(前情提要)
我不会离开 I'm not leaving.
但你会离开的 But you will,
因为你就是这性子 because that's what you do.
现在是正式的了 你可以再次服役了 'It's official, you can return to active service.'
汤姆 格伦·博伊尔也在 Tom, Glen Boyle's in there.
我们不可能回你那里去 We couldn't have gone back to yours.
不是我不想 It wasn't that I didn't want to.
不是不想? Didn't?
这对你来说不容易吧 This can't be easy for you.
如果有人看到我们... If anyone even sees us...
-==破烂熊乐园倾情奉献==- 本字幕仅供学习交流，严禁用于商业用途
-=破烂熊字幕组=- 翻译：黄先森 菱子 校对：小魉 时间轴：绿
-==http://www.ragbear.com==- 争分夺秒 第一季第11集
格伦·博伊尔先生 主任医师 紧急护理外科
呼叫创伤科 请到地下救护停车场T区 'Trauma call to Thames lower ambulance bay.
呼叫创伤科 请到地下救护停车场T区 'Trauma call to Thames lower ambulance bay.'
你卡住了吗? 对 卡住了 Are you stuck? Yeah, I'm stuck.
帮帮我 Help me.
好了 OK.
好了 好了 Yeah. Yeah.
地下救护停车场现在封闭 The lower ambulance bay is a restricted area.
闲杂人等请勿入内 Essential personnel only.
地下救护停车场现在封闭 The lower ambulance bay is a restricted area.
闲杂人等请勿入内 Essential personnel only.
他们并不着急嘛 Not exactly in a hurry, are they?
肯定是流血速度慢 Must be a slow bleed.
你还好吗? 是的 You OK? Yeah.
请把挡板放下好吗? 好的 Can we get these sides down, please? Yeah.
是你发现他的? 对 You're the one who found him? Yeah.
他是我儿子 He's my son.
我是格伦·博伊尔 我是弗兰克·霍克 I'm Glen Boyle. Frank Howker.
我是创伤科主任医师 I'm the trauma consultant.
弗兰克 Frank...
请你留在这里 I need you to stay here, please.
谢谢 Thank you.
我上来了 Stepping up.
菲奥娜 Fiona.
好 Yeah.
病患有三处穿刺伤 Patient is impaled at three points.
有脉搏 He's got a pulse.
请开始计时 Somebody start the clock, please.
消防队来了以后 我们才能移动他 We can't move him until the fire team get here...
所以我们要先在这里帮他稳定情况 So we're going to have to stabilise him where he is.
把推车上的工具准备好 Let's set up the kit on the trolley.
康斯坦丝 剪刀 谢谢 Constance, scissors, please.
给你 Here you go.
可以上来吗 头儿? 一次上一个 All right to come up, boss? One at a time.
马克 请帮我在这儿清理出地方来 好的 Mark, I need you to make some room for me here, please. OK.
好 Yep.
小心点 各位 Be careful, guys.
不好意思 Excuse me.
谢谢 Thank you.
我的老天爷啊 Shit a brick.
需要快速诱导插管 Going to need to RSI.
而且肯定需要输血 Definitely going to need some volume as well.
快速诱导插管工具 O+型血 谢谢 An RSI kit, please. O positive on the blood, please.
康斯坦丝 静脉留置针 马上来 Constance, a Venflon, please. On its way.
谢谢 Thank you.
右胸部没有活动迹象 No chest movement on the right side.
我要进行针刺降压 来缓和张力性气胸 I'm doing a needle decompression to relieve the tension pneumothorax.
(张力性气胸: 又称高压性气胸 指较大的肺气泡破裂或较大较深的肺裂伤或支气管破裂 裂口与胸膜腔相通 且形成单向活瓣 张力性气胸的急救处理是立即排气以降低胸膜腔内压力 在危急状况下 可用一粗针头在伤侧第2肋间锁骨中线处刺人胸膜腔 有气体喷射出 即能收到排气减压效果)
噢天哪 Oh, God.
弗兰克 你有办法让这车稳定住吗? Frank. Is there any way you can stabilise this lorry?
我可以把支架放下来 I can bring the legs down.
那能帮大忙 麻烦了 That would help, please.
好的 谢谢 OK. Thank you.
心率125 血压78/56 So heart rate's 125, BP is 78/56.
血氧80% Sats are 80%.
需要给他插管 而且他必须输血 Going to need to tube him and he definitely needs volume.
哈莉 在左侧准备静脉注射 输入快速诱导插管药物 Harry, IV access on the left for RSI drugs.
我是钱德拉曼医生 能听见我吗? I'm Dr Chandramohan, can you hear me?
失血过多 Blood out.
从静脉留置针输入O+型血 插入大号导管 O pos through the Venflon and a trauma line in, please.
无睁眼 代表E1 No eye opening, E1.
无语言反应 代表V1 No verbal response, V1.
对疼痛有非正常的收缩反应 代表M3 Abnormal flexion in response to pain, so that's M3.
昏迷指数五分(重度昏迷) GCS is five.
琥珀胆碱100毫克(麻醉药) SUCCS 100mg
保险起见 再给他注射250毫克硫喷妥钠 and let's play it safe and give him 250mg of thiopentone as well.
请拿一下针头垃圾桶 Sharps bin, please.
好 OK...
在这里面装上血 拿去化验 Can you fill these up and run them?
弗兰克 Frank.
这卡车不能动 这很重要 It's really important that this lorry doesn't move.
我知道 没事的 I know. It's OK.
好的 来把这辆车稳定住 OK, let's get that vehicle stabilised.
动作轻一点 各位 Nice and gently, please, guys.
我要做胸廓造口术 OK, I'm going to do a formal thoracostomy.
把工具给我 康斯坦丝 好的 Can I have the kit, please, Constance? Yes.
我在插入大号导管 I'm doing a trauma line.
已连接仪器 On VET.
我是柯蒂斯·泰勒 消防站站长 Curtis Taylor, station manager.
格伦·博伊尔 创伤科小队领导 该死 Glenn Boyle, trauma team leader. Aw, shit.
我们得把他挪下卡车 We need to get him off this lorry...
你还好吗? 是的 Are you OK? Yeah.
最重要的是 扎进他身体里的长钉千万不能移动 ...and our priority is that these spikes don't move inside him.
BPG结果 BPGs!
(BPG: 即二磷酸甘油酸 在血红蛋白运输氧气的过程中起极其重要的调控作用)
乳酸12 PH值7.19 Lactate 12, pH 7.19.
(乳酸为体内血氧缺乏时的产物 有资料表明 若乳酸水平>10.5毫克分子/升 存活率仅30% 而血液PH值在7.35-7.45间为正常)
最好能把它拆解 但螺钉已经锈住了 Dismantling it would be best, but those bolts are rusted in.
我们需要15分钟 That's 15 minutes.
我们可以把它切割开 但可能会让它有点移动 We can cut, but there could be some movement.
他没有15分钟可耗 He doesn't have 15 minutes.
你们把它切开吧 拿切割工具 You're going to have to cut. Get the cutting gear!
我要一单位O+型血 一单位新鲜冷冻血浆 I want one of O pos, one of FFP
等哈莉准备好后 马上给他输入 to go straight in as soon as Harry's ready.
我来 I'll go.
情况如何? Where are we?
血氧84% 心率102 OK, sats at 84%, heart rate is 102...
血压89/65 BP is 89/65.
请动作快点 胸廓造口完毕 Need to hurry, please. Thoracostomy's completed.
新鲜冷冻血浆正在输入 很好 FFP and blood in. Good.
弗兰克 Frank...
你应该进去 You should go inside.
妮可拉? 好的 Nicola? Yeah.
我想留下 I want to stay.
我们会尽最大努力帮他 没错 We're going to do our very best for him. And they are.
莉迪亚 请带他到家属休息室好吗? Lydia, can you get him into the relatives room, please?
把他安顿好 Make him comfortable.
让出点地方来 Let's make some space.
交给你们了 Over to you.
好 我们开工吧 OK, we need to get on with this.
谁来帮我一下可以吗? Can somebody help me here, please?
好的 穿透他的长钉 OK. Spikes that have penetrated.
一 二 三 懂了? One, two, three. Yes?
是的 Yep.
稳住 Steady.
准备 小心眼睛 准备切割 准备切割 Ready. Watch your eyes. Cutting. Cutting.
菲奥娜 你帮忙扶一下长钉好吗? 好 Fiona, can you get a hand on that spike, please? Yeah.
他情况稳定 He's stable.
准备 Ready.
准备切割 Cutting!
可以 稳定 Yeah, stable.
准备切割 Cutting.
检查脉搏 Pulse check.
可以 稳定 OK, stable.
把长钉拿开吧 Release the spikes, please.
好的 Just in.
放铲式担架 Scoop in now.
完事了? 对 That's it? Yes.
谢谢 Thank you.
数到三 往病人的右边抬 So we are bracing to the patient's right on three.
一 二 三 One, two, three.
数到三放回 Back on three. One, two, three.
很好 That's great.
来了 Coming in.
这次往病人左边抬 Bracing to the patient's left this time.
一 二 三 One, two, three.
可以了 数到三放回 OK, we're in. Back on three.
一 二 三 One, two, three.
很好 Great.
接下来 抬起来一点 走到卡车尾部 Next step is a short lift just to the foot of the truck.
数到三 一 二 三 On three. One, two, three.
把他放下 把他放下 Put him down. Put him down.
别再后退了 Don't go back any further.
心率太快了 血压53/46 他在失血 Heart rate's through the roof. BP's 53/46. He's losing blood.
请给他输血 Get blood in, please.
胸部没有流血 OK, there's no bleeding from the chest area.
肯定是下方部位 It must be lower down.
我要在左胸做前外侧胸廓切开术 把主动脉钳住 OK, I'am going to do a left anterolateral thoracotomy and clamp the aorta.
给我工具 再拿一双手套 Get me the kit, extra gloves!
最快速度 Quick as we can!
博伊尔先生 好的 Mr Boyle. Yes.
给我手术刀 Give me the blade.
快给我刀 好的 好的 Give me the blade, please! Yes, yes.
谢谢 Thank you.
可以切开吗? 行行行 Good to cut? Yeah, yeah, yeah.
准备切开 Cutting.
剪刀 Scissors.
谢谢 准备输血 Thank you. Blood going.
准备好了 Ready.
给我那个 Give me that.
给我主动脉钳 Let's get the aortic clamp.
谢谢 Thank you.
主动脉...已经钳住 Aorta...is clamped.
好的 给他盖上 帮他保温 血压在稳定 OK, let's cover him up, keep him warm. BP's stabilising.
还在计时呢 咱们得走了 OK, we're on the clock, we need to go.
拉玛克里士纳 听你口令 Ramakrishna, on your call.
一 二 三 抬 One, two, three, lift.
把推车推过来 停 放下 放下 Bring the trolley in, please. Stop there, down. Down.
换个位置 Reposition.
把线理理清楚 Sort these lines out.
小心背后 小心头顶 Mind your backs there. Heads.
可以了? 是的 Got it? Yeah.
数到三 一 二 三 On three. One, two, three.
阿尼娅 贾斯汀 康斯坦丝 Ania, Justin, Constance.
你们把长钉收拾一下 好的 You manage the spikes, please. Yeah.
行了 走吧 OK, let's go.
伙计们 非常感谢 Guys. Thank you very much.
不客气 是啊 谢谢了 Our pleasure. Yes, thank you.
祝你们好运 谢谢 Good luck with this one. Thank you.
小心长钉 On the spikes...
摁电梯吧 Hit the button, please.
电梯门关闭 Doors closing.
失去心输出量了 We've lost the output.
检查一下左心室 Check the LV, please.
情况不太好 输血 We've got something here. Blood in.
尽量给他输点血 Let's try and get some volume.
一层到了 Ground floor.
上帝啊 Jesus Christ.
哈莉 继续输血 走开 Harry, keep the blood going. Go away!
请动作轻点 Nice and easy, please.
稳住了 Keep it steady, please.
哈莉 汤姆? Harry... Tom?
继续输血 嗨 stay on the blood. Hi.
我在考虑今晚的事 Yeah, I was just wondering about tonight.
我不记得咱们有计划啊 But I didn't know we'd anything planned.
我要带你去吃晚餐 I'm going to take you for dinner.
谢谢 Thanks.
看起来希望不大啊 Seems like a bit of a long shot.
我见过情况更糟的病人也活了下来 I've seen people survive worse.
汤姆怎么样? How's Tom?
什么意思? 你知道我什么意思 What do you mean? You know what I mean.
汤姆不用你关心 Tom isn't your concern.
你得把现在的情况告诉他 You need to tell him what's going on.
坦白说... 格伦 我... And frankly... Glenn, I...
你也得告诉我 ...you need to tell me.
我也爱你 丹尼 拜拜 And I love you too, Danny. Bye-bye.
开始吧 Let's do the hoops.
我是格伦·博伊尔 创伤科主任医师 I'm Glen Boyle, I'm the trauma consultant.
菲奥娜·罗马斯 创伤科研究员 Fiona Lomas, trauma fellow.
拉玛克里士纳·钱德拉曼 麻醉师 Ramakrishna Chandramohan, anaesthetics registrar.
布鲁斯·科比 快速输液操作员 Bruce Corby, rapid infuser operator.
比利·芬利 负责麻醉的手术部医生 Billy Finlay, anaesthetic ODP.
黛比·王 洗手护士 Debbie Wong, scrub nurse.
病患为重伤患者 爱德华·霍克 Patient is major trauma, Edward Howker.
生日 1977年7月17日 Date of birth is 17/07/77.
主动脉已钳闭...8分30秒 Aorta has been clamped for...eight minutes 30.
已签署四号同意书进行胸廓切开术 Consent form four signed to do a thoracotomy,
以及剖腹术 以此控制出血 a laparotomy for haemorrhage control.
好的 Good.
已经过了16分钟 16 minutes gone.
我要把切口完全打开 找到并控制出血点 I'm going to complete the clamshell to find and fix the bleed.
刀 谢谢 Blade, please.
正在切开 Cutting.
可以切开了 Ready to cut.
谢谢 Thank you.
麦金杜侧挛手术剪 McIndoe's, please.
谢谢 Thank you.
加油啊 Come on.
大剪刀 Shears.
谢谢 Thank you.
撑开器 Spreaders.
放的时候请千万小心 And let's be really careful placing these, please.
一根长钉已经穿透了横膈膜 A spike has gone through the diaphragm
并且挤压到下腔静脉 and is crushing the IVC.
血氧饱和度下降 呼末二氧化碳下降 Sats dropping, end tidal CO2 is dropping.
下腔静脉有轻微撕裂 There's a small tear in the IVC.
Satinsky钳 Satinsky, please.
(Satinsky钳头端咬合面是带锯齿 夹闭后留有缝隙 相对于完全夹闭的普通血管钳 对血管内膜损伤较小)
我会试着夹住它 I'll try and clamp it.
天啊 Christ.
血氧79% Sats level to 79%.
长钉挡着 我还是用纱布吧 This spike's in the way, I'm going to have to pack it.
给我 Hit me.
用掉两块 用掉两块 Two packs in. Two packs in.
好 纱布控制住出血了 OK, the pack's controlling the bleed...
但是请继续输血 but keep the blood going, please.
动脉钳已经夹了多久了 The aortic clamp's been on for...?
11分钟 11分钟 11 minutes. 11 minutes.
好 我要实施剖腹术来控制大出血 Right, I'm going to do a laparotomy to control the haemorrhage
好拿掉动脉钳 让他的下半身得到再灌注 so we can take the clamp off and reperfuse his lower half.
手术刀 Blade, please.
谢谢 Thank you.
可以切开了 博伊尔先生 OK to cut, Mr Boyle.
谢谢 Thank you.
麦金杜剪 McIndoes, please.
谢谢 Thank you.
镊子和手术刀 Forceps and blade, please.
缝线 Sutures, please.
请扶住这里 谢谢 Just hold it here. Thank you.
剪刀 Scissors, please.
剪 Cut.
谢谢 Thank you.
请放开手 Take out, please.
腹部拉钩 Balfour retractors, please.
谢谢 Thank you.
我需要吸引器 I need suction.
情况如何 Where are we?
好多了 心率109 血氧87 血压88/64 Yeah, better. The heart rate is 109. Sats 87. BP's 88/64.
最上面一根长钉穿透肝脏直达横膈膜 The top spike has gone through the liver on its way to the diaphragm.
肝脏没有大出血迹象 No sign of haemorrhage from the liver.
心胸外科医生来了 That's cardiothoracics coming in now.
中间的长钉穿透了左肾门 The middle spike has perforated the hilum of the left kidney.
(肾门: 肾内侧缘中部凹陷 是肾血管 淋巴管 神经和肾盂出入部位)
有大量失血的迹象 Evidence of extensive bleeding.
静脉血气分析 VBG.
乳酸浓度18 酸碱度7.13 Lactate 18, pH 7.13.
我们必须得把动脉钳拿下来 再灌注他的器官 We've got to get this clamp off and reperfuse his organs.
好吧 我们切掉肾脏 把肾血管结扎起来 OK, we will take in the kidney, tie off the renal vessels
然后扔掉 可以吗 and we'll bin it later, yes?
长钉插着 根本无法操作 There is no access with the spike in place.
给中间的长钉消毒 比利 准备拔出来 Let's disinfect the middle spike please, Billy. Get ready to pull it.
我? 请去戴手套 Me? Just glove up, please.
好吧 All right.
真是太好了 Get in.
别有压力 No pressure.
我需要穿罩袍吗 D-do I need to gown up?
不需要 那又不是无菌的 上面都是牛粪 No, that's not sterile. It's covered in cow shit.
赶快 Let's go.
嘿 看着我 Hey. Look at me.
稳住 慢慢来 Nice and gently.
就像 Like...
王者之剑 Excalibur.
(亚瑟王年轻时从石头中拔出的象征其血统的剑 但也有版本称王者之剑和石中剑是两把剑)
是啊 Yeah.
拔 Pull.
用力 Harder.
再用力 Harder.
停 不能让他动 Stop. He can't move.
我知道 但这他妈一动都不动 Yeah, I know but it's not bloody shifting.
请让开 Step, please.
这个听上去很有趣 This one sounds interesting.
胸主动脉已钳闭... 16分钟 The thoracic aortic clamp has been in place for... 16 minutes.
中间的长钉刺穿了左肾门 The middle spike has perforated the hilum of the left kidney.
我们需要结扎左肾血管 We need to ligate the left renal vessels
然后才能拿掉主动脉钳 before we can take the aortic clamp off.
但是如果想要对血管进行操作 But in order to get access to the vessels
我们就需要把中间的长钉拔掉 we need to pull this middle spike.
那最好赶快拔 Better get on with it.
长钉扎得很牢固 The spike is firmly embedded
所以请你在我们拔中间这根的时候 so if you could monitor the tissues at the top spike
监控一下最上方那根长钉下的组织 while we pull the middle one, please.
谢谢 Thank you.
拔出来 Just pull it out.
用力 Harder.
停! 下腔静脉出血 Stop! Bleed from the IVC.
纱布 Pack!
出血被纱布控制住了 Packs are controlling the bleed.
用掉一块纱布 One pack in.
上吧 比利 不 别动它 Go, Billy. No, don't move it at all.
我们得把它拔出来 We have to pull it out.
我理解 但是一动就会使撕裂口打开 I understand but the movement made the tear open.
再多动几下就有可能扩大撕裂口 Any more movement could extend the tear.
我们可以让钳子就这么夹着 We can leave the clamp where it is.
这样的话 他今晚就会因器官衰竭而死在重症监护室 In which case, he dies in the ITU tonight of organ failure.
或者我们可以给他一次机会 冒个险 Or we give him a chance and take a risk.
好吧 谢谢 OK. Thank you.
比利 Billy?
拔出来 Pull it out.
但是 But...
我不想杀了他 I don't want to kill him.
好吧 我来 OK, I'll take over.
抱歉 Sorry.
准备好 Be ready.
好 OK.
谢谢 Thank you.
出血被纱布控制着 你现在可以放松了 Packs are controlling the bleed. You can relax now.
他的情况没有转坏 心率106 He's no worse. Heart rate is 105.
血氧88 血压87/63 Sats are 88. BP is 87/63.
手套 请给我八号的 Gloves. Size eight, please.
我们来搞定肾脏 And then let's sort out that kidney
然后再灌注他的器官 请给我七号手套 and reperfuse his organs. Seven to me, please.
越快越好 ASAP.
马上26分钟了 我要结扎肾血管 Coming up to 26 minutes. I'm going to ligate the renal vessels.
我们少个人手 We're a pair of hands short.
你能帮我牵开小肠吗 Can you retract the small bowel for me?
形势所逼啊 呵 Under the circumstances. Hmm.
谢谢 Thank you.
打扰一下 Excuse me.
镊子和麦金杜剪 Forceps and McIndoes, please.
钳子 Clamp.
肾动脉已钳闭 Renal artery is clamped.
钳子 Clamp.
肾静脉已钳闭 The renal vein is clamped.
镊子 Forceps.
剪刀 Scissors, please.
肾动脉已结扎 The renal artery is ligated.
6-0号的薇乔缝线 Metric Vicryl tie, please.
镊子 Forceps, please.
已过去27分钟 主动脉已钳闭20分钟了 27 minutes gone. That's 20 minutes now with the aortic clamp on.
剪刀 Scissors, please.
肾静脉已结扎 The renal vein is ligated.
干得好 Nice work.
我会将主动脉钳移到肾下 I'm going to move the aortic clamp infrarenally.
谢谢 Thank you.
好 肾下腹主动脉已钳闭 OK, the aorta has been clamped infrarenally.
菲奥娜会听我的口令 移除胸主动脉钳 Fiona will remove the thoracic aortic clamp on my say so.
做好准备 准备好以后告诉我 Let's get ready, please. And let me know when you are.
增加供血 好了 Increase the blood. Yep.
好了 Yep.
好 血压上升 102/85 准备好了 OK, BP rising. 102/85. Ready.
很好 松开一半 Good. Let's release the clamp by half.
松开一半 谢谢 Unclamped by a half. Thank you.
血压下降 BP dropping.
下腔静脉出血 该死 Bleed from the IVC. Shit!
纱布 增加供血 比利 Pack. Increase the blood, Billy.
纱布 Pack.
用掉两块 Two packs in.
一共用掉五块 Five packs total.
纱布没有止住出血 我们得再次把主动脉夹上 Packing isn't controlling the bleed. We have to reclamp the aorta.
主动脉被钳闭的时间已经够久了 That's a long time for the aorta to be clamped.
总比死了好 Better than being dead.
请将主动脉完全钳闭 Let's fully re-clamp the aorta, please.
完全钳闭 Fully re-clamped.
降低血压 Reduce the blood pressure.
撕裂口稍微大了点 我需要钳闭下腔静脉并修复 Tear is slightly bigger. I'm going to clamp the IVC and fix it.
血管钳 Vascular clamp.
我要把上面的长钉拔出来 给你更多的空间 I'll pull the top spike, give you a little bit more room.
好 我会拔出半厘米 OK, I'm going to pull it out by half a centimetre.
你准备好了吗 准备好了 Are you ready? Ready.
拔 Pulling.
我看不清里面到底怎么了 慢点 I can't quite see what's happening. Slowly.
好的 Yeah.
看起来像是它带动了下腔静脉 再拔一次 It seems to be pulling the IVC. Back up.
停 Stop.
纱布和镊子 Swab and forceps.
尖端带钩 It's hooked.
刺穿下腔静脉了 It's torn the IVC.
该死 Shit.
撕裂口大约2厘米 The tear is approximately 2cm.
哦 拜托 血压直线下降 Oh, come on! BP crashing.
主动脉钳无异常 The aortic clamp is in place.
长钉刺穿胸膜腔进入肝脏 纱布 There's back bleeding into the liver. Pack.
用掉一块纱布 One pack in.
一共用掉六块 Six packs total.
比利? 来了 Billy? Yes.
梅克提夫人 我需要你按住下腔静脉 Mrs Murkherjee, I need you to compress the IVC
来阻止背部出血 to stop the back bleeding.
我可以缝合撕裂处 I can close the tear
但是有长钉挡着 我无法按住下腔静脉 but I can't compress the IVC with the spike in the way.
我无法拔出来 也无法夹住 I can't pull it out and I can't clamp it.
我不能让钩子穿过肝脏 那样会毁了它的 I can't pull the hook through the liver. It will destroy it.
他不可能今晚接受肝脏移植的 There is no possibility of him getting a liver transplant tonight.
或许你可以切开肝脏把长钉拿出来 不行 Maybe you can open the liver and lift the spike. No.
他会流血致死的 He'll bleed to death.
面对现实吧 这手术无法进行下去了 Let's face it, we can't proceed surgically.
我们已经技穷了 We've reached the end.
你好 Hello.
请坐 Please take a seat.
其中一根长钉刺穿了爱德华的肝脏 One of the spikes went through Edward's liver.
如果要救他的命 我们显然要移除长钉 In order to save his life, obviously we need to remove the spike.
但是如果拔出来 But pulling it out
那将几乎无法避免地摧毁他的肝脏 will almost certainly destroy his liver.
恐怕现在的供体肝中没有和他组织相配的 I'm afraid there's no tissue match for an available donor liver.
如果我们再进行下去 And any further efforts
就有可能危及他的生命 弗兰克 we make run the risk of killing him, Frank.
你们要放弃? Y-you're giving up?
这对外科医生来说实在是进退两难 It's an impossible dilemma for a surgeon.
所以你们就要放弃?! So you're giving up?!
我们能做的只有把这里收拾干净 All we can do is tidy this up.
我是格林医生 请留言 该死 'Dr Green...Please leave a message.' Shit.
你好 老大 如果你在未来几分钟内听到这条留言 Hi, boss. If you get this message in the next few minutes,
能请你来创伤科手术室吗 can you come down to trauma theatre please
因为我觉得这人会死在手术台上 cos I think this one's going to go tits up on the table.
格伦? Glen?
我需要人来帮我系带子 准备矫形外科器械包 I'm going to need tying. Orthopaedic instrument set.
好吧 我们要做什么 OK. What are we going to do?
我要试着把长钉的尖端剪掉 I'm going to try and cut the tip off of the spike.
黛比 请给我最大号的钢丝剪 Largest K-wire cutter you've got, Debe!
来了 OK.
听着 抱歉打断一下 Look, I'm sorry to interrupt
但是他肠子的颜色看起来不健康 but that is not a healthy colour for bowel.
听着 我们先不管肠子了 我们需要继续下去 Look, we are losing the bowel. We need to get a move on.
谢谢 Thank you.
请你把左边让出来给我 I need space on your left, please.
没有位置了 There is no space.
把手伸进去 拨开肝脏和横膈膜 Stick a hand in. Retract the liver and the diaphragm, please.
如果你损伤下腔静脉 他会死在手术台上 If you damage the IVC, he will die on the table.
当心你的手指 Mind your fingers.
真是一点意义都没有 This is pointless!
再坚持几秒钟 Just hold on a few seconds.
他的器官已经长时间没有再灌注了 His organs have had no profusion for a protracted period.
你觉得还有几秒钟吗 Do you think we have a few seconds?
快啊! Come on!
菲奥娜 帮帮我 Fiona, help me, please.
加油 Come on.
托盘 Dish.
把长钉拔出来吧 Let's pull the spike.
你能看看我有没有损坏到下腔静脉吗 Can you see if I damaged the IVC?
谢谢 Thank you.
很好 Good.
好了 Got it.
谁来拿一下这个 Someone take this.
肝脏出血 We've got a bleed in the liver.
给我 Hit me.
纱布用掉两块 一共用掉八块 Two packs in. Eight packs total.
下腔静脉已钳闭 我们控制住肝脏出血了 The IVC is clamped. We've got control of the hepatic bleed.
好 现在修复撕裂口 OK, let's fix the tear
然后把这该死的主动脉钳拿下来 呃? and finally get this bloody aortic clamp off, eh?
不行 I can't.
你剪断钩子时在下腔静脉上开了一个3厘米的洞 Cutting off the hook made a 3cm diameter hole in the IVC.
缝合的话只会造成下腔静脉管腔狭窄 Stitching it would only stenos the IVC completely.
那就进行修补 Patch it.
我真觉得我无法按时补完 I honestly don't think I could do it in time.
我们已经做到这一步了 We've come this far.
能不能至少先试一下 Can we at least try?
20毫米宽的血管膜补丁片 20mm vasa tunica sheet.
谢谢 Thank you.
请把胸腔再打开些 I'll need more access to the chest, please.
这伤口被污染了 It's a contaminated wound.
我们稍后需要改成全自体移植 We'll need to revise later to a full autologous graft.
(自体移植: 用病人自身的皮肤 血管或者骨骼从一处取出 移植到另一处 自体移植组织愈合度更高 不易产生排斥)
双头聚丙乙烯缝线和镊子 Double-ended fibro-prolene and forceps.
请帮我一起引导下来 Help me guide it down, please.
动脉血气分析 ABGs.
乳酸浓度19 酸碱度6.97 Lactating 19, pH 6.97.
好 最多只能撑几分钟了 OK, it's down to minutes, at best.
有人有安全套吗 Does anyone have a condom?
我需要帮他的肝脏做一个临时球囊 I'm going to improvise a balloon tamponade for the liver.
有人有吗 Anyone?
把你从初中起就放在钱包里的那个给他 Give him the one you've had in your wallet since school.
不行 用在你女朋友身上了 Can't. Used it on your girlfriend.
54号储物柜 钥匙在我口袋里 Locker 54. The key is in my pocket.
你听到了吗 Did you get all that?
54号储物柜 罗马斯女士的安全套 Locker 54. Miss Lomas' condoms.
赶紧去拿 Now, please!
大约什么时候好 ETA, please?
三分钟 Three minutes.
我需要你在两分钟之内完成 I need you to do it in two.
我做不到 你做得到 I can't do it. You can do it.
你做得到 You can.
罗马斯女士的安全套 给博伊尔先生 Miss Lomas' condoms for Mr Boyle.
比利 请尽快拿过来 Billy. Quick as you can, please.
不是我的号 我用超大号的 Not my size. I use extra large.
比利 当我没说 Billy! Never mind.
另外说一句 花很漂亮 罗马斯女士 Nice flowers, by the way, Miss Lomas.
Foley管 Foley catheter, please.
准备一针管无菌水 Put a syringe in sterile water.
给我 比利 好 Just here, Billy. Yeah.
薇乔缝线 Vicryl Tie.
谢谢 Thank you.
剪 Cut.
拿出三块纱布 Three packs out.
一共还剩五块 Five packs total.
塞入球囊 Balloon going in.
针管 Syringe, please.
如果运气好的话 安全套会撑开 With any luck, the condom will expand
堵住肝脏上的撕裂口 and seal the tear in the liver.
好了 There you go.
请紧急呼叫肝胆外科医生 Fast bleep the hepatobiliary surgeon, please.
你好 这里是创伤科手术室 Hi, this is trauma theatre.
能请你呼叫肝胆外科医生吗 Could you bleep the hepatobiliary surgeon, please?
好了 这钳子得立刻拿下来 OK, I need to get this clamp off.
马上 Now!
剪刀 Scissors, please.
好了 Done.
干得好 Good work.
希望不会掉下来吧 If it doesn't come apart.
好 我会先取下下腔静脉上的钳子 OK, I'm going to take the clamps on the IVC off first.
准备好了吗 You ready?
好的 Yeah.
球囊看起来维持得住 Balloon seems to be holding.
准备好取下主动脉钳 Be ready for the aortic clamp.
准备好了 好的 Ready. OK.
我先松开一半 准备好了吗 I'm going to take it off by a half. Ready?
松开了 Here.
血压下降 BP dropping.
给他输血 比利 血浆和血小板 Fill 'em up, Billy. Blood and FOP.
维持 Holding.
有点上升 Climbing slightly.
好 松开四分之三 OK. I'm going to take it three quarters.
好了 Now.
下降 Dropping.
加油啊 Come on.
该死 Shit.
高尖T波 宽QRS波 Peaked T waves. Broadening QRS complex.
我们得降低他的血钾 不然他的心脏会停跳 We've got to get his potassium down, otherwise he's going to arrest.
(钾离子对心肌有毒性作用 故钾离子过高或输入高浓度钾盐会导致心肌收缩不能 心脏停跳)
需要10毫升的10%氯化钙 Need 10ml of 10% calcium chloride.
(钾离子与钙离子相拮抗 而心肌依赖外源性钙 氯化钙中的钙离子可恢复心肌兴奋性和提高心肌收缩性)
来了 谢谢 Yep. Thank you.
还有20毫升的50%葡萄糖加10单位的胰岛素 And 20ml of 50% glucose solution with ten units of insulin.
来了 Yep.
慢慢推注 比利 好的 Slow bolus, Billy. Yep.
给他一些碳酸氢盐来减轻他的酸中毒 Let's get some bicarb for his acidosis.
(血液中钾离子升高时 细胞外液中的钾离子也会随之升高 这时细胞膜就会进行氢离子和钾离子交换 钾离子向细胞内运动 氢离子被从细胞内置换出来进入血液 从而引起氢离子浓度增高 出现代谢性酸中毒)
好了吗 好的 Yeah? Yep.
好没? Yes?
十秒钟 老大 Ten seconds, boss.
好了 葡萄糖-胰岛素溶液正在输入 OK, glucose-insulin solution is running.
好 我要把钳子都松开 松吧 OK, I'm going to take the clamp fully off. Go.
主动脉完全松开 The aorta is fully unclamped.
下降 Dropping.
维持 Holding.
上升 Climbing.
心电图恢复正常 ECG returning to normal.
血压维持在88/53 心率112 血氧97 Maintaining BP 88/53. Heart rate 112. Sats 97.
是我想多了 还是说我们刚刚把他救过来了? Is it me or did we just save him?
干得好 Well done.
大家都做得不错 That's good work, everyone.
真的 Really.
做得好极了 It's great work.
做一整套血液检测 动脉血气分析 Let's have a full set of bloods, please, ABG...
狄奥尼索斯·斯特玛特拉奥斯 肝胆外科主任医师 Dionysus Stematelayos. Consultant hepatobiliary surgeon.
我们来换班吧 Let's do the swap.
那是...安全套? Is that...a condom?
他的血液动力学记录是什么 What's his haemo-dynamic?
他稳定了 他状态不错 He's stable. He's looking good.
谢谢你 Thank you.
我需要和你谈谈 I need to see you.
可以的话 就现在 Now, if we can.
不行 I can't.
因为汤姆? Because of Tom?
因为你要走了 Because you're leaving.
有谁能来帮我系一下吗 I'm going to need ties, please.
你们救了他 You saved him.
是的 Yes.
请接布莱恩特中校 Lieutenant Colonel Bryant, please.
呃 能帮我转到她的留言箱吗 Um...Can you put me through to her answering machine?
你好 汤姆 谢谢你送的花 Hi, Tom. Thank you for the flowers.
非常漂亮 They're lovely.
所以 是什么大事件啊 So, what's the big occasion?
你好 简 我是格伦·博伊尔 Yes, Jane. This is Glen Boyle.
我只是想和你说说我再度派遣的事 I just wanted to talk to you about my redeployment.
我还不能百分之百确定我想回去 I'm not absolutely sure I'm ready to come back.
有人给我机会延长我在城市综合医院的合同 然后 I've been offered a chance to extend my contract at City General and...
我决定留下来 ..I have decided to stay.
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