匹兹堡医护前线（2025）

The Pitt S01E14

Part 4 May 20, 2025, 4:18 p.m.

Dr. King, what are you thinking?
皮疹意识改变伴败血症可能是脑膜炎球菌感染
Uh, well, rash, altered with sepsis-- could be meningococcus,
链球菌肺炎可能是某种病毒比如播散性单纯疱疹病毒或者脑炎
Strep pneumo, something viral like disseminated HSV, encephalitis?
高压82低压49 血氧饱和度上升到87
BP's 82 over 49. Sat up to 87.
那皮疹呢
What about the rash?
主要集中在下半身脸部不多
It's more prominent on the lower body, not much on the face.
没有水疱
There's no vesicles.
看起来不像水痘或典型的莱姆皮疹
It doesn't look like chicken pox or typical Lyme rash.
同意
Agreed.
你知道这是什么吗
Do you know what this is?
不知道先做复苏之后再诊断
Nope. Resuscitate first, diagnose later.
我们要把病人从黄区转移到
We're moving patients from the Yellow Zone
南区和中心区走廊的病房♥
into real rooms along the South and Central Corridors.
到目前为止这些病人对我们而言都是编号♥
Till now, all these patients have just been numbers to us.
是时候问问他们的名字了
Time to ask them their names.
我们扫描他们的腕带把他们录到信息板里
So we scan their wristbands and put them into the big board.
对然后我和达娜会根据医疗优先级分配病房♥
Yeah, and then Dana and I will assign rooms based on medical priority.
骨科四肢伤去做X光检查
Ortho extremity wounds go get X-rays.
麦凯医生 - 是的
Dr. McKay,
你忙完手头的工作来行为健康科室2号♥病房♥找我
can you finish up whatever it is you're doing and come meet me in BH-2?
好的当然
Uh, yeah, sure.
我告诉过你不是他干的 - 我知道
I told you he didn't do it. - I know.
但你自己也说了他是很严重的威胁
But you said yourself his threats were serious.
至少现在我们把它消灭在萌芽中了
At least now we're nipping it in the bud.
你觉得这很容易吗再想想吧
You think this is that easy? Think again.
100%的氧气下他的脉搏血氧饱和度仍然只有88
He's on 100% oxygen. His pulse ox is still only 88.
楼上情况怎么样 - 手术室的常规水疗日
How's it going upstairs? - Regular spa day at the OR.
42例剖腹探查和开胸手术 - 太厉害了
42 ex-laps and thoracotomies. - Impressive.
你这边什么情况
What do you got?
枪伤贯穿大腿未伤及动脉
GSW through and through the thigh, not arterial,
现在是低血压和缺氧
now hypotensive and hypoxic.
听起来像是失血过多导致的 - 不是
Sounds like blood loss. - No.
血红蛋白水平是正常的两倍很稳定
Hemoglobin times 2 is stable. Vena cava is plump--
下腔静脉充盈如果有出血它会变扁
it would be flat with hemorrhage.
事实上有点太充盈了
It's actually a little too plump.
让我看看相控阵探头
Let me see the phased array probe.
有心脏病史吗
Any history of heart disease?
不确定但他很强壮
Not sure, but he's a strong guy.
中枪后在大腿上绑了一件衬衫和一条皮带
Got shot, strapped a T-shirt and a belt around his thigh
跑来跑去几个小时帮助别人
and ran around helping people for a few hours.
天啊看看四腔心尖切面
Holy shit. Check out the four chamber apical view.
右心房♥和右心室扩张
Dilated right atrium and right ventricle.
右心负荷过重伴室间隔膨出
Right-sided strain with bowing of the septum.
像是肺栓塞他因为用了止血带而形成了血栓吗
Sounds like a PE. He throw a clot from having the tourniquet on?
现在诊断为深静脉血栓还为时过早我们给他做个左侧卧位超声检查
Way too soon for a DVT. Okay, let's get him in left lateral decubitus.
一二尽快采取头低脚高位 - 为什么
One, two. Trendelenburg ASAP. - What for?
心内空气栓塞他因为跑动太久
Intracardiac air embolism. All that running around
导致空气进入股静脉直达心脏
introduced air into the femoral vein right up to the heart.
阻断了血液流向肺部 - 需要做CT确认
Now it's blocking blood flow to the lungs. - Need a CT to confirm.
那里还有别的病人
They're still backed up with other patients.
也许心导管室可以接收他们他们有透视设备我去看看
Well, maybe the cath lab can take them. They have fluoro. I'll go check.
祝你好运
Yeah, good luck with that.
我需要一个中心静脉导管包和一个5F猪尾导管
I need a central line kit and a 5 French pigtail catheter.
好的
I got it.
他的肺没塌陷 - 是吗
He doesn't have a collapsed lung. - Yeah?
那你打算怎么办
So what are you going to do?
我什么都不会做你来
I'm not gonna do anything. You are.
谢谢你凯西嘿大卫你好吗
Thank you, Casey. Hey, David. How you doing?
嗨大卫
Hi, David.
我没开枪打人
I didn't shoot anybody.
我不会那么做的
I wouldn't do that.
我知道
I know.
你列了一份你想伤害的女孩名单吗
Did you make a list of girls you wanted to hurt?
我妈妈在哪 - 你列清单了吗
Where's my mom? - Did you make a list?
我想回家
I want to go home.
你会回家的
You're gonna get to go home.
但首先我们得让你强制性留院观察72小时
But, first, we have to keep you here for a mandatory 72-hour hold.
什么为什么我什么都没做
What? Why? I didn't do anything.
我知道你很难过我们这么做也是为了你着想
I know you're upset. We're only doing what we think is in your best interest.
去你的你又不了解我你对我一无所知
No, fuck you! You don't know me! You don't know anything about me!
我知道这很难接受但是... - 不我想见我妈妈
Look, I know it's a lot to process, but-- - No, no! I want to see my mom.
她在哪里她在外面吗
Where is she? Is she out there?
妈妈妈妈 - 这不是...
Mom! Mom! - This is not helping your case, David.
妈妈
Mom!
妈妈 - 这对你没有帮助...
Mom! - This is not helping your case--
去你的
Oh, fuck you!
我们出去吧
Let's go outside.
我只想见我妈妈拜托
I just want to see my mom, please!
拜托我只是想见我妈妈
Please, I just want to see my mom.
妈妈
Mom! Mom!
输氧两升后高压92低压60
BP's 92 over 60 after 2 liters.
仍然是室速非再吸入型面罩下血氧饱和度只有84 太低了
Still tachy. Sats are way down at 84 on the non-rebreather.
弗林睁开眼睛你怎么样伙计
Flynn, open your eyes. How you doing, bud?
他还是呼吸困难而且比之前更昏昏欲睡
He's still having trouble breathing. He's more lethargic than before.
再给他输一升氧气准备插管吧
Let's give him a third liter and prep for intubation.
没有父母同意可以吗 - 来不及了他会死的
Can we do that without parental consent? - We wait, he dies.
技术人员带了便携式胸片过来
Tech is here for a portable chest.
金医生插管需要哪些药物 - 依托咪酯和罗库溴铵
Dr. King, what are your intubation meds? - Etomidate and Roc.
好的准备好你需要的东西多大尺寸的管子
Great. Gather up everything you need. What size tube?
年龄除以四加三 6.5带套囊的管子
Age divided by 4 plus 3 would be 6.5 cuffed.
开始吧找到他的父母 - 好的
Let's do it. And find his parents. - Okay.
把这些放好
Prep these.
你今天几点上班的 - 早上7点
What time you start today? - 7:00 a.m.
谢谢 - 能给我一个吗我快饿死了
Thanks. - Can I get one of those? I'm starving.
不行 - 但我饿了
No can do. - But I'm hungry.
我们不能给你食物以防你需要手术你可能会误吸
We can't give you any food in case you need surgery. You might aspirate.
你得提升一下医患沟通技巧了 - 混♥蛋♥记者
You need to work on your bedside manner. - Mm, asshole reporter.
另一个病人的动脉血气分♥析♥结果出来了吗
ABG back on the blue man?
还没有我们直接给他注射亚甲蓝
Not yet. Should we just give him the methylene blue?
脉搏血氧饱和度85 我们可以再等等
Mm, pulse ox holding at 85. We can wait a little.
桑托斯医生我们如何评估血红蛋白血症
Dr. Santos... how do we evaluate methemoglobinemia
并确定治疗方案
and determine a treatment plan?
累了吗 - 是的
Tired? - Yeah.
脚疼大脑感觉像一团浆糊吗
Feet hurt? Brain feeling like mush?
当然
Absolutely.
那个病人根本不在乎
That patient doesn't give a shit.
他需要你高铁血红蛋白血症
He needs you. Methemoglobinemia.
我们走吧
Let's go.
罗比 - 嘿珍妮
Robby? - Hey, Janey.
杰克在哪里
Where's Jake?
我尽快赶来了但街道都被封锁了...
I got here as fast as I could, but there were street closures--
他没事他受了些轻伤需要治疗
He's okay. He's okay. He had some minor injuries that are going to need to be treated,
但他没事他今晚就能回家了
but he's okay. He's gonna go home tonight.
谢天谢地
Oh, thank God.
莉亚没能活下来
Leah didn't make it.
她死了天哪
She's dead? Oh, my God.
他有点怪我没救活她
He, um, is kind of blaming me for not saving her.
罗比他只是个孩子
Robby, he's just a kid.
她也是
So was she.
别自责嘿看着我
Don't do that to yourself. Hey, look at me.
杰克爱你好吗他在哪
Jake loves you, okay? Where is he?
嘿达娜你还记得珍妮吗 - 当然记得
Hey, Dana. You remember Janey? - Of course.
谢谢你给我打电♥话♥
Thank you for calling me.
能带她去找杰克吗 - 没问题来吧
Mind taking her to go find Jake? - Yeah, no problem.
谢谢
Come on.
管子进去了 - 颜色变化不错
Tube's in. - Good color change.
做得好汇报情况
Nicely done. Present.
我们有一名13岁的败血患者患有肺炎
Uh, we have a septic 13-year-old with pneumonia.
我刚插了管子也给他注射了头孢曲松
I just intubated, and ceftriaxone is on board.
片状实变可能有结节
Patchy consolidation, maybe some nodules.
可能是病毒性肺炎伴有或不伴有细菌性继发感染