中医中药学案例外文版 (11).pdf

Good morning everyone.I am doctor Zheng Wang from depart of Surgeon Intensive Care Unit Department of Hepatobiliary Surgery.Today what I want to discuss with you is about quick transformation and establishes of special ICU for this corona virus disease 2019 treatment.As we know,this virus is infecting pine the world quickly and threaten all the public health.It is a big disaster,we must pay more attention about it.According to the classifications,this disease divided into four types:mild,model,severe and critical.It depends on the severity of disease and all the patients clinical manifestations.This figure is from the lancet.We can see these figures with the age older,the ICU requirement is much more.Even the patients,is bigger than 65 half of the patients will go into the ICU.So that means the ICU is very important for all the patients to be treated.These are also some data from 41 infected cases in Wuhan city.We can see at the seven states after on site the patients will admission.And also the first day after his admission the patient will dyspnoea.And also if the percentage is nearly 1/2 at the 10 states of the onset,the patient will go into the intensive care unit.The percentage is nearly 40%.So it seems that ICU is the last defense place for the disease.Also with the guidance for the treatment,the ICU admission is very important especially on the severe and critical cases.It also stressed that the successful therapy on severe and critical cases is the key factor to reduce the mortality of this disease.This strategy consists of the complication provision and secondary inflammation prevention and organ support and psychological treatment.For the intensive care unit,we called ICU.I think more of the person will be familiar with this.This picture is also,at here we can see this is the preparation in the ICU in Zhong Nan hospital,Wuhan city.ECOM is one of the important technique to save the critical patients.Also here is 3 dimension.And we can see here this dimension construction of ours patients CT.And it will help us to give some treatment strategy for this.In our ICU,we also have a bundle of critical care organ support technique.Such as CRT ECOM and so on.We also have a static class clinics more than 10000 and total positive pressure environment.And also for this,if its suitable for this disease?I want to say no.Why?First the confused pathways.As we can see here,this is our ICU draft.The blue line is our medical staff pathway,the red line is patient pathway.It could be applied to most of the patient to you this way.But for the infectious disease,it will be a confused pathway.And well make some cross infection.And also we know that these virus could transmit others through respiratory drop it and contact combinations.This is a sample detection picture in the Singapore.And we can see here and the blue line,we can see here there is no virus detector.But the yellow line and also the red line we can see here,this is various detected.It told us that contact and hand hygiene could should be paid more attentions.In the general ICU what we always ignored is the control of respiratory related infectious disease.So the transformation of special ICU for the corona virus disease is very important.So just we should go back to our all of them,experience from the defection of infectious disease.This is usually the distribution of defection disease.We called three district with two channels.So what is three district with two channels.The three districts are clean area,partly exposed area,also called as buffer area and exposed areas.So at the same time,the medical staff and patient should go the different path.And we can see these figures the medical staff will go into this way.So first they will from the clean areas to the buffer areas.And then we will go to the exposed areas and also go to see the patients.And also for the patients they could from the exposed areas and go back into the into their room.And at there they will see the doctor.So what is the important for this three districts with two channels.It could prevent the pollute airs to and also it could avoid the cross infection.Additionally,negative pressure ward is also very important for the department infectious disease.As we can see here,our outside is zero Pa and also for the corridor is negative 10 Pa.And also for the ward negative 15 Pa and also for the bathroom is negative 25 Pa.What is this benefit or what they have advantage.It will help us to from the airflow direction.It could be like this,the air will be flow from the outside and go back to the corridor and go back to the ward and finally well go back to the bathroom.So this is the airflow direction.It could help prevent the pollute air to spread outside.It would help all the patients and help all the medical staff.So learning from all of the this experience we could transform it in our ICU.Here is a new draft,from the left side we design the clear way.We can see here,we have the medical staff pathways and also patient pathways.So the different way from here,the medical doctor will be go back from the clean areas and also go to the buffer areas.And also we can go to the exposed areas and go back to return back to here and from the buffer areas and do another treatment and then go back to the clean areas.And also for the patients they go to go the exposed areas.So this will be helped to separate all the pathways.And also we can see here we have the clearly district,this is our buffer area.From the right side,we can see more clear about air flow direction.So we can see here the corridors is negative 10 Pa.And also for here our medical pathways for here we can see this is all the positive pressures.But then in the buff areas negative 10 and in the ward negative 15.All the airflow will be go back from outside to inside and didnt go outside.This will be help us to prevent the polluted air to outside and to transmit to other persons.So whats the meaning of this establishment.I think it will be relative separation between staff and patient.And also it could also provide different access route to avoid cross infection with optimal airflow directions.So these pictures what I want to see here is our the fourth team.Our 133 medical doctors who go to the Wuhan city to help to treat the corona virus disease 2019.It has been about one month since they left our hospital.So when they arrived at the infected city Wuhan they did a quick transformations.We can see here this is also a transient transformation for our all the medical team.So in the hotel they go to the clarified the three district.So at here near the door we can see the exposed areas.And also for here is a,we called the semi exposed areas and buffer areas.And near here bed,its a clean area with these three districts.It will help us to protect themselves from contamination,And also,these tips could help all the public to keep the virus out of the home as much as possible.We can see here,this is the,this is what we want to reconstruction in your home.Near the door we can see exposed areas.And also for here this is near the shows we can see there partly exposed areas.And also for this its clean areas.This will be avoid bring the virus home and also with our reconstruction of conditional air flow and also to treat more about keep the bathroom clean.We could our home will be more safer.So now what I want to summarize here is about ICU technique is the king and establishment of the special ICU is the queen.We believe with the king and the queen combined,we will conquer the battle finally.Thanks for your attention.