匹兹堡医护前线（2025）

The Pitt S01E01

Part 3 March 11, 2025, 8:29 p.m.

Jesus. - Yeah.
这可能是一起仇恨犯罪
Could be looking at a possible hate crime.
我猜你现在有空了
I take it you're free now?
我们需要谈谈你的数据 - 我们救过的人数
We need to talk about your numbers. - Of people we've saved?
考核数值
Metrics.
我们的入院至球囊扩张时间超过了联邦标准
Our door-to-balloon times beat federal standards.
我说的是普雷斯甘尼分数
I'm talking about Press Ganey scores.
病人满意度
Patient satisfaction.
如果他们还活着他们应该很满意
If they're still alive, they should be satisfied.
我们的目标是36%的病人对照护非常满意
Our goal is 36% very satisfied with their care.
你们部门是8%
Your department is at 8.
你知道病人愿意推荐这家医院的分数是多少吗
Do you know how likely patients are to recommend this hospital?
这是急诊室不是塔可钟
This is an emergency department, not a Taco Bell.
11%
11%.
如果你希望人们更快乐不要让他们等12个小时
Well, if you want people to be happier, don't make 'em wait for 12 hours.
全国都面临护理人员短缺的问题
There's a nursing shortage across the country.
我们大部分的病人都是等楼上♥床♥位的住院患者
Most of our patients are boarders who are waiting for a bed upstairs.
我们没有床位 - 胡说八道楼上明明就有
We don't have the beds. - That's bullshit. The beds are up there.
你只是不想雇用额外的员工去照顾他们
You just don't want to hire the staff you need to care for them.
医生这不管用
Oh, Doc. Doc, it ain't working.
不管他们给我什么都不管用
Man, whatever they're giving me, it's not working.
对柠檬酸盐没有反应我应该用辉力灌肠剂吗
No response to mag citrate. Should I send in the Fleet?
好的先生我们要试试灌肠
OK, sir, we're gonna try an enema.
就像我说的护理人员短缺
Like I said, there's a nursing shortage.
如果你付给他们足够生活的工资他们会排着队来这里应聘
Well, if you paid them a living wage, they'd be lining up to work here.
我们的预算不足以支撑 - 一个肮脏的小秘密
Our budget can't support that. - Here's a dirty little secret.
医院为了省钱让病人待在匹兹堡
The hospital saves money keeping patients down here in the Pitt.
我们这比楼上的人手要便宜得多
It's way cheaper than staffing upstairs.
我一再要求你别再把急诊室称为“匹兹堡”
I have asked you repeatedly to stop referring to the emergency department as the Pitt--
这是自我贬低而且不符合医院形象
it is derogatory and incompatible to the institution's image.
你知道什么与医院形象不符吗
You know what's incompatible with the institution's image?
我去和媒体聊聊在候诊室里死去的人
Me speaking to the media about people who code in our waiting rooms
在走廊里被糟糕对待为了一个重症监护室床位要等上好几天的人
and people who get shitty care in our hallways waiting for an ICU bed for days.
我听说有医生尝试过
I've heard about doctors who have tried that
结果发现自己失业了
and find themselves out of work.
我知道今天对你来说很难 - 这里的每一天都很艰难
I know today is difficult for you. - Every day is difficult down here.
住院难是一个全国性的问题
Boarding is a nationwide problem.
你的前任亚当森肯定知道这一点
Your predecessor, Adamson, sure as hell knew that.
难道他没教你吗 - 该死哇认真的吗
Or wasn't that something he taught you? - Fuck. Wow. Really?
是的认真的
Yes, really.
其他医院正在更有效地处理这个危机
Other hospitals are managing this crisis much more effectively.
所以要么给我打起精神来要么让开
So you can either step up your game, or you can step aside.
那个好心人左静脉有短暂性出血
Good Samaritan dude has a small left temporal intraparenchymal bleed.
没有硬膜外硬膜下和脑中线偏移
No epidural, no subdural, no midline shift in the brain.
这是好消息
Oh, that's good news.
他可能会康复 - 五分钟后可以做CT
He could recover. - CT can take her in five.
我们来看一下绷带剪刀 - 好的
Let's have a look. Bandage scissors? - All right.
如果动脉完全横断平滑肌和中膜层
If an artery is totally transected, the smooth muscle
会随着止血而收缩
and the tunica media contracts with hemostasis.
但如果是部分横断拿好雨伞
But if it's a partial cut, get out your umbrella.
在复位前从开放腓骨中提取培养物
Grab a culture from the open fibula before you reduce.
你来吧
You're up.
我会稳定住膝盖帮助你们复位
I'll stabilize the knee for the reduction.
朗登医生在向内侧移♥动♥清除胫骨之前会向远端牵引
Dr. Langdon will be distracting distally before moving medially to clear the tibia.
很好准备好了吗
Good. Ready?
一位医学生晕倒了
Med student down.
多亏了你酒吧大战比利捡了条命
Good catch on Bar Fight Billy.
胸部X光片上有一颗牙掉进了气管
There was an aspirated tooth on chest X-ray.
如果你让他出院的话他已经死于肺脓肿了
Would have been dead in a week from a lung abscess had you let him be discharged.
也多亏了你给他做了肺部检查 - 心脏骤停患者预计十分钟后到
Good call on the pulmonary. - Cardiac arrest, ETA 10 minutes.
要放在哪里 - 随便什么地方都行
Where should we put it? - Anywhere.
我们可能得让一个患者去走廊了
We might have to put somebody in the hall.
罗比医生她晕倒了
Dr. Robby? She, uh, took a fall.
我是被轮床绊倒了我没事
No, I-- I tripped on the gurney. I'm fine.
你去员工休息室喝杯冷饮吧
Why don't you go get a cold drink in the staff lounge?
我没事真的我发誓 - 我知道但这是医院规定
I'm fine, really. I swear. - Oh, I know, but it's hospital policy.
哪怕是有人被纸割伤了
Anytime someone gets a paper cut around here,
我们也得填写一份员工补偿报告
we have to fill out a workers' comp report.
另一边
Other way.
我一直都好好的直到大约两周前我跑完罗切斯特马拉松
I was fine until about two weeks ago, after the Rochester Marathon.
好的有摔倒或受伤吗
OK. Any falls or injuries?
我只是觉得很累肌肉酸痛
Just tired. Sore muscles.
是啊要是我得卧床一个月这是你第一次参加铁人三项吗
Yeah, I'd be in bed for a month. Was this your first triathlon?
天啊不是我每隔几个月就参加一次
God no. No, I do one every few months.
你看过医生吗
Have you seen a doctor yet?
没有我今早去跑步了
Uh, no. I went for a run this morning.
一分钟后就气喘吁吁不得不停下
Had to quit after a minute. Pretty short of breath.
这个放在舌下
This goes under your tongue.
没有使用药物没有过敏史
No current meds, no allergies?
我们要做几项检查和心电图拿一个红色管子和一个紫色管子
We're gonna check a few labs and an EKG. Draw a red and purple top.
好的
Yep.
体温36.7摄氏度 - 深呼吸奥蒂斯
Temp 98.2. - Take a deep breath for me, Otis.
你只会感到一点轻微刺痛好吗
Little pinprick now, OK?
奥蒂斯我没想到他这么胆小
Otis? Otis. I didn't take him for a lightweight, huh?
该死没有脉搏了急救车让他平躺
Oh, shit. No pulse. Crash cart! Lay him flat!
检查下心跳 - 盐水垫
Let's check a rhythm. - Saline pads.
电击板观看心律
Quick look paddles.
室性心动过速
V-tach.
充电200焦耳已充电 - 清场
Charging at 200. Charged. - Clear!
好了他恢复正常窦性心律了我需要一个轮床
All right, he's back to normal sinus. Need a gurney in here!
有什么计划
So what's the plan?
送进重症监护室前提是我们能得到床位和辅助治疗
ICU when we can get a bed and admit for supportive care.
三小时后再做一次头部CT
Repeat head CT in three hours.
如果瞳孔扩大时间可以提前 - 需要开浦兰吗
Or sooner, if he blows a pupil. - Want a Keppra load?
已经开好了做得好
Order's already in. Nice job.
你觉得他会醒过来吗
Do you think he'll wake up?
也许吧也许不会
Maybe. Maybe not.
好人没好报
No good deed goes unpunished.
有人通知家属了吗
Oh, has anyone, um, notified the family?
我可以试试
I could try.
奥蒂斯威廉姆斯身体健康 31岁铁人三项两周后出现室颤心脏骤停
Otis Williams. Healthy 31-year-old. V-tach arrest two weeks after triathlon.
一次电击后恢复窦性心律
NSR with one shock.
脉搏98 高压110低压60 - 他这个年纪得心梗有点早了
Pulse 98, BP 110 over 60. - He's a little young for an MI.
没错柯林斯医生鉴别诊断怎么说
Exactly right, What's in the differential, Dr. Collins?
药物过量电解质异常长QT综合征布鲁格达综合征预激综合征
Drug overdose, electrolytes, long QT-- ooh, Brugada syndrome, WPW...
你怎么样奥蒂斯
How you doing there, Otis?
还好发生什么事了
OK. What ha--
再次室颤 - 200焦耳
V-tach again. - 200 joules.
已充电清场
Charged, and clear!
恢复窦性心律
Back in sinus.
奥蒂斯
Otis?
奥蒂斯
Otis?
呻♥吟♥良好 5个氧气鼻导管全血计数全套代谢功能肌钙蛋白和D-dimer
Oh, groaning's good. 5 of nasal O2, CBC, CMP, troponin, and D-dimer.
你在干什么 - 一克葡萄糖酸钙静脉注射
What are you doing? - One gram calcium gluconate, IV push.
化验结果还没出来呢 - 看看监控器
We don't have the labs back. - Look at the monitor.
QRS和PT宽波这是高血钾症
Widened QRS and PT waves. Hyperkalemia.
他怎么得上这个病的
How'd he get that?
激烈运动会导致肌肉分解横纹肌溶解症使他的肾脏衰竭了
Intense exercise caused muscle breakdown. Rhabdomyolysis knocked out his kidneys.
他的钾无法代谢出去我敢肯定已经超过7.5了
Now he's not clearing potassium. I bet it's over 7.5.
再等两分钟看下i-STAT数据
Wait two minutes for the i-STAT.
他已经心脏停跳了到时候可能就救不回来了
If he arrests again, we might not get him back.
万一是高血钙症你这么做会害死他的再等等
If it's hypercalcemia, you could kill him. Wait.
会担责的是我不是你
Oh, it's my ass, not yours.
水平扫描结果阴性也就是说你可以做骨科手术
Pan scan is negative. That means you can admit to orthopedics.
但如果她晕倒了可能有医学病因
But there may have been a medical etiology if she fainted.
那不需要手术
That's not surgical.
找内科会诊或者去内科住院再找骨科会诊
Get an internal medicine consult, or admit to medicine with ortho consulting.
不管怎样这病例不归我管了
Either way, I'm off the case.
好的谢谢你什么都没做 - 头孢唑林来了我去叫医生
OK. Thanks for nothing. - Ancef's in. I'll grab the gent.
我们弄清楚她说的什么语言了吗
Did we figure out what she's speaking?
前一个翻译认为她可能来自巴基斯坦