匹兹堡医护前线（2025）

The Pitt S01E15

Part 4 May 20, 2025, 4:18 p.m.

What was that all about?
你不是说我得收拾自己的烂摊子吗我在努力去做了
You told me it was my mess to fix, right? So that's what I was trying to do.
他跟你说话了吗
Did he talk to you?
算不上
Not really.
你觉得我把警♥察♥牵扯进来让情况变得更糟了吗
Do you think I made it worse by bringing the police in on this one?
我们可能永远都不会知道
We may never know.
他的整个72小时留观期间估计都要待在这里了
He's probably gonna be stuck down here for his entire 72-hour hold.
如果他能得到需要的帮助那也值了
Well, maybe if he gets the help he needs, it's worth it.
回家吧
Go home.
明天处理好那个脚踝监视器之前不要来医院
Don't show up tomorrow before taking care of the ankle monitor.
我觉得我们的亚甲蓝病人麦克斯需要做心理评估
I think our blue man, Max, needs a psych eval.
依据是什么
Based on what?
无明确健康原因需服用可能导致此症状的药物
No health reason for taking anything that could have caused this.
在工作场所没有接触过任何化学品
No exposure to anything in the workplace.
他没让我给任何人打电♥话♥
He didn't ask me to call anyone.
我只是担心他有自残倾向
I'm just worried he was trying to hurt himself.
这有点太牵强了新来的
It's a stretch, new girl.
他也没要求回家
Well, he's also not asking to go home.
如果这是自杀未遂
I mean, if this was a failed suicide attempt,
他害怕或羞于承认自己做过的事
it makes sense that he's too frightened or embarrassed to admit to
也害怕回家就全都说得通了
what he did and too afraid to go home
因为他可能还会再次尝试
because of what he might still do.
好吧我们给精神科打电♥话♥ 但找个人来接手你的工作吧
OK, I'll call Psych, but find someone to take over for you.
你几小时前就该下班了
Your shift ended a couple of hours ago.
我想再套套他的话
I'd like to try and get a little more out of him,
看看能不能让他承认点什么
see if I can get him to confess to something.
我看过你的医患沟通技巧
I've seen your bedside manner.
那只适用于混♥蛋♥
OK, that is reserved for assholes.
我不希望这孩子被漏诊了
I don't want this kid slipping through the cracks.
好吧
OK.
谢谢
Thanks.
谢谢你让我回来
Thanks for letting me come back.
我没让你回来
I didn't let you come back.
你自己回来的我只是让你留下来
You came back on your own, and I let you stay.
为了更大的利益我愿意赌上我的职业生涯
I figured it was the one time throwing my career away was for a greater good.
我没嗑药我只是在治疗自己的戒断症状
I--I was never high. I was just treating my own withdrawal symptoms.
你应该在医生的监督下去做这件事
Well, you should have done that under the care and supervision of a physician.
有了这种不良记录我以后申请工作的时候
With that on my record, I could-- I could have my hospital privileges denied
随时都可能被医院拒之门外 - 不现在不是这样了
whenever I apply for a job. - No. No, that's not true anymore.
现在不是这样了你本可以来找我的
That's not true anymore. You could have come to me.
相反你现在可能会因为
Instead, you could be arrested on felony charges
从医院盗窃管制药物被指控重罪
for stealing controlled substances from the hospital.
罗比我可能会被吊销行医执照的
Robby, I could lose my medical license.
拜托了伙计你没听说过第二次机会吗
Come on, man. You never heard of second chances?
这是我给你的第二次机会
Here's your second chance.
30天住院治疗
30-day inpatient treatment program,
后续每年接受50到60次随机尿检
followed by random urine tests, 50 to 60 a year, followed by mandatory NA meetings
并在头三年强制参加每周3到4次匿名戒毒会
three to four times a week for the first three years.
三年 - 这是一个五年项目
Three years? - Of a five-year program.
你需要帮助 - 那你呢
You need help. - What about you, man?
那你呢我不是唯一搞砸的人罗比
What about you? I'm not the only one who's a little fucked up here, Robby!
你能照照镜子吗 - 什么意思
Why don't you look in the mirror? - What's that supposed to mean?
我可从来没完全崩溃过 - 是啊你只是把别人搞崩溃了
I never had a complete meltdown. - No, you just caused them in other people.
你把你经历的事怪在我头上
You're blaming me for what happened
我经历的事
to you?
我经历的事 - 对
What happened to me? - Yeah.
你真是满嘴胡说八道是你让我失望了
You are so full of shit! You let me down!
你让所有人失望了尤其是你自己
You let everybody down, especially yourself.
有人在停尸间看到你了
Someone saw you in Pedes.
谁维塔克
Who, Whitaker?
不是一个夜班护士看到你坐在地板上说你看起来像...
No. A night shift nurse saw you on the floor, said it looked like--
看起来像什么
Looked like what?
像什么
你如果放任它这份工作就会蚕食掉你
This job will fuck you up if you let it.
你放任它了
You let it.
是吗在停尸间跟卡♥通♥动物说话的人又不是我
Yeah? I wasn't the one talking to cartoon animals in Pedes.
去你的
Fuck you!
你还好吗
Doing OK, man?
你为什么一直问我这个 - 我不知道
Why do you keep asking me that? - Oh, I don't know.
你确实把病人的家长带进了临时停尸间
You did take the parent of a patient into our makeshift morgue.
你忘了那严格来说算是犯罪现场
Forget that it's technically a fucking crime scene.
有点欠妥当啊兄弟
That's just not cool, man.
刚好是我想见的两个英雄
Just the two heroes I wanted to see.
我们要在教育礼堂举办一场新闻发布会
We're holding a press conference in the education auditorium.
不行
Not a chance.
我知道你讨厌这种事
I know you hate this stuff,
但这对急诊科和医院都很重要
but it's important for this department and the hospital.
相信我格洛丽亚你不会想让我现在去记者会上发言的
Trust me, Gloria. You don't want me speaking to the press right now.
或者永远都不会
Or ever.
听着尽管你们急诊室的牛仔们让我很头疼
Look, as much as you ER cowboys are a pain in my ass,
但你们今晚的表现堪称奇迹
what you and your department did here tonight was nothing short of miraculous.
人们需要知道这一点
People need to know that.
学会享受胜利吧
Take the win.
需要启动第二轮♥大♥量输血方案
Need a second round of MTP.
搞什么
What the fuck?
收缩压降到高压6♥4♥低压38了室速132
Systolic's down to 6♥4♥ over 38. He's tachy to 132.
骨盆骨折
Pelvic fracture?
对需复查排除迟发性腹腔内出血
Yeah, rechecking for delayed intra-abdominal bleed.
你不是说他稳定了吗 - 他输血三单位后是稳定了
I thought you said he was stable. - He was, after three units.
并且在持续好转
And he continued to improve.
完成全套大量输血方案后收缩压升至118
Pressure got up to 118 systolic after the full MTP.
收缩压118 - 之前输血三单位后是90
Systolic at 118? - It was 90 after three units.
你们给他输了太多血导致他的血压升高
You gave him too much blood and raised his pressure so high that it blew apart the developing clots
把已形成的止血栓冲开了
that was stopping him from bleeding out.
第一轮♥大♥量输血方案是六单位红细胞六单位新鲜冷冻血浆
First round of MTP is 6 units red cells,
和六单位血小板
6 FFP, 6 platelets.
都是按规定来的 - 治病救人不能照本宣科
That's what we gave him. - Treat the patient, not the protocol.
收缩压90是理想的
Systolic of 90 is ideal.
罗比你教你的住院医生允许性低血压了吗
Robby, you teach your residents about permissive hypotension?
这个病例是沈医生负责的 - 沈医生是住院医生
Dr. Shen was on this case. - Shen is a resident.
他现在是主治医师了
He is an attending now.
我们认为患者转介入治疗的时间延迟导致了...
We thought with the long delay in getting him to IR, that--
他可能撑不到介入科了
He might not make it to IR.
你们输血过多冲掉了凝血块他现在出现失血性休克了
You over-transfused, you popped the clots, and now he's exsanguinating.
腹部没有出血
OK. There's no bleeding in the belly.
位置在骨盆深处无法通过超声波检查
It's too deep in the pelvis to see on ultrasound.
第二轮♥大♥量输血方案的血包来了
Second round of MTP is here.
马上输注血液和血浆
Blood and plasma on the infuser.
我们救活过他一次就能再救一次
We got him back once. We'll get him back again.
三克葡萄糖酸钙 - 为什么是钙
3 grams calcium gluconate. - Why calcium?
输入血液中的柠檬酸盐会引发螯合反应导致低钙血症
Citrate in the transfusions chelates, leading to hypercalcemia.
判断精准埃利斯医生
Excellent call, Dr. Ellis.
嘿我在楼梯间发现了正在抽烟的周太太
Hey, I found Mrs. Cheu in the stairwell smoking.
做得好
Oh, good job.
周太太吸烟不是健康的习惯
You know, Mrs. Cheu, tobacco use is not a healthy habit.
我熬死了三任丈夫 - 他们可能是死于二手烟
I've outlived three husbands. - Yeah, they probably died of secondhand smoke.
金医生我们想让你在弗林病情恶化前给他做腰椎穿刺
Dr. King, we want you to do the spinal tap before Flynn gets any worse.
好极了我马上过去
Great. I will meet you in there.
沈医生很高兴有你加入我们 - 收缩压只有68
Dr. Shen, nice of you to join us. - Systolic's only 68.
输了几单位了 - 第二轮第三袋
After how many units? - Three units into the second MTP.
一共九个单位 - 情况不妙孩子们
Total of nine. - This is not looking good, kids.
如果我给他输了太多血我很抱歉
I'm--I'm sorry if I gave him too much blood.
我以为... - 埃利斯医生既然沈医生已经来了
I thought-- - Dr. Ellis, now that Dr. Shen is here,
这里人手已经够了你去看看其他病人吧
we have plenty of hands on deck. Why don't you go check on your other patients?
嘿可以尝试REBOA吗
Hey, what about REBOA?
球囊能阻断下半身的血液... - 不行
The balloon cuts off blood to the lower half of the body-- - No,
双侧挤压伤情况下不确定是否有能插管的完整动脉
with bilateral crush injuries, we don't know if we have an intact artery to thread it in.
我们还可以开胸夹闭主动脉保住他的命
We can always crack the chest, cross-clamp the aorta, and stabilize.
我有更好的主意 - 是吗
I got a better idea. - Yeah?
腹膜前填塞术
Preperitoneal packing.
脐下正中切口
Simple midline incision below the umbilicus,