Code blue, level 0: Diagnostic Imaging. Code blue, level 0: Diagnostic Imaging. 蓝色代码，级别0：诊断成像。蓝色代码，级别0：诊断成像。
Hey guys. I'm Siobhan, a 3rd-year medical resident. Right now 大家好。我是医学三年级的Siobhan。马上
it's Saturday morning and I'm heading to the hospital to start a 26-hour call shift in the intensive care unit. 今天是星期六早上，我要去医院开始重症监护室的26小时呼叫班次。
Oh, good morning Siobhan. Morning, how was the night? It was great actually. Yeah? I had a new patient come in. 哦，早上好Siobhan。早上，晚上怎么样？实际上很棒。是啊我有一个新病人进来。
It's a really interesting story, so 这是一个非常有趣的故事，所以
I was hoping for your advice. Each morning 我希望得到您的建议。每天早上
we do a handover where the resident who was on call overnight passes on information to the incoming resident. 我们进行了移交，过夜通宵的居民将信息传递给新来的居民。
So Kevin and I discussed each patient one-by-one so that I'm up to date on everything. 因此，我和凯文（Kevin）逐一讨论了每个病人，以便我随时了解最新情况。
And a lot can change in just 1 night in the ICU. Oh Kevin, 在ICU中，仅1个晚上就能做出很多改变。哦，凯文
I just realized thinking as I found you before you left, I didn't get the pager from you. Oh yeah, here you go! 我刚刚意识到在离开之前找到您的想法，却没有收到您的传呼机。哦，是的，你去！
Oh, okay. Here we go. 哦好的。开始了。
Now it's time to meet up with the attending physician and together 现在是时候与主治医师见面并一起聚会了
we'll walk around and see our 14 patients. And then comes the less glamorous part of medicine: all the notes and paperwork. 我们将四处走走，看看我们的14名患者。然后是医学上不那么迷人的部分：所有笔记和文书工作。
*Pager goes off* *寻呼机熄灭*
Code blue, level 0: Diagnostic Imaging. Code blue, level 0: Diagnostic Imaging. 蓝色代码，级别0：诊断成像。蓝色代码，级别0：诊断成像。
When I arrived at the CT scanner, the patient was lying unconscious and a nurse was doing CPR. 当我到达CT扫描仪时，病人昏迷不醒，一名护士正在做CPR。
Seconds later the anesthetist arrived, positioning herself behind the patient's head. 几秒钟后，麻醉师到达了，将自己置于病人的头部后面。
Skillfully she intubated the patient while CPR was ongoing. And just 2 minutes later another round of CPR was done and we got a pulse back. 在进行CPR时，她巧妙地为患者插管。仅两分钟后，又进行了另一轮心肺复苏，我们得到了回复。
Ok, so it always feels really good when you get the patient back. So our patient now has a heartbeat, 好的，所以当您让患者回来时，感觉总是非常好。所以我们的病人现在心跳加快，
a blood pressure... We basically brought him back to life, but this is just the beginning of the work in ICU. 血压...我们基本上使他复活了，但这只是ICU工作的开始。
We're transferring the patient up to the ICU right now and we're gonna continue to 我们现在正在将患者转移到ICU，我们将继续
try to resuscitate him, figure out what caused the cardiac arrest 尝试使他复苏，找出引起心脏骤停的原因
and then go from there. 然后从那里去。
So this is just the beginning of the night in ICU. 因此，这只是ICU中夜晚的开始。
First thing I'm gonna do is try to call the patient's family to update them. 我要做的第一件事就是尝试打电话给患者的家人进行更新。
Still no answer. 仍然没有答案。
Okay, I'm gonna call back again later or see if someone can track down another number. 好吧，我待会儿再打给我，或者看看是否有人可以找到另一个号码。
The next step is to read through the patient's chart carefully, looking through old notes, 下一步是仔细阅读患者的病历表，翻阅旧的笔记，
X-rays and blood work to help figure out what caused his cardiac arrest. X射线检查和血液检查有助于找出导致他的心脏骤停的原因。
Okay, so it looks like there are actually a lot of things going on with this patient. 好的，看来这个病人实际上正在发生很多事情。
He has underlying heart disease, he's had a heart attack in the past, he's had some funny rhythms in the past that 他患有潜在的心脏病，过去曾心脏病发作，过去曾有一些有趣的节奏，
I can see in the computer. 我可以在电脑上看到。
Plus his x-ray clearly shows an 另外，他的X射线清楚地显示出
infection and I wonder if he's gonna have an infection in his blood too. I'm kind of waiting for that to grow. 感染，我想知道他的血液是否也会感染。我有点在等待那增长。
So it's a couple things we can do: we're gonna make sure we manage his blood pressure with some 因此，我们可以做几件事：我们要确保通过一些方法来控制他的血压
special medications called pressors, which kind of squeeze the blood vessels tight. 一种特殊的药物，称为加压药，可以使血管紧绷。
We're gonna give antibiotics and we're gonna support him and continue to do some more investigations. 我们将给予抗生素，我们将支持他并继续进行更多调查。
And let's actually call the family back again. We're trying to try to get ahold of them. I've got a new number, so we'll see. 让我们实际上再次给家人打电话。我们正在尝试获取它们。我有一个新号码，我们拭目以待。
Hi, my name is Siobhan. I'm a 嗨，我叫Siobhan。我是一个
doctor in the ICU. 重症监护病房的医生。
Can I ask who I'm speaking with? 我可以问和谁聊天吗？
Great, okay. Well, I look forward to meeting you in person. 太好了好吧，我期待与您会面。
Again, I'm so sorry to have to tell you this over the phone. 同样，很抱歉不得不通过电话告诉您。
Okay, see you soon. 好的，很快再见。
I find it so much more difficult to break bad news to people over the phone, because 我发现通过电话向人们发布坏消息要困难得多，因为
you just... You don't get that kind of feedback 你只是...你没有得到那种反馈
from body language, someone's facial expression. You don't... You have no clue what they're feeling, what they're thinking. 从肢体语言来看，某人的面部表情。你不……你不知道他们在想什么，在想什么。
So anyway, I'll meet the family when they come in and I think I'll get a better sense of where they're at. 所以无论如何，当他们进来时，我会和家人见面，我想我会更好地了解他们的所在。
In order to give all these medications safely at the same time, 为了同时安全地服用所有这些药物，
it's helpful to insert a central line, which is basically a large IV that I'll be inserting into the patient's neck 插入中心线很有帮助，该线基本上是我要插入患者颈部的较大的静脉
right into the jugular vein. Because the vein is so close to the carotid artery, 正确地进入颈静脉。因为静脉非常靠近颈动脉，
I'll be using an ultrasound machine so that I can see exactly where my needle is at all times. 我将使用超声波机器，以便随时都能准确看到针头的位置。
Okay, so the central line went in well. 好的，所以中心线进展顺利。
So now we just need to actually order a chest x-ray to make sure it's going in the right place. 因此，现在我们只需要实际订购胸部X光检查以确保其正确放置在正确的位置即可。
Meaning it's in the vein and it's not in the artery, cuz that would be a nightmare. So it's something you worry about. 这意味着它在静脉中，而不在动脉中，因为那将是一场噩梦。所以这是您担心的事情。
And then we also look for any complications, make sure there's no pneumothorax. 然后，我们还要寻找任何并发症，确保没有气胸。
So it didn't actually puncture the lungs, all these things that you would never ever ever want to do to a patient, 因此，它实际上并没有刺破肺部，您永远不会想对患者做的所有这些事情，
but they're complications that are possible 但它们是可能的并发症
even when you use ultrasound. 即使使用超声波。
So we're just going to double check with the x-ray, but I think everything's fine. 因此，我们将对X射线进行仔细检查，但我认为一切都很好。
How much oxygen is she on? Oh you already intubated here?! Oh okay. 她有多少氧气？哦，您已经在这里插管了！哦好的。
Yeah, absolutely. Okay, I'll come by soon. 是的，绝对。好吧，我会很快过去。
Alright, thanks. 好的，谢谢。
So that was the emerge doc and it sounds like he just intubated a woman, which 这就是新出现的医生，听起来他只是在插管了一个女人，
automatically means that the patient is being admitted to the ICU. “自动”表示患者正在被送入ICU。
Because once you've been admitted and you're hooked up to a machine breathing for you, the only place you can go is the ICU. 因为一旦您被录取并且被机器吸引住了，唯一可以去的地方就是ICU。
So that makes it easy. 这样就很容易。
But the reason this patient got intubated is because she came in just gasping for air, breathing super fast and 但该患者插管的原因是因为她只是喘着粗气呼吸，超快呼吸和
she has a condition called 她有一个叫做
COPD. COPD。
So she's been a really heavy smoker for the last 40 years, smoking about 2 packs per day, 因此，在过去40年中，她一直是非常吸烟的人，每天吸烟约2包，
that's what he's telling me. In the emergency department I met with the patient's husband. 那就是他告诉我的。在急诊室，我遇到了病人的丈夫。
He tells me that his wife ran out of her puffers about a week ago. 他告诉我，他的妻子大约一周前用尽了河豚。
They planned on going to the doctor today, but her breathing became so severe that they came to the emergency department instead. 他们计划今天去看医生，但是她的呼吸变得如此剧烈，以至于他们去了急诊室。
So now I'm gonna prescribe some steroids puffers, 所以现在我要开一些类固醇激素
antibiotics and hopefully her breathing will improve and we can get her extubated in a few days. 抗生素，希望她的呼吸会好转，几天之内我们就可以拔管。
Alright. So now that we have admitted that patient in the emerge, we need to 好的。因此，既然我们已经承认该患者已经出现，我们需要
follow up on some blood work on the patient who had that code blue. 跟进对该代码为蓝色的患者进行的血液检查。
So I ordered some repeat blood work, so we can see what we're at in terms of 因此，我下令进行一些重复的血液检查，以便我们可以了解到
resuscitating and how he is doing: his heart, lungs, liver, kidney, all of that stuff. So, let's see. 复苏以及他的状态：他的心脏，肺，肝脏，肾脏，所有这些东西。所以，让我们看看。
Oh boy. Okay, so when blood work is abnormal, it turns red and unfortunately most of his blood work right here is red. 好家伙。好的，所以当血液检查异常时，它会变成红色，不幸的是，他在这里的大部分血液检查都是红色的。
So you can see that he's got strain to the heart, even 这样您就可以看出他对心脏感到紧张，甚至
just the act of CPR is gonna put some strain on the heart, the muscle of the heart. 心肺复苏术只会给心脏，心脏的肌肉带来压力。
Um, you can see he's got shock liver, meaning he didn't get great blood flow to the liver for a period of time. 嗯，您会看到他的肝脏休克，这意味着他在一段时间内没有大量血液流向肝脏。
Which means that you can see those enzymes are up. 这意味着您可以看到那些酶在上升。
Same thing with the kidneys. 肾脏也一样。
So I mean... The reality is it's expected at this point. We're gonna keep giving him fluids, we're giving the antibiotics. 所以我的意思是...实际情况是目前所料。我们要继续给他补液，我们要给予抗生素。
I'm gonna repeat some more blood work in the morning and hopefully we'll be able to see things trending 我要在早上重复更多的血液检查工作，希望我们能看到趋势发展
in a better direction, because right now 朝更好的方向发展，因为现在
it's not looking so great. 看起来不太好。
Okay, but let's actually let's go see the patient himself and see what he looks like clinically. So is he looking any better?! 好的，但实际上让我们去看看患者本人，看看他的临床状况。那他看起来好点了吗？
Okay, 4 o'clock. 好的，四点钟。
Finally back in 终于回到
my call room. I'm actually gonna try to go to sleep for the first time today. 我的呼叫室。我今天实际上要尝试去睡觉。
But I'm this weird combination of being a little bit wired from all the admissions and the excitement 但我是这种奇怪的组合，从所有的入场和兴奋中抽身而出
and then I'm also exhausted from the day. 然后我也筋疲力尽。
So I'm pretty sure when my head hits the pillow, I will be able to sleep. 所以我很确定当我的头撞到枕头上时，我就能入睡了。
Problem is the light, it's all the way over here and away from the bed. 问题是光线，一直到这里，一直到床都没有。
Good morning. 早上好。
Okay, it's time to look at blood work and 好的，该看一下血液检查了，
to get ready to hand over to the morning team now. 准备现在交给早上的团队。
Okay, so just looking at the blood work from the patient with the code blue yesterday. 好的，昨天只看患者代码为蓝色的血液工作。
Things look like they are at least holding steady right now, which honestly is all that we can ask for right now. 事情看起来至少现在就稳定了，说实话，这就是我们现在所能要求的。
I'm glad to see that he's turning the corner and stabilizing. 我很高兴看到他在转弯并稳定下来。
So we'll know in the next 所以我们接下来会知道
24-48 hours are gonna be critical to finding out about his long-term 24-48小时对于了解他的长期状况至关重要
prognosis, but I think we're making some good steps forward right now. 预后，但我认为我们现在正在向前迈出良好的一步。
Morning, Kevin. Hey Siobhan. 早上，凯文。嘿Siobhan。
Hey, you're back again. 嘿，你又回来了。
I'm back again. 我又回来了
Alright, so I need to tell you about some of the patients that you handed over and what happened today. 好吧，所以我需要告诉您一些您移交的患者以及今天发生的情况。
Yeah. 是的
Okay, but I won't forget to give you the pager. 好的，但我不会忘记给您传呼机。
Responsibility is all yours... For another 24 hours. 责任全由您承担...再过24小时。
Heading home, finally done and 回到家，终于完成了
that was a satisfying call shift. I really feel like being there really impacted someone's life. 这是一个令人满意的呼叫转移。我真的觉得去那里确实影响了某人的生活。
So I'm walking away at a high. 所以我要走高了。
But anyway, if you have any questions if you want to say hi, just leave a comment. 但是无论如何，如果您想打个招呼有任何疑问，请发表评论。
I really love to hear from you guys. And if you want to see more like this, don't forget to subscribe. 我真的很喜欢听到你们的消息。如果您想看到更多类似的内容，请别忘了订阅。
Otherwise, I'll be chatting with you in the next video. So bye for now! 否则，我将在下一个视频中与您聊天。所以再见！