匹兹堡医护前线（2025）

The Pitt S01E06

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

let's discharge before we start with somebody new, OK?
谢谢各位最后在你们的医疗记录中
Thank you. Lastly, in your medical records,
确保你的决策和笔记
make sure that your decision-making and your notes
不仅要反映诊断还要反映你们在鉴别诊断中
reflect not just the diagnosis but all the thought
排除其他重大疾病的过程
that you put into ruling out all the critical illnesses in the differential.
更多工作我填那些表已经够烦的了
More work? I do enough charting as it is.
医院是不会承认的
The hospital won't admit this,
但重点不是表格而是利润
but it's less about charting and more about profit.
好吗很好就这样再见
OK? Good. That's it. Goodbye.
去吧
Go.
我们的怀孕少女和妈妈还在聊吗
Are our pregnant teen and mom still talking?
是的 - 那个病房♥里没人♥大♥喊大叫了
Yeah. - No more yelling from that room?
我没听到 - 很好也许谈妥了
Not that I've heard. - Good, maybe it's working.
要么就是她们自相残杀了我对哪种都没意见
Either that, or they killed each other. I'm good with either one at this point.
你还奇怪为什么你的病人满意度分数低得要命吗
And you wonder why your patient satisfaction scores are in the toilet.
一如既往感谢你的支持
Always appreciate your support.
我得去看看我的尼泊尔病人她喜欢我
I need to check on my Nepali patient. She likes me.
每个注射了吗♥啡♥的病人都喜欢你
Everybody likes you when they're on morphine.
好吧我想我们会跟进吉莉安杜普里
All right, I think we'll follow up with Gillian Dupree,
我们在分诊处发现的4岁高烧患者
the four-year-old we saw in triage with the fever.
好的 - 好的
OK. - Yeah.
贾瓦迪医生
Dr. Javadi.
抱歉你在这里做什么
Um, sorry. What--what are you doing here?
我下来会诊有个年轻人得了阑尾炎
Oh, I'm down to see a consult-- young man with a hot appy.
你是医学生吗 - 是的女士
Are you a med student? - Oh, yes, ma'am.
这对学生来说是个好案例
This is a great case for the students.
他们能来吗我很乐意在床边教学
Can they come with? I'd be happy to do a little bedside teaching.
我们有个4岁的... - 可以我喜欢
Oh, we have a four-year-old-- - Oh, yeah, I would love that.
介意我加入吗也许我也能学点新知识
Do you mind if I join? Maybe I can learn something new.
当然 - 太好了
Sure. - Great.
我只是...我不想让别人把我和我妈扯上关系
I just-- I don't need anyone else associating me with my mom.
我知道但我不能拒绝一个阑尾炎病例
I know, but I just can't say no to a hot appy.
这些是医学生介意我在这里教教他们吗
These are student doctors. Mind if I do a little teaching?
随便 - 好了大家都知道麦氏点
Go for it. - Now, everyone knows McBurney's point.
但谁能告诉我这个征象的名字
But who can tell me the name of this sign?
提姆请抬起你的右腿
Tim, raise your right leg, please.
腰大肌征象
Psoas sign.
腰大肌与发炎的阑尾发生摩擦时会导致疼痛
Causing friction of the psoas muscle over the inflamed appendix.
很好
Excellent.
在以前得了阑尾炎意味着直接送进手术室
Now, back in the day, appendicitis meant you went straight to the OR.
谁能告诉我什么是CODA研究
Who can tell me about the CODA study?
这是2020年《新英格兰医学杂♥志♥》刊登的一个实验
Uh, well, it's from a 2020 "New England Journal" trial
将手术与抗生素的疗效进行比较
comparing surgery to antibiotics, you know?
结果显示没有阑尾粪石的情况下
It, um--it showed that without an appendicolith,
仅使用抗生素的实验组有75%的成功率
there was a 75% success rate in the antibiotic-only group.
没错
Exactly.
亲爱的我们在家里讨论过这个研究对吧
Honey, we discussed the study at home, right?
“亲爱的”
"Honey"?
等等她是你妈妈
Wait. She's your mom?
叫我维多利亚
It's--it's Victoria...
或者贾瓦迪沙姆西医生
or Javadi, Dr. Shamsi.
喂好的我马上过去
Uh, hello? Oh, yeah, I'll be right there.
格兰特太太突发胸痛我们得先走一步了
Mrs. Grant now has chest pain. If you'll excuse us.
好去吧病人是第一位的 - 谢谢好的
Oh, yeah, go. Patients come first.
谁是格兰特 - 没谁我瞎编的
Who's Mrs. Grant? - Nobody. I made her up.
抱歉你刚才的表情
Sorry. You just had that look on your face
跟我儿子听我在边线指导他的篮球队时的表情一模一样
my son gives me when I give his basketball team pointers from the sideline.
对不起
I'm sorry.
不我觉得装♥修♥和看牙一样
No, I think renovations should be treated like dental care.
应该交给专业人士
Leave it to the professionals.
他们是唯一应该爬梯子的人
They're the only ones that should be climbing on ladders.
我的家人到了吗 - 不确定我帮你问问 CT结果如何
Um, is my family here yet? - I'm not sure. We'll check. How was the CT?
头颈部正常但技术人员在右边发现了轻微血胸
Head and neck normal, but tech found a small hemothorax on the right.
那是什么
What's that?
你肋骨骨折那一侧的肺部出血了
It's a little bleeding around the lung where you broke a rib.
扫描后他的呼吸也更加急促了
He's also been more short of breath since after the scan.
是因为疼痛吗
Is that from the pain?
赛拉斯嘿赛拉斯醒醒
Silas? Hey, Silas, wake up.
没有桡动脉脉搏了 - 颈动脉微弱血压骤降
Lost the radial pulse. - Thready carotid. His BP'S crashing.
我觉得他可能需要胸部插管
I think he might need a chest tube.
检查另一个手持血红蛋白分♥析♥仪从血库里匹配血型
Check another hemocue. Get type specific from the blood bank.
高压72低压44 血氧饱和度89
BP 72 over 44. Pulse ox 89.
他的血压和血氧饱和度都下降了 - 戴上100%浓度氧气非再吸入性面罩
He just dropped his BP and sats. - Put him on 100% nonrebreather.
打给血库送两个单位全血 - 已经打了
Call for two units. - Already done.
常规头部CT 右侧轻微血胸
Normal head CT. Small hemothorax on the right.
现在变成了严重血胸
Which has now turned into a huge collection of blood.
准备胸部插管 6.7毫米的
Prep for a chest tube. 20 French.
我想做胸部插管 - 没问题我来指导你
I would love to do the chest tube. - You got it. I'll guide you.
血氧饱和度低要做气管插管吗 - 要等插完胸管再说
Sats are low. Should we intubate? - Not until after the chest tube's in.
我们不想引起张力性气胸
We wouldn't want to cause a tension pneumo.
她不会再犯同样的错误了
She won't make that mistake again.
十号♥刀给桑托斯医生
Ten blade to Dr. Santos.
有很多胸腺组织 - 专注于胸管
There's a lot of breast tissue. - Focus on the chest tube.
第五肋骨间隙腋前线
Fifth intercostal space, anterior axillary line.
很好
Perfect.
接下来是凯利止血钳
Long Kelly next.
该死 - 天啊你还好吗
Fuck! - Oh, my God. Are you OK?
一定很疼
Oh, that's got to hurt.
别管了 - 但是...
Leave it! - OK, but--
好吧我来接替你 - 不行你没戴手套我能搞定
OK, I'm stepping in. - No, you're not gloved. I got this.
我... - 我自己来
I-I-- - On my own.
戴上手套你来缝合
Glove up. You're sewing this in.
我们没事了不需要在这里盯着了
We're good. No need to hover.
好吧如果你需要我我就在隔壁
OK. I'll be next door if you need me.
血氧饱和度和血压都恢复了
Sats and BP look perfect.
我们准备好了吗 - 快了
We ready to go in here? - We're getting there.
你可以吗 - 当然
You good? - Absolutely.
如果头晕就大声说出来好吗
You start feeling lightheaded, just speak up, OK?
好的
Yeah.
好了你要想象自己是个海盗脚踩着一桶朗姆酒
OK, you're gonna pretend you're a pirate with your foot on a keg of rum.
你是认真的吗 - 是的
Are you serious? - Yep.
这叫摩根船长式髋关节复位术
This is the Captain Morgan technique for hip reduction.
摩根船长是谁 - 朗姆酒瓶上画的那人
Who's Captain Morgan? - The guy on the rum bottle?
我来稳定骨盆 - 好的你站到这边来
I'll stabilize the pelvis. - OK, you're gonna step up here.
其实让我...抱歉
Actually, let me just--sorry.
你要把右腿放在他膝盖下面
Yeah, and you are gonna put your right leg behind his knee.
像这样
Like this?
是的然后你要以你的腿为支点
Yeah. And you are gonna use your leg as a hinge
对他的股骨施加前力
to put anterior force on his femur.
物理学
Physics.
用左手推小腿
Push down on the lower leg with your left hand.
你可以的背部用力
You got this. Put your back into it.
臀部是一个很大的关节有很多肌肉稳定它
The hip is a big joint with lots of muscle stabilizing it.
好的
OK.
砰 - 他妈的我是说他喵的
Whoa! - Oh, shit. I mean, shoot.
这就是髋关节复位的感觉
And that is what a hip reduction feels like.
做得好 - 谢谢
Nicely done. - Thank you.
我听说你有个85岁的病人
I hear you have an 85-year-old patient
可能被她的主要照顾者遗弃了
who may have been abandoned by her primary caregiver.
也许吧希望不是我真的不知道该怎么办
Well, maybe. I-I hope not. I don't really know what to do.
我们找不到女儿我很担心她妈妈...
We can't find the daughter. And I'm really worried about the mom--
慢点说我们会想出办法的你觉得发生了什么
Slow down. We'll figure this out. What do you think happened?
金吉尔得了精神分♥裂♥症有天又摔倒了
Um, well, Ginger has schizophrenia, and she fell.
女儿已经不堪重负了我是说...
And the daughter was already so overwhelmed, I mean...
也许她跑了我不想说这是遗弃老人但是...
maybe she ran. I don't want to say this is elder neglect, but--
先别急着下结论
Don't jump to the worst case yet.
我看看能不能联♥系♥上其他家人
I'll see if I can get ahold of any other family members.
我跟那个女儿说...我让她休息一下
You know, I-I told the daughter-- I told her to take a break,
让她优先考虑自己我只是...
you know, to prioritize herself. And I-I just--
我没想到她会甩掉她妈妈所以...
I didn't think that she was gonna dump her mom, so--
这不是你的错