匹兹堡医护前线（2025）

The Pitt S01E09

Part 7 March 11, 2025, 8:29 p.m.

Pulse ox is down to 89.
准备插管然后…
Set up for intubation.
麦凯叫罗比进来
And, McKay, get Robby in here.
我会打给重症监护室让她排在镰状细胞患者乔伊斯的前面
I'll call ICU and get her bumped ahead of Joyce, our sickler.
她应该能得到下一张病床
She should get the next bed.
在体温过低和癫痫发作期间她会昏迷一阵子
Between the hyperthermia and the seizure, she's gonna be out of it for a while.
我朋友也遇到过这种情况
A similar thing happened to a friend of mine.
所以你才想到低钠血症吗
Is that what made you think of hyponatremia?
听着我知道你很看重循证医学
Look, I know you value evidence-based medicine.
但有时候经验也很重要
But sometimes experience counts for something.
我能问一下你为什么要那么做吗
May I ask why you did that?
做什么
What?
承担了不属于你的延迟照料的责任
Took the blame for a delay in care which didn't belong to you
还把本该属于你的功劳给了我
and gave me credit for a save that did belong to you?
朗登早就看我不顺眼了
You know, I've been on Langdon's shit list all day.
他大概率会因为我们没叫他进来而生气
It seemed like he was gonna be more upset about us
而不是因为我们阻止了癫痫发作而高兴所以…
not calling him in than glad that we stopped the seizure,
没必要让他生我们两个人的气
so no reason for him to be pissed at both of us.
他为什么看你不顺眼
Why have you been on his shit list?
我想他已经说得很清楚了
Well, I think he made it very clear
他觉得我不够资格来这里
that he thinks I don't have what it takes to make it here.
不管你有没有
Whether you do or do not, it was completely inappropriate
他那样跟你说话都不合适
for him to speak to you that way.
我听过更难听的
Eh, I've heard worse.
不管怎样他错了
Well, for what it's worth, he's wrong.
你很擅长这份工作
You're very good at this.
谢谢
Thank you.
这句话对我来说意义非凡
That's actually worth a lot.
CT不是正常吗 - 之前是
I thought the CTs were normal. - They were.
收缩压降到70 心率高达130
Systolic's down to 70. Heart rate's up to 130.
100毫克氯♥胺♥酮♥ 100毫克罗库溴胺
100 of ketamine, 100 of rock.
她可能是延迟出血吗 - 不是胸部心包没问题
Could she have delayed bleeding? - It's not the chest. Pericardium's still clear.
没有心包填塞射血分数良好肺部张开
No tamponade, good EF. Lungs are up.
她摸上去很温暖 - 我们会检查她的体温
She feels warm. - We'll check a temp.
药物已经注射完毕
Meds are on board.
腹部没问题没有出血
Belly's clear. No bleeding here.
她肌肉松弛了
She's loose.
好了开始吧
OK. Go for it.
我看到声带了
I see cords.
看起来不错
Looks good.
我来了
I'm in.
把袋子接上 - 很好
Connect the bag. - Nice.
双侧呼吸音良好
Good breath sounds bilaterally.
体温39.1
Temp is 102.4.
什么这是败血性休克
What? Is this septic shock?
我们得做最坏的打算
OK, we need to assume the worst here.
代号♥败血症两组血液培养
Code sepsis. Two sets of blood cultures,
每公斤30毫升乳酸林格氏液和四单位抗生素头孢曲松
lactate, 30 per kilo of LR and for antibiotics, ceftriaxone?
不她刚来医院
No, no, she was just in the hospital.
哌拉西林-他唑巴坦和万古霉素 - 好的
Pip-tazo and vanco. - Got it.
如果这是败血症那她是怎么得的
If this is sepsis, where is it coming from?
源头在哪 - 她的尿道感染
What's the source? - Her urinary tract infection.
没有感染 - 之前有
She doesn't have one. - She did when I saw her.
不是尿道感染我们半小时前做过尿检
It's not a UTI. We catheterized urine a half an hour ago.
没有亚硝酸盐没有白血球
There's no nitrates, zero WBCs.
你的尿样可能今天早上被污染了
Your specimen could have been contaminated this morning.
是肺炎吗 - 胸部CT阴性
Is it pneumonia? - Chest CT negative.
腹部CT传染病阴性
Abdominal CT negative for an infectious source.
她之前有脑膜炎
She was altered. Meningitis?
她刚生过孩子
She's postpartum.
子♥宫♥内膜炎子♥宫♥CT显示
Endometritis. The CT of the uterus shows
子♥宫♥内膜变厚但那是产后的正常现象
a thickened endometrium, but that's normal postpartum.
没有胎盘残留
No retained POCs.
它仍然可能是源头
It still could be the source.
等她稳定了我们做个骨盆检查
We'll do a pelvic after she's stable.
克拉科齐亚先生我有我的担心
Mr. Krakozhia, here's my obvious concern.
我给你开了30天的药物处方
I write you a script for 30 days' worth of pills.
然后怎么办
Then what?
什么意思我把药吃了
What do you mean? I'll take them.
你还会再来开30天的对吗
Well, you come back for 30 more, right?
这就是问题所在
I mean, that's the question.
即使我能给你开每月一次的针剂
Even if I could give you your dose in a once-a-month shot,
你月底还是得回来
you still have to come back when the month is over.
如果他不需要这么做呢
What if he didn't have to?
不他必须要不然的话他会尿尿
Oh, no. He has to. If he doesn't, he-- well, he pees.
我们这里有个街头医疗队
We have a street team here.
克拉科齐亚先生你最近都待在一个地方吗
Mr. Krakozhia, are you pretty much in one spot these days?
对我住在自♥由♥大道在贝尼登附近
Yeah, I'm over on Liberty near the Benedum.
巷子里
The alley?
我很熟悉那里
I know it well.
所以我们可以把药带给他
So we could bring the meds to him?
当然可以
Absolutely.
每月一次的针剂听起来更简单
The once-a-month injection sounds like the easier option.
我们可以把你安排在日程表上
We could just put you on our schedule.
我有兴趣加入那个医疗队也许我可以亲自带药过去
I'd be interested in joining that. Maybe I can bring out the medicine myself.
那就太好了我们需要更多人手
That'd be amazing. We could use all the help we can get.
谢谢你医生
Thanks, Doc.
是的宫颈脓性分泌物
Yeah, purulent drainage from the cervix.
取到培养样本了
Got the culture.
看来我们找到了源头
Looks like we have our source.
今早的阳性尿液被污染了
The positive urine this morning was contaminated.
也许吧 - 绝对是
Maybe. - Definitely.
不是非常干净的尿液样本
Not-so-clean catch specimen.
这种程度的感染不是短期形成的
This infection's been brewing for a while.
所以车祸只是巧合吗
So the car crash was a coincidence.
不一定
Not necessarily.
随着病情的恶化他可能已经得了败血症
She was probably already septic as the disease progressed,
并在开车时血压下降后晕倒了
dropped her BP, and passed out while driving.
她来的时候没有低血压
She wasn't hypotensive when she arrived.
撞车后肾上腺素飙升胸骨骨折都会导致血压升高
Adrenaline rush from the car crash and the sternal fracture raised her BP
但不会太久
but not for long.
没有发热史
No history of fever.
我打赌她为了止痛在服用泰诺
Bet she was taking Tylenol for the pain.
打给重症监护室让她住院吧
Let's call ICU for an admit.
让妇科也给她做个检查
Also want gyn to see her.
她当时有轻微的下腹痛尿液呈阳性
She had mild lower abdominal pain and a positive urine dip.
无发热和背痛表明是肾盂肾炎
No fever, no back pain to indicate pyelonephritis.
她很清醒能走路能说话
She was alert, walking, talking.
看起来像是简单的尿道感染
It just seemed like a simple UTI.
我没有理由让她等上八个小时
I saw no reason to have her wait eight hours
做盆腔检查
for a bed for a pelvic exam.
麦凯
McKay.
每个产后患者都需要做骨盆检查以排除子♥宫♥内膜炎
Every postpartum patient needs a pelvic exam to rule out endometritis.
等等你这是马后炮
Wait, you're saying that with 20 20 hindsight.
你问过泰诺或者布洛芬的使用情况吗
Did you ask about Tylenol or ibuprofen use?
因为那会掩盖发热
Because that can mask a fever.
没有发热
There was no fever.
你做了仔细的腹部检查吗
Did you do a careful abdominal exam?
那是个快速的候诊室检查而且膀胱只有轻微触痛
It was a quick chair exam, and there was only mild tenderness over the bladder.
也许是因为病人的某种特质
Perhaps there was something about the patient
让你忽视了正确的治疗
that made you overlook proper treatment.
比如什么
Like what,
除了明显的健康风险因素
other than the obvious health risk factors?
她的体型并不意味着她不健康
Her size doesn't inherently make her unhealthy.
你是说我因为她的体重而对病人有偏见吗
Are you saying I was biased against the patient because of her weight?
我提出的是一种可能性并不是指控
I raise it as a possibility, not as an accusation.
我不认为是这样
I mean, I really don't think that's the case here,
但我会小心的
but I will look out for it.
好的
Yeah.
你刚才做得很好
You were good with him.
匹兹堡有很多流浪汉吗