【義大利醫療崩潰】Silvia Stringhini是一個瑞士的社會和生物流行病學專家,研究社會不平等的生物學後果。生活在世界各地。
他張貼了一篇位於義大利貝爾加莫的醫生Daniele Macchini自述英文翻譯,透過當地醫生第一手的目擊資料,讓我們可以了解醫療崩潰的災難現場是什麼樣的情況。
https://twitter.com/silviast9/status/1236933818654896129
I may be repeating myself, but I want to fight this sense of security that I see outside of the epicenters, as if nothing was going to happen "here". The media in Europe are reassuring, politicians are reassuring, while there's little to be reassured of. #COVID19
我可能是在自言自語,但是我想要對抗我身處風暴中心之外看到的這種安全感,就好像「這裏」什麼都沒有發生一樣。歐洲的媒體在安撫人心,政客們在安撫人心,儘管沒有什麼可以讓人安心的。#COVID19
This is the English translation of a post of another ICU physician in Bergamo, Dr. Daniele Macchini. Read until the end. After much thought about whether and what to write about what is happening to us, I felt that silence was not responsible.
這是貝爾加莫的另一位ICU醫生Daniele Macchini的文章英文翻譯。讀到最後在深思是否該寫些什麼以及該寫些什麼發生在我們身上之後,我覺得沉默是不負責任的。
I will therefore try to convey to people far from our reality what we are living in Bergamo in these days of Covid-19 pandemic. I understand the need not to create panic, but when the message of the dangerousness of what is happening does not reach people I shudder.
因此,我將設法向遠離我們面臨的現實的人們傳達我們在這些Covid-19大流行的日子裏在貝爾加莫所生活的情況。我明白不需要製造恐慌,但當事情的危險性沒有傳達給人們時,我會不寒而慄。
I myself watched with some amazement the reorganization of the entire hospital in the past week, when our current enemy was still in the shadows: the wards slowly "emptied", elective activitieswere interrupted, intensive care were freed up to create as many beds as possible.
過去一週,當我們當前的敵人還在暗處的時候,我自己有些驚愕地看到了整個醫院的重組:病房慢慢地“清空”,可選擇性的活動被中斷,重症監護被解放出來,以創造儘可能多的床位。
All this rapid transformation brought an atmosphere of silence and surreal emptiness to the corridors of the hospital that we did not yet understand, waiting for a war that was yet to begin and that many (including me) were not so sure would ever come with such ferocity.
所有這些迅速的轉變給醫院的走廊帶來了一種我們還不瞭解的寂靜和超現實的空虛氣氛,等待着一場即將開始的戰爭,而許多人(包括我在內)都不確定戰爭是否會如此兇猛地到來。
I still remember my night call a week ago when I was waiting for the results of a swab. When I think about it, my anxiety over one possible case seems almost ridiculous and unjustified, now that I've seen what's happening. Well, the situation now is dramatic to say the least.
我還記得一週前我在等棉籤化驗結果時的夜間電話。當我想到這件事的時候,我對一件可能發生的病例的焦慮幾乎是荒謬和不合理的,但現在我已經看清發生了什麼事。至少可以這麼說,現在的形勢是急轉直下的。
The war has literally exploded and battles are uninterrupted day and night. But now that need for beds has arrived in all its drama. One after the other the departments that had been emptied fill up at an impressive pace.
戰爭確實爆發了,戰鬥不分晝夜地進行着。但現在,對床位的需求出現了戲劇性的變化。一個接一個被清空的科室以驚人的速度被填滿。
The boards with the names of the patients, of different colours depending on the operating unit, are now all red and instead of surgery you see the diagnosis, which is always the damned same: bilateral interstitial pneumonia.
寫着病人名字的板子,不同顏色的板子取決於作業單位,現在都是紅色的,你看到的診斷結果,總是該死的一樣:雙側間質性肺炎。
Now, explain to me which flu virus causes such a rapid drama. [post continues comparing covid19 to flu, link below]. And while there are still people who boast of not being afraid by ignoring directions, protesting because their normal routine is"temporarily" put in crisis,
現在,給我解釋一下是哪種流感病毒導致了這樣一場突如其來的大戲。[後繼續比較covid19與流感,鏈接如下]。儘管仍有一些人不顧指示,吹噓自己不害怕,但他們會抗議,因爲他們的正常生活“暫時”陷入危機,
the epidemiological disaster is taking place. And there are no more surgeons, urologists, orthopedists, we are only doctors who suddenly become part of a single team to face this tsunami that has overwhelmed us.
流行病學災難正在發生。這裡無所謂外科醫生,泌尿科醫生,骨科醫生,我們只是突然成爲一個團隊的一部分來面對這場席捲我們的海嘯的醫生。
Cases are multiplying, we arrive at a rate of 15-20 admissions per day all for the same reason. The results of the swabs now come one after the other: positive, positive, positive. Suddenly the E.R. is collapsing.
病例在成倍增長,我們每天有15-20人因同樣的原因入院。抽檢的結果一個接一個地出現:陽性、陽性、陽性。突然間,急診室崩潰了。
Reasons for the access always the same: fever and breathing difficulties, fever and cough, respiratory failure. Radiology reports always the same: bilateral interstitial pneumonia, bilateral interstitial pneumonia, bilateral interstitial pneumonia. All to be hospitalized.
使用急診的原因總是一樣的:發燒和呼吸困難,發燒和咳嗽,呼吸衰竭。放射學報告總是相同的:雙側間質性肺炎,雙側間質性肺炎,雙側間質性肺炎。所有人都要住院。
Someone already to be intubated and go to intensive care. For others it's too late... Every ventilator becomes like gold: those in operating theatres that have now suspended their non-urgent activity become intensive care places that did not exist before.
已經有人需要插管,需要去重症監護。而對其他人來說,一切都太遲了……每一個呼吸器都變成了黃金:那些在手術室裏的,現在已經暫停了他們的非緊急活動,變成了以前不存在的重症監護場所。
The staff is exhausted. I saw the tiredness on faces that didn't know what it was despite the already exhausting workloads they had. I saw a solidarity of all of us, who never failed to go to our internist colleagues to ask "what can I do for you now?"
團隊成員都筋疲力盡了。我看到了臉上的疲倦,儘管他們的工作已經很累了,但他們卻不知道在與什麼作戰。我看到我們所有人都團結在一起,每個人都會去問內科同事“我現在能爲你做些什麼?”
Doctors who move beds and transfer patients, who administer therapies instead of nurses. Nurses with tears in their eyes because we can't save everyone, and the vital parameters of several patients at the same time reveal an already marked destiny.
移動病床和轉移病人的醫生,他們代替護士進行治療。護士眼中含着淚水,因爲我們無法拯救每一個人,幾個病人的生命參數同時透露出一個早已註定的命運。
There are no more shifts, no more hours. Social life is suspended for us. We no longer see our families for fear of infecting them. Some of us have already become infected despite the protocols.
沒有更多的輪班,沒有更多的時間。我們的社交生活暫停了。因爲害怕感染,我們再也見不到家人了。我們中的一些人已經被感染了。
Some of our colleagues who are infected also have infected relatives and some of their relatives are already struggling between life and death. So be patient, you can't go to the theatre, museums or the gym. Try to have pity on the myriad of old people you could exterminate.
我們的一些被感染的同事也有被感染的親戚,他們的一些親戚已經在生死之間掙扎。所以要有耐心,你不能去劇院、博物館或健身房。試着憐憫那些因為你的不僅慎而可能消滅的無數老人吧。
We just try to make ourselves useful. You should do the same: we influence the life and death of a few dozen people. You with yours, many more. Please share this message. We must spread the word to prevent what is happening here from happening all over Italy."
我們只是想讓自己變得有用。你也應該這麼做:我們影響了幾十個人的生死。你和你們,還有更多人。請分享這條信息。我們必須傳播這個消息,防止這裏發生的事情在整個義大利發生
I finish by saying that I really don't understand this war on panic. The only reason I see is mask shortages, but there's no mask on sale anymore. We don't have a lot of studies, but is it panic really worse than neglect and carelessness during an epidemic of this sort?
最後我想說的是,我真的不理解這場恐慌戰爭。我看到的唯一原因是口罩不足,但現在已經沒有口罩出售了。我們沒有太多的研究,但在這種流行病中,恐慌真的比忽視和粗心更糟糕嗎?
https://t.co/zDC7de6wtI?amp=1 全文(義大利語)
原文:
https://www.ptt.cc/bbs/Gossiping/M.1583764796.A.DE6.html
同時也有10000部Youtube影片,追蹤數超過2,910的網紅コバにゃんチャンネル,也在其Youtube影片中提到,...
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加護病房查房日誌20180927
Amiodarone是我們用來治療心律不整的好朋友,不過其實他的副作用還滿多的,其中肺部毒性是最嚴重的。(可見圖片)
常見類型包括: chronic interstitial pneumonitis, organizing pneumonia, acute respiratory distress syndrome, and a solitary pulmonary mass。
機轉未明,但推測原因為cytotoxicity and hypersensitivity reaction。
危險因子包括: 單日劑量超過400 mg, 使用超過2個月,老人,肺部疾病等,但是文獻仍有提到低劑量也有可能出現。
診斷要用排除的方式。
至於治療的部份,第一步,就是要停用amiodarone,再來就是給予類固醇,但因為amiodarone的半衰期有45天,所以就算停用後,仍有可能在停用初期惡化,或是停用類固醇後再次惡化。
歡迎各位同學,分享自己遇過的經驗,或是分享amiodarone還有甚麼副作用呢?
#amiodarone
#肺纖維化
interstitial pneumonia 在 NEJS - the New England Journal of Stupid Facebook 的最讚貼文
【胸腔科必備!新版藥物引起的肺疾病,這些怪怪的藥物可能引起意想不到的疾病喔~】
您知道標靶藥物、單株抗體與免疫抑制劑可能引起肺部疾病嗎?
例如間質性肺病 (ILD, interstitial lung disease)、瀰漫性肺泡損傷 (DAD, diffuse alveolar damage) 等,雖然這些疾病並不常見,但發生了要想到這些藥物喔!
(1) TNF alpha抑制劑 (例如etanercept):用來治療風濕性關節炎,可能因為降低免疫力造成伺機性肺部感染、ILD等。
(2) EGFR TKI (例如Geftinib):廣為人知可能造成ILD、DAD。
(3) 傳統抗癌藥物 (例如Oxaliplatin + 5-FU):可能造成ILD、DAD或BOOP (bronchiolitis obliterans organizing pneumonia)
(4) 免疫抑制藥物 (例如mTOR抑制劑Everolimus):可能造成各式肺部疾病,包括ILD、DAD、BOOP,甚至是肺部血管炎 (vasculitis)
要"確認"這些藥物與疾病的關係並不容易,因為沒有確切的診斷工具或指標 (傷腦筋),大概也只有Dr. House等級的神人才想得到之間的關聯,別擔心,請追蹤NEJS,你也可以成為Dr. House般的神人喔~
資料來源:Clinical Respiratory Medicine, 4th ed.
interstitial pneumonia 在 Pathology Insights: Nonspecific Interstitial Pneumonia (NSIP ... 的推薦與評價
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