故事

ER S01E25

Part 2 Nov. 22, 2019, 11:59 a.m.

We're talking about Benton here.
就一分了
One.
"该住院医师对你的表现
"The resident provided you with constructive comments
提出了建设性改进意见"
and criticism of your performance."
建设性
Constructive?
-能打负分吗 -能打零分哦
- Do they have negative numbers? - There's a zero.
那就零分了
Zero it is.
-打完了 -总分多少
- That's it. - What's the total?
-十六 -总分多少
- Sixteen. - Out of a possible...?
四十也许我该给他多打一点
Forty. Maybe I ought to go a little easier on him.
他给你写的评价上周就该交了
He had to turn in his evaluation of you last week.
十六分打死不改了希克斯医生的信箱在哪
Sixteen it is. Where's Dr. Hicks' box?
-患者什么情况 -单车事故没系安全带
- What've you got? - Single-car accident, no seat belt.
撞在方向盘上酒驾
Hit the steering wheel, drunk.
-人休克了但我不清楚原因 -内出血吗
- She's shocky, but I'm not sure why. - Internal bleeding?
腹软无压痛反跳痛及腹壁紧张
Abdomen soft, non-tender, no rebound or guarding.
肠音正常脉搏血氧85 但她有抽烟习惯
Normal bowel sounds. Pulse ox is 85, but she's a smoker.
氧分压在室内空气下为70 呼吸频率高
PO-2 is 70 on room air, resps are high.
无纵膈膜增宽
No widened mediastinum.
主动脉破裂可能非常小
Ruptured aorta is highly unlikely.
可能是轻度心脏挫伤或心肌梗塞
Could be mild cardiac contusion or MI.
我在想是不是肺栓塞
I'm thinking pulmonary embolus.
她呼吸频率高氧分压低很糟糕
Resps are high, tacky, low PO-2.
她早上七点就喝醉了
She's drunk at seven in the morning.
很有可能只是心肌病
It's probably just cardiomyopathy.
我想让她做通气/灌注肺扫描
I want a VQ scan.
你真是病急乱投医
You're grasping at straws.
给她用硫胺素叶酸复合维生素
Give her thiamine, folate, multi-vits.
用糖盐水补水
Rehydrate with D5 NS.
用多巴胺给她升血压
Support her pressure with dopamine
再弄个远程心电监护测连续心电图和酶类反应
and admit her to Telemetry for serial EKGs and enzymes.
把她送到放射科做肺灌注扫描
Get her to Radiology and get a VQ scan.
斯威夫特的吩咐都照办但扫描无论如何都要做
Do Swift's orders and scan her anyway.
凯莱布你好我是罗斯医生这位是卡特医生
Hi, Caleb. I'm Dr. Ross. This is Dr. Carter.
你发烧了
You have a fever.
38.5度不咳嗽没有腹部疼痛
101. No cough, no abdominal pain.
-我感觉没事 -他刚做完一轮化疗
- I feel okay. - He's just finished a round of chemo.
我在查看细菌感染的情况
I'm looking for a bacterial infection.
你接触过什么病人吗
You been around any sick people?
八成就是希克曼导管的原因
It's probably just the Hickman.
上次就是这样
That's what happened the last time.
-导管吗那里疼吗 -疼
- Catheter? Is it sore? - Yeah.
一直都疼没什么大不了的
It's always sore. It's no big deal.
-萨拉真是大惊小怪 -我吓坏了凯莱布
- Sarah just freaks out. - I'm scared, Caleb.
你给父母打电♥话♥说你在这了吗
Did you call your parents and tell them you're here?
萨拉做得对
Sarah did the right thing.
化疗之后你的身体会没有抵抗感染的能力
After chemo your body doesn't want to fight infection.
给他做血常规和鉴别诊断三次血培养
CBC plus differential, blood cultures times three...
尿培养喉拭子胸透
...urine culture, throat swab, chest film.
还有什么卡特医生
What else, Dr. Carter?
-我觉得还有腰椎穿刺 -我不要做脊椎穿刺
- I'll do an LP. - I don't want a spinal tap!
我才做过一次不想再做了
I just had one. I don't need another one.
为什么要穿刺卡特
Why a tap, Carter?
易怒和/或嗜睡都是脑膜炎的早期征兆
Irritability and/or lethargy are early signs of meningitis.
没错事情是这样凯莱布
Yes, and the deal is this, Caleb.
你不嗜睡但你易怒
You're not lethargic, but you are irritable.
这既有可能由脑膜炎引起也有可能由你的性格引起
That could either be meningitis or just your personality.
所以我来告诉你我们打算怎么办
So I'll tell you what we are gonna do.
我们要稍等一下
We're gonna wait a couple of minutes,
看看几项检查结果
and take a look at some tests...
如果你还是疼得厉害
...and if you're still a pain in the ass
我们就得做穿刺好吗
they're gonna give you the tap, okay?
-注射广谱抗生素吗 -没错
- Broad-spectrum antibiotics? - Yep.
庆大霉素80毫克
Gentamicin 80 migs,
苯唑西林1克哌拉西林1.5克静脉推注
oxacillin one gram and piperacillin 1.5 grams IV.
查一下肿瘤科谁值班
Find out who's on call for Oncology.
皮特
Peter!
我给你打电♥话♥了你收到消息了吗
I called you. You get my messages?
收到了抱歉我实在太忙了
Yeah. Sorry, I've been working a lot.
而且你实在不该往我家打电♥话♥
And you really shouldn't call me at home.
-我们得谈谈 -行
- We need to talk. - All right.
午饭时好吗我们来谈谈
Lunch? All right, we'll talk.
-好 -行到时候见
- Yeah. - Okay. See you then.
-你呼叫我了吗医生 -鞍状栓子
- You paged me, doctor? - Saddle embolus.
-你让她做肺动脉造影了 -是
- You ordered pulmonary angiography? - Yes.
在你让她做扫描之前还是之后
Before or after you scanned her?
她血压在降低呼吸频率上升
BP was falling, increased respiratory rate.
二氧化碳分压上升氧分压和酸碱值降低
Rising PCO-2, falling PO-2 and pH.
心电图符合肺栓塞特征
S1-Q3 on the EKG.
手术室预约好了吗
Did you book an O.R.?
你还在等什么
What are you waiting for?
继续推走她快点
Go ahead, move her. Go, go!
-做得好 -谢谢
- Good work. - Thanks.
我们今天收到了你的
We got served today
先兆子痫患者家属发的传票
on your preeclampsia.
治疗失当
Malpractice.
-朱迪·奥布莱恩 -是的
- Jodi O' Brian? - Yeah.
不正常死亡受尽病痛折磨很平常
Wrongful death, pain and suffering, the usual.
怎么你认为他们不会吗
What? You didn't think they would?
我不确定
I wasn't sure.
一会过来找我我们好好聊聊
Come and see me later, we'll talk it out.
艾利森先生你服用了什么药物
What medication are you taking, Mr. Allison?
扎西他滨复方新诺明
DdC, Bactrim, AZT,
齐多夫定氟康唑和利福布汀
fluconazole and rifabutin.
开始用300毫升糖盐水补水
Let's start hydration with D5 NS, 300cc's.
苏珊什么情况
Susan, what've you got?
艾滋病晚期患者
End-stage AIDS patient.
多种药物体温38.3度血液粘稠
Multiple meds, temp 101, tacky.
病史有胃肠淋巴瘤和卡氏肺囊虫肺炎
History of GI lymphoma, PCP pneumonia,
卡波西艾滋病痴呆口疮和隐球菌性脑膜炎
Kaposi's AIDS dementia, oral thrush and cryptococcal meningitis.
肠鸣音亢进压痛肿胀
High pitched bowel sounds, tenderness, distention...
肝脾肿大愈创木脂呈阳性
...hepatosplenomegaly, positive guaiac,
近期无大便与排气
no recent stool or gas.
吐♥血♥和胆汁开始300毫升的静脉输液
Vomiting blood and bile. Started a 300cc fluid challenge.
拍一个肾脏及膀胱上部侧卧位的胸片
Okay. Let's get a KUB, lateral decubitus, chest films...
进行包括分枝杆菌真菌
...blood cultures including mycobacterium,
巨细胞病毒的血液培养
fungal, CMV...
血常规生化二十四项验尿
...CBC, Chem-24, urine
现在就去取个鼻胃管下来
and let's get an NG tube down now.
-他归你了 -4单位吗♥啡♥ 静脉注射
- He's all yours. - Morphine 4, IV.
我们怀疑是
We suspect a bowel obstruction
复发性淋巴瘤引起的
from enlarged lymph nodes
淋巴肿大导致了肠梗阻
due to recurrent lymphoma.
这位是本顿医生他是外科住院医师
This is Dr. Benton. He's the surgical resident.
-他会需要做手术吗 -可能会
- Is he gonna need surgery? - Maybe.
-我们先试试用药和补水 -谢谢
- We'll try drugs and hydration first. - Thanks.
我们用一些优保津
All right, let's get some Neupogen
300毫克来刺♥激♥中性粒细胞的生长
300 mics to stimulate neutrophil growth.
看看我们能不能让这些
See if we can get some of those
好的白细胞再次出现
good white blood cells going again.
我知道中性粒细胞是什么
I know what neutrophils are.
-我需要住院吗 -现在说还为时过早
- Do I have to stay in the hospital? - It's too early to say.
我们得看看你对抗生素的反应
We have to see how you respond to the antibiotics.
几个小时后告诉我情况如何
Let me know how it's doing in a couple of hours.
卡特医生会密切关注你
Okay. Dr. Carter is gonna keep an eye on you,
我一会儿就回来好吗
and I'll be back, all right?
上次我的抗生素引起了皮疹
Last time I got a rash from my antibiotics.
-你需要点什么吗 -你不用也走啊
- You need anything? - You don't have to leave too?
凯莱布他只是想表示友好
He's just trying to be nice. Caleb.
闭嘴胖萨拉
Shut up, Fat Sarah.
够了不是其实我哪也不用去