实习医生格蕾
Grey's Anatomy S20E01
Part 4
March 18, 2024, 8:45 p.m.
Talk to us! He's about to code.
亚当斯正在给他输液
Adams is bolusing him with fluids.
病人腹部僵硬或紧绷吗
Is his abdomen rigid, distended?
对
Uh. Y- Yes.
好了 低血压 僵硬紧绷
Okay, low BP, distended, rigid.
他在内出血 -是的
He's bleeding internally. - Yeah.
好 他需要做紧急开腹探查
Okay he needs an emergency ex lap.
你得找把手术刀 然后
You're gonna have to find a scalpel and- -
该死 你下刀有多快
Oh, damn it. How fast can you cut?
因为你只有3秒的时间 否则就会迎来
Because it appears that you have about 30 seconds between- -
下一次撞击
That!
您在让我们给他开刀吗 -是的
You- You want us to open him? Yes.
在这里吗 -对
In here? Yes!
然后怎么办 -给我们争取点时间
And then what? - You're gonna buy us some time,
好送他去手术室救命
so we can get him to the OR and save his life.
好的
Okay.
好吧
AlI right.
貌似是从被感染的心脏瓣膜上
It's likely a vegetation that showered off
脱落下来的赘生物
from the infected heart valve.
所以 我们做个血管造影定位阻塞区域
So, we” ll do an angio and locate the occlusion.
然后取出血块 恢复血液流动
We'll fish out the clot and reestablish blood flow.
当然 血栓有破裂的风险
Obviously, there's a risk that the clot could break into pieces,
但我们会尽其所能 避免最坏情况
but we'll do everything in our power so that that won't happen.
我们时间不多了
You don't have a lot of time.
欧文 温斯顿需要你的同意
Owen, Winston needs your consent.
亨特
Hunt.
我已经做过几百次的栓塞切除
I”ve done hundreds of embolectomies.
你要是对我有疑虑 我能理解
And if you don't trust me right now, I get it
但请你相信你妻子
So trust your wife.
是她让我当心脏科主任的
She's the one who made me chief of cardio.
做手术吧
Do the procedure. snt M D. JA. CS
先生 不要
Sir! Oh, no.
请你 请你保持手臂尽量不动
I need you to keep your arm- keep your arm as still as possible.
请你 请你保持手臂尽量不动
I need you to keep your arm- - keep your arm as still as possible.
请你 请你保持手臂尽量不动
I need you to keep your arm keep your arm as stjill as possible.
你很可能是骨折了
It's most likely fractured.
这种车不是都有手控功能吗
These cars were supposed to have an override function,
应该有个按钮可以控制
like a button you push.
是的 但韦恩好像出故障了
Yeah, uh- huh. Wayne seems to be malfunctioning.
我之前从不需要手控的 韦恩总是很听话
I've honestly never had to use it. Wayne has always stopped when I need him to.
他今天一定是出状况了 -传感器断线
He must be going through something today. Sensors offline.
你们找到纱布或心脏起搏器了吗
Okay, did you find any towels or ABD Pads?
有 整整一盒 -很好
Yes, a whole box. - Okay, good.
首先找到剑突
You're gonna need to identify the xiphoid process
然后在腹部做一个切囗
and then make an abdominal incision.
你们一人操刀 另一人要密切管理好
And whoever cuts, the other one has to alternate
他的液体状况和呼吸功能
between bolusing fluids and bagging.
韦恩 -注意 撞击来了
Wayne! - Okay, impact.
在真正的创伤剖腹探查中
In a true trauma ex lap,
只要快速切开三下就能进入腹部
you should be able to get into the abdomen with three quick cuts,
但对于你们来说 可能要花更久
but it's going to take you longer.
因为我们不在手术室
Because we're not in an OR?
因为你们是实习生
Because you're an intern.
嗯 对
Uh, uh, right.
对 当然 好的 我准备好了
Um, of course. Uh, yeah. Okay, I'm ready.
等等 我觉得不该这么做 -他都快死了
Wait. I don't think we should do this. - He's dying.
准备迎接撞击
Okay, brace for impact.
拜托 卢卡斯 这里没有合适的工具和照明
Lucas, please. We don't have the right tools, light.
没有血存 想想萨姆 想想昨晚发生的事
We don't have blood. Think about Sam. Think about what happened last night.
要是我们没开刀 也许他还活着 -我不能什么都不做
If we hadn't opened him, could he be alive? - I can't do nothing!
要是我们没开刀 也许他还活着 -我不能什么都不做
If we hadn't opened him, could he be alive? - I can't do nothing!
我不能因为你 再让一个病人死我手上
I can't have another death on my hands because of you!
不不不 别啊
No, no, no. Come on.
不不不 别啊
No, no, no. Come on.
我们教会人工智能模拟人类的决策
We designed the AI tech to simulate human decision- making.
但显然忽视了电车困境的道德问题
Um, but of course there's the whole ethical issue of the trolley problem.
应该是汽车困境才对吧
It looks more like a car problem.
不“电车困境”是一种道德理论
No, the- the trolley problem.
电车会为了一个行人紧急停车
Does the, uh, trolley stop to save one pedestrian,
把全车乘客的置于危险境地吗
thereby risking the passengers inside?
还是会优先考虑乘客
Or does it prioritize the passengers
撞死那个行人呢
and kill the pedestrian? You know?
贝利医生 格蕾医生 他陷入出血性休克
Dr. Bailey, Dr. Grey? He's in hemorrhagic shock.
我们可以不开刀 用输液帮他争取时间吗
Can we keep buying him time with fluids without cutting?
并在他心肺衰竭时 启动心肺复苏
If he codes, we'll start CPR.
只有你俩能回答这个问题 只有你们看得见病人情况
Okay, only you two can answer that. You have eyes on the patient.
他在流血 要想止血 只能开刀
Well, he”s bleeding out. We have to open him to try and stop it.
撞击
Impact!
卢卡斯
Lucas.
如果开刀 现在就下手 -卢卡斯
If you're gonna cut, do it now. - Lucas.
不
No.
检测到障碍
Obstacle detected.
你会看到很多血
You're going to encounter a lot of blood.
不要惊慌 用纱布控制好
Don't panic. Just keep packing.
注意了 -好的 撞击
Everyone, heads upl- Okay, impactl
他的血压触底了低 灌注不足 我马上开始按压
His BP” s bottoming out. He's- - He's not perfusing. I'm starting compressions.
不要对小肠施压太多 或许会伤害到
Don't put too much pressure on the small bowel. You can injure- -
要是流血而亡了 小肠完好也没用
It doesn't matter if he's bled out before then.
出血点在肝脏 光是按住无法止血
Uh, bleeding's coming from the liver, but holding pressure isn't helping.
好吧 那就做肝门阻断
Okay, then do a Pringle maneuver.
你做过吗 -没 你呢
You ever done one? - No. Have you?
他们会做肝门阻断吗
Do they know how to do a Pringle maneuver?
好吧 钳住肝十二指肠韧带
Okay. Clamp the hepatoduodenal ligament.
就是从十二指肠到肝脏的那一条
It runs from the duodenum to the liver.
我们没有血管钳 -两根手指也可以
We have no clamps. - Uh, two fingers can do it.
好吧 我 -我来 换一下
AlI right. Just...- I got it. Take over.
好吧
Okay.
好吧
Okay.
门静脉 肝动脉 胆总管
Portal vein, hepatic artery, common bile duct.
我好像找到了 怎么确定我找得对不对
I think I'm there. How do I know if I'm there?
捏住后血压应该会慢慢上升
Well, once you apply pressure, the BP should slowly start to rise.
就是这根 -撞击又来了 -不
There it is. Okay. Impactl No.
不 关掉引擎
No! Turn the engine off.
收缩压保持在90
Systolic's holding in the 90s.
你还好吗
You doin'okay?
传感器在轮胎上 -我昨晚赢下了福克斯奖
...sensors in the tires. - I won a Fox Award last night,
今天却在一个停车场教实习生做开腹探查
and today, I'm in the damn parking lot teaching interns how to do an ex lap.
我的开腹探查就是你教的
Well, as someone who Iearned how to do an ex lap from you,
你宝刀不老啊
you're very good at it.
等等 他在做什么
Wait What is What is he doing?
胎压过低
Low tire pressure.
胎压过低
Hey! Low tire pressure.
传感器终于正常了 -这都可以
The sensors work! - That worked?
谁推个轮床过来 快点快点
Somebody get a gurney over here. Right here. Come on.
我们把你们接出来
Okay, we're gonna get you out of there.
你说点什么 -什么
Say something. - What?
S
Anything. Because I'm obsessing over every possible complication,
说什么都行 我一直在想各种可能的后果
S
So please just say something so I stop visualizing Teddy having a stroke,
求你说点什么 把泰迪中风的画面从我脑子里赶出去
你想到什么就说什么
whatever's in your head.
泰迪的口腔感染导致心脏严重受损
An infection in Teddy's mouth led to severe damage to her heart.
两个相隔甚远的人体部位
Two parts of the body completely separate from one another.
你让我脱口而出的好吧 对不起
You told me to say whatever's in my- - I'm sorry.
由此我认为 也许梅瑞狄斯不是疯了
I- - It was making me think that maybe Meredith isn't insane
你的话并没有让我感觉好一点
This is not making me feel better.
梅瑞狄斯提出假设 阿茨海默症并不单纯与
Meredith is hypothesizing that Alzheimer's might not be singularly connected
大脑中斑块的形成有关
to plaque formation in the brain.
如果它根本不是由大脑中的病变引起的呢
What if it's not caused by anything°ih the brain at all?
那是什么引起的呢 -我不知道
So what's it caused by then? - Well, i don't know.
那个可以跟我探讨这些的人 已经不在了
And the person I want to talk to about it is not here anymore.
别再想奶昔的事了 欧文
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