匹兹堡医护前线（2025）

The Pitt S01E02

Part 7 March 11, 2025, 8:29 p.m.

Resume compressions, amp of epi.
慢点节奏慢点 - 要插管吗
Slower, slower tempo, slower tempo. - Should I intubate?
不用给他戴上喉罩我们不能暂停按压
No. Drop an LMA. We don't want to hold compressions.
瞳孔没活动扩张了
Pupils are fixed and dilated.
他已经昏迷很久了
He's been down a long time.
这里情况如何
How we doing in here?
好多了
So much better.
莫汉医生这是我妻子奥丁
Dr. Mohan, this is my wife, Ondine.
我是萨米拉莫汉医生很高兴认识你奥丁
Dr. Samira Mohan. Nice to meet you, Ondine.
谢谢你帮了她 - 不客气
Thank you for helping her. - Of course.
我要再次为你刚来时受到的待遇感到抱歉
And, again, I'm so sorry about how you were treated when you first arrived.
不是每个在这里工作的人都了解如何处理镰状细胞病
Not everyone who works here is accustomed to dealing with sickle cell.
从现在开始我们会竭尽全力治疗乔伊斯
We will be doing everything possible from here on in to manage Joyce's crisis.
与此同时你想喝点什么吗
In the meantime, can I get you anything?
我不用了 - 奥丁
I'm fine. - Ondine?
不用了谢谢
No, thank you.
好的有需要的话叫护士来找我
OK. Well, have the nurses come find me if you need anything.
缓慢地深呼吸伊恩
Take slow, deep breaths for me, Ian.
他们约了雾化器 5毫克沙丁胺醇 125毫克甲强龙
They ordered a neb, 5 albuterol, 125 solumedrol.
好的盯紧他然后问问朗登医生的意见
All right. Keep an eye on him and present to Dr. Langdon.
好的 - 好的很好
OK. - OK, great.
等他安顿好我们分诊处见
I'll see you back in triage once he settles down.
好的
Yeah.
我们把这个摘掉
OK, let's take this off.
好的坚持住伊恩这应该能缓解你的哮喘
All right, hang in there, Ian. This should really help your asthma.
有什么能帮你的亲爱的 - 我在找朗登医生
How can I help you, hon? - Um, I'm looking for Dr. Langdon.
好的我看看他在哪
Yeah, let me see where he is.
朗登医生中心区有个医学生找你
Dr. Langdon, we have a med student at Central looking for you.
收到他往这边来了 - 谢谢
Copy that. He's headed this way. - Thanks.
嘿宕机女孩你错过了一个很酷的筋膜切开术
Hey, Crash. You missed a pretty cool fasciotomy.
我不觉得筋膜切开术有多酷
I'm not sure I'd be describing a fasciotomy as cool.
如果是你做的那就不一样了
You would if you were the one who did it.
到达休息室情况怎么样
How's it going out in the arrivals lounge?
你认识麦凯医生吗
Do you know anything about Dr. McKay?
我刚到这里不到两小时
I've been here for less than two hours.
我谁都不认识包括你
I don't know anybody, including you.
我以为你是什么天才儿童呢
I thought you were some kind of kid genius.
我和其他三年级医学生没什么不同
I'm like any other third-year med student.
很明显
Clearly.
嘿我只是想找个话题闲聊不是要惹你不高兴
Hey, I'm just trying to break the ice. I'm not trying to annoy you.
但你还是叫我宕机女孩我明确说过不喜欢
And yet, you're still calling me Crash when I asked you not to.
不是吧你还在纠结那个 - 还在纠结
Really? You're still on that? - Still on that.
好吧我道歉
Yep. OK, sorry.
我不知道天才都这么敏感
I had no idea genius was so sensitive.
但我知道了
But I get it.
脑容量大情感也丰富
Big brain, big feelings.
完全说得通我会试着温柔点
Makes total sense. I'll try to be softer.
(二十美元赌她们中的一个在轮班结束前会被扇巴掌)
(我觉得那个年轻的比看上去更不好惹)
我们每隔几分钟就换一次你可以休息一下
We switch out every few minutes. You can take a break.
我没事 - 暂停按压
I'm fine. - Hold compressions.
仍然没有心跳 - 恢复按压
Still in asystole. - Resume compressions.
我们要电击他吗 - 没心跳不能电击
Should we shock him? - You don't shock asystole.
可能是间歇性心跳 - 不可能
It could be fine v-fib. - Not a chance.
好吧他上一次注射肾上腺素是什么时候
OK. Uh, when was his last epi?
三分钟前
Three minutes ago.
好吧高级心脏生命支持指南说每三到五分钟注射一次对吗
OK. Well, ACLS says every three to five minute, right?
所以我们再来一轮吧
So let's push another round.
好吧 - 罗比
Fine. - Robby,
斯宾塞先生的成年子女找你
Mr. Spencer's adult children are asking for you.
还有尼克布拉德利的父母那个芬太尼用药过量的孩子
And the parents of Nick Bradley, the fentanyl overdose,
也想和你谈谈 - 好的
also want to speak with you. - OK.
三轮肾上腺素然后就宣布死亡时间吧
Three rounds of epi and then call it.
斯宾塞先生爆了BiPAP面罩吸入压25 呼气压10
Mr. Spencer's maxed out on BiPAP, 25 on 10.
血氧饱和度呢 - 不是很好最高80左右
Sats? - Not great, High 80s.
嗨我听说你们找我
Hi. I heard you wanted to talk to me.
是的警报一直响
Yeah. That alarm kept going off.
是啊我们出去说吧
Yeah. Why don't we step outside?
警报是因为低氧
The alarm is for low oxygen.
他需要更多BiPAP吗
Does he need more of that, um, BiPAP?
恐怕这已经是极限了所以你们现在要决定...
I'm afraid that's as high as we go. So the decision at this point is--
我们想让你给我们的父亲上呼吸机
We want you to put our father on the breathing machine.
即使这违背了他不插管的意愿
Even though that goes against his desires to not be intubated?
我们还没准备好放手
We're not ready to let go yet.
如果你们的父亲准备好了呢
And if your father is?
他是个固执的混♥蛋♥
He was a stubborn son of a bitch
他永远不会放弃我们中的任何一个
who would never have given up on either of us.
我们也不会放弃他
We're not giving up on him.
在我跟你说了这么多之后
You're absolutely certain you want
你确定要让你父亲承受这一切吗
to put your father through this after everything I've told you?
我可能得遵照他的事前指示
I may have to honor his advanced directive.
不行你得遵照我们的医疗照护永久委托书
No, you have to honor our durable power for health care.
否则我们会找你们医院律师谈
If not, we can talk to your hospital attorney.
杰里米你也同意吗
Jereme, you're on board with this?
是的
Yeah, I guess so.
好吧你们可以陪着他我们去做准备
OK. You can sit with him until we're ready.
需要多久 - 很快
And when will that be? - Momentarily.
别告诉我你要给那个可怜的人插管
Please don't tell me you're going to intubate that poor man.
这是家人的决定 - 那又怎样他们想折磨他吗
It's what the family wants. - So what? They want to torture him?
我都解释过了
I explained all that.
如果我也签字你就能推♥翻♥他们的永久委托
If I co-sign, you can override their durable power.
他们威胁说要去找医院的律师
They're threatening to go to the hospital attorney.
让他们去吧打给道德委员会他们会站在我们这边
Let them. Call the Ethics Committee. They'll agree with us.
不你也许是对的但我们没有那么多时间
No, no, you're probably right. But we don't have that kind of time.
我们被困住了
We are stuck.
你在说什么 - 该死
What are you talking about? - Shit.
怎么了 - 我得去告诉那对父母
What? - I got to go tell those parents
他们18岁的儿子脑死亡了
their 18-year-old son is brain-dead.
要我跟你一起去吗 - 不没关系
Want me to come with you? - No, It's OK.
你打算怎么说 - 我会说虽然希望渺茫
What are you going to say? - I'm going to say that it's likely,
但我们还需要做呼吸暂停测试和大脑血流灌注研究
but we still need to do an apnea test and a cerebral perfusion study.
已经没有脑神经活动了
There's no cranial nerve activity.
他们需要一些希望
Those people need some hope.
虚假的希望 - 虚假的希望也是希望
False hope. - Hope is hope.
是吗我们今天要祈祷奇迹发生吗
Is it? What, are we praying for miracles today?
他们需要时间来消化才能接受正在发生的事情
They need time to process before they can accept what's happening.
你考虑过接受这个建议吗
You ever consider taking that advice?
医者自医
Physician, heal thyself.
你没有病人吗
Don't you have patients?
不昏迷的人也有醒来的你可以叫醒他
No, no, no, no, no, no. People wake up from comas. You can wake him up.
你可以的你可以电击他
You can do that. You can--you can shock-- you can-- you can shock him back.
尼克
Nick.
嘿
Hey, hey, hey.
你要醒过来啊尼克
Hey, hey, hey, hey, hey. Nick.
拜托了不要这样
Please, no!
没有变化
No change.
没有心包积液没有张力性气胸
No pericardial effusion, no tension pneumothorax, no cardiac activity.
没有心脏活动
no cardiac activity.
试试钙剂可能是高血钾症
Try calcium. Could be hyperkalemia.
不是他的钾含量正常
No, his potassium was normal.
准备好宣布时间了吗 - 还不行
Ready to call this? - Not yet.
罗比医生说三轮肾上腺素到时间了我们再推一次
Dr. Robby said three rounds of epi. It's time. Let's push another amp.
这次或许有用
This one could do it.
加油啊
OK.