匹兹堡医护前线（2025）

The Pitt S01E08

Part 2 March 11, 2025, 8:29 p.m.

我每天都去散步
I take walks every day.
他唯一吃的药物是美金刚
Only med is Namenda.
我数到三一二三
On my count. One, two, three.
心脏起搏器患者患有老年痴呆症心率为30
Pacemaker patient with dementia. Heart rate of 30.
收缩压80 略有改变
A little altered with a systolic of 80.
朗登医生有什么计划
What's your plan, Dr. Langdon?
马上注射第二次阿托品
Second mig of atropine now.
注射一单位肾上腺素0.1毫克便携式胸部X光机
Push dose epi, 0.1 milligram. Portable chest.
显示器脉搏31
31 on the monitor.
贾瓦迪医生这个心率代表什么
Dr. Javadi, what do you think of that heart rate?
不是贝塔受体阻断剂所以是房♥室交界处逃逸节律
Uh, it's not beta blockers, so junctional escape rhythm?
没错这在起搏器功能障碍的患者中很常见
Exactly--common with a non-functioning pacemaker.
病因莫汉医生
Etiology, Dr. Mohan?
电池没电或是电线故障
Dead battery or lead failure?
确实挤压有反应即使很缓慢
Indeed. Good squeeze, even if it is slow.
阿托品和肾上腺素已注射 - 接下来呢朗登医生
Atropine and epi on board. - What's next, Dr. Langdon?
我们可以试试经皮冠状动脉介入但最终他需要经静脉起搏
We can try percutaneous pacing, but eventually, he'll need transvenous.
同意 - 注射肾上腺素后收缩压上升至95
Agreed. - Systolic's up to 95 with epi.
太低了
It's too low.
我们开始滴注吧每分钟两微克
Let's start a drip. Two mikes per minute.
检查精神状态 - 他知道自己的名字
Check the mental status. - Um, he knows his name.
先生你知道今年是哪年吗
Sir, do you know what year it is?
二零几几年...
Um, it's 20-something.
你知道你在哪吗 - 看着像医院
Do you know where you are? - It looks like a hospital to me.
这里是匹兹堡创伤医疗中心
Pittsburgh Trauma Medical Center.
对我知道这个地方
Yep. Yep, I know this place.
这是亚当森医生工作的地方
It's Dr. Adamson's place.
他在哪里他今天上班吗
Where's he at? He working today?
你感觉疼吗 - 不疼麻醉的效果很好
Are you feeling any pain? - No, that shot worked great.
好的就像这样
OK. Just like this.
要拉多长
Uh, how far down?
直到皮肤能完全覆盖
Just so the sub-Q will cover.
你需要请几天假先生
You'll need to take a few days off work, sir.
太好了我有更多时间学习了 - 是吗学什么
Good. More time to study. - Oh, yeah? For what?
心理学硕士学位
Uh, master's degree. Psychology.
别开玩笑了
Oh, no kidding.
是真的暖通空调只是我白天的工作
Yeah. HVAC's just my day job.
我上商学院是因为我负担不起大学学费
I went to trade school because I couldn't afford college.
现在我可以了
Now I can.
骨钳用得很好
Good on the rongeur.
标记手术边界两个切口
Marking the surgical borders. Two incisions.
三角区域向前推进盖住指尖
Advance the triangle to cover the tip.
直到V变为Y
Until the V becomes a Y?
没错
Exactly.
我猜你是这里的老大
I guess you're the boss here?
算是吧
Something like that.
你很擅长教学
You're very good at teaching.
我是说真的你在一旁观察适时点拨几句传授智慧
Seriously. You step back, and with a few words, you impart wisdom.
你说是就是吧
If you say so.
你介意我问一句你不工作时都做什么吗
Do you mind if I ask what you do when you don't work?
睡觉
Sleep.
现在用钝性解剖来剥离组织
Now a blunt dissect to undermine the tissue.
你怎么看贾瓦迪医生
What do you think, Dr. Javadi?
三度完全性心脏传导阻滞
Third degree. Complete heart block.
依据 - 房♥室结分离
Because? - AV dissociation.
P波与QRS复合波之间没有关系
No relationship between the P waves and the QRS complexes.
清场 - 心率30
Clear. - Heart rate is 30.
他的低血压会让他更加神志不清
His low BP is going to make him a lot more confused.
不赶紧治疗的话会导致心脏病或中风
Could cause a heart attack or a stroke if we don't fix it.
好吧谜团解开了
Well, mystery solved.
电线都没连上
The wires aren't even touching.
完全断开了这种事常有
They're totally disconnected. Shit happens.
心率还维持在30左右注射阿托品后无变化
Heart rate still in low 30s. No change with atropine.
起搏电极片准备好了
Pacing pads are on.
我们可以试试
We can try.
威利你的心脏起搏器坏了
Willie, your pacemaker isn't working.
你最好把它修好
Well, you better fix it.
我们要尝试从外部起搏你的心脏
We're going to try to pace your heart from the outside.
你胸口可能会有痛感
You might feel it in your chest.
设定初始电流10毫安频率60
Let's start at 10 milliamps, rate of 60.
起搏器准备就绪
Pacer on.
我在抽搐
I'm twitching.
无夺获
No capture.
增加到20毫安
Increase to 20 milliamps.
现在更像是电击
Now it's more like a shock.
仍然无夺获 - 增加到30毫安
Still no capture. - Up to 30.
你们想电死我吗 - 关闭起搏器
Y'all trying to electrocute me? - Pacer off.
病人受不了了 - 把这东西拿走
Can't tolerate it. - Get rid of this shit!
朗登医生
Dr. Langdon?
注射一单位咪♥达♥唑♥仑♥ 我们能为经静脉起搏做好准备吗
One of versed. Can we set up for transvenous?
你来之前我就准备好了
I was set up before you got here.
咪♥达♥唑♥仑♥已注射
Versed's on board.
威利我们需要把临时起搏器经由你的脖子放到你的心脏里
Willie, we need to float a temporary pacemaker from your neck into your heart.
为什么
Why is that?
因为你的心率只有30
Because your heart rate is only 30.
那给我打一剂阿托品
Then, uh, hit me with, uh, a shot of atropine.
你已经打过三次了
You've already had three.
等等你是医生吗
Wait, are you a doctor?
他没意识了
He's out.
金吉尔你觉得请人来家里帮忙这个主意怎么样
Ginger, what do you think about having some help at home?
我觉得丽塔偶尔需要休息一下
I think Rita could use a little break every now and then.
我们负担不起
We can't afford it.
琪拉雅跟我说保健卫♥生♥部♥有个老年专线
Oh, um, Kiara told me about DHS senior phone line.
隶属于老年人地区代表处
It's part of AAA, the Area Agency on Aging.
他们会推荐住家服务
They make referrals for in-home services.
要多少钱
Uh, what's that going to cost?
医疗保险能报销短期的家庭护理费用每周至少10个小时
Medicare will cover short-term home care, at least 10 hours a week.
金吉尔你去过养老院吗
Ginger, have you ever been to a senior center?
我去过一次但那里全都是老年人
I went once. Nothing but old people.
老年人地区代表处每天还有几个小时的老年陪伴服务
AAA also has senior companions for a few hours a day.
如果丽塔需要在午餐时间离开 OPTIONS计划可以提供一顿饭
And if Rita needs to be away at lunchtime, the OPTIONS program can deliver a meal.
你没事吧
Uh, is everything all right?
我没事
Yeah.
我说了什么让你不高兴吗
Did I say something that upset you?
没有我没事这是...
No, it's all good. This is--
这比我预想的要多
This is way more than I expected, so...
好了
Bam.
已插入内颈动脉
Internal jugular accessed.
吸氧每分钟5升血氧饱和度99
Pulse ox 99 on five liters.
注射肾上腺素收缩压95 - 这足以灌注大脑了
Systolic's 95 on epi. - That's good enough to perfuse the brain.
导线
Guidewire.
你还好吗威利
You doing OK under there, Willie?
还行吧
I guess.
所以这类似三腔导管吗
So this is just like a triple lumen?
除了你需要一个直径7F的大号♥导入器让起搏器导线穿过
Except you need a big seven French introducer to fit the pacing wire.
我需要透透气
I could use some air.
好点了吗
Is that any better?
你们在干什么
What y'all doing?
我们要在体外心脏起搏器上安装一根临时电线
We're putting a temporary wire into an external pacemaker
直到你可以动手术修好你胸口的那个
until you can have surgery to repair the one in your chest.
心率还是31
Heart rate's still 31.
心动过缓
Bradycardia.
你是医生吗威利
Are you a doctor, Willie?
是的
Yeah, right.
他之前的病历中没提到任何医疗背景
No mention of any medical career in his past records.
只有轻度的老年痴呆
Just mild dementia.
“你是医生吗 ” 真好笑
"Are you a doctor?" That's a good one.
好吧最后一个 - 看起来怎么样
OK, last one. - How's it look?
完美
Perfect.
塞洛仿和管形纱布
Uh, Xeroform and tube gauze?