匹兹堡医护前线（2025）

The Pitt S01E14

Part 5 May 20, 2025, 4:18 p.m.

It could be viral pneumonia with or without bacterial superinfection.
这孩子还有奇怪的皮疹
Kid's got a weird rash, too.
腿上有斑丘疹
Oh, and it's maculopapular on the legs.
颈部和胸部的皮疹已经明显褪色
Pretty faded on the neck and chest.
开始脱落了
Starting to desquamate.
你以前见过这种病例吗
You ever seen anything like this before?
没有 - 我也是
Nope. - Me neither.
这说明我确实老了这看着像麻疹
Well, that just goes to show you how old I am. This looks like measles.
麻疹 - 天啊
"Measles"? - Holy shit.
有旅行史吗
Any travel history?
插管前他不能说话麻疹极具传染性
He wasn't able to talk before we intubated.
如果皮疹在消退就没有传染性我们需要了解更多病史
Measles is super contagious. It's not contagious if it's resolving. We need more history.
他父母呢
Where are the parents?
他们在电影院手♥机♥应该是关机了
Oh, they're at the movies. I'm sure their phone's off.
但他是和他妹妹一起来的我们可以跟她聊聊
But he came in with his little sister. We can talk to her.
哪家电影院 - 我不知道
What theater? - I don't know.
沈挨家电影院查 - 那得有十几家吧
Shen, try every theater. - There's got to be over a dozen in Pittsburgh.
离住处最近的那些我们需要找到他的父母
Start with the ones closest to where they live. We need to find those parents.
给公共卫♥生♥部♥打电♥话♥ 告诉他们我们可能爆发麻疹了
And call Public Health. Tell them we might have a measles outbreak.
我们拿到血气检测结果了吗
We get blood gas results back?
我刚拿到高铁血红蛋白水平为42% 足以导致发绀和嗜睡
I just got them. Methemoglobin level of 42%, enough for cyanosis and lethargy.
继续嗨韦恩
Ooh, party on, Wayne.
开始用亚甲蓝吧每公斤体重1毫克缓慢静脉注射持续五分钟
Okay, let's go ahead and start methylene blue. Uh, 1 mg per kg, slow IV push over five minutes.
好的
On it.
得有人站到床边用注射器推入
Gonna need somebody to stand bedside, push it with a syringe.
桑托斯就是你了
Santos, tag, you're it.
他的发绀多久能消退
How long until his cyanosis resolves?
五分钟大聪明
Five minutes, bright spark.
你们俩之间肯定有过节
Oh, you two definitely got beef.
嗨乔治娅这是罗比医生
Hi, Georgia. Um, this is Dr. Robby.
他会问你一些问题好让我们能帮助弗林好吗
He's gonna ask you some questions so we can help Flynn. Is that okay?
嗨乔治娅你能告诉我你哥哥第一次生病是什么时候吗
Hi, Georgia. Can you tell me when your brother first got sick?
一周前我已经开始好转了
A week ago. I was already getting better.
你也病了像弗林一样发烧起疹子
You were sick, too? Fever, rash like Flynn?
你的家人最近有坐飞机去过任何地方吗或者去过别的州
Has your family traveled anywhere recently on an airplane or to another state?
几周前去奥兰多参加过一个舞蹈比赛
Orlando for a dance competition a couple of weeks ago.
你的皮疹是从哪里开始起的
And where on your body did the rash start?
脸上然后一直蔓延到腿上
On my face. Then it went down to my legs.
好的谢谢你乔治娅 - 弗林会没事吗
Okay. Thank you, Georgia. - Is Flynn gonna be okay?
是的我们会尽一切所能帮助他
Oh, well, yeah. We're gonna do everything we can to help him.
这个故事印证了麻疹的判断在奥兰多有很多暴露机会
The story is consistent with measles. Plenty of opportunity for exposure in Orlando
那里有来自世界各地的游客
with all the international travelers.
隔离 - 不行因为只在皮疹出现后四天内
Isolation? - No, 'cause you're only infectious
才具有传染性所以我们已经过了那个时限了
for four days after the rash starts, so we're past that point.
但他的意识状态改变了正处于ADEM的时间范围
But the altered mental status, he's in the right time frame for ADEM.
ADEM - 感染后免疫反应引起的
ADEM? - Acute Disseminated Encephalomyelitis,
急性播散性脑脊髓炎
post-infection immune response.
所以要做脑CT和腰椎穿刺吗 - 恐怕是的死亡率有20%呢
So a head CT and an LP? - Afraid so. It has a 20% death rate.
金医生这是摩根
Dr. King, this is Morgan.
我是翠西格雷戈里的女儿我妈妈还好吗
Trish Gregory's daughter. Is my mom okay?
她很好罗比医生你介意我带摩根去看她妈妈吗
Oh, yeah, um, she's fine. Uh, Dr. Robby, do you mind if I show Morgan to her mom?
去吧我带弗林去做脑CT 并让沈做腰椎穿刺的准备
No, go ahead. I'm going to send Flynn for a head CT and get Shen to prep the LP.
那他父母呢 - 我觉得他还在找他们
What about the parents? - I think he's still trying to find them.
我能帮忙去吧我们没问题的
I can help. Go. We got this.
谢谢卢佩这边
Thanks, Lupe. Um, just this way.
她需要做个手术但她会没事的
So she's gonna need surgery, but she's...
过来坐下 - 什么为什么
Take a seat. - What? Why?
在经历过重大事件后肾上腺素会骤降
Adrenaline crash after a big event.
果汁谢谢
A juice box? Thanks.
今天发生的事是非常规的
What happened here today, it's not normal.
但你的表现非常亮眼维多利亚
But you-- You were a rock star, Victoria.
他知道我的名字
He knows my name.
已经置入颈内静脉导管
Got the IJ.
好的有所改善了谢天谢地导丝和导引器
Okay, back to business as usual, thank God. Guidewire and introducer.
你们在干什么
What the hell are you doing?
莫汉医生即将从右心房♥和右心室抽出空气
Dr. Mohan is about to pull air from the right atrium and right ventricle.
用什么 - 5F猪尾导管
With what? - 5 French pigtail catheter.
插入他的心脏
Inside his heart?
多处侧孔能让你更好地吸出所有空气
Multiple side-holes gives you a better shot at sucking out all the air.
阿伯特医生给我看过一个韩国的病例报告
Dr. Abbot showed me a case report from South Korea.
有没有搞错我刚问过心脏科他们想做个CT
What the actual fuck? I just talked to cardiology. They want a CT scan.
如果显示有空气你得把他放进高压氧舱
If it's showing air, then you need to dive him in the hyperbaric chamber.
到那个时候他已经死了
He'll be dead by then.
除非他先被你这种赤脚医生般的骚操作害死
Not if you kill him first with this banana-pants procedure.
我们没时间等你的先进机器了
We don't have time to wait for your fancy-pants machine.
不把空气从他心脏里抽出来他会死的
If we don't get the air out of his heart, he'll die.
这不是标准流程
This is not the standard of care.
去他的标准流程想救他的话现在就得插管
Oh, fuck standard of care. If we want to save him, we go in now.
也许我应该... - 在猪尾导管里放导丝吗
Maybe I should-- - Thread in the pigtail?
好主意莫汉医生
Excellent idea, Dr. Mohan.
放置到24厘米深度然后我们用X光确认很好
Go down to 24 centimeters, and then we'll confirm with X-ray. Good.
我看我还是留下来吧
Think I'll stick around in case you need
以防患者病情恶化时你需要多一双手来复苏他
another set of hands to resuscitate your patient when he crashes.
天哪你在流血你没事吧 - 妈妈我没事
Oh, my God. You're bleeding. What-- Are you okay? - Mom, I'm fine.
你得带我离开这里
You got to get me out of here.
他们只是想帮你我们都是 - 我不需要帮助
Well, they-- they just want to help you. We all do. - I don't need help. I just want to go, okay?
大卫你一整天都没给我回电♥话♥ 或发短♥信♥
David... you haven't called me back or texted me all day.
妈妈
Mom.
你没去上学我看到你在照片墙发的帖子了
You didn't go to school. I saw the Instagram post you made.
我还找到了那个写有女孩名字的清单
And I found the list about all the girls.
你翻我东西了
You went through my stuff?
我爱你而且我... - 不妈妈那是我的东西
I love you. And I don't-- - No, Mom, Mom. Those are my things.
我能说我们都有过可怕的想法吗
Can I just say that we all have scary thoughts?
这不代表你就是坏人
It does not make you a bad person.
处理这些情绪可能很难
And--and dealing with those feelings can be hard.
跟别人聊聊真的有帮助 - 天啊闭嘴
Talking to somebody can really help somebody about that. - Oh, my God. Just shut up.
我不会跟任何人聊的好吗你们不能强迫我
I'm not gonna fucking talk to anyone, okay? You can't make me.
大卫我签了一份请♥愿♥书
David, I signed a petition.
搞什么你签了关押我的文件
What the fuck? What, you signed some paper to get me locked up?
我签请♥愿♥书是为了让你得到帮助
I signed a petition to get you help.
这太荒谬了
This is fucking bullshit.
今天看到这么多人被送过来
Seeing all those people come in here today...
所有这些受伤的人死去的人和血淋淋的画面
all those hurt people and the death and the blood...
我害怕你因为伤心愤怒而做出什么事来
I was so afraid of you being that sad and angry.
我不能失去你
I cannot bear to lose you.
我绝不会做那种事
I would never do something like that.
我没有任何问题是我啊妈妈
There's nothing wrong with me. It's me, Mom.
你知道我绝不会那样伤害别人
You know I'd never hurt someone like that.
拜托了别这样对我你为什么要这么做
Please, don't-- don't do this to me. Why are you doing this?
我们只要求你跟专业人士谈谈
All we're asking is that you speak with a professional.
跟别人谈谈你的感受很重要
It's important to talk to somebody about how you're feeling.
你愿意接受这个提议吗
You think you might be open to that?
去你的你们都去死吧
Fuck you. Fuck all of you.
你们能出去吗出去
Can you just get out? Get out!
嘿波拉你能带特蕾莎去喝杯茶吗
Hey, Perlah, can you take Theresa to go find a cup of tea?
当然可以
Yeah, of course.
天啊现在怎么办
Jesus. What now?
我建议过一个更好的解决办法
Well, I suggested a better way,
但你让他被警♥察♥抓起来戴上手铐被拖到这里
but you had him taken down by the police, handcuffed, and dragged in here.
你把这事搞得一团糟你得负责善后
You made this fucking mess. You're gonna have to fix it.
猪尾导管在右心房♥ 位置很好抽吸一下看看能抽出什么
Pigtail's in the right atrium, good position. Aspirate, see what you get.
从心脏抽出血液
Pulling back blood from the heart...
还有一些空气 - 怎么样
Along with some air. - How about that?
收缩压仍然是85
BP's still only 85 systolic.
没有改善 - 慢慢地进入右心室
No improvement. - Advance slowly into the right ventricle.
我怎么知道我什么时候... - 室性早搏
How do I know when I'm-- - PVCs.
这就是你判断的方法再抽吸一次 - 连续出现三次
That's how you know. Aspirate again. - Run of three.
抽出了更多的血和空气 - 五次了
More blood and air coming out. - Run of five.
非持续性室速充电到200焦耳以防他病情恶化
Non-sustained V tach. Charge to 200 for when he deteriorates.
现在主要是血了 - 把猪尾导管拉回右心房♥
Mainly blood now. - Pull the pigtail back to the RA.
让开 - 把导管拉回来莫汉医生