良医

The Good Doctor S04E05

Part 1 March 10, 2021, 11:58 a.m.

只是偏头痛而已
It's just a migraine.
亲爱的只有确诊了才行
Honey, until we're completely sure...
是紧缩式疼痛还是搏动式疼痛
Is the pain a tight band or pulsating?
问得好
Good question.
是那种轻微的搏动式疼痛
Pulsating, light bothers me,
还恶心一直是这样
nausea -- I get these all the time.
你说过你没觉得有那叫什么来着
You said you didn't feel a, uh...what'd you call it? A...
是「发病征兆」我知道但是
An "aura." I know, but --
你多久发病一次
Exactly how often do you get these symptoms?
问问而已因为你男友似乎看不太出来
I just ask, since your boyfriend doesn't seem to recognize them.
萨恩和我才认识八天
Zane and I have only known each other for eight days.
进展很快
It moved fast.
埃莉你感觉到脚在抽搐吗
Ellie, did you feel your foot twitch?
没有
No.
巴彬斯基征阳性
Positive Babinski.
那是什么意思
What does that mean?
不是偏头痛的意思
It's not a migraine.
良医
第四季第五集
这个
Oh, that.
我当时在对新室友做尽职调查
I was performing due diligence on my new roommate,
我怀疑他是暴♥力♥狂
who might be a violent maniac,
瞧我在他衣橱里找到什么
and look what I found in his closet.
它很可爱
It's cute.
你搬来时只带了两只箱子
You moved in with two suitcases.
一共就四套内衣
You only have four pairs of underwear.
怎么偏偏带了只鹦鹉过来
How the hell did a parrot make the cut?
我是「鹦鹉头」
I'm a Parrothead.
美国演员吉米·巴菲特的粉丝名称
吉米·巴菲特的狂热爱好者
A Jimmy Buffett enthusiast.
就是唱「玛格丽塔维尔」的那个人
The "Margaritaville" guy?
他还有其他好歌♥
Well, he has other, far better songs,
但没错就是那个唱「玛格丽塔维尔」的人
but yes, the "Margaritaville" guy.
它给我带来好运
It brings me luck.
无法想象你的生活没有它会变怎样
Scary to think what your life would be like without it.
能还给我了吗
Can I have it back?
能更多地了解你真有趣
It's fun getting to know you better.
一切牺牲都是值得的
Worth every damn bit of sacrifice.
今天早上我在演示一个托举动作突然嘎吱一声
I was demonstrating a torch lift this morning, and -- bang.
「芭蕾舞大♥师♥」
"Ballet master."
你是一个舞者
You're a dancer?
不是我就像首席执行官
God, no. I'm like the CEO.
美国著名喜剧演员
我这个年纪相当于剧团里的贝蒂·怀特
At my age, I'd be the Betty White of the troupe.
她是个舞者吗
Is she a dancer?
我对文化方面不太了解
I don't know much about, uh...culture.
我想我只是哪里扭伤了对吧
I assume I just sprained something, right?
我们还需要对神经和腹部做检查
Uh, we will need neuro and abdominal exams,
拍X光片检查是否骨折
X-rays for fractures,
查血常规看是否感染
CBC for infection,
送到实验室培养排除脊髓脓肿
cultures to rule out a spinal abscess --
你是新来的吧
You're...new, aren't you?
这是我来的第二周
Uh, it's my second week here.
这是我第一天看病人
It's actually only my first day seeing patients.
我是你的第一个病人
Am I your first?
是的
Yes.
抱歉但是的
Sorry. But...yes.
令人印象深刻
That's impressive.
带你的人对你可真放心
Whoever's supervising you must really trust you.
我感觉不太放心
I'm not sure that's true.
他们不让我进那愚蠢的健身房♥
They won't let me join their stupid gym
因为我有高血压
because I had high blood pressure.
那我不锻炼怎么降血压
How am I supposed to lower it if I can't work out?
高压200低压105
200 over 105.
血压真高
That is quite high.
我和你说了我血压高
I just told you it was high.
你抽烟吗
Are you a smoker?
是的每天一两包吧
Yeah. Pack or two a day.
心情不好会抽更多
More if I feel crappy.
然后
And...
你有糖尿病吗
do you have diabetes?
你这是照本宣科吗
You're reading those questions out of a book?
是的
Yes.
你看过病吗
Have you ever done this before?
我和你说过你得相信他们
I told you. You have to trust them.
我不相信
I don't.
那就装作你相信他们
Then act like you do.
径直走开
Go away.
没什么比在急诊室
Nothing more romantic
度过第一次约会更浪漫了
than spending one of your first dates in an E.R.
紧张会释放催产素
Well, stressful experiences release oxytocin.
和促使感情纽带建立的激素一样
Same hormone that creates emotional bonds.
也许还会拉近他们的关系
This might actually cement their relationship.
海马体旁边
Next to the hippocampus.
那是颗...牙齿吗
Is that...a tooth?
皮样囊肿酷
Dermoid cyst. Cool.
她癫痫发作了
She's having a seizure.
确保她的呼吸道通畅注射两毫克劳拉西泮
Secure her airway. Push two milligrams Ativan.
谢谢你给我们足够的信任
Thank you for trusting us enough --
请报告
Please report.
58岁男性舞者背部疼痛
Uh, 58-year-old male dancer with back pain.
我排除了高危疾病像骨髓炎
I ruled out red flags like osteomyelitis
以及肾感染但我确实发现他
and kidney infection, but I did find evidence
第二腰椎轻微压缩性骨折呈轻度楔形
of a mild L2 compression fracture with moderate wedging
另外神经管上有撞击的迹象
and evidence of impingement on the neural canal.
你想开始用β受体阻断药
You want to start beta blockers?
我吗对我认为我的病人有中风的可能
Me? Yeah. I think my patient's a stroke risk.
血压200/105
B.P.'s 200 over 105.
和在健身房♥里是一样的
It was the same at her gym earlier?
你能抬起手臂吗
Can you raise your arms?
好用力握我的手
Okay. Now try to squeeze my hands.
她刚才给我做过这些检查了
I just did all these tests with her.
我以为你们已经准备给我开
I thought you were gonna give me stuff
降血压的东西了
to lower my blood pressure.
那就会害死你
That would kill you.
推我的手
Now push against my hands.
如果她有中风的危险
If she's in danger of having a stroke --
她不是有危险她现在就是中风
She's not. She's already having one.
吸烟对雌性激素的影响让她有高患病风险
Smoking on estrogen put her at high risk.
血压昼夜节律失调证明了这一点
Loss of circadian blood pressure variation confirms it.
伸出舌头
Stick out your tongue.
要进行血管成像
We gotta get a CTA.
不对静注组织型纤溶酶原激活剂
No. We're treating with IV TPA.
不用确定血块的位置吗
Don't we need to locate the clot?
刚刚已经确定了
We just did.
右偏表明右侧椎动脉闭塞
Right deviation means a right vertebral artery occlusion.
你可以把嘴巴闭上了
Oh. You can close your mouth now.
她的癫痫和昏迷都是皮样囊肿导致的
Her seizure and coma were caused by a dermoid cyst.
是一块由少量牙齿毛发和脂肪构成的组织
It's a pocket of tissue with bits of teeth, hair, and fat.
她可能在出生前就有了
She likely got it before she was born.
你们有办法吗
What can you do?
低侵入性的疗法是导入引流管
The less invasive option is to put in a drain
来减缓一些压力
to release some pressure,
用抗癫痫药物和类固醇来治疗
treat with anti-seizure meds and steroids,
然后基本就等着看肿块是否会消下去
then basically watch to see if the swelling goes down.
高侵入性的疗法呢
And the more invasive?
手术切除
Surgical removal.
但囊肿很深入
But the cyst is deep inside
而且周围环绕着主要动脉
and wrapped around major arteries,
所以这种方法更能解决问题
so it is more likely to fix the problem,
但也会带来中风或瘫痪的风险
but it carries risk of stroke or paralysis.
需要尽快做决定
We need a decision quickly.