急诊室的故事
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第二季
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急诊室的故事
ER S02E03
Part 3
March 14, 2020, 9:21 p.m.
快
Move!
真不敢相信
I don't believe this.
明年的外科住院医生实习就这样泡汤了
There goes next year's surgical residency.
卡特
Carter!
我认识马克·格林的时候
I've known Mark Greene since
他还是个医学生
he was a med student.
他留着一头漂亮的长发 非常有礼貌
He had the most beautiful curly long hair and so polite.
我只需要动动嘴
All I did was ask
他就会去清理便盆
and he would be cleaning the bedpans
换床单...
and changing the sheets and...
他是最听话的了
He was the best scut puppy I ever had.
所以你是说他那时候是个菜鸟吗
Would you say, back then, he was sort of green?
不 温蒂 我可不会这么说
No, Wendy, I would never say that.
好的 向下收回肝脏
Okay, retract the liver inferiorly
旋转右叶
and rotate the right lobe.
出来了
There she blows.
你抽到肝静脉了
You hit the hepatic vein.
扎得真准 卡特
Nice shot, Carter.
手术钳
Fiber bipolin.
非常抱歉 希克斯医生
I'm really sorry, Dr.Hicks.
当我感觉到阻力时...
It's just when I felt resistance...
-就是那儿 -感觉像是个粘连
- That's it. - It felt like an adhesion
-系上 -我遇到过一个病人就是这样
- Tie it off. - I'd encountered with a patient before
单手操作 皮特 你可没少练啊
One-handed. Peter, you've been practicing.
非常抱歉
I'm really sorry.
卡特 常见 没关系的
Carter, it happens. It's all right.
我最优秀的学生有次做乙状结肠镜检查
My best student once did a sigmoidoscopy
造成了穿孔 都能看到阑尾了
punched through and saw the appendix.
听着耳熟吧 皮特
Sound familiar, Peter?
剪刀
Metz.
我担心的是他的肝脏情况
What I'm more concerned about is the condition of his liver.
感受一下
Feel that.
硬得像石头 皱得像一只旧鞋
Hard as a rock, shriveled like an old shoe.
肯定每天都得喝七八斤酒
Gallon-a-day drinker.
至少七八斤
At least.
看看肠系膜静脉的大小
Look at the size of those mesenteric veins.
你觉得意味着什么 卡特
What does that suggest to you, Carter?
门静脉高压
Portal hypertension.
门静脉高压的特征是什么
What are the hallmarks of portal hypertension?
脐周静脉曲张 食管静脉曲张
Caput medusae, esophageal varices,
痔疮 腹水
hemorrhoids, ascites
脾肿大
splenomegaly.
很好
Good.
这样的肝脏 三周都活不过去
I wouldn't give this liver three weeks.
鼻胃管返血了
NG's returning blood.
静脉曲张出血
Varices are bleeding.
我们得做点什么了
We'll do something.
门静脉绕道术
Portal bypass?
可以
We could
但他的肝脏这么软...
But with a liver this oozy...
你做过经颈静脉肝内门体静脉分流术吗
Have you ever done a TIPS procedure?
没有 但我愿意试试
No. But I'd like to.
我想也是
I bet.
这是个非常好的教学案例
In fact, it's an excellent case for teaching.
西尔维亚 集♥合♥所有闲着的外科住院医生
Sylvia, round up all surgical residents who aren't busy.
告诉他们我们要做经颈静脉肝内门体静脉分流术
Tell them we're starting a TIPS--
只能站着观摩
Standing room only.
知道吗 卡特
What do you know, Carter?
你帮了这家伙一个忙
You did this guy a favor.
霍德豪斯先生
Mr. Holthouse?
什么事
Yes?
我是刘易斯医生 那是什么
I'm Dr. Lewis. What is that?
西♥藏♥的佛音钵
Tibetan singing bowl.
医院让我焦虑
I get anxious in hospitals.
它帮我放松
It helps me relax.
我知道今早你感到有点眩晕
I understand you're feeling dizzy.
是的 这种断断续续天旋地转的感觉
Yes. I've had these spinning sensations
已经整整一周了
on and off all week.
头痛吗
Headaches?
不 有点恶心
No. Some nausea, though.
眼前看到污点吗
Spots before your eyes?
没有
No.
你现在压力很大 是不是
Say, you're under A lot of stress right now, aren't you?
谁不是呢
Who isn't?
我看得出你脸上紧张的神情
Yes, I can see the tension in your face.
我可以建议几个让你放松的技巧
I could suggest some relaxation techniques.
多谢 但我其实比看上去要轻松地多
Thanks, but I'm really a lot more relaxed than I look.
张嘴
Open your mouth.
大块头
Hey, big guy.
领带不错
Love the tie.
谢谢 马利克
Thank you, Malik.
非常感谢
Thank you very much.
什么情况
What's the occasion?
既然你问起了 我升职了
Well, since you asked I've been promoted.
什么职务
To what?
监管紧急服务的协调员
Supervising emergency service coordinator.
挣得更多了 对吧
More money, huh?
可惜没有
Unfortunately, no.
福利更好
Better benefits?
没有
No.
责任更大
More responsibility.
没有
No.
恭喜啊
Well, congratulations.
马克 那个大块头米歇尔癫痫了
Mark, that big guy, Mitchell, he's seizing.
腾点位置出来
All right, let's make some room.
牙垫
Bite block.
0.5毫克安定 静推
0.5 ativan I.V. push.
巴宾斯基反射阳性
Positive babinski.
瞳孔缩小
Pinpoint pupils.
情况不妙
Does not bode well.
血压上升 250/140
Pressure's up, 250/140.
注射硝普钠
Jack up the nipride.
给他用地仑丁
Load him up with dilantin.
用多少
How much?
我看看 他大概有
Let's see. He's about,
400磅 再除以2.2
400 pounds divided by 2.2 is...
就是181千克
That's 181 kilograms.
每千克12毫克就是
Times 12 milligrams Per kilogram would be...
2,730.
我有一套速算法
I have a facility for simple math.
先用1克
Right. All right, we'll start with a gram
然后滴定法确定用量
and we'll titrate up.
米歇尔 坚持住
Come on, Mitchell, stay with us.
坚持住
Stay with us, Mitchell. Come on.
生命体征恢复正常了
Vitals are coming back to normal.
送他去儿科重症监护室
Let's get him to pedes I.C.U., huh?
佳佳 感觉怎么样
Hey, Chia-Chia, how you doing?
我是道格
I'm Doug.
他不喜欢医生
He doesn't like doctors.
一定是见了太多医生了
Bet he sees a lot.
你带他去哪了
Where did you take him?
楼上的儿科门诊
Pediatric clinic upstairs.
医生是谁
Who's your doctor?
每次都不一样
Always a different one.
是的 他们很忙
Yeah, they're pretty busy up there.
医生很好
Very nice
但有时我们要等上四五个小时
but sometime, we wait four, five hour.
他很受罪
It's hard for him.
为了确保这种药物问题不再发生
I have to make sure that this medication problem doesn't happen again
我得问你
so I have to ask you,
你看得懂英语吗
急诊室的故事
ER
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