匹兹堡医护前线（2025）

The Pitt S01E05

Part 1 March 11, 2025, 8:29 p.m.

匹兹堡医魂
第一季第五集

你送检了吗
You sent labs?
没有迹象生命体征正常神经检查正常
No indication. Normal vitals, normal neuro exam.
这家伙突然就昏过去了毫无预警
Dude just dropped--no warning.
（第五小时中午11点至12点）
哪个手术室能用 -创伤一室
What's open? - Trauma 1.
叫朗登或是任何有空的医生
Grab Langdon or whoever else is avail.
什么情况 -在候诊室突发癫痫
What have we got? - Seizure in chairs.
谢谢那边情况怎么样
Thank you. How is it out there?
一片混乱我们永远都赶不上进度
Chaos. We're never gonna catch up.
已注射劳拉西泮 -好的再加四毫克
Lorazepam's on board. - Okay, draw up another 4.
没有病历他好像没来过我们医院
Yeah, no history. Doesn't look like he's been here before.
每分钟5升输氧的情况下血氧饱和度90多
Satting low 90s on 5 liters.
再加四毫克 -我无法把盖子取下来
Another 4 milligrams. - I can't get the top off.
只取掉塑料就行不用管金属 -我知道
It's just the plastic, not the metal. - No, I know. I know, I know.
来给我
Here, give it to me.
不用我弄好了 -好的
No, I got it. - Okay.
开全血计数全套代谢功能检查和导尿管取尿样做毒理检查
Ordering CBC, CMP, and a straight cath for a urine tox.
正在注射第二轮四毫克劳拉西泮
All right. Pushing the second 4.
如果还没用我们就得准备开浦兰了
If this doesn't work, we need to prep Keppra.
不我们加大劳拉西泮的剂量我已经下了订单
No, we'll give more lorazepam. It's already ordered.
已经给他注射了八毫克他会停止呼吸的
He's already had 8 milligrams. He'll stop breathing.
那我们就插管有些病人需要多一点剂量
Then we'll intubate. Sometimes a patient needs a little more.
他抽搐多久了 -大约四分钟
How long has he been seizing? - About four minutes ago.
他在候诊室癫痫发作的已经给他注射了八毫克劳拉西泮
He started seizing in chairs. He's already had 8 of lorazepam.
我想改用开浦兰但朗登医生不同意
I want to move on to Keppra, but Dr. Langdon disagrees.
只是想在换药前再加两毫克试试
I just want us to try another 2 milligrams before moving on.
朗登医生的病人朗登医生说了算
Dr. Langdon's patient, Dr. Langdon's call.
丹尼斯维塔克这位是鲍勃查森
Dennis Whitaker, meet Bob Chazen,
一位53岁的自行车运动员 10天前在犹他州旅行时腿受伤
a 53-year-old cyclist who injured his leg about ten days ago on a trip to Utah.
我当时在摩押快速下坡时腿被踏板卡住了
I was in Moab, coming downhill fast, and jammed my pedal into my leg.
哎哟你这车骑得挺暴♥力♥啊
Ouch. That's some gnarly road rash.
白辕小道
White Rim Trail.
我每天涂好几次消炎软膏
I've been putting Neosporin on it a couple times a day,
但现在走路都疼
but now it hurts to walk.
你怎么看维塔克
What do you see, Whitaker?
伤口从外面看好像有蜂窝组织炎
Outside of the wound looks cellulitic.
那是什么 -细菌感染
What's that? - It's a bacterial infection.
我们需要给你口服抗生素
We'll need to get you on oral antibiotics.
猜到了 -伤口的中心呢
Figured. - What about the center of the wound?
只是简单的血肿
It's a simple hematoma.
你现在可以清创了
Which you can now debride.
维塔克会去除覆盖水泡的死皮
Whitaker will take off the dead skin covering the blister
以帮助它愈合
to help it heal better.
我马上回来 -我有个小问题
I'll be right back. - Yeah, quick question.
拿些鸢尾花剪刀有齿钳和无菌纱布
Get some Iris scissors, toothed forceps, sterile gauze.
不只是…
No, it's just...
水泡男认真的吗
Blister guy? Really?
查森先生按顺序就是下一位病人 -我知道我之前搞砸了
Mr. Chazen was the next patient on deck. - I know I screwed up earlier.
你没有搞砸病人死了这种事常有
You didn't screw up. The patient died. It happens.
只是别截肢查森先生的腿
Just don't amputate Mr. Chazen's leg.
好吧嘿
Okay. Hey.
再加两毫克劳拉西泮
Another 2 of lorazepam.
合计十毫克了 -我知道
For a total of 10. - I'm well aware.
他还在抽搐
He's still seizing.
呼叫呼吸科我要准备插管托盘了
Call respiratory. I'm setting up an intubation tray.
他不需要插管
Which we won't need.
桑托斯医生癫痫持续状态的定义是什么
Dr. Santos, what is the definition of status epilepticus?
癫痫发作持续超过五分钟
A seizure lasting more than five minutes
或反复癫痫发作且两次发作之间意识未完全恢复
or at least two seizures without full recovery in between.
很棒
Excellent.
癫痫发作停止了 -也非常棒
Seizure activity has stopped. - Also excellent.
自主呼吸潮气量良好
Spontaneous breathing, good tidal volume.
血氧饱和度上升到98 -欢迎回来马里诺先生
Sats up to 98. - Welcome back, Mr. Marino.
现在我们可以缓慢安全地给他使用开浦兰了
Now we can do a Keppra load slowly and safely.
干得好朗登医生如果你需要我我会在中心区
Nice work, Dr. Langdon. I will be at Central if you need me.
这个药瓶肯定有问题八毫克应该足够的
This must have been a bad vial. 8 milligrams should have worked.
根据你的急诊教科书
According to your textbook of emergency medicine.
有时候病人需要更多剂量你会慢慢学到的
But sometimes they need a little bit more. You'll learn that with time.
但为什么我打不开瓶子 -因为你是实习生
Well, why couldn't I open the vial? - Because you're an intern
你也需要学会信任你的资深住院医师
who also needs to learn to trust her senior resident,
尤其是在主治医生面前
especially in front of an attending.
现在去查一下化验结果照看他直到他去做CT
Now check his labs, babysit him until he goes to CT,
再拿些毯子放在这些围栏上以防他再次发作
and get some blankets on these side rails as a seizure precaution.
会疼吗
Is this gonna hurt?
不会皮肤已经坏死了你什么感觉都不会有
Oh, no. Skin's dead. You won't feel a thing.
你是第一次去摩押吗
First time in Moab?
不是我是俱乐部的日常就是骑车和啤酒
No, no. I belong to a club, Gears and Beers.
我们是从疫情期间开始去弗里克公园骑车的
We started riding to Frick Park during the pandemic--
只是为了走出家门
you know, just something to do to get out of the house.
但我们都坚持了下来现在我们会一起骑车旅行
But we all stuck with it, and now we go on biking trips.
做点什么伙计
Help! Do something, man!
伙计
Dude!
我这里需要帮助天啊
I need a little help here! Jesus!
嘿怎么了
Hey. What's up?
血泡下的动脉往外喷血 -我看看
Arterial pumper under a blood blister. - Let's see.
天啊 -天啊
Jesus! - Oh, God.
菜鸟
Noob.
你好我是金医生我们能解决这个问题
Hi, I'm Dr. King. We can fix this.
你切到动脉了吗
Did you cut an artery?
没有我刺破了血泡的顶部
No, no. I punctured the top of the blood blister,
但下面藏着动脉
but there was an artery hiding under there.
藏着你不知道它在那里吗
Hiding? Like you didn't know it was there?
你们不需要知道基本的解剖学知识才能成为医生吗
Don't you have to know basic anatomy to become a doctor?
他是个医学生
He's a student doctor.
搞什么学生
What the fuck? Student?
不是吧不行你能帮我吗你能弄好它吗
Oh, hell, no. No, no, no. Can you help me? Can you fix it?
当然可以
Oh, absolutely.
首先我们要戴上这个血压袖带来止血
First, we are going to put this BP cuff on to stop the bleeding.
往前一点就是这样
A little forward. There we go.
好了你可以松手了 -是吗
All right, you can let go. - Yeah?
谢天谢地 -谢天谢地
Thank God. - Oh, thank God.
好了维塔克 10毫升的1%利多卡因和肾上腺素
All right, Whitaker, 10 ccs of 1% lidocaine with epi.
好的
Yep.
我们要给你打♥针♥麻醉这个区域并收缩血管
The shot is gonna numb the area and also constrict any blood vessels
这样我们就能缝针了
so that we can put a little stitch in there.
这里发生了什么事
What happened in here?
血泡下隐藏的动脉撕裂
Hidden laceration of an arteriole under the vesicle.
血压袖带加到180成功止血
Bleeding stopped at 180 on the BP cuff,
我们现在要注射利多卡因和肾上腺素
and we are now injecting lidocaine with epi.
谢谢你金医生准备一个3-0尼龙线的缝合托盘
Thank you, Dr. King. Let's set up a suture tray with 3-0 nylon.
好的你会有针♥刺♥感和灼烧…
Okay. A pinprick and some burning--
医生你能代劳一下吗
Doc, Doc, can you step in here, please?
你可以的维塔克
You got this, Whitaker.
电视上正在直播救护车追逐
That ambulance chase is on live TV.
哪个频道 -每个频道
What channel? - Every channel.
你觉得那辆救护车会撞到多少辆车
What do you think the over-under on clipped cars should be?
十五辆
15.
来击掌
Come on.
我可以把它放到候诊室的电视上吗
Can I put it on the TVs in the waiting room?
我没意见我只希望不管结果如何那辆车别在我们的服务区内就行
Fine by me. I just hope wherever it ends up, it's out of our catchment zone.
能聊一会吗 -从来都不止一会儿但你说吧
Got a second? - It's never a second, but shoot.
我觉得我们给上一个病人用的劳拉西泮药瓶有问题
I think there was an issue with a vial of lorazepam used on our last patient
应该向制药厂报告
and it should be reported to the drug manufacturer.
什么问题
What kind of issue?
瓶盖很难摘下来就像被焊死了一样
The cap was really hard to take off, almost like it was super-sealed shut.
我担心这会是一个更大的问题 -比如
I'm worried it could be a bigger issue. - Like?
也许在运输过程中温度没有控制好
Like maybe the temperature wasn't properly controlled during transportation
导致瓶子上的封条融化了
and the seal on the vial melted shut,
这可能意味着药物被污染了
which could mean the medication is compromised.