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Merci de me dire si j'inonde trop.
Je mets les derni�res nouvelles l�, entre deux
"quarts" aux urgences:
----- Original Message -----
From: Tom
Buckley
Sent: Wednesday, March 19, 2003 4:53 AM
Subject: HK update Yesterday was a bad day. 7 admissions to ICU. Total of 24 admissions to ICU. 10 new cases admitted to hospital all in association with the original ward outbreak. Unfortunately 2 died last night. Both elderly with significant co morbidity. Contingency plans well in place but so far have not had to expand beyond ICU. Interesting news last night. Appears to be a paramyxovirus. Preliminary data thus far but it appeared in early nasopharyngeal PCR results in 6 of 15 patients. Also isolated in urine in one patient. Also reports of same result from Taiwan and Germany. Overnight in ICU despite the two deaths patients are stable though not improving. Two new admissions overnight but no more mechanical ventilation. Spontaneously breathing patients - respiratory rates improving but no improvements in A-a gradients. New admissions have all received pulse steroids on the general wards - is this limiting the inflammatory process (they are still deteriorating requiring ICU admission) or is this functional improvement due to natural course of the disease. My impressions are that we will be left with patients with ALI/ARDS. We have been trying to wean and extubate a 23 year old medical student whose oxygenation and ventilation are very good. She has now failed the oxyvent twice now. Finally gave myself a kick in the pants and realised I am expecting too much. This girl has ARDS and we are trying to extubate her after 3 days. 8 of 53 cases with atypical pneumonias are in ICU 16 of 43 cases are patients/visiting relatives It appears the younger fitter patients are not getting as ill. Yesterday I was well and truly frightened and I could see the fear was palpable around the hospital. I would love to be able to thank each and everyone of you personally for your support and encouragement. I have passed on many comments to the nursing and medical staff. They continue to amaze me. Medical staff helping me with infection control, equipment procurement, staff support have bent over backwards to help. Over the last few years I have become very disenchanted with the direction of intensive medicine. I am privileged to belong to such a community as ours. Thank you. Thank you to David Crippen for his vision. Back into it. Tom Buckley |
