《BBC》1/7日
*川普武裝支持者衝入美國國會,迫使國會停擺,華府宵禁。
*根據美國警方説法,共四人死亡。一位退役軍人女性在與警方暴力衝突後,警方開槍,送醫不治。另外三位,因自身疾病現場醫療危急,不幸死亡。
*國會一度停擺,在警方清場後,由現任美國副總統潘斯宣布議事恢復運作,持續國會確認拜登當選的議事程序。
*部分共和黨議員試圖推翻選舉結果確認案,但人數不足。
*川普在支持者於國會暴動後,建議支持者回家,但堅持這場大選是被偷走的。
*就在華府歷史性暴力的一天,1/5日前一天進行的喬治亞州第二輪參議員選舉,民主黨拿下兩席,翻轉去年11/3選舉結果,改變了喬治亞州長期共和黨主政的局面:更因此贏得50席參議員,和共和黨在參院人數相同,但加上主席副總統賀錦麗,民主黨自總統、參議院、衆議院,全面執政。
Armed supporters of President Trump stormed the Capitol building and forced a lockdown
A woman was shot dead by police and three others died of "medical emergencies", say police
Congress has reconvened after the violence halted a session to certify Joe Biden's election win
Some Republicans were trying to overturn the results in some states but lack sufficient support
Trump called on his violent supporters to go home but repeated false claims the election was stolen
Earlier, Democrats won two Senate seats in Georgia that tipped control of the Senate their way
Meanwhile, the Democrats have won control of the Senate after Raphael Warnock and Jon Ossoff defeated Republican incumbents
BBC以街頭暴民形容此次川普支持者抗爭,並集結以下文字圖片:Pro-Trump protesters storm the US Capitol building - in pictures https://www.bbc.co.uk/news/world-us-canada-55568131
*BBC:川普失去了選舉,但他的選票為什麼比上屆大選增長?並且超出預期?
Why Donald Trump keeps outperforming the polls https://www.bbc.co.uk/news/election-us-2020-55151424
*沒有川普總統的共和黨何去何從?
Where does the Republican Party go after Trump? https://www.bbc.co.uk/news/world-us-canada-55193791
*川普還有任何其他法律途徑推翻選舉結果嗎?在賓州,川普團隊仍未放棄訴訟。在以下幾州,川普已經在法律訴訟失敗。
■ In Michigan, the Trump campaign filed a federal lawsuit to block the certification of results in Wayne County, citing complaints from poll watchers - but this was dropped after a similar challenge was rejected at state-level
■ In Arizona, a lawsuit claimed some legal votes were rejected, citing problems with voting machines - but Arizona's Secretary of State said this was "grasping at straws", and the suit was dropped
■ In Georgia, an attempt was made to stop the count in Chatham County, alleging problems with ballot processing - but the lawsuit was rejected by a judge who said there was "no evidence" of improper ballot mixing
■ In Nevada, a suit asked that Mr Trump be named the winner in the state or that the results be void with no winner certified, alleging illegal voting. This was rejected by the state's Supreme Court, stating there was "no credible or reliable evidence" of fraud
■ In Wisconsin, Trump's legal team have argued around 220,000 ballots were unlawfully cast, as they seek to overturn the result there. The suit has been rejected by the state's Supreme Court
US election 2020: What legal challenges remain for Trump? https://www.bbc.co.uk/news/election-us-2020-54724960
certify死亡 在 一個平凡醫學生的日常。 Facebook 的最讚貼文
《一起找血管》
除了某幾間醫院現在還要求實習醫生為病人「打豆」(靜脈滴注)外,現在大部分醫院都有抽血員負責抽血和打豆的工作。不過打豆仍然是醫生需要掌握的技術之一,因為在需要急救或病人血壓不穩等危急情況,往往要由醫生盡快找到血管進行靜脈注射,未必能等得及抽血員的到來。事實上在急救的時候,實習醫生其中一個必要的職責就是打豆和抽血。
試過有個情況不多好的病人深夜血糖低,但抽血姑娘由早上開始一直幫不到這位病人打豆。護士神色緊張,叫我快點去嘗試一下,好讓她能盡快注射糖水。(「houseman,病人不能死於低血糖啊!」)我努力試了幾次,最後還是突然在最「大路」的手肘摺位找到一條將近無色的血管,成功打到豆。那時候病人還有一點意識,懂得跟我配合,自己伸出手讓我作嘗試。及後離開病房趕往處理其他病人途中,我接到電話,要去certify剛剛那位病人死亡。我大驚,剛才還跟他道歉說弄痛他,怎麼轉眼就去世了呢?回到病房,護士說幸好剛才及時下到糖水,過後獲得了一個正常的血糖讀數,確認病人血糖於去世前已經回覆正常。
除了緊急情況下需要我們打豆,我們也要為抽血員打不到的豆「包底」。七月第一天開始工作,我就遇到幾個抽血員抽不到的血和打不到的豆,那時候我還心想,如果連他們如此專業都打不到的豆,我怎麼可能成功呢?後來我還是決定向下一更的抽血員求救,為表誠意我幫她推著她的抽血車,一個一個地看著她成功抽到血打到豆。而她也大概知道我初來乍到,一邊打一邊分享自己的心得,自此我成功率大增。後來我發現這樣也是令我們急速成長的方法之一,因為我們要負責的豆baseline都已經比較困難的,所以反而練就了我們到危急情況下,能夠更加得心應手地應付難度一般的血管。
抽血員打不到的豆,主要分為兩種。其一是病人上肢已經因被多次抽血而弄得瘀痕處處,但原來下肢仍有美麗而且未經破壞的血管,只是抽血姑娘礙於權責所限,未能在該處嘗試。一看這些病人雙腿,我就會立刻放下心頭大石,盤算自己應該一兩下就能成功。不過聽病人說,在雙腿下針,會比在上肢抽血打豆痛得多,所以若非必要我都不會在下肢下手。
而另一類病人,就真的不容易打了。這包括那些全新腫脹的瀕死病人、因為吸煙或其他原因血管硬化的病人,還有那些長期使用靜脈注射藥物的癮君子。
其實我挺喜歡為後者那些IVDU (IV drug user)打豆,一來因為他們不介意跟我一起找血管,甚至會如數家珍地介紹過往能成功打到豆的血管,整件事非常搞笑。二來他們耐痛能力奇高,就算我有時候真的一點血色都看不到,要靠我對解剖學的認知,在「應該有血管」的地方下針然後在裡面撩來撩去直到有血液回流再一把推進導管,他們都可以面不改容,絕少流露出痛楚的樣子,更不會破口大罵。三來一但成功幫他們打到豆,他們會非常感激,我也會成功感滿滿。
傳說中這些癮君子會預留一條黃金血管予醫護人員做急救之用,但迄今為止我還未遇過這樣的「高手」,最後都要靠不斷的拍打、細心的找尋和無窮的創意,在大腿、雙膝、手指等奇怪地方才能成功打到豆。
在我工作的地方,抽血員都非常專業,我十分尊敬他們也感激減輕我們的工作量。有時候遇到難打豆難抽血的病人,她們大多都不介意仗義相助,我們一個在上肢一個在下肢一起找血管,最後無論是成功還是失敗,都可以說我們已經盡力了。待明早主診醫生巡房,再決定是否有非靜脈注射的替代藥物,或者是會否嘗試其他更入侵性的方法下藥。
不過我一直有個疑惑,護士一般甚少參與打豆的工作(我遇過碩果僅存幾個願意跟我一齊努力找血管的護士,也是心下感激非常)是因為護士課程沒有教授相關技巧,還是又是惱人的官僚權責所限呢?
certify死亡 在 一個平凡醫學生的日常。 Facebook 的最讚貼文
【同學投稿】《深夜cert case的二三事》
午夜時分,電話響起。
「你好,medical houseman。」
「要麻煩你certify個COVID positive case,屋企人係隔離啊。」
到隔離病房後,我在護士站裡粗略看了一下病人的病歷。
「唔係話屋企人黎左咩?我頭先係出面見唔到有人喔。」
「佢老婆同個仔都positive,而家係同一個cubicle裡面啊。」
我穿起保護裝束,走進隔離病房。
「你好,我係今晚當值醫生,而家要同伯伯做啲檢查。」
「醫生係咪黎certify我爸爸啊?」
「要做埋檢查先話得到你知,或者先生可以同媽媽睇住電視先,我做完檢查仔同你傾好冇?」
於是我硬着頭皮,第一次在家屬的注目下為病人進行檢查。(註:一般來說,certify case前,醫生會請家屬到病房外等候,待完成檢查後再與家屬交待。)
「伯伯,而家同你做少少檢查啦。」
進行檢查的同時,病人的兒子低聲安慰坐在輪椅上的媽媽。
「阿媽你要堅強啲啊,阿爸走左我得番你架咋,要堅強啲啊知唔知到啊⋯⋯」
完成檢查後,我移步到家人跟前。
「啱啱完成檢查,證實做伯伯已經走左,死亡時間係⋯⋯。其實伯伯本身都年紀大,加上原本肺功能差,之前主診醫生都有同你地傾過,如果插喉嘅話,伯伯會辛苦之餘,對佢都未必有幫助。你地自己屋企人傾過之後,都想伯伯可以舒服啲。我諗伯伯有兩位陪住,都算走得安詳。之後伯伯遺體嘅安排會有護士同你地交代,希望先生同太太節哀順變。」
「唔該醫生。多謝你啊。」
我想該說謝謝的是我。謝謝這位兒子兼病人在悲痛之時,仍能理解父親去世並非醫護不努力,仍能堅強地安撫和鼓勵一同患病的媽媽,仍保持對醫護的尊重和支持。
大家常云要支持醫護,現實卻是:當血庫告急社會賢達卻無動於衷(可詳閱前六)、當疫情擴散防疫政策卻朝令夕改、當醫護壓力爆煲有關當局卻宣佈凍薪⋯⋯
到頭來還是不及病人的一句「多謝醫生」來得合時。是該哭還是該笑呢?
Around midnight, my dect phone rang.
“Hello, medical houseman.”
“Hi, there’s a COVID positive case needs you to certify him. His family are here as well.”
When I arrived at the isolation ward, I took a brief look through his medical history at the nursing station.
“Didn’t you say his family were here? I didn’t anyone out there in the lobby.”
“Oh. Both his wife and his son are positive for COVID as well. So they’re now staying in the same cubicle.”
I put on my full PPE and went into the cubicle. For the first time ever, I certified a patient in front of his family. (Usually in our daily practice, we ask family members to wait at the corridor while the doctor is doing the physical examination for the patient.)
“Good evening, Sir. I’m tonight’s on call doctor. I’ll examine your father in a minute. Meanwhile, may I ask for your help to accompany your mother while I’m doing the examinations.”
The son was gently comforting his wheelchair-bound mother while I was certifying the father.
“Mom, please stay strong. Now that dad’s passed away, I’ve only got you with me, so please hold on.”
It was hard not to tear up listening to his soft but desperate words. And after performing all the necessary examinations, I approached the son and the wife.
“I’m sorry to notify you that Mr X was certified at ...... His premorbid conditions weren’t that great, and now COVID has taken its toll on him. Previously, the case doctor had discussed with you that intubation wasn’t our first option, in view of his advanced age and poor premorbid lung functions. And the rest of the family also agreed that comfort care was a better option. I believed that Mr X has had his last hours well spent with you and Mrs X on his sides. The nurse will help you with the upcoming arrangements. I’m really sorry for your loss and all that your family has gone through.”
The son replied in the most sincere tone, “Thank you doctor. Thank you for being here.”
In fact, I think it’s me who should say thank you to this gentleman. Thank you for believing in our efforts, despite we’ve lost our patient. Thank you for comforting his mother, despite he too had just lost his father. Thank you for being supportive, despite he too was a patient.
How ironic it is when government propaganda stressed so much on supporting medical staff, few supportive acts has been done. When our blood banks were in such great shortage that not even patients with a platelet count of 1 could be transfused, none of those in power cared to encourage blood donations. When the the third wave of COVID epidemic was taking away lives, the government policies were slow and confusing, not to mention effective. When medical staffs were on the verge of breakdown, the government just announced a pay freeze.
In the very end, nothing was more supportive than a sincere “thank you” from the already suffering patients. And I’m not sure if this is really something to be thankful for.
certify死亡 在 醫生醫生!電筒- certify death (證實死亡)是很平常遇到的事 的美食出口停車場
放大電筒?😱 在醫院, certify death (證實死亡)是很平常遇到的事,同樣地,有一位病人也停止了呼吸心跳,需要call 醫生來certify。 一般醫生來certify, ... ... <看更多>