实习医生格蕾

Grey's Anatomy S11E23

Part 4 Feb. 23, 2020, 9:22 a.m.

Do you know w-we're having a-a baby?
基思我们试着听你的呼吸
Keith, we're trying to listen to your breathing.
请不要说话
Stop talking, please.
在这很难听到呼吸声
It's hard to hear breath sounds out here,
但他有可能肺部严重受损
but he could have a collapsed lung.
他的下腹情况如何
How's his abdomen?
看起来是大量出血
Lot of blood, from what I can see.
基思我要检查你的肢体好吗
Keith, I'm just gonna check your torso, okay?
他有两处地方被钉住了
He's impaled in two places.
很糟糕是吧
It's pretty bad, huh?
挺糟糕的
It's pretty bad.
不过我见过更糟的
But I've seen worse.
两床病人需要呼吸辅助
Call respiratory for bed two,
给八床病人再一次进行血细胞比溶检查
and get a repeat crit on bed eight.
-谢谢 -亨特医生
- Thanks. - Uh, Dr. Hunt.
我是安德鲁·迪鲁卡
Hi. Un, I’m Andrew Deluca
是的你是跟那位怀孕女性一起来的
Oh, right. You came in with the pregnant woman.
是的我要填写什么文件
Yes. Uh, is there any paperwork I should fill out or...?
可以迟点再填
You can do it later
你能现在继续去帮忙吗
if you're good to just jump in and keep helping.
当然当然
Of course. Sure.
天啊还有一个
Oh, god, there's another one!
好保持呼吸缓慢呼吸
Okay. Keep breathing. Nice and slow.
爱德华兹手腕这边减压处理得不错
Edwards, nice job reducing the wrist.
-是迪鲁卡医生在现场处理的 -哪个医生啊
- Actually Dr. Deluca did that in the field - Dr. who?
是我你好我是迪鲁卡医生
Me. Hi. Dr. Deluca
-他在现场 -急救人员的夹板用完了
- He was at the scene. - Paramedics ran out of splints,
-所以那其实是我的领带 -之前是你的领带抱歉
- so that's actually my tie. - Was your tie. Sorry.
没问题但这是我最爱的一条领带
Eh, it's not a problem. It was my favorite one, though.
天啊好吧 3厘米扩大
Oh, god! All right. Three centimeters dilated.
看她第5到6节脊柱骨折了
Look, she has a fracture at c5-6.
什么是第5到6节脊柱
What's a c5-6?
琼你的颈部有骨头骨折了
Joan, you fractured a bone in your neck,
但现在稳定下来了
but it is stable for now,
我们会在帮你接生后治疗好吗
so we will fix it after you deliver, okay?
继续带着颈圈直到化验结果出来
Keep her in the collar until her labs come back,
然后我们送她去楼上分娩
then we'll get her upstairs so she can deliver,
修复骨折
and repair the fracture.
好的她宫缩变得频繁
Got it. Have them page me when her contractions
就让他们呼叫我
become more frequent, okay?
好的
All right.
非常感谢你的帮助
Thank you so much for your help.
我很高兴能帮忙
It was my pleasure.
他失血速度太快输血也没用
He's losing blood faster than we can put it in him.
我们得送他上楼
We should get him upstairs.
得做开胸手术给我戴手套
We need to open his chest. Glove me.
打开胸部然后怎样
Crack his chest and then what?
还是没有足够时间
That still might not buy us enough time
送去手术室修复伤口
to get to the O.R. and fix his injuries.
那我们就停止时间
Then we stop time.
-怎么做 -让他血液体外循环把血液抽干
- How? - Put him on bypass, drain out all of his blood
换上生理盐水然后手术
and replace it with cold saline, and then we operate.
能这样做吗
Can you do that?
不他撑不住这样太危险了
No, he can't. That's way too risky.
这等于让他假死
We put him in suspended animation,
从体内冷却
cooling him from inside out --
他的大脑心脏和器官
His brain, his heart, his organs.
这就能多出一到两小时亨特
That buys us an hour or two. Hunt!
十号♥手术刀
Ten blade.
外边情况怎样
How's it going out there?
伤员大批入院根本治疗不过来
Um, they're coming in faster than we can treat them.
听着凯瑟琳
Um, listen, Catherine...
我不想这么说
I-I-I hate to say this,
但你知道在这种情况下
but, you know, under the circumstances,
你觉得我们该推迟婚礼吗
do you think we should postpone the wedding?
我已经这么做了
I already did.
我的助手此时正在通知宾客
My assistant is notifying our guests as we speak.
你真的不介意吗
Oh. You're sure you don't mind?
我当然介意
Of course I mind.
但我俩都知道我们该在哪
But we both know where we need to be.
嘿主任我们需要你
Hey, uh, chief. Uh, we need you.
你不能说什么"假装死亡"
You can't just say
搞得像真有这事一样
"Suspended animation" like it's a real thing.
这是科幻小说吧
It's science fiction.
这称之为紧急保存与复苏
It's called emergency preservation and resuscitation.
外伤项目就这个主题讨论多年了
Trauma programs have been discussing it for years.
这能帮助来得及赶去手术室的患者
It's a way to save patients who can't make it to an O.R.
是啊这很危险很不负责任
Yeah, a risky way, an irresponsible way.
因为最保险的是
'cause the safe option is
继续给他输血然后快速送他上楼
to keep transfusing him and race him upstairs.
怎么做到
How do you do it?
我们往主动脉插入导管吸干血液
Well, we cannulate the aorta, drain out his blood,
注入冰盐水
infuse cold saline,
将主要器官体温降至50摄氏度
then drop his core temp to 50 degrees.
等于让他冬眠
You put him in hibernation?
用冰水来替代整个血液循环
You replace his entire blood volume with ice water.
你们要做什么啊
You're gonna do what to him?
-把她送走 -这样会导致体温过低
- Get her out of here. - So you induce hypothermia.
等等我们不会用你和医生朋友闲扯出来的方法
Hold on. We're not gonna consciously kill a kid over
这样做等同于
something you discuss over beers
杀害一个孩子的性命
with your trauma buddies.
什么不做这个孩子也会死
Kid's gonna die anyway.
至少我们可以试着救他还是试试吧
At least this way we can try to bring him back. I say do it.
不这样太不靠谱了
No. It's way too experimental.
而且我们需要皮尔斯在场她在事故现场
And we would need Pierce. She's at the site.
这不是心脏手术
This is not a cardio procedure.
如果你没法使他心跳复苏那得她来做心脏手术呀
It is if you can't get his heart beating again!
如果没法让他从血液体外循环中恢复过来你怎么办
What are you gonna do if you can't get him back after bypass?
那怎么做
What then?
所以说我们不能突发奇想做这事
That's why we don't do things like this on a whim.
这不是突发奇想这是孤注一掷
This is not a whim. This is a hail Mary.
但这是个孩子啊
On a child?
这病人是未成年人我们没有同意书
The patient is a minor. We don't have consent.
等找到父母就来不及了
By the time you find the parents, it'll be too late.
我同意杰克森说的
I agree with Jackson.
不能这么做亨特
It's a no, Hunt.
这绝对行不通
We're wasting time having this conversation.
我们只需要两位医生的同意
Okay. We only need two physicians to give consent.
-克莱夫 -真的吗你想这样玩的吗
- Karev? - Really? That's how you want to play this?
同意
In.
韦伯
Webber?
主任
Chief?
做吧
Just do it.
给我导管
I need a cannula!
今天死了太多人了
Too many people have died today.
不能让这个孩子也死
We're not adding this kid to the list.
气道怎么样他的血氧指数正常
H ow's his airway? His sats are okay.
他的左胸肯定有血液堆积
There's definitely blood in his chest on the left side.
-梅瑞狄斯你能包裹伤口吗 -我在试
- Meredith, can you get the packing in? - I’m trying.
我这个角度够不着
I can't really reach it from this angle.
我需要更多纱垫
Uh, I need some more trauma pads
还有纤维素聚合物
And cellulose polymer, please.
情况怎么样
What's going on?
我一碰伤口
Whenever I press on the wound,
血就从他的腹部流出来了
blood is flowing out of his abdomen.
金属塞住了出血点
The metal is tamponading it,
但这管不了多久
but it's not going to last very long.
他需要尽快做手术
And he needs surgery soon.
如果他没被血液呛住窒息的话
If he doesn't suffocate on his blood first.
我得插胸管
I got to get a chest tube in here.
你能够的着吗