急诊室的故事

ER S01E07

Part 4 Nov. 22, 2019, 11:57 a.m.

Going home?
我要去哪
Where am I going?
我能回来看你们吗
Can I come back and visit?
道格我这里有个在发烧的
Doug, I got a three-year-old
三岁病孩在2号♥房♥ 4号♥房♥有个六个月的小孩
with a fever in 2, a six-month-old in 4.
他的母亲说他吃什么吐什么
His mother says he's not keeping anything down.
好的我立刻就去看
Okay, I'll be right there.
我很抱歉罗斯医生我还是没有看见她
I'm sorry, Dr. Ross, I still haven't seen her.
-看见谁 -琳达·法瑞尔
- Seen who? - Linda Farrell.
是的杰瑞不要紧的谢谢
Oh! Right, Jerry. Okay, thank you.
迈克尔·卡森三十五岁
Michael Carson, age 35,
被一部时速五迈的车撞倒
victim of a five-mile-an-hour car accident.
毫发无伤完全找不出他昏迷的病因
None a scratch on him. No clue why he's comatose.
他的CT结果怎样
Results of the CT?
很正常对高糖输液和纳洛酮无反应
Normal. No improvement with glucose and narcan.
他的症状不归外科管了
Well, he's non-surgical.
-归你了 -昏迷的病因鉴别是吧
- He's all yours. - The differential diagnosis of coma, huh?
-祝你好运 -你也是祝你面试顺利
- Good luck. - You too, on your interview.
好吧让我们来看看能有什么头绪吧
Well, let's see what we can come up with.
我让你去接治那个有撕裂伤的男孩
I asked you to take that boy with the laceration.
-海勒你进来做什么 -你为什么不接
- Haleh, what are you doing here? - Why didn't you?
因为卡特能搞定有什么大问题吗
Because Carter could handle it. What's the big problem?
问题就在于我叫的人是你
The problem is I asked you to treat him.
我还想着你也许能跟他谈谈
And hoped maybe you'd talk to him.
我有个必须去看的恢复科病人
I had a patient I have to see in Recovery.
信你的鬼话
The hell you did.
你只是不想被扯进这种事里
You just didn't want to be involved.
好吧打住等一下
Okay. Whoa, wait a minute.
难道我非得做知心哥哥不可吗
Am I supposed to be the Big Brother's program or someting?
我非得把每一个进来急诊的帮派少年
I'm supposed to turn every gang kid that comes in here,
都教育成尼尔森·曼德拉那样的伟人吗
into some kind of Nelson Mandela or something?
我知道你从来不做这样的事彼得
I know you'd never do that, Peter.
这就是我为什么以前没有求你做
That's why I never asked you before.
我从穆奇四岁起就认识他了
I've known Mookie since he was four years old
他过去是个好孩子
and he was a sweet kid.
也许某天有人能让他洗心革面
And maybe someone will get through to him
再度做回那个好孩子
and he will be that again someday.
也许这比让你洗心革面容易多了
Probably wouldn't be half as tough as getting through to you.
病因会不会和代谢有关
What about metabolic causes?
低血糖糖尿病酮酸中毒
Hypoglycemia, diabetic ketoacidosis?
血液检查排除了这个可能
Blood tests rule that out.
也不是心律失常和心肌梗死
We know it can't be arrhythmia or an MI.
CT结果显示没有肿物病变以及外伤
Negative CT rules out mass lesion and trauma.
本顿给他注射了纳洛酮吗
Benton gave him narcan?
他还给了50%浓度的糖水
And an amp of D-50.
血检结果
The blood came back normal
除了白血球数偏高外一切正常
except for the slightly elevated white count.
白血球数高达14500
Up to 14,500.
他脉搏在变慢现在以及降到50了
Pulse is slowing. It's down to 50.
他的血压也在降
And his BP's dropping.
将静脉注射流速调快然后给他输300毫升盐水
Well, speed up the IVs and give him 300cc bolus of saline.
给他注射一剂阿托品如何
What about atropine?
可以静脉推注0.5个单位
Yeah. Point 5 IV push.
也许他是癫痫发作
Maybe he had a seizure.
康妮量下他的体温
Connie, get a temperature.
他的舌面有轻微的磨损伤
He's got a slight abrasion on his tongue,
也许是他咬伤的
probably from biting it.
部分代谢性酸中毒
Partially compensated metabolic acidosis.
这是癫痫的并发症之一
You see that with seizures.
38.4度
101.5.
会是脑膜炎吗
Meningitis?
对有可能
Yeah, could be.
我们要通过做腰穿来确诊你做过吗
We'll have to do a lumbar puncture. You ever done one?
没我没有但我看过别人操作
No, no. But I've seen it done.
观察操作教学
See one, do one, teach one.
-本顿 -你好莎拉
- Benton. - Hey, Sarah.
-你换衣服了 -是的
- You changed clothes. - Yeah.
-现在是谁在里面 -道尔顿
- Who's in there now? - Dalton.
乔治·道尔顿吗
George Dalton?
这个人连门都关不上更别说是切口了
The guy can't close a door, much less an incision.
是啊所见略同
Yeah, who are you telling?
我跟你讲我有次看见
You know, I once saw him
他想把输尿管接到乙状结肠上去
try to connect a ureter to a sigmoid colon.
你觉得这就已经够离谱了吗
You think that's bad?
我看着他在股动脉做了个
I watched him do a beautiful
做了个一流的右股腘动脉分流术
right fem-pop bypass on a femoral artery.
做在了左股动脉上
The left femoral artery.
所以说你认为他当时怎么和患者说的
So what do you think he said to the patient?
"先生我们有些好消息
"Ah Sir. There's some good news and, well,
和一些坏消息"
there's some bad news."
"是这样先生手术很成功"
"Well, sir, the operation was a success."
"但我们做错腿了"
"But it was the wrong leg."
非常棒谢谢你道尔顿医生
That was terrific. Thank you, Dr. Dalton.
真的很棒真的非常感谢
It was good. It really was. Thanks a lot.
本顿医生你介意
Dr. Benton, you don't mind
我们让兰沃尔西医生先来吗
if we take Dr. Langworthy first, do you?
她 4:30 要做一台小肠手术
She's scrubbing on a small bowel at 4:30.
没事我不介意
Oh, no. Not at all.
-莎拉你准备好了吗 -是的当然
- Sarah, you ready? - Yeah, sure.
进来吧来吧
Come on in. OK.
在第4和第5腰椎间插入针头
Insert it between L-4 and L-5.
稍微将针抬起一点与床平行
Tilt it slightly upwards so it's parallel with the bed.
好了
OK.
缓慢将针向脊椎骨推进
Advance it slowly between the vertebrae,
当针头碰到脊髓的时候
then you'll feel a slight pop,
你会感到砰的一下
when the tip punctures the spinal canal.
-我感觉到了 -好的你还没做完
- I felt it. - Okay, you're not done yet.
现在将导管从针上移开
Now remove the stylet from the needle
检查是否有液体抽出
and check for fluid.
完美就是这样
Perfect. Bingo.
第一次就完美完成
Perfect on the first shot.
液体晶莹剔透卡特先生
Crystal clear, Mr. Carter.
这可真是个"香槟穿刺"
That's one hell of a champagne tap.
"香槟穿刺"是什么
Champagne tap?
第一次穿刺就完美成功
Perfect hit the first time,
住院医师就欠你一瓶香槟
resident owes you a bottle of champagne.
不不不是住院医师是护士
No, no, not the resident, the nurse.
格林医生你的妻子刚打电♥话♥找你
Dr. Greene, your wife called,
问你能不能四点钟在医生之家碰面
asked if you could meet her at Doc's at 4 o'clock
好的谢谢你杰瑞
Okay. Thanks, Jerry.
等不及今晚见面了吗
Couldn't wait till tonight?
我倒是想
I wish.
富兰克林法官一个小时前打电♥话♥ 说他认为
Judge Franklin called an hour ago. He said my zoning opinion
我对用地性质规划的观点
wasn't what he'd hoped for
不像出自他所期待的芝加哥大学毕业生之口
from a University of Chicago graduate.
-那个人就是个疯子 -他是个上诉庭的法官
- The guy's nuts. - He's an appellate judge.
所以呢
So what?
这是你写的第一份东西你还想怎样
It's the first thing you've written. What do you expect?
比此更好的情况
Something better
例如他能亲自带我
which he'll personally lead me in
进今晚九点的会议
at tonight's 9 o'clock meeting.
我打电♥话♥拜托我妈了她早上会带瑞秋回来
I called my mom. She's gonna bring Rachel up in the morning.
我又得用车了
I'll have to use the car again.
没关系我坐轻轨
It's all right. I'll take the EL.
珍你会成功的
Jen, you'll do fine.
你怎么知道呢
How do you know?
这次是"不成功便成仁"
This is a "Make it or break it" Job.
如果我这次搞砸了...
I mean, if I blow this chance...
我本来想今晚陪你的
I wanted to spend the night with you.
没关系你周一就回来了
Well, you'll be back Monday.
瑞秋的托儿所周一办万圣节派对