Voici un message d'un confr�re intensiviste travaillant � Hong Kong d�crivant bri�vement son exp�rience � ce jour avec les SARS...
Esp�rons que cela ne fera pas son apparition dans nos h�pitaux... De plus le Minist�re de la Sant� Ontarien a �mis un communiqu� suite au d�c�s de patients atteints de cette forme particuli�re et atypique de pneumopathie... Jean Levasseur -----Message d'origine----- De�: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] De la part de Tom Buckley Envoy�: 15 mars, 2003 22:40 ��: [EMAIL PROTECTED] Objet�: Re: WHO statement on SARS Dear All, I have not read all of the below because we seem to be close too or are the centre of this form of atypical pneumonia. So just a brief summary of our experience. Male arrives on the medical ward having been admitted thru A & E. Other patients and STAFF start to develop symptoms - fever, headache, dry cough. Unresponsive to various combinations of cefotaxime, chlarithromycin, levofloxacin, doxyclycline and Tamiflu. All microbiology is NEGATIVE (after one week). Physicians have started patients on ribovarin and steroids. As of yesterday there were 64 patients with "atypical pneumonia" in the hospital - a large number of whom are staff. Patient visitors, medical consultation staff, medical students visiting patients have all developed symptoms and to a large degree CXR signs. While most of our cases revolve around the patient admitted to the medical ward we have admitted (to ICU) another patient from another hospital with atypical pneumonia. In ICU we have twelve patients admitted so far Five are ventilated. Seven breathing spontaneously but very oxygen dependent. My impressions CXR reveal progressive bilateral infiltrates starting at the bases. Patients invariably have a low WCC and maybe thrombocytopenic. Patients invariably have an elevated CPK. No ECG changes and Troponin T negative. Post mortem on an Indonesian maid (not in our hospital) showed evidence of ARDS and myocarditis. So far 2-3 of our older patients with chronic disease have deteriorated fastest. Medical staff - younger and fitter have faired better. Their radiological findings have deteriorated in all but one case. We receive 2-3 admissions per day. So far no-one has shown any improvement. Once intubated however they remain relatively static but very oxygen and PEEP dependent. Those ventilated have solid lungs. Interestingly one patient developed a pneumothorax on the medical ward and after chest drain and re-expansion his pneumonia involves only the side without a chest drain. Another patient (ventilated) has developed surgical emphysema. ICU is now closed for all but atypical pneumonias. All our other "clean cases" have been transferred to other ICUs. All elective surgery is being cancelled and wards are being closed and evacuated. Al ambulances are being diverted. We are taking strictest possible isolation procedures available to us including hand washing, gloves, gowns, N95 masks and visors. Masks are worn throughout the hospital. Staff are not going home to children. Please take the warning below seriously. My impression is that even with minimal contact with an infected person people have been becoming ill. Staff morale in ICU is high but If ICU staff start developing symptoms then this is a big problem as we have instituted isolation procedures earliest. Other hospitals in Hong Kong are admitting sporadic cases. I am off to a noon update. Any suggestions will be gratefully received. Tom Buckley Consultant Intensivist Department of Anaesthesia and Intensive Care, Prince of Wales Hospital Shatin, Hong Kong ph (852) 2632-2735 (W) fax (852) 2637-2422 (W) ph (852) 2791-6434 (H) fax (852) 2791-6394 (H) email [EMAIL PROTECTED] On 3/16/03 3:38 AM, "Keith D. Lamb" <[EMAIL PROTECTED]> wrote: > Sure that most have already been alerted BUT..........in case you haven't > > keith > > Keith D. Lamb, RCP, RRT > Charge Respiratory Therapist > Christiana Care Health Services > Newark, Delaware USA > > > >> From the World Health Organization at > > http://www.who.int/mediacentre/releases/2003/pr23/en/ > > Severe Acute Respiratory Syndrome (SARS) Spreads Worldwide > > 15 March 2003 | GENEVA -- During the past week, WHO has received reports of > more than 150 new suspected cases of Severe Acute Respiratory Syndrome > (SARS), an atypical pneumonia for which cause has not yet been determined. > Reports to date have been received from Canada, China, Hong Kong Special > Administrative Region of China, Indonesia, Philippines, Singapore, Thailand, > and Viet Nam. Early today, an ill passenger and companions who travelled > from New York, United States, and who landed in Frankfurt, Germany were > removed from their flight and taken to hospital isolation. > > Due to the spread of SARS to several countries in a short period of time, > the World Health Organization today has issued emergency guidance for > travellers and airlines. > > "This syndrome, SARS, is now a worldwide health threat," said Dr. Gro Harlem > Brundtland, Director General of the World Health Organization. "The world > needs to work together to find its cause, cure the sick, and stop its > spread." > > There is presently no recommendation for people to restrict travel to any > destination. However in response to enquiries from governments, airlines, > physicians and travellers, WHO is now offering guidance for travellers, > airline crew and airlines. The exact nature of the infection is still under > investigation and this guidance is based on the early information available > to WHO. > > TRAVELLERS INCLUDING AIRLINE CREW: All travellers should be aware of main > symptoms and signs of SARS which include: > > � high fever (>38oC) > > AND > > � one or more respiratory symptoms including cough, shortness of breath, > difficulty breathing > > AND one or more of the following: > > � close contact* with a person who has been diagnosed with SARS > > � recent history of travel to areas reporting cases of SARS. > > In the unlikely event of a traveller experiencing this combination of > symptoms they should seek medical attention and ensure that information > about their recent travel is passed on to the health care staff. Any > traveller who develops these symptoms is advised not to undertake further > travel until they have recovered. > > AIRLINES: Should a passenger or crew member who meets the criteria above > travel on a flight, the aircraft should alert the destination airport. On > arrival the sick passenger should be referred to airport health authorities > for assessment and management. The aircraft passengers and crew should be > informed of the person's status as a suspect case of SARS. The passengers > and crew should provide all contact details for the subsequent 14 days to > the airport health authorities. There are currently no indications to > restrict the onward travel of healthy passengers, but all passengers and > crew should be advised to seek medical attention if they develop the > symptoms highlighted above. There is currently no indication to provide > passengers and crew with any medication or investigation unless they become > ill. > > In the absence of specific information regarding the nature of the organism > causing this illness, specific measures to be applied to the aircraft cannot > be recommended. As a general precaution the aircraft may be disinfected in > the manner described in the WHO Guide to Hygiene and Sanitation in Aviation. > > * * * > > As more information has become available, WHO-recommended SARS case > definitions have been revised as follows: > > Suspect Case > > A person presenting after 1 February 2003 with history of : > > � high fever (>38oC) > > AND > > � one or more respiratory symptoms including cough, shortness of breath, > difficulty breathing > > AND one or more of the following: > > � close contact* with a person who has been diagnosed with SARS > > � recent history of travel to areas reporting cases of SARS > > Probable Case > > A suspect case with chest x-ray findings of pneumonia or Respiratory > Distress Syndrome > > OR > > A person with an unexplained respiratory illness resulting in death, with an > autopsy examination demonstrating the pathology of Respiratory Distress > Syndrome without an identifiable cause. > > Comments > > In addition to fever and respiratory symptoms, SARS may be associated with > other symptoms including: headache, muscular stiffness, loss of appetite, > malaise, confusion, rash, and diarrhea. > > * * * > > Until more is known about the cause of these outbreaks, WHO recommends that > patients with SARS be isolated with barrier nursing techniques and treated > as clinically indicated. At the same time, WHO recommends that any suspect > cases be reported to national health authorities. > > WHO is in close communication with all national authorities and has also > offered epidemiological, laboratory and clinical support. WHO is working > with national authorities to ensure appropriate investigation, reporting and > containment of these outbreaks. > > *Close contact means having cared for, having lived with, or having had > direct contact with respiratory secretions and body fluids of a person with > SARS. > > Richard Culver > > Manage your subscription on the web. Start, stop mail. Change to Digests, > etc. > RC_WORLD archives: http://www.listserv.iupui.edu/archives/rc_world.html > Open for learning every day -- since 1994. > --- URG-L Aimeriez-vous obtenir une adresse de courriel @URGENCES.CA? Suivez-le lien http://www.groupegiroux.com/messagerie pour de plus amples informations.
