匹兹堡医护前线（2025）

奥兰多 睁开眼睛
Orlando, open your eyes.
他撞到头了吗 - 应该是吧
Hit his head? - I guess.
你为什么不叫救护车 - 他不肯 他当时还能说话
Why didn't you call 911? - He wouldn't let me. He was talking--
现在不怎么说了
not so much now.
奥兰多 迪亚兹先生
Orlando. Mr. Diaz.
天哪 - 他喝醉了
Jesus. - He drunk?
不是 呼气有酮味 他有糖尿病吗
No. Ketones on his breath. He diabetic?
我不知道
I don't know.
头部创伤 意识状态改变 可能并发糖尿病酮酸中毒 立即急救
Altered head trauma, possible DKA. Call it overhead.
启动一级创伤急救
Code trauma tier one now. Code trauma tier one now.
维塔克医生 你的评估一针见血
Dr. Whitaker, your assessment was spot-on.
你那位患有阿尔茨海默症的遗孀 需要安置到养老院
Your Alzheimer's widow definitely needs placement.
有今天就能接收她的养老院吗
Do you have a nursing home that can take her today?
我也希望有
I wish.
医保规定 必须住院满三天
Medicare requires a three-day hospitalization
他们才会批准
before they'll approve that.
我没有让她住院的理由
I don't really have a reason to admit her.
但是我有
But I do.
她已经丧失了行为能力
She's gravely disabled.
我会让她坐轮椅 这个方案可行
I'll put her on a cycle. We'll make it work.
谢谢你 卡勒布
Thank you, Caleb.
你有时间吗 迈克尔
Yeah, you have a few moments, Michael?
我没有
Actually, I do not.
但我这边处理完之后 我会去找你的
But once I get things settled here, I will come and find you.
好的
Okay.
罗比医生
Dr. Robby,
迪伦跟那个女友谈过了 - 罗比
Dylan just talked to the girlfriend. - Robby!
等会儿再跟我汇报吧 他怎么了
You'll have to fill me in in a minute. What do you got?
意识状态改变 我判断不了 他是因为意识不清才摔倒的
AMS. I can't tell if he fell 'cause he was altered
还是因为摔倒了意识不清
or he's altered because he fell.
他呼气有酮味 - 交给我就行了 谢谢
There's ketones on his breath. - Okay, I got this. Thank you.
好吧 就剩咱俩了
All right, I guess it's just us.
那个女友是怎么说的
Um, what did the girlfriend have to say?
吉娜对此显得很困惑和紧张
Well, Gina seems a little confused and on edge by this,
但我并不怀疑虐待跟她有关
but I'm not suspicious about abuse on her part.
那凯莉的父亲呢
What about Kylie's father?
我是社工 不会读心
Well, I'm a social worker, not a mind reader.
我得跟他谈谈
I need to speak with him.
是啊 他这会儿应该到了的
Yeah, he's supposed to come in.
如果没来 那就是心虚
If he doesn't, looks pretty guilty.
咱们先别急着下结论
Let's not jump to any conclusions just yet.
我没有
I'm not jumping.
我只是想说 如果那家伙不出现
I'm just saying, if this dude doesn't show up,
我会亲自去找他
hell, I'll go find him myself.
开玩笑的
Kidding.
在她父亲来之前 我会先跟凯莉聊聊
I will speak to Kylie before her dad gets here.
如果他会来的话
If he shows up.
是的
Yes.
那绝对是酮味 我们需要测个快速血糖
That's definitely ketones. We need to do an Accu-Check.
我来吧 他心动过速 心率124
I'm on it. He's tachy at 124.
血氧饱和度97 高压106 低压72
Pulse ox 97. BP's 106 72.
双侧肺滑动正常 肠鸣音良好
Lung sliding bilaterally. - Good bowel sounds.
腹部柔软无压痛 - 你怎么知道无压痛
Abdomen is soft, non-tender. - How do you know it's non-tender?
因为我没看到他呲牙咧嘴
Because I didn't see any grimacing.
他没意识了 扎静脉针他都不会皱眉头的
He's altered. He didn't even flinch for the IV start.
我是想说无僵硬
I meant to say non-rigid.
双侧脚趾向下弯曲 无证据表明上运动神经元受损
Toes down--going bilaterally. No evidence of upper motor neuron deficit.
很好 - 床旁超声阴性
Good. - E-FAST negative.
需要我帮忙吗
How can I assist?
你可以去看看麦凯医生 或是桑托斯医生
You can check in with Dr. McKay or Dr. Santos.
如果你不介意的话 我想旁观 了解一下你是如何工作的
If you don't mind, I'd like to observe, learn how you handle things.
血糖值很高 超过500了
Whoa, blood sugar's critical high--it's over 500.
警铃大作 - 听上去像是糖尿病酮症酸中毒
Ding, ding, ding, ding. - Sounds like diabetic ketoacidosis.
我们必须马上治疗
We need to start treating that,
然后做CT排除颅内出血
then right to CT to rule out an intracranial bleed.
有一个严重呼吸窘迫患者 预计三分钟后到达
Severe respiratory distress coming in--ETA three minutes.
我把他们安排到创伤一室 - 好的
I'll stick them in Trauma 1. - Yep.
你想让我接手吗 - 太好了 谢谢
Would you like me to take that? - Yes, please. Thank you.
他需要胰岛素滴注 对吧
This guy needs an insulin drip, right?
每公斤体重0.1单位
0.1 units per kilo?
不 得先查过血钾
No, not without knowing his potassium.
胰岛素会导致钾向细胞内转移
Insulin causes an intracellular shift.
如果血钾浓度低于3.5 滴注会害死他的
And if the potassium is under 3.5, the drip would kill him.
完全正确
That is very true.
我们可以从乳酸林格液开始
We can start with lactated ringers.
以每小时一升的速度输注 直到我们拿到
1 liter per hour until we get the results
生化七项和静脉血气的结果
from the chem-7 and the VBG.
他为什么会出现糖尿病酮症酸中毒
Why is he in DKA?
也许他没注射足够的胰岛素
Maybe he's not taking enough insulin.
更常见的情况是有诱发事件
More frequently, a precipitating event can be identified,
比如肺炎 尿路感染 中风
such as pneumonia, urinary tract infection, stroke,
心肌梗死或胰腺炎
myocardial infarction, pancreatitis.
是的 我们都会查的 这是标准流程
Yeah, we always check for those. They're part of the standard order set,
对吧 莫汉医生
right, Dr. Mohan?
他是疯癫的吉米爷爷那一支的
He's from crazy Grandpa Jimmy's side.
她是我爷爷的弟弟那一支的
She's from my grandfather's brother's side.
里奇叔祖父也是个神经病
Grandpa Ricky is still a psycho.
这显然是家族遗传 - 等等
Clearly runs in the family. - Well, hold on.
你的祖父是里奇和吉米·汉森
Your grandparents are Ricky and Jimmy Hansen...
那个赛车家族
from the racing family?
很不幸 是的
Unfortunately.
有件事需要你处理一下
I got something that needs attention.
不会又是个婴儿吧
Not another baby.
抱歉 失陪一下
Sorry. Excuse me.
这是兰德尔先生
This is Mr. Randall.
他已经勃起了八个小时
He's been erect for the last eight hours.
应该早就软下来了 对吧
Should have gone down by now, right?
这种情况时有发生 你回来是明智的选择 兰德尔先生
It happens. It's a good thing you came in, Mr. Randall.
我马上给他办理入院
I'll take him right back.
你能劝劝那对斗嘴的表亲吗
Do you mind finishing up with the Bickersons?
还是不了吧
I'd rather not.
那么 兰德尔先生… - 叫我伊恩吧
So, Mr. Randall-- - Ian.
伊恩 你是吃了什么东西 导致这种状况的吗
Ian, did you take anything that might have led to this condition?
我注射了一支勃起功能障碍药剂
I used an ED injection--
其实是两支
two, actually.
我又给自己打了一针 一边一针
I gave myself a second shot, one on each side.
所以 你用了双倍的推荐剂量
So double the recommended dosage?
那是我们的结婚纪念日
It's our wedding anniversary.
很重要吗
Is this a big one?
我是说纪念日 很重要吗
The anniversary, is it important?
有什么特殊意义吗 比如 里程碑式的…
Like, uh, significant? Like, a milestone or--
那是我们的二十年结婚纪念日
It's our 20th. - Oh, nice.
真好 恭喜
Well done. Congratulations.
血糖 521 血钠 129
Glucose 521. Sodium 129.
血钾 3.7 氯 97
Potassium's 3.7. Chloride's 97.
碳酸氢盐 8 - 这代表什么
Bicarb's 8. - Meaning?
我们可以开始胰岛素滴注 并在每升液体中加入20单位的钾
We can start the insulin drip and add 20 of K to each liter.
阴离子间隙高达24 它应该小于10的
Big anion gap of 24. It should be under 10.
我们通过监测这个指标 来评估病情发展
We follow it to assess progress.
其实 2024国际指南中指出
Actually, the 2024 international guidelines
不应以阴离子间隙作为判断依据
state that anion gap should not be used,
因为在合并高氯性代谢性酸中毒时 它可能产生误导
as they can be misleading in the presence of hyperchloremic metabolic acidosis.
我最近接诊了一个重症监护室病例
I-I recently had a case in the ICU.
静脉血气结果出来了 pH值6.97
VBG is back-- pH of 6.97.
正常是7.4
Normal's 7.4.
是什么导致了酸血症
What causes the acidemia?
没有胰岛素 身体就无法利用葡萄糖
Without insulin, the body can't use glucose,
于是它分解脂肪产生酮体
so it breaks down fat-producing ketones,
导致严重酸中毒 而这可能引发心脏骤停
leading to severe acidosis, which can cause cardiac arrest.
但高血糖会导致身体 排出更多的水分和电解质
But the hyperglycemia causes the body to excrete more water and electrolytes,