很高興昨天的人工皮講解獲得了廣大回響與分享，今天讓朱育瑩我繼續抱怨一下⋯⋯
呃...不是，是衛教一下🤪
事情是這樣子的...

朱醫師門診中！
病人：「醫師，請問我傷口縫幾針？」
朱醫師：「我沒有算！」
病人：「可是我診斷書要寫！」
朱醫師：「傷口沒有在算縫幾針，只有算幾公分。」
病人：「可是我的保險員叫我寫縫幾針。」滿臉愁容。
朱醫師：「那你的保險員一定不專業...」

以上非常典型的案例， 10次門診裡面， 10次都會聽到一模一樣的對話。到底是誰教病人說要算縫幾針的啊？！🙄🙄🙄就讓我來告訴大家為什麼寫縫幾針不合理。

因為，一個傷口該縫幾針，不是教科書規定，不是健保局規定，是醫師自己判斷決定的！
你說，這不是廢話嗎？是你醫師在縫，當然是你醫師決定啊！我就是要從縫幾針來知道我傷口的嚴重度嘛！

這位觀眾朋友，又錯了！
傷口嚴重度無法從針數多少判斷！😏
為什麼？
這要從傷口的分類說起...
外科傷口分成四類：

(1)清淨傷口(Clean):指沒有感染的手術傷口，沒有發炎而且不是位於呼吸道、消化道、生殖道、泌尿道等。

(2)清淨污染傷口(Clean-Contaminated):指在控制情形下進入呼吸 道、消化道、生殖道、泌尿道的傷口，而且無不尋常之污染。 特定手術。

(3)污染傷口(Contaminated):指開放性、且為新產生的意外。

4)骯髒或感染傷口(Dirty or Infected):包括舊的創傷傷口有殘餘壞 死的組織以及現有的感染或穿孔的臟器。

（以上中文翻譯摘錄自衛生福利部疾病管制署文件！）

通常外傷造成的撕裂性傷口，至少是第三類以上起跳，換句話說就是一個污染，而感染風險較大的傷口。傷口感染風險越大，醫師縫合時，越無法臨行密密縫，必須留一些空間讓組織液或髒東西排出！
順著這個道理，舉例同樣兩公分的傷口，朱醫師可以在第一類乾淨傷口上縫個20針（例如雙眼皮）；卻在第三類傷口上ㄧ針也不縫（例如狗咬爛）
請問哪個比較嚴重🤨😏🙄
這樣大家看明白了吧！
所以睿智的大家，千萬不要再去跟醫師盧說要寫傷口縫幾針了！真正有臨床意義的是傷口的長度及深度，絕對不是看朱醫師幫你縫了8針還是9針！
縫10針還是縫0針，是對傷口感染風險的判斷；縫8針還是9針，是看朱醫師的心情啊🤪



「Protecting health-care workers from subclinical coronavirus infection(2020/02/13)+中文摘要轉譯」


➥中文摘要轉譯：
考量2019-nCoV高傳染力與無症狀可能傳染，作者呼籲高規格防護(如N95、護目鏡、與隔離衣)以防止醫護感染。


台灣CDC 2/14發布的『醫療人員防護裝備建議』符合作者觀點。
【註】：『醫療人員防護裝備建議』於- ( 衛生福利部-疾病管制署)【醫療機構因應嚴重特殊傳染性肺炎感染管制措施指引】有完整詳細的說明 : http://bit.ly/2Hykv32。(財團法人國家衛生研究院-郭書辰醫師整理)


➥Health-care workers face an elevated risk of exposure to infectious diseases, including the novel coronavirus (COVID-19) in China. It is imperative to ensure the safety of healthcare workers not only to safeguard continuous patient care but also to ensure they do not transmit the virus. COVID-19 can spread via cough or respiratory droplets, contact with bodily fluids, or from contaminated surfaces.1 According to recent guidelines from the China National Health Commission, pneumonia caused by COVID-19 was included as a Group Binfectious disease, which is in the same category as other infectious viruses such as severe acute respiratory syndrome (SARS) and highly pathogenic avian influenza (HPAI). However, current guidelines suggest ensuring protective measures for all health-care workers similar to those indicated for Group A infections—a category reserved for highly infectious pathogens, such as cholera and plague.2 WHO confirmed 8098 cases and 774 (9·6%) deaths during the SARS outbreak in 2002, of which health-care workers accounted for 1707 (21%) cases.


➥Link：(The Lancet)https://www.thelancet.com/action/showPdf…


衛生福利部
疾病管制署 - 1922防疫達人
疾病管制署
國家衛生研究院-論壇

#2019COVID19Academic

「Protecting health-care workers from subclinical coronavirus infection(2020/02/13)+中文摘要轉譯」


➥中文摘要轉譯：
考量2019-nCoV高傳染力與無症狀可能傳染，作者呼籲高規格防護(如N95、護目鏡、與隔離衣)以防止醫護感染。


台灣CDC 2/14發布的『醫療人員防護裝備建議』符合作者觀點。
【註】：『醫療人員防護裝備建議』於- ( 衛生福利部-疾病管制署)【醫療機構因應嚴重特殊傳染性肺炎感染管制措施指引】有完整詳細的說明 : http://bit.ly/2Hykv32。(財團法人國家衛生研究院-郭書辰醫師整理)


➥Health-care workers face an elevated risk of exposure to infectious diseases, including the novel coronavirus (COVID-19) in China. It is imperative to ensure the safety of healthcare workers not only to safeguard continuous patient care but also to ensure they do not transmit the virus. COVID-19 can spread via cough or respiratory droplets, contact with bodily fluids, or from contaminated surfaces.1 According to recent guidelines from the China National Health Commission, pneumonia caused by COVID-19 was included as a Group Binfectious disease, which is in the same category as other infectious viruses such as severe acute respiratory syndrome (SARS) and highly pathogenic avian influenza (HPAI). However, current guidelines suggest ensuring protective measures for all health-care workers similar to those indicated for Group A infections—a category reserved for highly infectious pathogens, such as cholera and plague.2 WHO confirmed 8098 cases and 774 (9·6%) deaths during the SARS outbreak in 2002, of which health-care workers accounted for 1707 (21%) cases.


➥Link：(The Lancet)https://www.thelancet.com/action/showPdf?pii=S2213-2600%2820%2930066-7


衛生福利部
疾病管制署 - 1922防疫達人
疾病管制署
國家衛生研究院-論壇

#2019COVID19Academic