伊波拉病毒到底有多恐怖？
下面這篇文章，是最近的美國醫學雜誌上的文章，在討論，關於美國第一例因為伊波拉病毒死亡案例產生後，對於整個醫療界的影響。
NEW YORK (Reuters Health) - "Ebola collateral damage" is a term coined by Dr. Thaim B. Kamara, the Chief of Surgery at Connaught Hospital in Freetown, Sierra Leone. He defines it as the disruption of routine patient care by Ebola.
"Since the outbreak took its first victim in our hospital, all elective operations and routine clinics were discontinued," he said. "Because vomiting and abdominal pain are often associated with surgical abdominal problems, patients presenting with these symptoms at the Accident and Emergency Unit risk being sent to the Ebola Isolation Unit. Once there, they cannot be discharged until a negative result is returned or they die from their surgical illness."
這是一篇負責照顧一位伊波拉病毒患者的醫院，的外科部主任醫師所寫的文章。因為伊波拉病毒的主要症狀，就是嚴重的腹痛及嘔吐，但是這卻又是許多腹部急症一定會出現的症狀，因此，所有出現這樣症狀的病人，必須送去隔離單位，直到確認是否是伊波拉患者？但是這樣確有可能會延誤病情及治療，所以不論是院方，或是病人，都不願來這家醫院處理及就醫。
Late last week, anesthetists in Sierra Leone refused to care for a patient who badly needed a laparotomy for peritonitis because he had a documented history of vomiting and fever.
"This is the problem we face now. If a patient has any of the symptoms regarded as part of the case definition for Ebola, he or she may be sent to the isolation unit and kept there until the result of their test comes back," said Dr. Kamara.
He also told of a man who was admitted to one of the surgical wards with a gangrenous extremity and scheduled for an amputation. "Minutes before the patient was sent to the operating theater, someone sounded an alarm that the patient was suspected of having Ebola," Dr. Kamara said.
Although the patient did not have any of the case definition symptoms or signs for Ebola, the surgery was cancelled and the patient was placed on quarantine for 21 days.
一位因為腹膜炎，需要緊急開刀的病患，麻醉醫師拒絕麻醉，因為不確定他是不是伊波拉病毒患者？另一位更扯，因為某些原因，下肢壞死需要截肢的病人，因為有人說，他可能是伊波拉病毒患者，而被延後手術21天。
Yesterday, the American College of Surgeons posted a link on its website to a protocol describing precautions operating room teams should take if a patient with suspected or confirmed Ebola requires surgery. (The protocol is here: http://bit.ly/1tC85Xf.)
The protocol was conceived by Dr. Sherry M. Wren, chief of surgery at the Palo Alto VA Hospital and a professor of surgery at Stanford University. She reasoned that Ebola is not 100% fatal, and patients may develop standard surgical problems while infected.
"As a concerned citizen and experienced global surgeon, I was thinking of our colleagues in West Africa and knew that they were still operating on some cases," she said. "I thought about the dilemma of how would I operate on an Ebola patient if I needed to."
After looking at the Centers for Disease Control and Prevention website and finding nothing about surgery on patients with Ebola, she decided to write a guideline herself and asked Dr. Adam L. Kushner, a global surgeon who is the Founder and Director of Surgeons OverSeas, to help her. They based the protocol on existing CDC information for other infectious diseases and what they personally would want for protection doing such a case
Among other things, the protocol calls for all operating room personnel to use Association for the Advancement of Medical Instrumentation (AAMI) Level 4 Impervious Surgical Gowns, leg coverings that have a full plastic film coating over the fabric (not just the foot area), full face shields, masks, double gloves, and surgical hoods.
"I think that the guidelines should be followed and that all OR personnel should have the maximum personal protective equipment (PPE)," said Dr. Wren.
In Sierra Leone, Dr. Kamara said, "We use normal fabric gowns, goggles, face masks, caps, plastic aprons, and rubber boots to protect ourselves when we are operating on any patient."
你也不得不讚嘆美國人行事之迅速確實。負責全國感染事務的外科醫師的Dr. Sherry，在短時間內，針對外科醫師面對伊波拉患者時，該採取怎樣的自我保護措施，提出了完整的規則 ( protocol )；包含完全不可穿透的手套、整條腿都必須被隔離衣保護，而不光是腳、整個頭部、臉部都必須被完整包覆保護起來。簡單的說，就是全套的防護衣啦！但是即使在美國，本文的作者也說，我們只有一般的手套、面罩、塑膠靴可以用來面對伊波拉病毒患者。
而且今天早上新聞中甚至還提到，現在已經有醫師在擔心，伊波拉病毒是否已經從原本以為，僅從體液傳染，進化到可以從飛沫傳染？天哪！大家要小心了
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