急诊室的故事

ER S03E18

Part 7 July 17, 2020, 11:42 a.m.

No.
是跟其中一位比较受欢迎的女孩
It was with one of the more popular girls.
从那以后瑞秋就总是一个人玩了
Since then, Rachel often winds up playing by herself.
我敢肯定装病只是吸引注意力的一种手段
Feigning an illness I'm sure was just a way to get some attention.
瑞秋可以走了吗
Hey, Rach. Ready to go?
我们回家吗
Are we going home?
我也希望但是我们得回医院
I wish, but we got to get back to the hospital.
你可以做你的数学作业
You can do your math homework.
好棒棒哦
Big whoop.
不能这样跟希尔德布兰德老师说话
That is no way to talk to Mrs. Hildebrand.
我们明天见
We'll see you tomorrow.
说再见
Say good-bye.
再见
Bye.
再见
Bye-bye.
再见
Bye.
什么情况
What's the story?
老人家打着牌突然就倒下了
Old guy was playing cards when he keeled over.
肯定是牌太烂了
Must've gotten a bad hand.
一二三
One, two, three.
血压80/50 心率高至130
B.P.'s 80/50, heart rate's up to 130.
你没有静脉注射吗
You didn't start an I.V.?
路上弄砸了两支
Blew two on the ride.
他的静脉血管状况很差
His veins are shot.
我尽量在手上打
I'll try stick on the hand.
我听到了啰音
I'm hearing rales.
中度指压性水肿
Three-plus pitting edema.
他是充血性心力衰竭
He's got congestive heart failure.
-对 -准备速尿和多巴胺
- Yep. - Prep lasix and dopamine.
我们要把他肺部的积水抽出来
We need to get the fluid off his lungs.
静脉注射情况如何
How's that I.V. coming?
放弃吧他的皮肤脆得像纸一样
Forget it. His skin's like paper.
我来扎深静脉帮我拿一套器械
I'll do a central line. Grab me a kit.
有主治医师在吗
Any attendings around?
格林离开医院了韦弗在放射科
Greene left the hospital, and Weaver's in radiology.
请拿一下聚烯吡酮磺
Betadine, please.
呼叫韦弗给外科打电♥话♥
Page Weaver and call surgery.
让他们帮我们扎深静脉
Have them help us put in the central line.
用不着我可以
Cancel that. I got it.
给我一根8号♥法式软管
Give me an eight french.
外科医生经常扎深静脉的
Surgeons put in lines all the time.
我说了我可以
I said I got it.
血压降到60了
B.P.'s down to 60.
多巴胺准备好
Standing by with dopamine.
需要多长时间
How long is it gonna be?
如果你在找事做的话
If you're looking for something to do
不如给这个人拿个枕头吧
Why don't you grab the guy a pillow.
我去给外科打电♥话♥
I'm calling surgery.
管子进去了多巴胺400毫克溶剂250毫升
Line's in. Run the dopamine 400 in 250.
注射至血压90为止
Titrate the B.P. to 90.
暂停注射速尿直到血压回升
Hold the lasix till his pressure's back.
听好了
Here's the deal.
救护车会送你去参加舞会
The ambulance is gonna take you to the dance
然后十点准时去接你
and pick you up at 10:00 sharp.
拿着这个
Take that.
十点十五分吧
10:15!
十点不要到处跳舞
10:00. No dancing around.
针不要拔掉不要胡来
Keep that I.V. in. Nothing too wild.
-好的 -好的我不会的
- All right. - All right. I won't.
她什么都不能吃
For her, nothing to eat
不能喝酒不能抽烟
No alcohol, no smoking.
确保她十点半回到这里
Make sure she's back here by 10:30
一分钟都不能晚
Not a minute later.
好的罗斯医生你就相信我吧
Okay, Dr. Ross. You can count on me.
-再见 -再见玩得开心
- Bye. - Bye-bye. Have fun.
听话
Be good.
把门关上
Close the door.
我从没见过像你今天这样
I have never seen as devious, underhanded
狡诈卑劣自我毁灭的做法
and ultimately self-destructive a maneuver as you pulled today.
你到底是怎么想的
What the hell were you thinking?
我觉得应该给患者一个机会
I thought the patient deserved a chance
而且我对安斯弗医生
And I had reservations about
认为患者情况不稳定
Dr. Anspaugh's assessment
不适宜手术的评估持保留意见
that the patient was unstable for surgery.
如果我是那位患者
If I was the patient
我会想听听第二种意见
I would've liked a second opinion.
你让我以为我的意见是
You led me to believe that mine
唯一的意见
was the only opinion.
如果我知道不是这样
If I'd known otherwise,
我不可能会进行手术
it's unlikely I would have proceeded--
当然会先征求安斯弗医生的意见
Certainly not without consulting Dr. Anspaugh first.
在我和希克斯医生
Before Dr. Hicks and I
决定是否终止你的住院实习之前
decide whether to terminate your residency,
你有什么话想说吗
is there anything you'd like to say?
有
Yes.
我道歉和您讨论这个病例时
I apologize for not being more forceful
没能更强有力地说服您
in making my case to you when I spoke to you.
希克斯医生我也为我没有
And I apologize to you, Dr. Hicks,
把安斯弗医生的评估告诉你而道歉
for not telling you about Dr. Anspaugh's assessment.
但我还是认为我们应该给这位患者
But I still believe that we owed this patient
一个挽救他生命的机会
a chance to saving his life.
我很高兴我们给了他
I'm glad we gave it to him.
还有吗
Anything else?
我有个问题
I have a question.
什么
What?
巴托克先生从手术中挺过来了吗
Did Mr. Bartok survive the surgery?
挺过来了
Yes, he did.
检验结果出来了
Labs are back.
血尿素氮45 肌酐3.5
BUN.'s 45, creatinine is 3.5
他是肾衰竭
He's in renal failure.
有人呼叫了韦弗医生吗
Anyone page Weaver?
我呼叫了
I did.
血压降到50了
B.P.'s down to 50.
我们要提高他的输出量
We got to increase his output.
准备一些依那普利
Prep some vasotec.
不能给肾衰竭患者用血管紧张素转化酶抑制剂
You can't give ACE inhibitors to someone in renal failure.
我们要维持他的心跳给他1.25毫克
We got to get his heart pumping. Give him 1.25.
这会让他的肾脏崩溃的
It'll shut his kidneys down.
如果我们能提高他的心输出量
If we can improve his cardiac output,
就能缓解他的肾衰竭
it will help his renal failure.
相信我用依那普利
Believe me, give the vasotec.
你要我把禁忌症读给你听吗
Do you want me to read the contraindications?
你会读我也会读
I can read as well as you can.
但如果我们不能维持他的心跳他会咽气的
But if we don't get his heart pumping, he's gonna croak.
这是错误的
It's a mistake.
上依那普利
Load the vasotec.
什么情况
What's going on?
患者有充血性心力衰竭
Patient is in congestive heart failure
和肾衰竭
and renal failure.
血压正在下降
B.P. is crashing.
我提出用1.25毫克依那普利
I have ordered 1.25 of vasotec
但我说服不了护士们这样做
But I can't convince the nurses to carry it out.
给他依那普利
Give him the vasotec.
我们要维持他的心跳
We got to get his heart going.
那他的肾脏怎么办
What about his kidneys?
要先维持住心跳
Got to get the heart going first.
她在哪里
Where is she?
你为什么不告诉我
Why didn't you tell me?
还是这样吗
Still hanging on?
她神志不清
She's delirious.
什么导致的
From what?
有机磷酸酯甲醇三环抗抑郁剂