Do we have any Italians in here at the moment
Sunday, February 23, 2020 12:10 PM
Karamay has no new cases of coronary pneumonia, but she is not allowed to go out since February 3, and her body temperature has been reported three times a day for 19 days. It ’s not enough to buy food at home. It does n’t sell one by one to test the Chinese people ’s survivability and pressure resistance.
Sunday, February 23, 2020 12:10 PM
Unbridled in the name of “enforcement”
Hong Kong Vulcan Hill Hospital🏥
Location Wuhan, 86 years old, 106 years old mother, children are abroad! Sick at home.
The doctor stated that he had saved many people by means of preventive treatment, but he ran all over the government agencies and even gave the materials to Zhong Nanshan, but they were all dead!
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The filter layer uses ordinary medical masks. After this modification, one mask can be used as 6
Little Iranian girl suffers from Wuhan lung disease and can see difficulty breathing.
A smart one Getting ready
Simona Are children infected in Italy?
#Readers Contributed Outbreak
[Wuhan doctor Xia Sisi unfortunately died of new crown pneumonia]
Xia Sisi, digestive physician, Xiehe Jiangbei Hospital / Caidian District People’s Hospital, female, 29 years old. In the first line of fighting the epidemic, he was unfortunately infected with new coronary pneumonia. He was admitted to our hospital on January 19, and the hospital gave full treatment. The condition deteriorated on February 7. The hospital urgently died at 6:30 am on February 23, 2020, and died after treatment at Wuhan University Zhongnan Hospital. Our hospital expresses its deep condolences to Dr. Xia Sisi’s unfortunate death and expresses his deep condolences to his family.
Xiehe Jiangbei Hospital / Caidian District People’s Hospital
February 23, 2020
(Xiehe Jiangbei Hospital
Panic buying in Italy
Expert consensus | 2019 Coronary Virus Disease (COVID-19) Neurology Clinical Prevention and Treatment
Mental Rehabilitation Today
Since December 2019, it first appeared in Wuhan City, Hubei Province, and has quickly spread to unknown pneumonia nationwide and around the world, causing widespread concern worldwide. The pathogen of this outbreak was identified as a new coronavirus. On February 8, 2020, China officially named it Novel Coronavirus Pneumonia (NCP). On February 11, WHO announced that the disease caused by the new coronavirus is Corona Virus Disease 2019 (COVID-19). When neurological symptoms are the first symptoms in the early stage, it is often easy to misdiagnose and delay treatment. At the same time, these patients are also invisible communicators. In order to let neurologists understand the occurrence, development, and outcome of this disease, and to be familiar with the related prevention and treatment processes, we summarize the current clinical diagnosis and treatment of COVID-19 and related research progress, and write "2019 Coronavirus Disease (COVID- 19) Expert consensus on clinical prevention and treatment of neurology ", to guide neurologists in the clinical prevention and treatment of COVID-19.
In addition to systemic and respiratory symptoms, which neurological symptoms may patients with COVID-19 have?
General and respiratory symptoms
COVID-19 patients often have fever, dry cough, and fatigue as the main manifestations, and some patients present with sore throat, abdominal pain, diarrhea, and conjunctivitis. Therefore, even if the symptoms are mild, they must be given high attention.
Some patients have neurological symptoms. At present, neurological symptoms of COVID-19 patients have been observed: symptoms of acute cerebrovascular disease such as sudden unclear speech, limb paralysis; symptoms of intracranial infection such as headache, epilepsy, and disturbance of consciousness; Symptoms of muscle damage such as sore limbs and weakness; a few patients are accompanied by symptoms such as neuralgia, paresthesia, and dysuria. During the period of high incidence of COVID-19, neurologists need to pay great attention when receiving such patients, especially those whose first symptoms are these neurological symptoms. We must be vigilant against COVID-19, pay attention to differential diagnosis, and protect and respond.
3．Matters needing attention in laboratory inspection
Most of the patients with COVID-19 have low fever, and a few have high fever. It is worth noting that some patients have no combined fever, and even the lung CT manifestations are very significant, dyspnea has occurred, the temperature is still normal, but they just feel weak; During treatment, body temperature dropped, but pneumonia actually progressed. Therefore, to judge the progress of the disease, it is important to review the lung CT.
In related blood biochemical examinations, it is worth noting that some patients, when reviewing their pre-onset blood images, have seen a decrease in the number of lymphocytes, suggesting that we should attach great importance to changes in lymphocytes in the blood image. At present, some companies have developed 2019-nCoV coronavirus antibodies, clinical monitoring and application are ongoing, and may become an important indicator of prognosis in the future.
At present, nucleic acid testing is still an important criterion for diagnosis. However, the positive rate is not high. Some patients need several consecutive tests to find a positive result. Therefore, there is a lot of clinical consensus at present, even if the nucleic acid test is negative, if combined with the comprehensive judgment of epidemiological history, clinical manifestations, and lung CT, a preliminary suspected diagnosis can still be given; if there are obvious characteristic changes in lung CT, the diagnosis can be confirmed. Do not treat a suspected patient with symptoms just because you wait for a nucleic acid test result or a negative nucleic acid result.
What are the poss
ible causes of neurological symptoms and treatment precautions in patients with COVID-19?
Symptoms related to acute cerebrovascular disease
Among the COVID-19 patients, middle-aged and elderly people accounted for the majority, especially critically ill patients. D-dimer abnormally increased, and embolic vascular events were more likely to occur. Many of these patients also had cerebrovascular disease. Risk factors, some patients may have acute ischemic stroke, so medical staff also need to pay attention to related neurological symptoms. Once the patients with COVID-19 who presents with acute ischemic stroke should be treated by a neurologist and infectious disease department Physicians participate in emergency treatment together. For patients with cerebrovascular disease with abnormally high D-dimer, secondary prevention of stroke is recommended to be given anticoagulation therapy. After the treatment was completed, the patients were admitted to the isolation ward of the infection department. At the same time, neurologists were arranged to visit the isolation ward every day to assist the doctor in the isolation ward to manage the patients.
Due to the 2019-nCoV virus binding to the ACE2 receptor, some patients with hypertension may develop abnormal blood pressure after COVID-19, increasing the risk of cerebral hemorrhage. In addition, critically ill patients with COVID-19 often have severe platelets. Decrease, these may also be a high risk factor for such patients to be prone to acute cerebrovascular events. Studies have shown that ACEI and ARB antihypertensive drugs may increase the expression of ACE2 receptors. In order to avoid aggravating the symptoms of patients with COVID-19 infection and blood pressure control in hypertension patients, it is recommended to stop using ACEI and ARB antihypertensive drugs For CCB, diuretics and other antihypertensive drugs.
- Symptoms related to intracranial infection
The SARS-CoV virus may also infect the central nervous system. Researchers have detected SARS-CoV nucleic acids in patients with cerebrospinal fluid, and SARS-CoV viruses have also been found in autopsy brain tissue. We have also found that some patients with COVID-19 have symptoms similar to intracranial infections such as headache, epilepsy, and disturbance of consciousness, and some have COVID-19 related symptoms after the first symptom of intracranial infection. Therefore, neurologists Attention needs to be paid to it when necessary. If possible, MRI plain scan and enhanced examination of the head can be performed, lumbar puncture examination is feasible under the condition of patients, and 2019-nCoV virus nucleic acid detection of cerebrospinal fluid is performed. Such patients need to combine the principles of diagnosis and treatment of intracranial infection and COVID-19 diagnosis and treatment guidelines to increase routine neurological treatment such as dehydration, brain protection, epilepsy control, and antipsychotic symptoms.
- Symptoms related to muscle damage
Some patients may experience symptoms of muscle damage such as fatigue, sore limbs, and mildly elevated muscle enzymes, which may be related to the inflammatory response caused by the 2019-nCoV virus or the virus directly causing muscle damage. For patients with muscle damage as the first symptom, it is recommended to improve COVID-19 related examinations. While such patients are actively undergoing COVID-19 related treatment, it is recommended to strengthen nutritional support treatment. Those with severe muscle damage should be treated with gamma globulin as soon as possible (0.25g / kg / d or 15-20g / d, course of treatment 3-5 day).
What precautions do neurologists need to take when encountering patients with COVID-19?
At the very moment when the COVID-19 epidemic is severe, neurologists may see COVID-19 patients whose first symptom is a neurological symptom in the outpatient clinic, or the patient may find it a “suspect” case after hospitalization, and may also diagnose neurological symptoms Confirmed patient. Based on t
he “Technical Guidelines for the Prevention and Control of New Coronavirus Infection in Medical Institutions (Trial Version)” developed by the National Health and Health Commission, combined with the characteristics of COVID-19 patients that neurologists may encounter, supplements The following considerations.
- Precautions for neurology clinic
Most patients with neurological symptoms are the first to see a neurologist. The following points should be noted:
(1) Wear disposable work caps, medical protective masks, work clothes, and disposable latex gloves for spare time before taking the consultation, and carry hydrogen peroxide hand disinfectant with you.
(2) Before entering the consultation room, patients and their families routinely take their body temperature at the pre-screening triage table. All patients and accompanying family members (to reduce cross-infection, try to avoid family members to enter the office) must wear disposable medical masks. If there are symptoms related to pneumonia, it is recommended to go to a fever clinic first, and then consult a neurologist if necessary.
(3) For ordinary neurological non-emergency patients, avoid hospitalization as much as possible, and choose to be hospitalized after the epidemic is controlled.
(4) For patients with neurological symptoms but no typical COVID-19 symptoms, but highly suspected patients, it is recommended that patients go to the hot clinic and consult a neurologist if necessary.
(5) After the consultation, remove the protective equipment strictly in accordance with the procedures for putting on and taking off protective equipment, and it is forbidden to wear protective equipment to leave the contaminated area to avoid cross-contamination in each district.
- Neurology greenway and neurological emergency prevention and control management
While ensuring the timely treatment of patients with green road strokes and neurological emergency patients, also ensure that patients, family members, and medical personnel avoid cross infection during treatment. It is recommended that:
(1) In areas with high incidence of COVID-19, the protective equipment for neurological greenways and emergency medical staff in neurology departments should be Level III protection.
(2) Strictly separate the neurological greenway and neurological emergency channel (including the consultation room, CT / MRI room, interventional operation room, etc.) from the emergency department and the fever clinic to ensure that there is no intersection with fever patients.
(3) The doctor should ask the patient and family members if they have fever, sore throat, and other pneumonia-related symptoms within 14 days, and if they have a diagnosis of COVID-19 or a history of suspected patients. In case of the above, arrange for a professional medical staff to accompany the patient to the fever clinic, follow the procedure of the fever clinic to perform stroke greenway / emergency treatment, and enter the infectious department isolation ward after the treatment is completed. At the same time, arrange a neurologist to visit the isolation ward regularly. . If the above conditions are ruled out, arrange treatment according to the stroke greenway / emergency work flow, and then enter the neurology ward.
(4) Patients receiving thrombolysis and thrombolysis, avoid entering the NICU, and perform treatment in a single room. Medical staff pay attention to isolation and protection (because patients are in emergency department and patients with acute cerebral infarction have low resistance, cross infection is prone to occur). Day, blood routine, lung CT, and new coronavirus nucleic acid test results were negative, and infection could only be entered into the multi-person ward.
(5) Greenway medical staff should combine work with rest to avoid physical overdrafts such as staying up late and working long hours. It is appropriate to strengthen physical exercise and nutritional support.
- Prevention and control management of neurological ward
(1) In areas with a high incidence of COVI
D-19, protective equipment for medical staff of the Neurological Ward Unit (NICU) should be Level III protection. Medical staff in general wards need to wear disposable work caps, medical protective masks, and work clothes.
(2) Implement a strict access control system to reduce stays and visits, arrange special personnel to enter the ward, measure the temperature of the entering personnel, and wear disposable medical masks for all patients and family members to avoid cross infection. If conditions permit, it is recommended to have at least 1 paramedical staff in every 2 wards.
(3) Implement the real-time temperature reporting system for ward medical staff and other staff, patients, and accompanying family members. Once there is a fever, immediately notify the department’s COVID-19 prevention and control team, and the team will assist in arranging and guiding treatment, inspection, and isolation of patients and family members. , Ward disinfection, etc.
(4) Once a highly suspected patient is found, an in-hospital COVID-19 expert group consultation should be arranged immediately. At the same time, other patients and their family members and contacted medical staff should be isolated. The temperature of all contacts and the symptoms related to COVID-19 should be closely monitored. Suspected patients should be as soon as possible. Transfer to the isolation ward of the hospital. If the bed cannot be transferred immediately due to the shortage of beds, temporarily arrange a separate room for the patient, and transfer to the isolation ward or the designated hospital as soon as possible with the assistance of the hospital. The patient’s original space is strictly disinfected.
Source: National Stroke Prevention and Treatment Project. China Cardiocerebrovascular Network
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