急诊室的故事

ER S02E13

Part 7 March 14, 2020, 9:25 p.m.

- Pleural effusion. - Pleural effusion.
别这么做了
Stop that!
我听到激励了吗
Do I hear prompting from the?
好的快做血气分♥析♥和心电图
OK, let's get a gas cooking and get an E.K.G.
看她的心脏情况如何
See how her heart's doing.
你先来
After you.
你歇班这一天可真充实
Whoo! Hell of a way to spend your day off.
我希望我从没进来过
Wish I never would have come in.
相信我
Believe me.
朱迪·奥布莱恩
Jody O'Brian?
这是我从那天之后第一次看这个
It's the first time I've looked at that since the big day.
她的高低血压都很高有蛋白尿症
She had two high B.P.'s, proteinuria.
我没注意到先兆子痫
I missed the pre-eclampsia.
如果我注意到了她就会活下来
If I hadn't, she'd be alive.
这事换了我们都可能发生
It could have happened to any of us, any of the day.
但我不应该犯错
Not supposed to happen to me.
你真自大
Well, you are arrogant.
自大
Arrogant?
就像是只有你和教皇两个人
It's like there's you and the Pope.
你们无可挑剔
You guys are infallible.
当然了剩下的就是我们这些人
And, of course, there's the rest of us.
是吗
Yeah?
今天过后教皇要孤军奋战了
Well, after today, the Pope's on his own.
很好
Good.
今天早晨那个家伙的死可能怪我
I think I might have killed that guy this morning.
马克马克
Mark! Hey, Mark!
我第一次检查他的心脏时
When I first checked his heart,
听到了低沉的声音
I heard a murmur.
他一定有先天性缺陷
He must have had a congenital defect.
那家伙送进来10分钟后就心跳停止了
That guy crashed ten minutes after he got in there.
你也无能为力
There's nothing you could have done about that.
是吗并不是的
Yeah? Yes, there is.
可以给他做超声波检查
I could have gotten an echo
然后可以直接把他送进手术室
and then I could have gotten him straight to the O.R.
你对自己的要求标准太荒唐了马克
You're holding yourself to a ridiculous standard, Mark.
我要去看尸检
I got to get to an autopsy.
今天你歇班回家去吧
It's your day off. Go home.
低压心电图
Low-voltage E.K.G.
血压在下降
B.P.'s falling.
她在代谢失调血气分♥析♥结果呢
She's decompensating. Where's that blood gas?
我去看看
I'll check.
拿到了吗
You got it?
这些数字不合理
These numbers don't make sense.
怎么了
What?
你好像检查的是静脉而不是动脉
Looks like you hit a vein instead of an artery.
是血气分♥析♥结果吗
Is that the blood gas?
是不本来是的
Yeah. No. I mean, yeah.
但我搞错了我检查了静脉而不是动脉
But I screwed up and I tapped a vein instead of an artery.
不是我搞错了我检查了静脉
No, I screwed up and tapped a vein.
不管是谁搞错了再做一遍这次做对
Whoever screwed up, do it again and do it right.
卡特你去做吧
Carter, you do it.
非特异性的ST波变化
Non-specific S.T. changes.
进行到哪里了苏珊
Where are we? Susan.
我不知道你进行到哪里了凯瑞
I don't know where you are, Kerry.
但我在处理心包积液
But I'm at pericardial effusion.
或是心泵衰竭
Or pump failure
或者栓塞
or an embolism.
快做超声波检查
Let's get an echo!
有钝音
Positive Ewart's sign.
血压下降 50/30
Pressure's down, 50/30.
心包穿刺抽液托盘
Pericardiocentesis tray!
你不觉得应该先确认诊断
Don't you think you should confirm your diagnosis
再给她的心脏扎一针吗
before sticking a needle into her heart?
我已经做出了诊断
I've made my diagnosis.
针头上夹好鳄鱼夹了
Alligator clamp is on the needle.
诊断的黄金准则是超声波检查
The diagnostic gold standard is an echocardiagram.
行你先等检查结果
Fine, you wait while the tech comes.
我看看她心脏周围有没有积液好了
I'll see if there's any fluid around her heart. Okay.
扎进去了
I'm in.
有积液吗
Anything yet?
没有暂时还没
Nope. Not yet.
出来了
Here it comes.
谁能想到呢
What do you know?
有些浑浊
Looks a little cloudy.
我想知道这是渗出液还是分泌液
I wonder if it's transudate or exudate fluid.
谁知道区分这二者的黄金准则
Anyone know the gold standard to differentiate the two?
凯瑞
Kerry?
检查乳酸去氢酶和蛋白质的浓度比
Measure L.D.H. to protein.
确定为渗出液的乳酸去氢酶比例是多少
What's the L.D.H. ratio to identify exudate fluid?
我得查一下
I'd have to look it up.
0.5到1
It's 0.5 to 1.
格林
Greene?
是
Yeah.
你们应该多下来看看
You guys should come down more often.
多复习一下你们差劲的解剖学
Brush up on your gross anatomy.
发现确凿的现象了吗
You guys find anything conclusive?
怎么你在找什么
Why, what are you looking for?
心脏的问题
Something wrong with the heart.
你觉得自己疏漏了什么
Think you missed something?
可能是
Possibly.
你来得正是时候
Well, you came at just the right time.
大小与形状正常
Size and shape normal.
380克
380 grams.
好的谁想把它切开
Okay. Who wants to section this?
比尔应该到你了
Bill, I think it's your turn.
马丁给他一把刀
Martin, will you hand him a knife?
道格过去一小时了
Doug, it's been an hour
精神科还没人下来看那男孩
and psych still hasn't come down for that boy.
好的我会打给他们
All right, I'll call them.
你为什么不自己和他谈
Why don't you talk to him yourself?
他生理上没有问题
There's nothing physically wrong with him
我还有四个病人
and I have four other patients.
是因为这孩子是同性恋吗
Is it because the kid's gay?
什么
What?
你听到了
You heard me.
如果你是说因为
If you mean, is it because
那男孩的问题
that boy's particular problems
不在我的专业领域的
fall out of my frame of reference
参考范围之内那我要说是的
or my area of expertise, then the answer is yes.
如果你是说是因为我恐同
If you mean, is it because I'm homophobic.
那我要否认
Then the answer is no.
好吧
Okay?
无先天或瓣膜疾病
No congenital or valvular anomalies.
心内膜正常
Endocardium, normal.
心肌厚度与颜色均正常
Myocardium of normal thickness and color.
基部血管正常
Blood vessels at base, normal.
冠状动脉口
Coronary ostia
位于正常解剖位置
are in the usual anatomical position.
动脉也无斑块现象
Arteries show no sign of plaque.
他是正常的
He's normal.
没有先天性的疾病吗
No sign of anything congenital?
你刚才没听到吗
Were you here just a second ago?
死因是什么
What's the cause of death?
典型的急诊科想法
Typical E.R. thinking--
肯定得有因果联♥系♥ 对吧
Got to be cause and effect, right?
我们这里遵循的是有点不同的格式塔理论
See, down here, we operate on a slightly different gestalt.
有时会有答案但很多时候都是谜
Sometimes, there are answers, but many times... mystery.
不是很令人满意
That's not very satisfying.
你觉得你是科学家吗
You think you're a scientist?
你想要解释
You want explanations,
绝对的答案谨慎的算法