(前情提要)
我是拉帕波特夫人 This is Mrs Rappaport.
我是重伤待命主任医师 I'm the consultant on call for major trauma.
资源紧张 Resources are stretched.
那么我们中就有人得加把劲了 Well, then, some of us need to raise their game.
你到底想说什么 Where is this going, exactly?
罗琳去哪儿了 谁来接手 What's happened to Lorraine? Who's covering?
你最好不要管这事 所以你别管了 It's in your best interests to stay out of this, so stay out of this.
我最不愿意麻烦的就是你 You're the last person I want to call,
但你是唯一能帮我的 but you're the only one who can help.
我觉得我老大好像被停职了 I think my boss just got suspended.
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创伤急救呼叫 速去急诊部 'Trauma Call - attend Emergency Department...
创伤急救呼叫 速去急诊部 'Trauma Call - attend Emergency Department.'
她两分钟前晕过去了 She went off a couple of minutes ago.
该死 Shit!
把她送进去 快 快 Let's get her inside. Move. Move!
40多岁的女性 邻居在4点30分报警 Right, mid-40s female, next door neighbour at 4.30.
现在不行 亲爱的 先把她送进去再说 Not now, luvvie. Wait till we're inside.
抱歉 耐莉丝 Sorry, Nerys.
这就是...? 是的 Is this the...? Yes.
你知道今天谁是创伤主任医师吗 Have you got who's Trauma Consultant, today?
呃 还没有接到消息 Uh, that information's not come through yet.
请呼叫克莱夫 同事呼叫 阿彻菲尔德医生 Call Clive, please. Colleague call - Dr Archerfield,
请立刻到创伤复苏室 紧急事态 please attend Trauma Resus, urgently.
开始计时 Starting the clock.
困难气道 Critical airway.
直接送去医务室 先别交接 Straight into the bay. No hand-over.
钱德拉曼医生呢 今天去进修了 Where's Dr Chandramohan? On study leave, today.
谁来代替他 巴斯比医生 Who's covering? Dr Busby.
紧急呼叫他 我们需要麻醉师 Fast bleep him, we need an anaesthetist.
数到三 一 二 三 On three - one, two, three.
为什么要把脸遮起来 What's with the whole Elephant Man thing?
好吧 哦 天啊 Right. Oh, my God.
我去 Bloody hell.
请帮我紧急呼叫巴斯比医生 Can you fast bleep Dr Busby for me, please?
还有阿彻菲尔德医生 And Dr Archerfield.
供给纯氧 尽量给她通气 100% oxygen, and bag as best you can.
我不知道你是否能听见我说话 I don't know if you can hear me,
但我们会采取一些措施帮助你呼吸 but we're going to do something to help you breathe.
硫喷妥纳(麻醉药) 司可林 探镜 探针 窄导管 Thio, sux, 'scope, bougie, narrow tube.
别蠢了 管子插不进去的 Don't be daft. You'll never get a tube in.
无法插管 好吧 Cannot intubate. OK.
菲奥娜 Fiona!
请紧急呼叫巴恩比医生好吗 是巴斯比 Could you fast bleep Dr Barnby, please? Busby.
巴斯比 抱歉 还有阿彻菲尔德医生 Busby, sorry, and Dr Archerfield.
到创伤复苏室 To Trauma Resus.
嗯 谢谢 Well? Thanks.
好了 已经去呼叫了 能够挤进去吗 Yep. Put the call out. Getting any in?
木头挡着呢 这是什么东西 The wood's in the way. What is it?
栅栏柱 她从窗口掉下来的 Fence post. She fell out a window.
两侧肺野都通气不畅 Poor ventilation across both lung fields.
无法插管 "Cannot ventilate."
告诉我饱和度 知道了 稍等 Give me a sat. Yeah, in just a second.
好了么 好了 OK? OK.
有了 Yep.
氧饱和度60% 该死 Oxygen saturation 60%. Shit.
栅栏柱 60% Fence post. 60%.
现在的情况是无法插管 无法通气 This is the situation, "Cannot Intubate, Cannot Ventilate."
她需要做气管切开术 She needs a tracheotomy.
耐莉丝 能请你写下来吗 是我说的 Nerys, can you write that down, as stated by me.
时间是 一分钟二十秒 And the time is...one minute, 20 seconds.
是 Yep.
现在氧饱和度50% Oxygen saturation now 50%.
还在下降 And falling.
无法插管 无法通气 "Cannot Intubate, Cannot Ventilate."
你已经找到借口了 现在我们来做吧 You've covered your arse. Now let's do it.
看起来克莱夫不会来了 Looks like Clive isn't joining us.
耐莉丝 请细心冷静地 Nerys. Nice and calmly,
准备好一套快速气管切开套件 please, get a Quicktrach ready to go.
该死的 Bloody hell!
硫喷妥纳和司可林剂量? Uh, Thiopentone and Suxamethonium doses?
200 100 知道了 200, 100. Got it.
把固定块拿走 Let's get the blocks off.
哈莉 能来帮一下忙吗 Harry, can you give me a hand?
我来帮她中立位固定 I'll give in-line immobilization.
饱和度偏低
硫喷妥纳 Thiopentone.
冲洗 司可林 Flush. Sux.
硫喷妥纳200毫克 司可林 Thiopentone, 200 milligrams, suxamethonium,
100毫克 已注射 100 milligrams - given.
冲洗 Flush.
现在请给我快速气管切开套件 Quicktrach to me right now, please.
我勒个去 Shitting shit!
马上到2分30秒了 没有气道 It's coming up to two minutes 30 - no airway.
有麻醉师的消息吗 只有我们 Anyone heard from the anaesthetist? It's just us.
好吧 OK.
让开 Step away.
该死 她没有被麻醉 Shit, she's not under.
开他敏(麻醉药)30毫克 马上 比利 Ketamine, 30 milligrams, now, Billy!
来了来了来了 没关系的 没事的 Yep, yep, yep. It's all right. It's OK.
我正在抽取 比利 拜托快点 I'm drawing it. Billy! Come on, quicker!
这就来这就来 我正在抽取 I'm coming, I'm coming, I'm drawing.
一秒就好 快点 比利 快点 One second. Come on, Billy! Come on!
快点 比利 赶紧弄好 稳住 稳住 Come on, Billy. Give it! Stay still, stay still.
现在快三分钟了 还是没有气道 Now coming up to three minutes. Still no airway.
好姑娘 拜托 稳住 你不会有事的 Good girl, come on, that's it. You'll be fine.
没事的 没事的 拜托 亲爱的 这就对了 It's OK, it's OK. Come on, darling, here we go.
开他敏 30毫克 已注射 Ketamine, 30 milligrams, given.
好了 她已被麻醉 让开 OK, she's under. Step away.
你以前做过这个吗 You have done this before?
现在做过了 I have now.
有气了 I'm getting air.
谢谢你 比利 抱歉 Thanks, Billy. Sorry.
我根本没在意 Water off a duck's back.
我会固定住气管 I'll hold the trach in place.
你把带子装上去绕在她脖子上好吗 Attach the strap and loop it around her neck, will you?
人工通气 Bagging.
没关系 It's OK.
血氧和饱和度上升中 现在是70% Oxygen and saturation climbing, now 70%.
对 从木头底下穿过去 对了 Yeah, under the wood. That's it.
系好了 好的 Strap's on. OK.
现在是80% Sats now 80%.
90% 很好 90%. Good.
气道畅通 把担架拿掉 Airway secure. Scoop out.
谢谢你 贾斯汀 Thanks, Justin.
支架 Brace.
好了 请把固定块重新放回去 贾斯汀 OK, let's get the blocks back in, Justin, please.
好 我来放固定块 好 我来帮忙固定 Yep, I'll do blocks. Yeah, I'll help with the blocks.
干得好 我不是帮自己找借口 Well done. I'm not covering my arse,
我是在对的时间帮我的同事做出对的决定 I'm helping my colleagues make the right decision at the right time.
一时着急 Stress of the moment.
固定好了吗 好了 Blocks in? They're in.
同时请剪开她的衣服好吗 Can someone cut her out of her clothes, in the meantime, please?
好的 抱歉 亲爱的 Yep. Excuse me, love.
气道通畅 Airways secure.
两侧肺都通气了 Ventilating both lungs.
脉搏强劲 血压正常 Strong pulses. Good blood pressure.
要是每次都这么容易就好了 If only it was always this easy.
哦 他来了 Oh, here he is.
啊 欢迎加入 巴斯比医生 Ah. Good of you to join us, Dr Busby.
该死 呼叫上显示是十分钟 Shit. The call said ten minutes.
她在救护车上晕过去了 She went off in the back of the truck.
最后一分钟才更新的 It didn't get updated till the last minute.
我没收到更新 I never got the update.
现在别讨论这个 好吧 Let's not discuss it now. OK.
人工气管可以一直帮我们支撑到耳鼻喉科的人来 The trach will tide us over until we get ENT involved.
氧饱和度逐步恢复正常 Sats normalising.
快速气管切开术完成得很棒 Nice job on the quicktrach.
谢谢 Thank you.
现在请交接 Can we have the handover now, please?
病患是女性 应该是45岁上下 The patient is female, believed to be mid-40s,
但还没有确认身份 but we don't have an I'D yet.
报警的是隔壁的邻居 999 call was made by the next-door neighbour,
但是他不认识病患 but he couldn't ID the patient.
说他不知道她叫什么 她深居浅出 Said he didn't know her name - she kept herself to herself.
事发是在4点30分 邻居听到撞击声 This was at 4.30. Neighbour heard a crash
然后看到她躺在后院里 and saw her lying in her back garden.
二楼有扇窗户开着 A first-floor window was open
他觉得她可能是在擦窗户 and he thinks she was cleaning the windows.
她落在了一根栅栏柱上 所以有穿刺性颚伤 She landed on a fence-post, hence the penetrating mandibular injury.
检查后没有发现其他明显创伤 No other major injuries apparent on examination.
在现场时她半昏迷 昏迷指数11分(中度昏迷) She was semi-conscious at the scene, GCS - 11.
在来的路上 她开始呼吸困难 En route, she started to have difficulty with the airway.
无法进行口咽插管 人工通气有困难 She wouldn't take a Guedel and there was difficulty bagging.
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普莉玛 还真是重要的医疗信息 Primark. Important medical information, that is!
别犯傻 集中注意力 Don't be silly. Concentrate.
抱歉 谢谢 Sorry. Thank you.
有问题吗 给过麻醉吗 Any questions? Any analgesia given?
没有 因为昏迷指数评分太高 No, due to the GCS.
在这里注射了30毫克的开他敏 She's been given 30 milligrams of ketamine here.
她口袋里有东西 She has stuff in her pockets.
好吧 我们来检查下 All right, let's do a BA3, then.
还注射了200毫克硫喷妥纳和100毫克司可林 She's also had 200 of thio and 100 of sux.
谢谢你 比利 Thanks, Billy.
手机 手机 Mobile phone. Mobile phone.
有带名字的吗 Anything with a name?
不 没有信用卡 乐购会员卡? No, no credit cards. Tesco Club Card?
哦 干洗店发票 Oh! Dry cleaning ticket.
水果... 水果糖 Fruit... Fruit pastilles.
水果糖 Fruit pastilles.
请到耐莉丝那里去签署文件好么 Can you sign off on the paperwork with Nerys for me, please?
抱歉 她需要填一份PS20表 啊? Sorry, she needs to complete a PS20. Huh?
重伤病人体验调查 Major Trauma Patient Experience Survey.
她昏迷着呢 She's unconscious.
谁去验一个血好吗 哈莉? Can someone do bloods? Harry?
当然 没问题 Yeah. Sure, no problem.
所以你是哈莉? 对 是我 So you're Harry? Yep, that's me.
多米尼克 小多 Dominic. Dom.
你好 Hey.
你好 小多 很高兴认识你 Hi, Dom, nice to meet you.
所以你现在是创伤急救队长了? 现在? So, you trauma team leader now? Now?
顶替罗琳 不 Instead of Lorraine. No.
我来吗 Shall I do these?
比利可以帮你做 Billy can do those for you.
好吧 All right.
腹部鼓胀 有可能是液体 There's fullness in the abdomen, could be fluid.
准备好O-型血 Let's get O-neg
做血型和抗体测验 以及血栓弹力图检测 on standby and G&S and TEG,
(抗体测验: 检验患者血液中是否存在非典型性抗体 若存在 则需使用不存在相对应抗原的血 血栓弹力图是反映血液凝固动态变化 包括纤维蛋白的形成速度 溶解状态和凝状的坚固性 弹力度的指标)
以及血常规 好的 as well as the usual bloods. Yeah.
(静脉血气检查可用于判断酸碱失衡)
能做个静脉血气检查吗 好的 Can you run off a VBG? Yep.
可以请谁立刻打电话给CT吗 And can someone call CT straight away, please?
我来打 I'll call them.
我想看她骨盆和腿部的造影 I'd love images of her pelvis and legs.
去做X光吗 X-rays now?
如果扫描器空着 我宁可做CT If the scanner's free, I'd prefer a CT.
快到八分钟了 Time is coming up to eight minutes.
八分钟整 Eight minutes, Mark.
你们可以走了 That's you done.
谢谢你们 谢谢你 耐莉丝 Thank you, guys. Thanks, Nerys.
请为麻醉主治医师拉玛克里士纳·钱德拉曼医生留言 'Leave a message for dr Ramakrishna Chandramohan, Anaesthetics Registrar.
你知道你想要 你好 我是哈莉 'You know you want to.' Hey. It's me, Harry.
进修是怎么回事 what's this about study leave?
我是希克林夫人 This is Mrs Hicklin.
有个重伤FB病患要做全身CT We've got Major Trauma Foxtrot Bravo for a top-to-toe.
四肢没有严重创伤 No major limb trauma.
谢谢你 他们可以立刻接收她 Thank you. Yeah, they can take her right away.
好极了 那边见 Great. I'll see you there.
好吧 Yeah.
好吧 我们继续吧 好吗 Yes. Well, well, let's just keep at it, shall we?
克莱夫 抱歉 你好 菲奥娜 Clive, Sorry. Hi, Fiona.
他们呼叫你了 They put out a call for you.
是啊 抱歉 我脱不开身 进展如何 Yep, I'm sorry, I'm snowed under. How's it going?
病人情况稳定 Patient's stable.
我早些时候看到罗琳的名字不在今天的值班表上 I saw earlier, Lorraine's name's not on the rota for today.
是不在 No.
我一周都试着打电话给她 但她没给我回电话 I tried calling her in the week but she hasn't got back to me.
对 她还是感觉不舒服 可怜的家伙 Yes, well she's still feeling under the weather, poor thing.
如果你和她联系上 代我问候她 好吗 If you speak to her, give her my best, will you?
我会的 好吧 我们没有创伤主任医师 Yeah ... OK...so...we haven't got a trauma consultant.
不 有人会来代班 他还没来吗 No, there is somebody coming in. Isn't he here yet?
没有 No.
重伤案需要创伤急救队长 A major trauma case needs a trauma team leader.
是么 如果你有需要 来这里找我 Yep, well I'm here if you need me.
你们肯定能够应付 I'm sure you can cope.
好吧 OK.
创伤急救呼叫 速去急诊部 'Trauma call - attend emergency department.'
菲奥娜 你最好赶快回来 Fiona! You better come quick.
别管血气了 过来帮忙 Stop messing about with the blood gas and get back over here.
继续给她输血 试着让她的血压回升 Let's keep filling her up and try to get her BP back.
手术气道已建立 Surgical airway is established,
下颚显然已经止血了 所以我建议 there's apparent haemostasis in the mandible, so I propose
她稳定后就听听口腔颌面外科医生的意见 we leave for a max-fax opinion once she's stable.
我说过了 As I've said,
做过CT以后就送口腔颌面外科和耳鼻喉科 once we have a CT we can send to max-fax and ENT,
但现在最重要的是加紧输血 but right now our priority is addressing the low BP
解决血压偏低问题 by pushing the blood transfusion.
同意 Agreed.
呃 血气结果出来了吗 Uh, did we get gases?
我是创伤主任医师 I'm the Trauma Consultant.
很有可能是内部大出血 Most likely, this is an internal haemorrhage,
所以我们得在她死之前找到出血点并止血 so we need to find the bleeding and stop it before it kills her.
输一单位O-型血 用所有静脉留置针一起输入 Let's run a unit of O-neg into each of the Venflons, please.
已经在输了 We're doing that.
那再准备一单位 这个完了立刻换上去 Then have another one ready to go up straight after.
再加两单位的新鲜冰冻血浆 Plus two units of FFP,
用3比2的比率输进去 continuing at a ratio of 3:2.
再给她一克氨甲环酸 And let's give her a gram of TXA.
(氨甲环酸: 用于急性或慢性 局限性或全身性 纤维蛋白溶解亢进所致的各种出血)
黄金一小时已经过去20分钟了 所以 We're already 20 minutes into our golden hour, so...
请立刻照办 Right now, please.
他是谁 Who's he?
耐莉丝 再从冰箱里拿两单位O-型血 好的 Nerys, get another two units of O-neg from the fridge. Yep.
尽快开始输血 请问你是谁 get them running ASAP. Who are you, please?
格伦·博伊尔 临时创伤主任医师 Glen Boyle, Locum Trauma Consultant.
很高兴认识你 你是? Pleased to meet you. You are?
妮可拉·希克林 护士顾问 Nicola Hicklin. Nurse Consultant.
我是这部门的副护士长 I'm the Deputy Clinical Lead in this department.
你该早点介绍自己的 You should've introduced yourself earlier.
血压还是没有回升 BP's still down.
那立刻开始输血 使用压力输液袋 So, let's get the transfusions going. Pressure bags, please.
好的 有人提出红色警报了吗 Yep. Anyone called a Code Red?
没有 那赶紧提出来 或者打电话给血库 No. Well, let's make the call, or call Blood Bank
要求送12单位交叉配血或者O-型血 and request 12 units of crossmatch or O-neg,
哪个能先送到就送哪个来 whichever is most quickly available,
8单位新鲜冰冻血浆和4单位血小板 eight of FFP and four of platelets, please.
好吧 你需要签到 OK. You need to sign in.
那里吗 There?
叫血了吗 Do we have the bloods yet?
五分钟前就叫了 Sent off about five minutes ago.
我是希克林夫人 This is Mrs Hicklin.
请送以下物品到创伤复苏室 I need the following to Trauma Resus,
病人 酒精 patient... EtOH.
天啊 酒精 我全忘光了 Christ, EtOH, I'd forget me head, me.
氨甲环酸 Tranexamic acid.
一克静脉快速滴注 随后注射 One gram IV bolus. Infusion to follow.
需要更多的输入口 Need more access.
我来接一根大号导管 好的 I'll do a trauma line. Yep.
好了以后请通知我 And let me know when that's done, please.
你好 我是威廉·芬利 手术部医生 Hello, this is William Finlay, ODP,
我要申请酒精 I'd like to request an EtOH.
我不能... 如果系统里还没有你 I can't... If you're not on the system yet,
就先从下拉菜单中选择"零时员工" just choose "temporary staff" from the drop-down list.
临时? 是的 Temporary? Yep.
抱歉 Excuse me?
你是要告诉我们血气结果吗 是的 You were going to show us her VBGs? Oh.
谢谢 Thank you.
他是谁 Who's he?
格伦·博伊尔 Glen Boyle.
谢谢 Thanks.
大号导管好了 谢谢 Trauma line's in. Thank you.
等刚开始的两单位O-型血输完后 Let's run two more units of O-neg through the trauma line,
用大号导管再输两单位的O-型血 and two of FFP through the Venflons,
然后用静脉留置针输两单位新鲜冰冻血浆 once the first two units of O-neg are through.
现在差不多输完了 More or less through now.
继续 你是? Crack on. You are?
贾斯汀 Justin.
血压上去了 现在是100/80 氧饱和度正常 Blood pressure's moved up - now 100 over 80. Sats remain good.
在去耳鼻喉科前气道通畅吗 差不多吧 Airway stable pending ENT? Just about.
那我们送她去做CT Then...let's get her a CT.
好吧 但我觉得最好... 那 OK, but I'd rather... Then...
我们送她去做CT let's get her a CT.
我去打电话 谢谢 I'll call them. Thank you.
他是谁 Who's he?
格伦·博伊尔 Glen Boyle.
我是罗马斯女士 创伤科副主任医师 Ms Lomas, Trauma Fellow.
有个重伤病人 We've got a Major for you.
谢谢 Thank you.
谢谢 Thanks.
CT现在可以接收她了 CT can take her now.
现在血输进去很快 谢谢 Blood running in fast now. Cheers.
血压又上去一点了 现在是105 BP's coming up a little more. Now 105.
那我们送她去做CT吧 Then let's get her a CT.
哈莉 你来拿输液架好吗 好的 Harry, take the drip stand, will you? Yep, on it.
我来帮你做完 Finish that for you.
重新把通气设备连接到... Reconnecting the ventilation to the...
你什么时候开始 When did you start?
今天 Today.
所以你不是来代替罗琳·拉帕波特的? So, you're not Lorraine Rappaport's replacement?
谁 不是 Who? No.
只是临时的 你会在这里工作多久 Temporary. How long are you here for?
不知道 只是来代班的 Not sure. Just filling in.
你知道我们这里要精益求精吧 You do know that we're a Centre of Excellence?
当然 Absolutely.
我们是全区的重伤转诊中心 We're the referral centre for major trauma for the whole region.
我知道了 I got it.
请赶快走吧 Get a move on, please.
你还好吗 So, how's it going?
好极了 Great.
没完没了的急救呼叫 These trauma calls!
是啊 Yeah, I know.
你们得退后 你们得退后 You'll have to back up. You'll have to back up.
我们来了 布莱恩 请帮我们开门 We're here, Brian, if you could open the doors for us, please.
你看起来像看到鬼一样 You looked as if you'd seen a ghost.
可以先通知我一声嘛 Could've warned me.
我是该说的 I should have.
我该打电话给你的 I should've called.
不是吧 真的吗 No, really?
抱歉 Sorry.
我还以为你已经不会再做让我措手不及的事了 I thought you would have grown out of trying to catch me off guard.
很高兴见到你 It's good to see you.
我也是 You too.
抱歉 要开始扫描了 Sorry. Scan's about to start.
谢谢 Thank you.
我们想要启动大量输血方案 We've been trying to enact a major transfusion protocol,
但是一些血液科主任医师坚持说要通过他们 but some of the haematology consultants insist on it going through them.
那么就得有人去提意见啊 Well, then someone needs to speak up.
已经有人提了 Someone already did.
罗琳·拉帕波特 Lorraine Rappaport.
所以才叫你来填补空缺 Hence the vacancy you've just filled.
矫形外科医生呢 她去哪儿了 The orthopod? Where is she?
丽贝卡吗 她一定是回病房去了 Rebecca? Must've gone back to the ward.
马上就回来 我快憋不住了 Back in a mo. I'm busting.
总是这样 我们一来做CT Usual story, once we reach CT,
他们就回去做正常的工作了 they start catching up with their normal jobs.
有一点硬膜下血肿 Small subdural.
我们需要叫神经科医生来看看 We're going to need a neuro opinion.
你还真是新来的 对不对 You really are new, aren't you?
你在吃东西 Are you chewing?
没有 No.
(对比剂: 也叫造影剂 用于CT扫描时增强图像的显像)
我要去连接对比剂 然后开始全身扫描 I'm going to connect up the contrast and start the body scan.
不许碰任何按钮 Nobody press any buttons.
别担心布莱恩 会叫的狗不咬人 Don't worry about Brian. His bark's worse than his bite.
真让人安心 What a relief.
病人安全已固定好 为扫描做准备 Patient's secure. Let's get ready to scan.
我不知道你是否知道 我教插管辅导 I don't know if you know, but I teach an intubation tutorial...
真的? Really... ?
开始对比扫描 Starting contrast run.
停止扫描! Stop the scan!
正在停止 Stopping...
里面怎么了 What's going on in there?
他听说如果他额外教你 He's heard that if he gives you extra teaching,
你一定会同意跟他睡 you're bound to put out.
巴斯比医生 Dr Busby?
犯不着生气 布莱恩 Keep your hair on, Brian.
我没法这样工作 I cannot work like this.
你造反是不是 抱歉 This is anarchy. Sorry.
金发妞儿呢 What happened to blondie?
扫描中 Scanning...
警察打电话来了 The police called.
他们去她家确认了她的身份 They went to the house and obtained an ID on the patient,
但是在系统里她还是FB 好的 but on the system she'll still be Foxtrot Bravo. OK.
对比剂有一点溢出 Small contrast extravasations.
没有填塞或胸腔主动脉破裂 No tamponade or thoracic aortic rupture.
水果糖? 不是 Fruit pastille? No.
好的 所以现在我们知道了 OK. So now we know.
如果有大出血 是在腹腔内 If there is a haemorrhage, it's in the abdomen.
我去看有没有追踪到她的家人 I'll go and see if there's any progress on tracking down next-of-kin.
谢谢 肝周围是什么 Thanks. What's that around the liver?
一点这个 一点那个 没什么严重的 It's a bit of this, it's a bit of that, nothing major.
该死 她在大出血 Shit, she's haemorrhaging...
左肾破裂加多处腹膜内溢血 Left renal tear plus various intraperitoneal extravasations
紧急呼叫创伤手术室 Fast-bleep the Trauma Theatre.
我要他们十分钟内准备好 I want them ready to cut in ten minutes.
我去紧急呼叫普外科医师 I'll fast-bleep the general surgeons.
去催催血库 抱歉 Chase the blood bank. Excuse me?
这个病人需要去手术室制止内出血 This patient needs to go to theatre to stop the internal bleeding.
如果是告知克莱夫一声的话我会更安心 I'd be more comfortable if it went through Clive.
克莱夫? Clive?
克莱夫·阿彻菲尔德 他在急诊部门 Clive Archerfield. He's in the ED.
好吧 Right.
菲奥娜·罗马斯 创伤科副主任医师 Fiona Lomas, Trauma Fellow.
请你立刻紧急呼叫创伤手术室的人员 Would you kindly fast-bleep the trauma theatre staff
以及普外科待命医生好吗 and the general surgeon on call, straight away please?
然后再帮我接通血库 And put me through to blood bank again.
请普外科待命医生 Would the on-call general surgeons
立刻到创伤手术室 please report to Trauma Theatre.
以及髋骨骨折 去做胸部X光扫描和验血 ...as well as the Nof, X-ray the chest and get the bloods done,
然后直接送到病房去 so there are no delays taking her up to the ward.
她已经在这里呆了两个小时了 She's been here two hours already...
抱歉 我有急事 格伦·博伊尔 Sorry, I'm in a hurry. Glen Boyle.
创伤科代班医生 啊 克莱夫·阿彻菲尔德 Trauma Locum. Ah, Clive Archerfield.
我的病人需要做紧急剖腹手术 My patient needs an urgent laparotomy
显然我得先征求你的同意 and, apparently, I need to ask for your approval.
这不是我说的 很好 谢谢 That hasn't come from me. Good. Thanks.
我还想谈谈大量输血方案的事 But also I'd like to discuss the major transfusion protocol.
是 当然 我会找个时间 Yep, sure. I'll fix a time.
不 今天还行不通 所以今天就得解决 No, it's not working today so it needs fixing today.
听着 你管创伤急救 而我得管整个部门 Look, you run the trauma call, I run the entire department,
所以 留给我解决吧 so, leave it with me.
谢谢 Thanks.
我们收了一个 ...we're receiving a
从儿童医院转来的多形性黄色星形细胞瘤病患 pleomorphic xanthoastrocytoma from the Children's...
是一例急性神经外科转诊 It's an acute neurosurgical referral.
得有人告诉我病人到底有没有在来的路上 Someone just needs to tell me if the patient's in transit or not.
你是神经外科主治医师? You're the neurosurgical reg?
惭愧 你能帮我看一看CT吗 Guilty. Any chance you could take a look at a CT for me?
不 No!
我是重伤待命主任医师 I'm the consultant on call for major trauma.
就算你是乔治·克鲁尼 你也得先发邮件 You could be George Clooney. You'd still have to e-mail it.
呃 他是新来的 你好 Er, he's new. Hi.
你好 Hi.
我们是神经科的三级转诊中心 We're the tertiary referral centre for neuro.
如果我们内部转诊的服务加快的话 The other hospitals complain of favouritism
其他医院就会抱怨我们偏袒 if we provide a faster service for intramural referrals.
重点是 伙计 我们没那么重视头部受伤 The thing is, hombre, we're not that into head injuries.
你他妈嘲笑我么 You're taking the piss.
我无意中听到了 I couldn't help but overhear...
我来帮你登录系统找到你的病人吧 Let me get you on the system and let's find this patient of yours.
哦 谢谢 Oh, thanks...
好了 快走吧 我们送她去手术室 OK, let's get moving. We're taking her to theatre.
我一点也不满意 什么不满意 I am not happy with this at all. With what?
对他 他是创伤科主任医师 Him. He's the Trauma Consultant.
临时主任医师 Locum consultant.
我们对他一无所知 We don't know the first thing about him.
我们需要立刻给这病人做手术 This patient needs opening up right away
不然她会流血致死 or she's going to bleed to death.
把血送去手术室 好的 Let's get the blood delivered to theatre. Yep.
好 一 二 三 OK, 1, 2, 3...
赶快 动起来 Come on, let's get moving.
喂 调控 这里是手术室 Hello switch this is theatre.
我们已经紧急呼叫普外科医生了 We have fast-bleeped the general surgeons.
能催一下吗 Can you chase them, please?
普外科待命医生 On-call general surgeons
请到创伤手术室报道 please report to Trauma Theatre.
请普外科待命医生立刻到创伤手术室 That's on-call General Surgeons to Trauma Theatre, please.
查到亲属了 有个成年女儿 叫蕾切尔 Re next of kin, there's a grown-up daughter, name of Rachel,
正在从伦敦赶过来 谢谢 coming up from London. Thanks.
今天过得很糟 说得是啊 Not had a good day. Good shot, there.
请问普外科医生还要多久才来 How far away is General Surgery, please?
这医院很大 It's a big hospital.
能再紧急呼叫普外科医生一次吗 谢谢 Can you fast-bleep the general surgeons again please? Thank you.
血压还在下降 BP's still dropping.
不 等不及了 去洗手 No. Can't wait. Scrub in, please.
我们需要止住大出血 We need to stop the haemorrhage.
你要我来准备吗 Would you like me to prep?
拜托你了 Please do.
每次都是这样吗 Is it always like this?
罗琳告诉克莱夫上百次了 Lorraine told Clive over and over that
其他专家需要自动回应急救呼叫 other specialities should automatically come to the trauma calls.
你觉得罗琳改变不了的事我能改变吗 You think I can change things when this Lorraine couldn't?
你 You...
你就像闯进瓷器店的公牛一样莽撞 You're a bull in a china shop.
嗯 神经外科主治医师刚刚帮我们看过CT了 Um, the Neurosurgical Registrar just reviewed the CT scans for us.
开玩笑吧 You're kidding.
我也有走运的时候 说说看 I have my moments. Let's hear it.
"轻微硬膜下血肿 "Insignificant subdural haematoma.
"CT上无明显脑损伤 "No gross brain injury visible on the CT.
"也无其他形态变化 "No other morphological changes visible.
"本次不需要神经外科介入" "No neurosurgical intervention is indicated at this time."
很好 谢谢 干得好 请帮我系一下 Good. Thanks. Well done. Do my ties, please.
普外医生正在做另一个... Gen-Surg are operating on another...
你不该在这里的 You shouldn't be here.
回去急诊部看病人去 Return to seeing patients in the ED.
是 抱歉 希克林夫人 Yes, sorry, Mrs Hicklin.
没关系 It's OK.
请容我问一句 你这是在干吗 May I ask, what on earth are you doing?
如果我们不阻止内部大出血 If we do not stop the internal haemorrhage,
就会造成不可避免的 致命的器官损伤 organ damage will be irreversible and fatal.
叫做黄金一小时不是没有道理的 There's a reason why this is called the Golden Hour.
所以我要开始手术 等普外科医生 So I'm going to get started and the general surgeons
来了以后可以加入进来 can muck in when they get here.
这让我不快 I'm not happy.
为什么你觉得不快 And why are you not happy?
你说自己是 What exactly do you mean
"创伤科手术医生" 这到底是什么意思 when you've described yourself as a "trauma surgeon"?
我的意思是我在全世界行过医 What I mean is I've practised all over the world,
在军队里干过 也去过平民医院 in the Forces and civilian hospitals.
我的专长就是危重伤患 I specialise in critical injuries.
不幸的是 这国家里太多的急救服务 Unfortunately too many trauma services in this country
是由一群乱糟糟的 are formed from a jumble of
普外科医生和矫形外科医生组成的 general surgeons and orthopods.
我们的重伤急救服务 We provide a major trauma service
是由一群有奉献精神的专家提供的 of dedicated professionals
而其中剖腹手术是由普外科医生做的 in which the general surgeons perform the laparotomies.
我熟悉腹部 I'm comfortable in the abdomen.
你是自说自话 We've only got your word for that.
那你最好在病人的病历上记一笔 Then you should write in the patient's notes that
你在阻止我们进行救命的手术 you are blocking a life-saving procedure.
你很安静 You're very quiet.
我希望手术成功 I hope the procedure goes well.
如有需要请叫我 Call me if there is anything you need.
谢谢 Thank you.
公牛得1分 瓷器店0分 Bull 1, China Shop 0.
自我介绍 我是格伦·博伊尔 创伤科主任医师 Let's who... I'm Glen Boyle. I'm the Trauma Consultant.
达莉赛·根托护士 洗手护士 Sister Dalisay Guinto, Scrub Nurse.
(洗手护士: 亦称器械护士 指需要消毒双手上台传递器械的护士)
多米尼克·巴斯比 麻醉师 Dominic Busby, Gas Reg.
比利·芬利 负责麻醉的手术部医生 Billy Finlay, Anaesthetic ODP.
阿尔敏·库拉尔 手术部医生 Armin Khular, ODP.
阿历克斯·巴吉尔 普通护士 Alex Badger, Staff Nurse.
克拉拉·罗伊德 普通护士 Clara Lloyd, Staff Nurse.
波莉·梅森 记录护士 Polly Mason, Documentation Nurse.
菲奥娜·罗马斯 创伤科副主任医师 Fiona Lomas, Trauma Fellow.
夏洛特·布莱斯 巡回护士 Charlotte Brase, Circulating.
请确认病患身份 Can we confirm who the patient is, please?
重伤FB Major Trauma Foxtrot Bravo.
出生日期 不明 Date of Birth 1.1.1900.
谢谢 Thank you.
我已经签了四号同意书 OK, I've signed a consent form four.
(四号同意书: 针对无法对某项治疗方案作出同意的成年病患)
我要进行剖腹手术 制止危及病人生命的大出血 I'm performing a laparotomy to arrest a life-threatening haemorrhage.
大家都同意吗 Everyone good with that?
是的 Yes.
准备好了吗 Are we ready?
准备好了 博伊尔先生 Ready, Mr Boyle.
手术刀 Blade.
可以切了吗 OK to cut?
可以 OK.
切开 Cutting...
该死 吸引器 真空泵 Shit. Suction. Vacuum.
血压直线下降 Pressure's dropping like a stone.
纱布 我什么都看不见 Packs. I can't see a thing.
我正在努力 那再努点! I'm trying. Then try harder!
给 Here.
腹部使用五条纱布 用掉五条 Five packs in the abdomen. Five in.
钢圈 Ring.
你知道我要说什么 You know what I'm going to say...
那就别说 我一定要说 So don't say it. I've got to say it.
血压下降 氧饱和度下降 BP's dropping, sats are dropping.
(气道峰值压 传感器未连接)
好了 好了 我需要主动脉钳 OK. OK. I need an aortic clamp.
我 不 呃 我需要主动脉钳 I, don't er... I need an aortic clamp.
好的 呃 是 Right, er, yes...
我需要主动脉钳 我们没有... I need an aortic clamp. We don't have...
我需要主动脉钳 I need an aortic clamp.
楼上手术室 快去 Upstairs theatres! Go!
啊 小心 Ow! Careful!
血压是65/38 请给我更多纱布 马上! BP's 65 over 38. More packs, please! Now!
手 Hands.
把手伸进去 按住流血口 Get your hands in there, press down on the bleed.
好的 OK.
血压... 我们看得到 BP... We can see.
腹部又塞入五条 Five more in the abdomen.
用掉十条 Ten in.
把那关掉 Turn that off!
该死 抱歉 Shit, sorry.
没关系 It's OK.
血压下降 纱布没用 Pressure's falling. Packs not working.
我们一个区一个区地拿掉 We unpack quadrant by quadrant,
然后一个个处理出血点 and we deal with the bleeds as we get to them.
从左上区开始 好么 Starting with the left upper quadrant. OK?
脾脏在出血 Spleen's haemorrhaging.
腹膜后血肿正在变大 There's an expanding retroperitoneal haematoma.
该死! 重新包上 Shit! Repack.
血压又下降了 Pressure dropping again.
脾脏出血可以控制 The spleen is controllable.
肾脏出血会要她的命 It's the renal bleed that's killing her.
我真的需要动脉钳 I really need that clamp.
她正在下来 对 按住 She's going down. Yeah, pressure.
我们快失去她了 We're losing her!
好 她需要更多的血 给她输血 OK, she needs more blood - let's fill her up.
30分钟前呼叫过失血过多了 Code was called 30 minutes ago.
这里是创伤手术室 病人是FB This is Trauma Theatre, for patient Foxtrot Bravo.
我们还在等... We are still waiting on...
12单位血 8单位新鲜冷冻血浆 4单位血小板 12 units, eight of FFP, four of platelets.
12单位交叉配血 8单位新鲜冷冻血浆 12 units of crossmatch, eight units of fresh frozen plasma
以及4单位血小板 谢谢 and four units of platelets. Thank you.
我拿到主动脉钳了 I've got the aortic clamp.
给我 快 To me! Quickly!
好了 OK.
所以我们可以钳住大动脉 止住下半身的出血 So we can clamp off the aorta and stop all bleeding in the lower body.
那表示我们需要把纱布拿掉才能夹 That means unpacking her to get the clamp on.
是的 没错 Yes, it does.
看在上帝的份上! 是谁的手机 For Christ's sake! Whose phone is that?
一定是病人的 Must be the patient's.
上面有短信记录 There's a text trail here.
稍后再说 你听听上面说的 Later. You ought to know what it says.
最后一条短信是发给一个叫蕾切尔的人的 The last text she sent was to someone called Rachel.
那是她女儿 能稍后再来说这个吗 That's her daughter. Can we do this later?
不 现在处理 赶快 No, we do it now, quickly.
"对不起 我很想见他 "I'm sorry. I miss him so much.
"我全心爱你 但他曾经是我的宝贝 "I love you with all my heart, but he was my baby.
"我以为有一天我会释怀 但我永远不会 "I thought one day I'd get over it, but I never will.
"对不起 我爱你 "I'm sorry. I love you.
"妈妈" "Mum."
她是自己跳下来的 She jumped.
我说"开始"以后 拿掉所有的纱布 When I say "go" we rip out the packs
然后打开腹膜后隙 and we open up the retroperitoneal space.
明白了吗 You got it?
是的 Yes.
按住 Pressure.
该死 开始 Shit. Go.
血压下降 Pressure dropping.
吸引器! Suction!
赶紧吸液 不然我看不清手底下 I need more suction if I'm going to see what I'm doing here.
还在下降 Still falling.
好了 OK.
我要做一个内旋来找到大动脉 I'm going to do a medial rotation to access the aorta.
该死 在哪里 Shit! Where is it?
请把血弄出去 把血清掉 Let's get the blood out of there, please. Clear the blood.
我找不到大动脉 I can't locate the aorta!
不 我看不见就无法进行 No, I can't do this blind.
我要你用吸引器把里面清干净 I need you to clear the field with suction.
好了 钳子 OK, clamp.
找到了吗 Have you got it?
是的 找到了 Yes, I've got it.
好了 钳子 OK, clamp.
夹住了 夹住了吗 Clamp on. Is it on?
是的 数据? 快 Yes. Numbers? Quickly.
还在下降 50/20 Still falling, 50 over 20.
等等 等一下 Hold on, wait a minute.
血压上升了 BP climbing.
干得好 Good work.
血压70/45 BP 70 over 45.
好了 来收尾吧 吸引器和纱布 OK, let's mop up, suction and swabs, please.
好了 血止住了 OK, We've got haemostasis.
血压100/70 BP now 100 over 70.
很好 Good.
我要结扎右肾动脉 I'm going to ligate the left renal artery.
止血钳 Dardic.
谢谢 Thank you.
肾动脉在断裂处上方被夹住 Renal artery clamped above the rupture.
握住那镊子 Hold that clamp.
握住了 2-0号缝合线 Got it. 2-0 tie, please.
(每种缝合线按线径可以分为4, 3, 2, 1, 0, 2-0, 3-0, 4-0/T, 4-0, 5-0, 6-0, 7-0, 8-0 从4号线到8-0 依次减小)
谢谢 Thank you.
抱歉 有人正在实施手术 Sorry, we had someone on the table.
你是普外科医生吗 Are you the general surgeon?
罗伯特·斯特里特 格伦·博伊尔 Robert Street. Glen Boyle.
腹主动脉横跨钳闭 The abdominal aorta is cross-clamped.
左肾动脉已结扎 The left renal artery has been ligated.
病人现在需要做脾切除术和肾切除术 The patient is currently awaiting a splenectomy and a nephrectomy.
血液循环稳定 病人安定 Hemodynamically stable. The patient is settled.
好的 谢谢 下面我来接手 Okey-dokey. Thanks, I'll take it from here.
完事了吗 你可以走了 干得好 Are we done? You're done. Good work.
谢谢各位 Thank you very much, everybody.
谢谢你们 Thanks, guys.
是血液科的 很好 给她输血 That's haematology. Good, we can fill her up.
谢了 伙计 Thanks, mate.
赶紧把血包挂起来 Let's get those transfusions running...
你想去喝杯咖啡吗 Do you want to grab a coffee?
谢谢你的付出 Thanks for what you did...
但最好不要 ...but best not.
没有人知道你打电话给我吧 没人知道 No-one knows you called me, do they? No.
克莱夫和妮可拉 他们 嗯 Clive and Nicola, they're, um...
戒备心很重 defensive.
这里一切都是最先进的技术 Well, it's a state-of-the-art unit
但却没人想到要在手术室里放主动脉钳 and no-one thought to stock the theatre with an aortic clamp.
全天下的专家都在这里 却没有一个 Every speciality under the sun and not one of them
有空来响应急救呼叫 are available to attend the trauma call.
我觉得他们戒备心重也是应该的 I'd say they've got a lot to be defensive about.
现在你理解为什么我要打电话给你了吧 Now you might understand why I called you.
现在你觉得不是个好主意了吧 Now you don't think that was such a great idea.
我可没这么说 没有吗 I didn't say that. No?
我们先不说我们俩之间的事 Let's set aside the you-and-me part.
作为一个每天都在接待危重伤患的 As a registrar receiving critically injured patients
主治医师 on a day-to-day basis,
我很高兴你能来 I'm glad you came.
这里的体制 The set-up here...
国民健康保险制度的权术 很困难 ...the NHS politics it's difficult.
随时让我想到赫尔曼德(阿富汗一个省) Give me Helmand any time.
那你为什么来 So why did you come, then?
我还以为你需要我 I thought you needed me.
这里需要你 是啊 This unit needs you. Right.
我该好好考虑一下的 I should think this through.
你欠我人情 You own me.
你是说 我"欠"你的 You mean, I "owe" you.
我就是这么说的 That's what I said.
干得好 干得好 谢谢你 Good work. Well done. Thank you.
谢谢 对 她在创伤手术室里 Thanks. Yeah, she's in Trauma Theatre.
是口腔颌面外科和耳鼻喉科的人来处理栅栏柱 That's Max-Fax and ENT. Here to take care of the fence post.
我最好进去 I'd better get in there
确保他们不会冒犯对方 and make sure they don't step on each other's toes.
你做得很棒 谢谢 Very good work. Cheers.
你们有时间和病人的女儿谈谈吗 Have you got a moment to speak to the patient's daughter?
你是蕾切尔? 是的 You're Rachel? Yes.
博伊尔先生和罗马斯女士是创伤科手术医生 Mr Boyle and Ms Lomas are the trauma surgeons.
你好 蕾切尔 Hello, Rachel.
手术非常成功 So we've done our part successfully.
你妈妈情况很糟 现在她稳定了 Your mum was in a bad way but now she's stable.
一切顺利 她会康复的 All being well, she should make a full recovery.
我们带你去亲属室 We'll show you to our Relatives' Room.
谢谢你们 请你带她去吧 娜塔莎 Thank you. If you wouldn't mind, Natasha...
抱歉 菲奥娜 能请你填完创伤急救记录吗 Sorry, Fiona, can you complete the trauma record?
没问题 No problem.
谢谢 Thank you.
结果不错 是的 Good outcome. Yep.
有名摩托车手正在过来 There's a motorcyclist on his way into us,
严重下肢受伤 预计15分钟后到达 severe lower limb injuries, ETA 15.
创伤急救呼叫 预计14分钟到达 Trauma call, ETA 14 minutes.
怎样 Well?
来吧 Bring it on.
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