急诊室的故事

ER S01E15

Part 3 Nov. 22, 2019, 11:58 a.m.

I only need a half-hour or so.
那你呢卡特先生你也需要延长时间吗
What about you, Mr. Carter? Do you also need more time?
不我都准备好了
No. I'm all set.
好吧如果你能赶上来参加一定要来
Well, when you find you have the time to rejoin us, please do so.
84岁男性腹部疼痛
84-year-old man, complaining of abdominal pain.
-他的病历呢 -在架子上
- Where's his chart? - In the rack.
桌子上
At the desk.
卡特去拿他的病历
Carter, go get his chart.
需要做血常规生化七项凝血检查
I'll need a CBC, Chem-7, coag panel and drop...
插鼻饲管你要把这些写下来吗
...A nasogastric tube. You gonna write this down?
我不喜欢接受你的口头指令
I'm not comfortable taking verbal orders.
我觉得你最好把所有事情都给我们写下来
I think you better write everything down for us.
-我们 -护士们
- Us? - The nurses.
他的病历
Here's his chart.
开始写吧
Start writing.
格蕾丝
Grace...
我们在吗♥啡♥里加了芬太尼看看有没有用
...we've added fentanyl to the morphine. See if that helps.
如果不管用我们有三种选择
If it doesn't work, we have three choices.
我们可以用一根导管
We can insert a catheter
插到你的脊髓里面输送吗♥啡♥
into your spinal cord to deliver the morphine.
不
No.
或者可以手术切除脊髓束
Or we can surgically cut the spinal tracts...
切断腿部和背部疼痛感的传导
...that carry the pain from your legs and back.
或者增加你的吗♥啡♥用量
Or we can increase your morphine...
但是你的用量已经很高了可能会抑制呼吸
...but your dosage is so high it might depress your breathing.
你能让疼痛停止吗
Can you stop this pain?
不好说我们正在努力
I'm not sure. We're trying.
再努力一点
Try harder.
-呼吸频率 -14
- Resps? - Fourteen.
她呼吸变差的话来通知我
Let me know if her breathing gets any worse.
问都别问
Don't even ask.
马克跟我走
Mark, keep me company.
-那例肺部栓塞的诊断不错 -谢谢
- Good call on that pulmonary embolism. - Thanks.
肿瘤科发现了一个小息肉如果他没发生栓塞
Oncology found a small polyp. If he hadn't tossed a clot...
谁知道在它冒头之前
...who knows how far that would've gone
还会发生什么
before rearing its ugly head.
-这是干什么 -有条树蛇跑出来了
- What's all this? - Some kind of tree snake got loose.
-真的吗 -对
- Really? -Yeah.
今早你对那些医学生的关心
I was impressed this morning
给我留下的印象很不错
about your concern for the medical students.
确保他们参与进来学到知识
Making sure they were involved and learning.
-你是个好老师马克 -谢谢
- You're a fine teacher, Mark. - Thanks.
考虑过明年去做什么吗
Given any thought as to what you'll do next year?
开始还医学院的贷款
Start repaying med school loans.
寄出了几封信但还没开始
Sent a few letters but I haven't started.
你为什么不考虑在这任职呢
Why don't you think about joining the staff here?
作主治医师吗
As an attending?
赚的钱
You won't make as much
肯定没有私人医院的老滑头们多
money as the cowboys at private hospitals...
然是还有其他回报尽管不多
...but there are other rewards, ephemeral as they may be.
-那你考虑考虑吧 -不十分荣幸真的
- Well, think about it anyway. - No, I'd be honored. Really.
我电梯到了
Here's my bus.
-谢谢你 -谢谢你你自己赢来的
- Thank you. - Thank you. You earned it.
12岁男性腿部腹部多处枪伤
12-year-old male, multiple gunshots to the leg and abdomen.
我们火速赶来了静脉滴注流速最大
We scooped and ran. IV's wide open,
输液两公升测不到血压
had two liters, no palpable pressure.
好了动作快点把他推进去快
All right, let's look alive. Let's wheel him in. Come on, now.
-O型阴性血开始吧 -把监护仪给我
- O-neg. Let's move. - Grab me that dynamap.
-静脉渗漏了吗 -把输血管挂起来
- That IV infiltrated? - Hang the blood Y-tubing.
准备起
Ready, lift.
-做血红蛋白和红细胞压积检查 -摸不到脉搏
- Get an H and H. - I don't get a pulse.
他还有呼吸
He's still breathing.
试过加压但是他都漏成筛子了
Tried to apply pressure but he was a sieve.
不知道该从哪开始他叫亚米·杰克逊
We don't know where to start. Name's Yummy Jackson.
-飞车枪击吗 -毒品交易谈崩了黑帮那套
- Drive-by? - Drug deal gone bad. Gang thing.
才12岁
At 12 years old?
发现他的时候他身上一把九毫米冲♥锋♥枪♥一把鲁格
Kid had a Tech-9 and a Ruger on him when we found him.
-创伤一室快进来 -小心那根管子
- Trauma 1, get in here now! - Watch that line.
-她还是很痛苦 -好
- She's still in a lot of pain. - Okay.
格蕾丝抱歉芬太尼没起作用
Grace, I'm sorry the fentanyl isn't helping much.
有一点用
It's helping a little.
我们能做点什么让你好受一点吗
Can we do anything to make you more comfortable?
你可以朝我开一枪
You can shoot me.
抱歉今天上班没带枪
I'm sorry, I didn't bring my gun to work today.
我觉得再增加吗♥啡♥的用量不安全
I don't think it's safe to up the morphine any higher.
怕它会要了我的命吗
Afraid it'll kill me?
有可能
It might.
你的病情急诊室已经无能为力了
There's not a lot more that the ER can do to help you.
你想让我收你住院吗
Do you want me to admit you to the hospital?
我能回临终关怀医院吗
Can I go back to the hospice?
可以但是如果需要增加用量
Yes you can, but they're gonna need
他们还是得把你送回来
to bring you back here for a higher dosage.
我能考虑一下吗
Can I take a little while to decide?
当然
Sure.
有什么事吗
Can I help you?
不好意思你有什么事吗
Excuse me, can I help you?
你不能到这来
You can't be back here.
你快离开
You must go now.
我的老天爷
Oh, my God.
-小兔崽子 -别挡道
- Son of a bitch! - Get out the way.
你太晚了
You're too late.
他已经死了
He's already dead.
真是疯了
It's madness.
你们可以很清晰地看到膝盖后脱位
You can clearly see the posterior dislocation of the knee...
与这个滑雪橇所致的伤口相吻合
consistent with this sledding injury
这是在屈膝时雪橇
which occurred when the impact of the sled applied
将力直接作用于前胫骨
direct force to the anterior tibia
而导致的结果伤口
while the knee was flexed. Injury to the...
-我好紧张 -别担心
- I'm really nervous. - Don't worry about it.
我选题太简单了应该选...
I picked too easy a topic. It should have something with
放轻松本顿医生没要求那么高
Relax. Dr. Benton doesn't expect that much.
这是你第一次轮值
It's your first rotation.
还需要水平摩擦力和关节的调整
With horizontal traction and realignment of the joint.
血管造影术应当着重考虑
Angiography should be considered...
以下五个P
with attention paid to the five P's:
痛苦苍白感觉异常
Pain, pallor, paresthesias
脉搏消失和瘫痪
pulselessness and paralysis.
好了下一位是谁卡特
All right. Who's next? Carter.
当尝试花样轮滑时
While attempting a Rollerblading maneuver
这名12岁男孩
this 12-year-old male
摔倒时右手支撑着地面
fell on his outstretched right hand
导致了近端肱骨的
resulting in a Salter-Harris type II epiphyseal fracture
二型索尔特哈里斯骨折
of the proximal humerus.
为了避免对生长板造成伤害
To avoid damage to the growth plate,
必须通过一种方式减少
the humeral head, which is in various angulation
多种成角和外部旋转的肱骨头
and external rotation, must be reduced
首先通过外展手臂并向外旋转
by abducting and externally rotating the arm
然后缓慢地放下手臂
and then slowly bringing the arm down.
如果没能减少
If the reduction is not accomplished,
手臂一定保持在
the arm must be maintained
自♥由♥女神像的姿势上
in a cast in the Statue of Liberty position.
完事了吗
Is that it?
有人提问吗
Any questions?
陈女士
Ms. Chen.
你会成功的
You'll do great.
给你
Here.
面部骨折
Facial fractures.
你会在这里看到大纲和近期文章研究的
You'll find an outline and recent research articles.
你能帮我传一下吗
Would you pass it down?
下面我们来看关于
Here we see examples
左侧额骨的凹陷骨折