匹兹堡医护前线（2025）

Surgery not needed.
太好了 我能回到游♥行♥队伍了
Excellent. I can get back to the parade.
不行 我们还是得给你缝针 并固定手腕
No, we'll still need to stitch you up and splint your wrist.
输注一克头孢唑林
Hanging a gram of Ancef.
等一下 他对青霉素过敏
Wait, he has a penicillin allergy.
PEN-FAST评估阴性 没问题的
No, PEN-FAST was negative. We're OK.
我妈说我小时候吃阿莫西林起过疹子
My mom said I got a rash with amoxicillin when I was two.
是啊 可能不是真的过敏 给他打上吧 金
Yeah, probably not a true allergy. Go ahead and give it, Kim.
但还是备一点肾上腺素和苯海拉明吧
But have epi and Benadryl standing by, right?
行 以防万一
Yes, to be on the safe side.
大部分认为自己对青霉素过敏的人 其实并不过敏
Most people who think they have a penicillin allergy actually don't.
永远要听护士的话 他们掌管急诊
Always listen to the nurses. They run the ER.
我们只要尽量别碍事就行了
We just try and stay out of their way.
现在我们可以正式开始清理了
Now we can really clean him up.
我们不是已经清理过了吗
Didn't we already do that?
面部 颈部和手上干掉的血迹
Dried blood on the face, neck, hands.
不论谁过来 都不应该看到血迹
If anyone comes, they shouldn't have to see that.
有时可能是本地流浪汉来探视
Sometimes the local unhoused folks will pay a visit,
但我们也要把遗容整理得体面些 以防有人来
but we always make them presentable in case anyone comes.
这是我们能为他们做的最后一件事了
That's the last thing we can do for them.
在新冠疫情期间我们没那个机会
Didn't get to do that during COVID.
等他被收拾得干净整洁后 我们会给他盖上被子
Once he's spotless, we'll tuck him in nice and tight,
但要留一只胳膊在外面
but we always leave one arm outside the sheet.
为什么
Because?
这样亲朋好友能握着他的手
So loved ones can hold their hand.
那个癌症妈妈罗克茜可以出院了
We're ready to discharge our cancer mom, Roxie.
救护车马上就到 只需要核对一下她在家里的用药清单
Ambulance is on the way; we just need to reconcile her home meds.
嘿 我就说我看到了另一位护士长
Hey, I thought I saw another charge nurse around here.
是啊 我们是成群结队的 - 你还没受够这地方吗
Oh, yeah. We travel in packs. - Aren't you sick of this place yet?
有人迫不及待去休假了 - 被你发现了
Oh, someone is ready for his sabbatical. - Guilty as charged.
嘿 我刚接到消息 家用吗♥啡♥泵会延迟配送
Hey, I just got word that the at-home morphine pump is gonna be delayed.
医院药房♥需要配制 然后晚点送过去
Hospital pharmacy has to mix it and then deliver it later today.
我们要一直把她留到那个时候吗
Well, should we keep her here until it's ready?
不用 你可以给她吃一片 200毫克硫酸吗♥啡♥缓释片
No, you can give her a 200-milligram tablet of MS Contin.
200毫克
200 milligrams?
这是最大含量的
Biggest pill they make.
针对阿片类耐药患者 12小时长效释放
Releases over 12 hours for patients with opiate tolerance.
明白了
Got it.
嘿 你要多待一会吗
Hey, do you want to stick around a little bit?
西桥纪念医院因为内部灾难 暂时关闭了
Westbridge is closed to internal disaster.
他们的病人都转过来了 - 是啊 我听说了
We're getting all their runs. - Yeah, I heard.
我赌20块是下水问题
I put 20 bucks on a plumbing issue.
我刚看了那个《粪便邮轮》的纪录片
I just watched that poop cruise documentary.
我满脑子都是那个画面
Oh, I cannot stop thinking about it.
光听这描述 我这辈子都不会看
That sounds like something I will absolutely never watch.
罗比医生
Dr. Robby,
大约一小时前 你送来了一位 氯氮平致肠梗阻患者
you gave us a clozapine ileus about an hour ago.
你的住院医生说没有手术史
Your resident reported no surgical history,
但病历显示患者做过阑尾切除手术
but the chart says they've had an appendectomy.
没有外科会诊 我们不能收治这个患者
We're not admitting the patient without a surgery consult.
是哪个住院医生 - 崔妮蒂·桑托斯医生
Who called it in? - A Dr. Trinity Santos.
桑托斯医生
Dr. Santos,
你之前有个肠梗阻病人
you had an ileus patient.
你漏报了阑尾切除病史
You neglected to mention a history of appendectomy.
那名患者没做过阑尾切除术
There was no history of appendectomy.
你在备注里写了
It was in your note.
我可能忘记校对了
I may have forgotten to proof check it.
我在用阿尔-哈希米医生建议的应用
I was using the app that Dr. Al-Hashimi suggested
补病历 - 好极了
to catch up on my charting. - Wonderful.
阿尔-哈希米医生 - 有事吗
Ah, Dr. Al-Hashimi. - Yes?
桑托斯医生在用你的AI工具写病历
Dr. Santos was just using your AI tool for her charting,
结果它凭空编造了阑尾炎病史
and it hallucinated a history of appendicitis.
正如我对桑托斯医生所说 生成式AI并不完美
As I mentioned to Dr. Santos, generative AI is not perfect.
每一份生成的病历仍然需要人工校对
We still need to proofread every chart it creates.
患者还有头痛史
Mm-hmm, the patient also has a history of headache,
由泌尿科朴医生随访
followed by Dr. Park from Urology.
那大概率是神经科
That should probably be Neurology.
除非泌尿科医生也开始治偏头痛了
Unless urologists are now treating migraines.
另一个本应在人工校对时修正的错误
Another example that should have been caught by proofreading.
AI虽有2%的错误率 但仍好过一字一句...
AI's 2% error rate is still better than dictation.
老实说 我根本不在乎 你们用不用机器人
Yeah, I don't really give a shit whether or not you want to use robots down here.
我需要准确无误的医疗记录
I need accurate information in the medical record.
明白 - 好的
Understood. - OK.
桑托斯医生
Dr. Santos.
桑托斯医生
Dr. Santos!
听到了 绝不再犯
Yup. Won't happen again.
把这个喝了
Hoy.
谢谢 波拉
Thanks, Perlah.
还有六个小时 你能行的
Six hours to go. You got this.
当伤口裂到这种程度
When a wound is gaping like this,
你要通过皮内缝合拉近伤口边缘
you want to use sub-Q to bring the edges together.
有很多皮肉要缝合啊
A lot of meat to close.
如果我们只做简单的伤口缝合 会怎样
What would happen if we just did a simple wound closure?
十天后拆线时 伤口会崩开
You take the stitches out in ten days, the wound opens, dehisces.
没错 所以我们在皮下用哪种缝线
Exactly. So what suture do we use under the skin?
薇乔线能提供一个月的支撑力 两个月吸收
Vicryl provides support for a month. It takes two months to dissolve.
所以 表皮用5-0尼龙线 皮下用4-0薇乔线
So 5-0 nylon on the skin. 4-0 vicryl under the skin.
我会用3-0薇乔线
I'd go with a 3-0 vicryl.
你这么想 - 毫无疑问
You think? - Most definitely.
唐尼是伤口缝合大♥师♥
Donnie is the master of wound closure.
我在分诊每天至少 要做十个缝合 所以...
I do at least ten lacs a day out at triage, so...
能让我们见识下你的皮内缝合术吗
Can we see your sub-Q?
请便吧
Be my guest.
那我就露一手吧
If you insist.
所以...
So...
秘诀是要确保
The secret is to be sure
伤口两侧的进针点和出针点
your entry point and exit point on both sides of the wound
与另一侧的深度一致
matches the depth on the other side.
第一针要下得深
Start deep.
从真皮层穿出
Come up at the dermis.
大针距有助于组织闭合
Big bites help the tissue close.
另一侧镜像操作
It's a mirror image on the other side.
由浅入深
Superficial to deep.
顺便把线结埋进去了 - 没错
So you bury the knot. - Bingo.
避免疤痕处有凸起
Avoids bumps on the scar line.
打三个结 不是四个
Three ties, not four.
很漂亮
Yeah, that's beautiful.
然后剪短线头 别剪太短
And then you cut it short. Not too short.
我习惯把剪刀滑到线结处
I like to slide my scissors down on the knot,
旋转45度再剪断
then rotate up 45 degrees before I cut.
还需要两个皮内缝合
Could use two more sub-Qs,
一个上面 一个下面
one above, one below.
你们来试试吧
Have at it.
纹身挺帅的
Interesting ink.
有什么特别寓意吗
Do they mean anything?
这个...
This,
意思是死亡和混乱
this is "death and chaos,"
这个意思是奇迹和祝福
and this is "miracles and blessings."
这个是我在匹兹堡音乐节 枪击案之后纹的
Got this one after the PittFest shooting,
而这个
and I got this
是我女儿出生后纹的
after my daughter was born.
把轮床床头抬高 好让人们能看到他
Put the head of the gurney up so people can see him,
但别抬得太高 免得头歪向一侧
but not so high that his head flops to the side.
你觉得如何 - 他看上去很安详
What do you think? - He looks peaceful.
这份工作最难的部分是什么
What's the hardest part of this job?
这份工作出力不讨好 干久了挺难受的
It's pretty thankless, and that can be tough.
你看过职业倦怠率吧 学校肯定教过你们
You've seen burnout rates. I'm sure they teach you that in school.
我的好友们在新冠后都离开这一行了 有些疫情期间就不干了
All my closest friends left after COVID. Some during.
我不怪他们
But I don't blame them.
他们得为自己的精神健康着想
They needed to do what was best for their mental health.
很多人都崩溃了