夜班医生（2014）

The Night Shift S04E08

Part 5 March 5, 2021, 3:52 p.m.

Yeah, we know. So was Pres.
这是我的搭档福特
This is my partner, Ford.
脖子被饵雷炸伤
Yeah, he took a booby trap to the neck
胸部中了子弹
and a bullet to the chest.
他情况很不稳定需要马上做手术
He's unstable. He needs an OR now.
还要多久才有电
How much longer before the power's back on?
不知道已经停了几个小时的电了
I don't know. - We've been like this for hours.
T 我们的血库也被入侵了
Tee, our blood bank was hacked, too,
已经用完了红十字会
and we have gone through all of the O negative
给我们的O型血
that the Red Cross has sent us.
-还在等血液补给 -我们要怎么办
- We're waiting for more now. - What can we do?
他再搭一次直升机估计就扛不住了
He can't make another chopper trip.
我明白我们没有血手术室和电
No. Okay, so we got no blood, no O.R., no electricity.
我们直接在急诊室里做野战救治
Okay, we're gonna do field medicine in the ER.
瑞克你帮我
Okay, Rick, I need you to get
把急救车的灯拿到创伤一室
the ambulance lights to shine onto Trauma 1.
然后接通小型发电机
Okay, I need you to route the power for the genny
这样就能用抽吸器和呼吸机
so we can have a suction and a vent.
雷把所有的金属推车和金属盘
Ray, get all the metal carts and all the metal trays
拿到创伤一室乔丹把保罗叫过来
into Trauma 1 right now. Jordan, find Paul.
我需要他帮我一起做开胸术
I need help with a thoracotomy now.
他在帮德鲁他们在电梯里做手术
He's assisting Drew - with a surgery in an elevator.
我有空会来帮你但现在只能靠你了
I'll be in when I can, but right now, it's all on you.
好
Okay.
终于有点光了
Let there be light.
小心我把东西放下来
All right, it's coming down, guys.
-拿到了 -去皮质强直
- I got you. - Decorticate posturing.
脑疝在恶化颅内血压升高
The herniation's worsening. Intracranial pressure's rising.
你一定在开玩笑
You gotta be kidding me.
米罗瑞德说钻头很有用
Milorad says the drill's powerful.
钻头是新的包装都没拆
The bits are brand-new, still in package.
还有足够的皮肤消毒液来消毒所有东西
Yeah, and you've got enough chloraprep to sterilize everything, okay?
一个维修工来当我的手术助理护士
I got a maintenance man for a scrub nurse.
这疯了吧
This is insane.
没问题的
It'll work.
我拿了儿科重症监护室的球型吸引器工具包
All right, I sent you a bulb suction tray kit from peds ICU.
你们有手术刀牵开器和要求的所有东西
You've got a scalpel, retractors, everything you require.
-还需要别的吗 -还要祈求上天保佑
- Anything else? - Yeah, maybe a prayer.
鼻息管取走了血也检查过了
NG's removed. Blood is cleared out.
好是时候止住出血的地方了
Okay. Time to fix the bleeder.
往前进入食管
Okay, advancing. Entering the esophagus.
这就是流血的地方
There's the source of the bleeding.
这是食管贲门黏膜撕裂综合征
It's a Mallory Weiss tear.
呕吐使得胃和食管间的黏膜撕裂了
All her vomiting ripped the lining between her stomach and esophagus.
她又出血了
She's bleeding again.
香农怎么样了
Shannon, hey. What's going on?
就这样我在用止血夹止血
What's it look like? I'm applying hemoclips.
就跟她说的一样
What she said.
这个撕裂伤口很严重
That was a nasty tear.
你是怎样拿到这些设备的
How did you get all of this equipment?
我跑去消化内科化验室拿的
I ran up to the GI lab and got it.
从哪儿学的操作方法
And where did you learn how to do this?
暑假时我在保留地的肠胃诊所当过志愿者
Spent the summer volunteering at a gastro clinic on the reservation.
那时治疗过很多出血患者
We treated a lot of bleeds.
你的技术很扎实
Your technique is solid.
救了这个女人一命
You just saved this woman's life.
做得非常好
Good job.
而且是在无人监管的情况下
Yep. And all unsupervised.
这孩子会喜欢他的新发型的
Kid's gonna love his new hair do.
是啊希望他能醒来
Yeah. Let's hope he gets a chance.
消毒剂
Chloraprep.
手术刀
Scalpel.
手术刀
Scalpel.
呼气末二氧化碳分压
What's his end tidal?
稳定在35
Steady at 35.
出血了
And a little blood.
-有我呢 -保持血压
- I got you. - Hold pressure.
好了没事了
All right. We're good.
我们知道下一步是什么
We know what comes next.
开始了
Here we go.
-好的 -要慢要稳
- All right. - Slow and steady.
天哪太危险了
Son of a bitch, that was close.
一点没错怎么回事
You're telling me. What happened?
出现去大脑强直
He's progressing to decerebrate posturing.
-肯尼没时间了 -等等
- Kenny, we don't have a lot of time. - Wait, wait, wait.
如果他继续这样有可能造成脑损伤
If he keeps posturing, we could give him brain damage.
那就再打一针麻药好进行手术
Then let's give him another dose of paralytics so I can do this.
德鲁没麻药了怎么办
Drew, we're out. What now?
朱利安你找我
Hey, Julian. You called for me?
人手不够
Yeah, they were short-handed.
我临时接了这个腹主动脉瘤修复手术
I stepped in and started this triple A,
但是便携式发电机不能用
but the portable genny is worthless.
我来让我看看
Here. Let me -- Let me see here.
C形臂电量不足
There's not enough juice to power the C-arm.
几乎不可能在荧光透视下缝合
It's damn near possible not to jail the gate with fluoroscopy.
但是在这里
But...come this far.
也许可以通过触诊解决
Maybe we can finish by palpation here.
人造血管的位置可能有点过低
Yeah, the graft probably deployed too low.
是吗
Really?
我还以为放对位置了呢
I thought I had it.
事实是我确实有点不舒服
Well...truth is, I'm not feeling too great.
这周一直在生病
I've been sick all week.
这里病菌也确实多
Yeah, there's some nasty stuff going around.
不如这样这个我来
You know what? I got this.
你去休息一会儿吧今晚够累的了
Why don't you go take a break? It's been a long night.
朱利安去吧
Julian, go on.
圣安东尼奥纪念医院的斯科特·克莱门斯医生
Dr. Scott Clemmens, San Antonio Memorial.
艾伦·琼斯第一年外科住院医师
Ellen Jones. First-year surgical resident.
很高兴认识你艾伦
Nice to meet you, Ellen.
血压下降医生
Pressure's dropping, Doctor.
系好安全带我们要「盲飞」了
Okay, buckle up. We're flying blind.
人造血管没起效
Graft's not working.
肯定是出现了内漏
He must have a large endoleak.
必须进行开放性手术
I'm converting to an open repair.
你要给他开腹吗
You're opening him up?
没有办法准备开腹
I don't have a choice. Prep the abdomen.
但开腹后不会流血过多吗
But when you open him up, won't he bleed out?
血库情况依然很糟糕
Our blood bank's still a disaster.
我的职业生涯进行过多次腹主动脉瘤手术
I have done a thousand open triple A's in my career,
这位牧师很幸运
and lucky for the good reverend, here,
我很厉害而且很快
I am good, and I am fast.
听着我唯一能保证的结果
Okay, look. The only outcome I can guarantee
就是如果不给他开腹他一定会死
is if I don't open him right now, he's going to die.
我知道我不是这里的医生
I know I'm not part of your regular team,
但现在这是我的手术室
but right now, this is my O.R.,
也就是说你们为我工作
which means you work for me,
所以调整好心态开始工作
so get your heads in the game, and let's go.
手术刀
Scalpel.
是医生
Yes, Doctor.
找到子弹了吗
Did you find the bullet?
还没有他失血的速度
No, not yet, and he's bleeding out
比输血的速度快
faster than I can put blood back in.
-我能做什么 -拿一个腔静脉止血钳
- How can I help? - Okay, grab a vena cava clamp.
好的子弹撕破了下腔静脉侧壁
All right, the bullet tore through the lateral wall of the IVC.
脱脂棉和5-0丝
Pledgets and 5-0 silk.
谢谢
Thank you.
你找子弹我缝合
You find the bullet, I'll suture the wound.
好
Gotcha.
好了胸腔其他部分没事
Okay, rest of the chest looks clear.
还是没找到子弹也没有射出口
There's still no bullet, and there's no exit wound.
也许子弹卡在了心脏上