驻院医生

The Resident S03E13

Part 4 Feb. 19, 2020, 9:48 a.m.

我们看过他的病历已知什么情况
We've seen his records. What do we know?
他通常会在剧烈运动后呕吐
He typically experiences vomiting after strenuous workouts.
并且最近他经历了一系列的
And most recently, he's been suffering a string
肌肉骨骼损伤并有横纹肌溶解
of musculoskeletal injuries and now has rhabdo.
我认识这表情
I know that look.
我喜欢这表情
You know, I dig that look.
我花了一段时间才喜欢上
It's been an acquired taste for me.
他没有感染虽然横纹肌溶解
He's not septic. And while the rhabdo alone
会导致乳酸水平升高
can cause some elevation in the lactate,
但比我预期的要严重
it's more than I'd expect.
我觉得这是
I think we're seeing...
乙型乳酸性酸中毒
Type B lactic acidosis.
用普通话说有东西在阻止达克斯
In plain English, there's something that's preventing Dax
用正常的方式分解葡萄糖
from breaking down glucose in the normal way.
这要怎么治疗
How do you treat that?
乙型乳酸性酸中毒是另一种病的症状
Type B lactic acidosis is a symptom of something else.
而这种病
And it's that something
或许可以解释
that might explain what's been causing
达克斯为什么会频繁受伤
all of Dax's injuries in the first place.
看来你们挺有把握的
Well, you guys seem to know what you're doing.
也许达克斯来这里是件好事
Guess it's good that Dax landed here.
查斯汀只聘请最好的医生
We only employ the best at Chastain.
谢谢
Thank you.
别客气
You bet.
外科医生通常不具备如此深入的
Surgeons usually don't possess such an in-depth knowledge
内科治疗知识
of medical management.
不好意思
Well, I'm sorry,
据我所知你不是医生
last time I checked, you weren't a doctor.
对所以你还是去
Yeah, so why don't you run along
操心你该操心的事吧
and worry about whatever it is you worry about?
让我们专心救治我们的病人
And you let us focus on saving our patient.
英格丽护士你检查莱利·杰克逊了吗
Nurse Ingrid, have you checked on Riley Jackson?
我没在病房♥看到她
I don't see her on the floor.
我不知道那是谁她是内科病人吗
I don't know who that is. Is she a medicine patient?
两小时前我收她入院
I admitted her two hours ago,
现在我们有空床了
and we have open beds now.
你知道她为什么没被送进病房♥吗
Do you know why she hasn't been brought up?
我来告诉你普瓦什
I can tell you, Pravesh.
我取消了她的入院
Canceled her admission.
我让你做个拒收机器但是你却
I told you to be a blocking machine, but instead
任你急诊室的朋友摆布
you let your friend from ER run over you.
不不是这样的我为了缓解
No, that's not what happened. I made a compromise
我们两个部门之间的矛盾做出了让步
to ease the tension between our departments.
你是谁节目主持吗
Who are you, Oprah?
我们还没检查她但愿急诊室检查了
Since we haven't checked on her, hopefully the ER has.
莱利
Riley?
莱利
Riley?
睁开眼睛
Open your eyes.
瞳孔散大对光反应微弱
Pupils dilated, minimally reactive.
她中风了
She's having a stroke.
我们走
Let's go.
-我这有个中风抢救 -三区
- Hey, I have a code stroke here. - Three.
中风抢救急诊三区
Code stroke, ER Bay Three.
中风抢救急诊三区
Code stroke, ER Bay Three.
我需要插管工具包
I need an intubation kit.
抽70毫克依托咪酯 20毫克罗库溴铵
Draw up 20 of etomidate and 70 of roc.
等我们建立通路后就给她上移♥动♥监护仪
Okay, once we get better access, let's get the portable monitor
还要做CT 她来的时候只是恶心呕吐
and get her to CT. She came in with nausea and vomiting.
怎么会这样
How did this happen?
凯尔那边怎么样了
Hey, how is it going with Kyle?
不太好
Not good.
他要离开亚特兰大
He's leaving Atlanta.
都不打算告诉我一声
Wasn't even gonna tell me.
妮珂我很抱歉
Nic, I'm so sorry.
我放松了戒备
I let my guard down.
我让他重新回到我的生活里
I let him back into my life.
你以为他改了我也以为
Well... you thought he changed, so did I.
我应该知道他的
I should have known better.
他总是逃避
I mean, he always bails.
他总是骗我说这样最好
He usually tells me some lie as to why it's best.
这次他都懒得骗我了他就
This time, he didn't even bother to lie. He's just...
他就是要走
he's just leaving.
贝尔和奥斯汀能联♥系♥上我
Bell and Austin know how to reach me.
不如我就收拾东西
Why don't I pack up,
马上回家我们把这糟糕的一天
come home, and we turn this horrible day
变得好一些
into something else?
不用了
It's okay.
我可能只是需要时间
I think I just need some time.
好吧
Okay.
但你如果需要什么就立马打给我
But you call me the second you need anything.
-我爱你 -我也爱你
- I love you. - I love you, too.
我不能这样下去了
I can't do it anymore.
我很抱歉我让你以为
I'm sorry that I led you to believe
以为我变了哪怕只是一小会
that-that-that it was different, even for a second.
今天是我身为义工第一天上班
First day on the job as a volunteer.
我只有你了孩子
You're all I got, kid.
他确实骗我了
He did lie.
妮珂来电
已拒接
我觉得我做得不对
I don't think I'm doing it right.
来让我来
Oh, here, let me
-示范一下她喜欢的方式 -好
- show you what she likes. - Okay.
你比我更了解她
You know her better than I do.
我一直在照顾米歇尔
I've been taking care of Michelle.
这过程中自然学到了点技巧
Of course I learned a few tricks along the way.
这样有规律地拍她的背
Rhythmically, tap on her back like this.
好
Yeah.
来妈妈这对
Oh, come to Mommy. Yes.
来妈妈这
Come to Mommy.
-你还好吗 -挺好
- You okay? - Fine.
是吗
Yeah?
米娜你会不会觉得难过
Mina, is this hard for you?
你会不会想她
Will you miss her?
你在开玩笑吧她是挺可爱的
Are you kidding? She's cute and everything,
但是我能回归正常生活了
but, um, I'll have my life back.
达克斯的新检验报告出来了吗谢谢
Are Dax's next set of labs in? Thank you.
他们还在做
They're cooking.
糟糕别挂断
Oh, damn it. Just stay on the line.
他们叫我去达克斯的病房♥
I'm being paged to Dax's room.
-发生什么了 -我不确定你先听着
- What's going on? - I'm not sure. Just listen in.
他在迅速切换
Okay, he is rapidly alternating
快心律慢心律
between fast and slow heart rates.
快慢综合征但为什么呢
Tachy-brady syndrome, but why?
不他还年轻不会有原发性心血管疾病
No, he's too young for primary cardiac disease.
而且他几个月前的心超是正常的
And his echo from a few months ago was normal.
他的肌细胞正在涌入他的血液
His muscle cells are bursting into his bloodstream.
是的所以可能是电解质问题
Yeah, making it likely an electrolyte issue.
我们需要做床边生化八项
We need a point-of-care chem-8.
血钠134 血碳酸氢钠22
Sodium 134, bicarb 22,
血糖110 血钾6.9
glucose 110, potassium 6.9.
他需要钙和碳酸氢钠
He needs calcium and bicarb.
立即注射一安瓿葡萄糖酸钙和碳酸氢钠
Need an amp of calcium gluconate and bicarb now,
再注射一安瓿高浓度葡萄糖十单位常规胰岛素
then an amp of D50 and ten of regular insulin.
我不确定这是否符合他的潜在病情
I'm not sure how this fits into his underlying condition.
奇怪
This is odd.
-又怎么了 -他的腹部鼓胀
- What now? - His abdomen is distended.
雷吉帕特里克
Reggie? Patrick?
-你在考虑什么 -我只是担心
- What are you thinking? - I'm just, I'm worried
他的脾撕裂伤口扩大他开始
his splenic lac has opened up and he's starting
重新出血了带他去做CT
to rebleed. Take him down to CT
-看看是怎么回事 -我想帮忙
- and find out what's going on. - I want to help.