匹兹堡医护前线（2025）

The Pitt S01E05

Part 6 March 11, 2025, 8:29 p.m.

Induction with 75 of propofol, 100 rocuronium.
明白了
Got it.
为了以防万一我们还准备了探针和喉罩
For backup, we have a bougie and an LMA ready.
好的
Yep.
在我们开始之前有任何问题或担忧吗
Any questions or concerns before we start?
我想保持清醒
I wanna be awake.
我们不能那样做插管
We can't perform an intubation that way.
我是说之后
I mean after.
之后我们会减少你的镇静剂
After, we will lighten your sedation.
你没办法说话
You won't be able to talk,
但你可以用笔和纸或者用平板电脑交流
but you can use a pen and paper or an iPad to communicate.
我爱你
I love you.
直到时间的尽头
Till the end of time.
罗比马上去创伤二室 -你能做插管吗
Robby, Trauma 2 right now. - Cover the intubation?
当然
Of course.
发生什么事了
What happened?
他又吐♥血♥了 -已注射氯♥胺♥酮♥ 准备插管
Bleeder opened up. - Ketamine on board to intubate.
血氧饱和度97 -你能保证气道通畅吗
Sats holding at 97. - Can you get an airway?
来吧我们让他躺下
Come on. Let's lie him down.
压住结痂处
Keep pressure on the scab.
除了血什么都看不见看不到声带
Nothing but blood. Can't see the cords.
血氧饱和度94
Sats 94.
没有足够的空间放管子和海绵棒
Not sure we have room for the tube with the sponge stick.
如果我抽出来会有更多的血
If I pull out, there's gonna be even more blood.
看起来你没打开气道
Doesn't look like you secured that airway.
他正在努力 -探针
He's working on it. - Bougie.
打开一个切开术托盘消毒颈部
Open a crike tray and prep the neck.
等等我要用探针盲测也许能感觉到软骨环
Hold on, I'm going in blind with the bougie. I might be able to feel the tracheal rings.
我也许会和麦当娜三人行呢让开
And I might have a three-way with Madonna. Move.
不行加压 -给成年人腾出空间
Not happening. Pressure. - Make room for the grown-ups.
好的等一下我们可以试试反向插管
Okay, okay. Hold on, hold on. We can try a retrograde intubation.
什么 -没有障碍物
A what? - There's no obstruction.
我们只是看不见我们在做什么
We just can't see what we're doing.
我们拿一根针把它刺入环甲膜
So we take a needle, and we put it in the cricothyroid.
我们把导线从嘴里拉出来然后把导管连到导线上
We run a guide wire up and out the mouth, and we slide the ET tube up over the wire.
我没见过这么干的 -血氧饱和度90
Never seen one before. - Sats 90.
没时间在这个孩子身上玩麦克盖弗游戏了该切开了
No time to play MacGyver with this kid. Time to crike.
很快的 -你只有一次机会然后我就开刀了
It'll be quick. - You got one shot, and then I cut.
已注射异丙酚和罗库溴铵
Propofol and rock are on board.
现在我们等着镇静剂和麻痹剂开始起作用
Now we wait for the sedative and paralytic to start working.
罗比医生不是应该在这里吗
Should Dr. Robby be in here?
我和莫汉医生已经做过几百次这样的手术了
Between Dr. Mohan and myself, we've done hundreds of these.
我有点困了
I'm getting sleepy.
我就在这里宝贝
I'm right here, babe.
好了我进去了
Okay, I'm in.
导线
Guide wire.
当你开始感觉到它的时候告诉我
Let me know when you start to feel it up top.
还没有继续抽吸 -我在努力
Nothing yet. More suction. - I'm trying.
还是找不到
Still can't find it.
继续找一定在某个地方
Well, keep feeling in there. It's gotta be there somewhere.
快到了 -血氧饱和度降到89
Maybe it's curling up. - Sats down to 89.
伙计们这不管用 -等我一下
Guys, this is not working. - Just give me a second.
等到他心脏停跳吗
Until he arrests?
我的天我又要失去病人了
Oh, my God. I'm gonna lose another patient.
闭嘴维塔克我们继续 -血氧饱和度降到87了
Shut up, Whitaker. Let's get on this. - Sats down to 87.
好的我要重新定向导线
Okay, I'm gonna redirect the wire.
血氧饱和度还在降 86
Sats still dropping. 86.
你可以的
You got this.
奥丁如果你愿意你可以在屏幕上看
Ondine, if you'd like, you can watch on the screen.
我没事
I'm okay.
声带视野清晰莫汉医生
Excellent view of the cords, Dr. Mohan.
我进去了
I'm in.
给气球充气
Inflate the balloon.
双侧呼吸音良好 -血氧饱和度92 还在上升
Good breath sounds bilaterally. - Sats 92 and rising.
就这样完事了
That's it? You're done?
是的一切都很顺利
Yes. It all went perfectly.
她多久会好起来 -要看情况
How long until she gets better? - Depends.
肺部要从急性胸腔综合征中完全恢复
It can take anywhere from a few days to a few weeks
可能需要几天到几周不等
for the lungs to heal from acute chest syndrome.
我可以让加护病房♥在乔伊斯的病房♥里为你设置一个躺椅
I can ask the ICU to set up a recliner for you in Joyce's room
这样你就可以陪着她了
so you can stay with her.
非常感谢你们俩 -不客气
Thank you both so much. - You're welcome.
保重
Take care.
血氧饱和度84 我们得给他输氧了
Sats 84. We need to bag him.
还是没看到 -我在疯狂抽吸
Still not seeing it. - I'm suctioning like crazy.
我们不玩演医生了把导线拔♥出♥来♥ 我要给这孩子开刀
Okay, we're done playing doctor. Lose the wire. I'm criking this kid.
好了我们试过了我很遗憾 -不等等我找到了
All right, we tried. I'm sorry. - No, wait. Wait. I've got it.
你还是没有打开气道
You still don't have an airway.
把喉镜放好这样管子就能轻易通过
Okay, keep the laryngoscope in place so the tube passes easily.
把管子传过去连着导线一起
Pass the T, the T tube over the wire.
快啊 -抓紧导线
Come on. - Hang on to that wire.
千万别松手
Do not let go of that wire.
好吧我会给你挤出点空间这样你就能越过声带了
Okay, I'm gonna give you a little slack so you can get past the cords.
好的我能感觉到你在气管里了
Yeah, yeah. I feel you at the trachea.
距离嘴唇25厘米
25 centimeters at the lips.
应该可以了拉导线给他输氧
That ought to do it. Pull the wire, bag him.
气球充气了
Balloon's up.
二氧化碳指示灯黄色这是好迹象
Yellow on CO2. That's good.
非常好
That is very good.
双侧呼吸音良好 -血氧饱和度上升
Good breath sounds bilaterally. - Sats coming up.
90 92
90, 92.
看来你的手术刀得留着改天再用了
Guess you're gonna have to save that scalpel for another day.
你们很走运 -不是我们技术好宝贝我们技术好
You guys got lucky. - No, we got skills, baby. We got skills!
纱布留在血块上 -好的
Keep gauze on the clot. - Yeah, copy.
开一个异丙酚和芬太尼滴注
Ordering propofol and fentanyl drips.
很高兴你能加入我们弗洛雷斯医生
Oh, nice of you to join us, Dr. Flores.
抱歉我刚在在做一个根治性颈廓清术
Sorry, I got stuck in a nasty radical neck dissection.
还在流血 -没有直接施压就不会
Still bleeding? - Not with direct pressure.
我们负责气道你负责止血
We got the airway. You get the bleeder.
手术室准备好了 -我可以取消网约车了吗
OR's standing by. - So I can cancel the Uber?
我们带他上楼吧
Let's get him upstairs.
给你一个新海绵棒维塔克
Fresh sponge stick for you, Whitaker.
你想让我… -陪着你的病人
You need me to stay with the-- - Your patient.
你做得很好只要等麻醉师接手就行
You did a good job. It's only till the anesthesiologist takes over.
你能行吗 -是的没问题
You got it? - Yeah, I got it.
在下楼途中给自己换件新工服
Get yourself a fresh pair of scrubs on your way back down.
抱歉这么久才来我只是…
I'm sorry that took so long. I was just--
别道歉你在里面做的事
Don't apologize. What you did in there,
和你的病人建立关系
building a relationship with your patients,
赢得他们的信任这就是最重要的事
earning their trust, that's what this is all about.
罗比似乎不这么认为
Robby doesn't seem to think so.
别管他
Don't worry about him.
我应该向你道歉
You know, I should be apologizing to you.
慢动作医生我不该那么叫你的
Slo-Mo, you deserve better.
继续做你自己就好莫汉医生
Keep doing you, Dr. Mohan.
你那招是在哪学的
Where'd you get that move?
反向插管这是亚当森的独门绝技
Retrograde intubation, that's an Adamson special.
我从最棒的人那里学到的
I learned that from the best.
你自己也不差啊教授
Well, you're not too shabby yourself, Professor.
里面有点混乱但你很镇定
Yeah, that got kind of rough in there. You kept your composure, though--
正是他们想要的那种急诊医学教育奖学金候选人
exactly the kind of candidate they want for the ED Medical Education Fellowship.
那个名额估计有超过50名申请者
Oh, there's probably over 50 applicants for that one slot.
对可能吧但我知道他们会选一个
Yeah, probably. But I know that they like to go with someone
他们从第一手经验中获悉具备成功所需技能的人
that they know from firsthand experience has the skills to be successful.
至少我在推荐信里是这么写的
At least that's what I told them in my letter of recommendation.
谢谢
Thank you.
很高兴你还在 -我又没得选对吧
Glad you stuck around. - It's not like I had a choice, did I?
对完全没有
No, not really.
你今天过得怎么样
So how's your day going?
还行吧 -挺好
It's going. - Cool, cool, cool.
你问这个干吗 -我不能问吗