匹兹堡医护前线（2025）

匹兹堡医魂
第二季第五集

罗比 - 怎么了
Robby. - Yep.
患者脚背蜂窝组织炎 现在向上扩散到腿部了
Cellulitis on the dorsum of the foot, now spreading up the leg.
（第5小时 中午11点至12点）
你好 我是罗比医生 介意我看一下吗
Hello, I'm Dr. Robby. Mind if I take a look?
你觉得需要多久
How long do you think this is gonna take?
我提前午休了
I took an early lunch break.
我不确定你今天能回去工作
I don't know that you're gonna make it back to work today.
红肿和发热已经蔓延至膝盖一半高度
Erythema and warmth halfway up her knee.
你什么时候给她看诊的 唐尼 - 不是他 是我看的
When did you see her, Donnie? - He didn't. I did.
什么时候 - 大概一小时前
When? - About four hours ago.
给她打了先锋霉素 嘱咐她如果情况恶化就回来复诊
Gave her a dose of Keflex, told her to come back if things got worse.
情况确实恶化了
Things have definitely gotten worse.
达娜 哪个房♥间空着 - 创伤二室
Dana, what's open? - Trauma Two.
杰西 你能带她去创伤二室
Jesse, can you get her started in Trauma Two
给她注射万古霉素并做血培养吗
with some vanco and blood cultures, please?
好的 头儿 - 我也一起去
Got it, boss. - I'm coming with.
随便你吧
Suit yourself.
桑托斯 你要去创伤二室帮忙吗
Santos, you want in on Trauma Two?
我还有一堆病历要写 时间紧任务重
Too much charting, too little time.
62岁男性
62-year-old male
主诉左下背部疼痛
presents with chief complaint of left lower back pain.
考虑诊断为… - 嘿
Considered the diagnosis-- - Hey.
老天爷啊
Oh, Jesus Christ.
我在写病历呢 - 抱歉
I'm charting. - Sorry.
我做错什么事了吗 - 除了打断我之外 应该有吧
Did I do something wrong? - Besides interrupting me? Probably.
那我跟你道歉
Then I apologize.
我知道第二年住院医生压力很大
I know that second year of residency can be stressful,
所以如果有什么我能帮上忙的…
so if there's anything I can do to help you...
比如闭嘴
like stop talking.
这是个好主意 - 是啊
That's a great idea. - Yeah.
考虑诊断为主动脉瘤或动脉夹层…
Considered the diagnosis of aortic aneurysm or dissection.
13号♥病房♥有个新病人给你
Got a new one for you in 13.
我要补20份病历 那个新来的主治医生
I'm 20 charts behind, and the new attending
威胁我说如果补不齐的话 就要再熬一年
is threatening to make me repeat a year if I can't catch up.
别诉苦了 那个老太太肚子疼得厉害
Cry me a river. Old lady with bad abdominal pain.
得有人给她看看 - 达娜 拜托帮个忙
Somebody's gotta see her. - Dana, please do me a solid.
这是节日周 西桥纪念医院又关门了 我们的候诊室已经超负荷运转了
Holiday weekend. Westbridge is down, and our waiting room's on overdrive.
我很抱歉 但你得等轮班结束后 再补病历了
I'm sorry, but your charting's gonna have to wait until after your shift.
奥吉尔维
Ogilvie.
桑托斯医生需要你去13号♥病房♥ 接诊一位新病人
Dr. Santos needs you to pick up a new patient in 13.
好的 我马上去
Y-yes, ma'am. I'm on it.
一边监督新人一边写吧 我尽力了
Chart while you supervise. Best I can do.
发布个水滴筹 这就是他们这代人的常规做法
Setting up a GoFundMe, that's what her generation does.
这是他们互相支持的方式
That's how they support each other.
医生 你劝劝他 - 你妻子说得对
Doctor, tell him. - Your wife's right.
我们负担不起住院的费用
Staying here's gonna cost more than we can afford.
听着 我感觉好多了
Look, I'm feeling better.
让我出院吧
I'll just leave.
迪亚兹先生 即使你的血糖恢复正常了
Mr. Diaz, even if your blood sugar is back to normal,
我们也得继续滴注胰岛素
we have to continue with the insulin drip
直到你血液中的酮体被清除干净
until we clear the ketones from your bloodstream.
否则的话 你可能会出现电解质紊乱
Otherwise, you could experience electrolyte disorders,
心脏和肾脏问题
heart and kidney problems--
亲爱的 你的健康才是最重要的
Mi amor, your health is what matters.
这样吧
I'll make you a deal.
如果你同意继续滴注胰岛素
You agree to stay on the insulin drip,
我就找我们的病例经理
and I'll go find our case manager
商量一下如何降低你住院的费用
to discuss cost-cutting options for your stay.
成交
Deal.
我就坐这儿 确保他老实待着
And I'm sitting here making sure he doesn't move.
你应该去找安娜
You should go look for Ana.
我去找吧 马上回来
I can find her. BRB.
准备滴注万古霉素 - 那是什么
Hanging vanco. - What's vanco?
是一种能杀灭皮肤细菌的强效抗生素
A really strong antibiotic to kill skin germs.
需要搭把手吗
Need a hand?
不用 我们能搞定 - 那我在一旁观摩好了
No. We got this. - I'll just observe.
就当我不存在
Pretend I'm not even here.
开个血常规 血培养 生化全项
Let's send off a CBC, blood cultures, and CMP.
还有乳酸 C反应蛋白和降钙素
And also a lactic acid, CRP, and calcitonin.
等等 她不发热 也无心动过速 没有SIRS的迹象
Wait, she's not febrile, not tachycardic. No evidence of SIRS.
暂时没有 - SIRS是什么
Yet. - What's SIRS?
全身炎症反应综合征
Systemic inflammatory response syndrome.
抱歉 - 一种过度的防御反应
Sorry. - An exaggerated defense response.
抱歉 什么
A what?
有时人体会对感染产生过激反应
Sometimes the human body can have an overreaction to an infection,
所以我们要监测你 防止病情进一步发展
so we're gonna monitor you to make sure that this does not progress.
是我老板 抱歉 我得接一下 否则他会解雇我的
It's my boss. Sorry, I have to take this, or he's gonna fire me.
好的
OK.
喂
Hello.
没 我还在医院
No, I'm still at the hospital.
正在看呢
Being seen right now.
不是 他们刚给我扎了一针
No, they just stuck me with a needle.
我不知道
I don't know.
你要跟他们通话吗
You wanna talk to them?
他们现在有点忙
They're kind of busy right now.
我知道
I know you are.
第二组输液打上了
Second IV's in.
我没有反应过度 是我的身体反应过度了
No, I'm not overreacting. My body's overreacting.
拜托…拜托不要解雇我 我…
Please--please don't fire me. I--
我是迈克尔罗宾纳维奇医生
This is Dr. Michael Robinavitch.
我是匹兹堡创伤医疗中心急诊部主管
I am the chief of emergency medicine at PTMC.
如果你解雇她 她会告你 而我会为她出庭作证
If you fire her, she will sue you, and I will testify on her behalf.
好了
OK.
别担心 我们支持你
Don't worry about it. We got you.
你知道杰克逊要睡多久吗
Do you know how long Jackson's gonna be asleep?
很难精准预测 我们给他的镇静剂何时会失效
So there's no exact timeline with the sedatives we gave him,
但他应该快醒了
but he should be awake soon.
你跟父母联♥系♥过了吗
Have you spoken to your parents yet?
是的 他们正从哥伦布往回赶
Yeah, they're on their way back from Columbus.
也许你应该在他们抵达前 好好休息一下
Maybe you should take some time for yourself before they arrive.
是啊 餐厅就在走廊尽头
Yeah, cafeteria's right down the hall.
烤奶酪很好吃 别碰金枪鱼
Decent grilled cheese. Stay away from the tuna.
谢谢 但我不饿
Thanks, but I'm not hungry.
我只是不敢相信 一个学校保安竟然电击了我哥哥
You know, I just can't believe that a campus security guard tased my brother.
他们不是应该帮助学生
Aren't they supposed to be helping students
保护他们吗 怎么能对他们下手呢
and protect them, not shoot at them?
你完全有理由生气
You have every right to be upset,
而且绝对应该追究责任
and you should absolutely pursue accountability.
但现在 我们会照顾好你的哥哥
But right now, we are taking care of your brother.
你应该好好照顾自己
And you should really take care of yourself.
我有你的号♥码
I--I have your number.
杰克逊的腰椎穿刺结果出来了 或是他醒过来了
I'll text you as soon as Jackson's LP results get back
我会立刻给你发信息
or if he wakes up.
好吧
OK.
好吧 谢谢你们 - 不客气
OK, thank you. - Of course.
肠鸣音偏低
Hypoactive bowel sounds.
腹部柔软 左下腹中度压痛
Soft, with moderate tenderness in the left lower quadrant.
兰道夫太太 你每天都吃扑热息痛吗
Mrs. Randolph, do you take Percocet every day?
不是
No.
那你的饮水量呢 因为…
And what about your water intake, 'cause--
打住
Pause.
兰道夫太太 你刚才说 你不是每天都吃扑热息痛
Mrs. Randolph, you said you don't take Percocet every day,
你上一次吃是什么时候
but when was the last time you took some?
上周可能吃了三四次吧
Maybe three or four times last week.
养老院举办了一场交谊舞比赛
Assisted living had a ballroom dance competition,
我不小心闪了腰
and I tweaked my back.
还有别的问题吗 奥吉尔维
Any further questions, Ogilvie?
你上一次排便是什么时候
When was your last bowel movement?
我不知道 大概是上周吧
I don't know. Sometime last week.