良医

The Good Doctor S06E08

Part 2 Feb. 9, 2023, 11:56 a.m.

和富有成效的做法
and productive.
我们已经到达肿块正在切入囊体
We've reached the mass, cutting into the capsule.
等等天哪那是…
Wait. Oh, my God, is that…
医用手术巾？
a surgical towel?
准备好我的开腹探查托盘输血两个单位
Ready my ex lap tray, transfuse two units.
再备两个单位现在插入导尿管
Stay two ahead. Place catheter now.
她的血细胞比容很低
Her hematocrit is low.
跌倒不应该造成这种损伤
A fall shouldn't cause this damage.
如果她嗑药了任何事情都可能发生
If she was high, anything could've happened.
先别急着指责她等毒理报告出来吧
Let's hold judgment till tox results come back.
现在放置动脉管路
Placing arterial line now.
瞳孔呆滞、失忆
Sluggish pupils, memory loss,
意识模糊她吸毒了
confusion, she's using.
不是指责只是识别出某些行为
Not judgment, just recognize certain behavior.
更不稳定了稍后再争论吧
More dynamically unstable. Debate later.
我们必须给她止血
We need to stop the bleed.
艾伦医生你为什么不插导尿管？
Dr. Allen, why aren't you placing the catheter?
淤青很严重
Severe bruising
骨盆区有创伤痕迹
and signs of major trauma in her pelvic region.
我认为她被强♥奸♥了
I think she was raped.
我们修复了你的脾脏但是…
We saved your spleen. But…
你在手术中流了很多血
You bled a lot during surgery.
我们不清楚原因需要做更多检查
We don't understand why. Need to run more tests.
插导尿管的时候我们发现你的骨盆区
While placing your catheter, we discovered some bruising
有一些瘀伤和外伤痕迹
and signs of trauma in your pelvic region.
我们担心你遭到了性侵犯
We're worried you've been sexually assaulted.
不那不可能
No, that's… that's not possible.
你的尿检结果显示氟硝西泮阳性
Your urine testing came back positive for Rohypnol.
它与约会强♥奸♥有关联
It's associated with date rape.
不我…
No, I…
我是和一群朋友一起出去喝酒的
I went out for drinks with my friends.
庆祝他找到了新工作
We were celebrating his new job.
我亲眼看着调酒师调了酒
I watched the bartender mix my drinks.
我有点微醺但没有喝醉
I was tipsy, but I wasn't drunk.
瘀伤一定是我绊倒时留下的
The bruises must be from when I tripped.
如果你说的事情发生了我会记得的
I would remember if what you're saying happened.
氟硝西泮会造成短期失忆
Rohypnol can cause short term amnesia.
我相信这个消息让你很震惊
I'm sure this information is a shock.
我们都是来支持你的
We're here to support you.
收集相关证据的最佳方式是
The best way to gather evidence as to what happened is…
做一个强♥奸♥测试包
to do a rape kit.
不我不需要那个
No, I… I don't need that.
我和我的朋友在一起
I was with my friend.
他不会让我出事的
He wouldn't let anything happen to me.
你不必马上做决定
You don't have to decide right now.
休息一下
Get some rest.
我们会把检查结果告诉你
We'll let you know results.
遗留的手术用品？
A retained surgical item?
是一条手术巾手术后留在你体内了
It's a towel, that was left in you after a procedure.
它附着在几个重要器官上
That is adherent to several vital organs.
想要移除它难免造成不可逆转的…
We can't remove it without irreversibly--
是谁留下的？我的医生吗？
Left behind by who, my doctor?
我们先想办法把它弄出来然后再…
Let's focus on getting it out. Then we--
是谁给我做的阑尾切除术？
Who did my appendectomy?
好像是贝特朗 -海绵和其他物品
Berter, I think. -The count of sponges
是由首席手术护士清点的
and other items is done by the lead scrub nurse.
你们可以晚点再讨论这个
You may discuss this later.
首席手术护士是谁？
Who was the lead scrub nurse?
也许是戈麦斯或者克劳斯我真的不记得了
Gomez, maybe, or Krause. I really don't remember.
但你肯定在场
But you were definitely there.
你在怪我吗？
Are you blaming me?
你是其中一名护士你没注意吗？
You're one of the nurses. Didn't you notice?
我是巡回护士不是手术护士
I was circulating, not scrub.
这绝对不是我♥干♥的
No way I did this.
你刚才还说不记得
You couldn't remember.
现在又确定不是你干的
Now you're sure you didn't do it.
我们应该暂时放下… -你为什么攻击我？
We should move on-- -Why are you attacking me?
我刚发现我的肠道里有一条感染的手术巾
I just found out I have an infected towel in my gut
需要做大手术
that will require major surgery.
你却让自己变成了主角
You're making this about you.
这不是我的错
It wasn't my fault.
是谁的错都不重要
Doesn't matter whose fault it was.
我们会把手术巾当成肉瘤对待
We will approach the towel like a sarcoma.
进行整块切除
Perform an en block resection,
绕过交织在一起的重要动脉网
bypass intertwined vital arterial structures,
最后进行彻底清创
finish with a thorough debridement.
这是一个合理的选择
That's a reasonable option.
你的意见已经没那么重要了
Right now, your opinion doesn't mean a lot.
给我一点时间
I just need a minute.
我去大厅里等着
I'll be in the hall.
她…没有意识了
She's… not conscious.
她晕厥了
She's syncopal.
她晕过去了？
She fainted?
纳温 -血压飙升
Naveen. -BP spiking.
心跳加速
Heart rate's up.
可能有出血或感染性休克
Possible bleed or septic shock.
气道疏通托盘
Crash airway tray.
手术巾上的脓肿腔可能破裂了
An abscess cavity in the towel may have ruptured.
我们得返回手术室
We need to get to the OR.
你找我？
Wanted to see me?
我明天的日程有重叠
Yeah. I'm double booked tomorrow.
你和阿纳尼安医生一起做格温德琳的手术吧
Scrub in with Dr. Annanian for Gwendolyn's surgery.
她对你印象深刻
She was impressed with you.
她非常期待你能做她的外科医生
She's excited to have you as a surgeon.
我有一场不能错过的会议
It's a meeting I can't miss.
我已经把手术计划告诉阿纳尼安医生了晚点我再来
Dr. Annanian has my surgical plan. I'll check in after.
破裂引起了大面♥积♥的腹膜炎
Rupture caused widespread peritonitis.
这次感染比之前严重多了
This infection is worse than before.
大量冲洗、清创和吸液
Aggressively irrigate, debride and suction.
我们需要控制感染
We need to control the infection,
把组织、液体送到微生物实验室
send tissue, fluid to the micro lab
以便我们集中力量给她使用抗生素
so we can focus her antibiotics.
血压骤降心率飙升
Big drop in BP. Heart rate spiking.
她承受不住手术
She isn't tolerating surgery.
我们得再次给她缝合
We need to close her again.
缝线
Sutures.
手术巾怎么办？
What about the towel?
在她的血压和血氧值得到控制之前我们不能做手术
We can't operate until her BP and O2 sats are under control.
让她保持镇静和插管状态直到她稳定下来
She's to remain sedated and intubated until she stabilizes.
我们得找一种新方法把手术巾弄出来
We need to find a new approach to removing the towel.
缝合之后我就可以开始研究
Once she's closed, I can research.
我会咨♥询♥利姆医生的
I will consult with Dr. Lim.
我想咨♥询♥一台手术的事
I would like a surgical consult.
慕克吉的手术？
The Mukherjee case?
CT上的肿块是一块遗留在体内的手术巾…
The mass on the CT was a retained surgical towel…
引起了急性感染粘附在重要器官上
It's acutely infected, adherent to vital organs.
病人责怪她的妻子
The patient blames her wife,
她在阑尾切除术中担任外科护士
a surgical nurse during the appendectomy,
巡回不是手术护士
circulating not scrub.
还是讨论医学问题吧
Stick to the medical.
病人不明白清点器械不是她妻子的职责她们争论…
Patient didn't understand the count wasn't her wife's responsibility. They argued--
当务之急是手术巾从体内毒害她
The pressing issue is the towel poisoning her from the inside.
你打算如何取出它？
Your plan to remove it?
那…
That…
正是我来找你讨论的话题
is what I am here to discuss.
你是主治医生墨菲医生
You are an attending, Dr. Murphy.
你的病人还需要几个小时才能稳定下来接受手术
Your patient has a few hours before she's stable for a procedure.
研究遗留手术器械的问题找你的团队集思广益寻找解决方案
Research RSI's and brainstorm possible solutions with your team.
在那之后如果你还需要咨♥询♥ 我随时欢迎
If you still need a consult, my door is open.
托妮的血小板计数怎么样了？
How's Tony's platelet count?