我在1990年代末开始我的医疗培训。这是艾滋病的流行;也就是说,到那个时候,人类免疫缺陷病毒是已知的,已经有行之有效的治疗方法。所以,对于一定年龄的医生,这是我们第一次与一个新兴疾病。这创造了一系列的混乱和治疗失误。黄金标准双盲、随机、计划周详,安慰剂对照的事实已经众所周知的美国标准马桶。它已经一段时间因为我跑一个杂志俱乐部,认为与他人的实际意义单中心,选取,不受控制的研究。COVID仍然是未审核关键数据产生的海啸几乎每天。运转非nocere !或者你是一个坚信神的殿的规则13:“良好的医疗保健的尽可能多的没有。” During this pandemic, I may have crossed my imagined personal boundary of clinical excellence with my desire to help in an extreme situation. In retrospect, it had unexpected positive effects that had nothing to do with the actual medical procedure.
它已经出现在一个假设的与我的医生讨论组,与冠状病毒第一波淹没。血液滤过装置连接到一个血液透析机器的发展刚刚开始研究治疗在透析患者菌血症。这些治疗被率先实现抗生素耐药性呈上升趋势,而新颖的管理需要脓毒症的治疗。在我的组内讨论,我是坚决反对使用未经证实的治疗。我已经回顾了现有文献,没有积极成果的研究,没有一个人。进入一个全球大流行,与小说SARS-COV2制造商看到潜在的更广泛的市场的开放。想象我的惊喜当黑衣人出现在我的门口。
就像一部科幻电影,两个黑色的越野车停在了医院的入口。一个单一的、普通的棕色纸箱被两个巨额退出后挡板,先生们。他们被政府特工的缩影与深色太阳镜,耳机,黑色领带,西装。后来我发现盒子及其内容、8 hemofilters,已交付的州的前州长。盒子里然后交给主任重症监护室。hemofilters,像许多其他疗法COVID期间,收到了一个欧洲大学协会(紧急使用授权)。他们可以通过适当的同意,但规避了严格的试验需要一个设备通过FDA由于危机。不可预测的命运编织他们的胶乳摘我的字符串,和电话来找我。重症监护医生想尝试一个未经证实的,自然的治疗ICU病人需要肾脏学知识。我没有意识到这一点,但在最初的波COVID,我已与一位医生在社交媒体上被证明是计划研究的首席研究员的过滤器。2022卡塔尔世界杯预选赛排名 I reached out and discussed what I would need to do and the goals of therapy. It was not intended, but it turns out that a majority of the people who ultimately received this treatment were medical personnel: doctors, nurses, EMTs. Perhaps it was easier for me to justify because medical professionals had a concept of risk versus benefit and what “unproven” really meant. We had done a half dozen treatments over several weeks, and all had gone according to plan. Most patients improved, maybe because of the treatment or maybe despite it. Some patients didn’t change, but no one got noticeably worse. Then I got the call I’d been dreading: young, female and pregnant.
怀孕是在生存的边缘。病人迅速下降,尽管优化传统疗法。她变得神志不清,需要插管,和她的丈夫变得沮丧。这个过滤器是众所周知的厨房水槽。现在有两个生命岌岌可危。使风险与收益方程容易吗?如果这是我的妻子和未出生的孩子,我会怎么办?所做的一些事情真的比什么都不做吗?大声的批评提供一个未经证实的治疗回荡在我的思想。医学界的预期不面对艰巨的疾病没有真正知道诉讼可能是无效的或潜在的有害几乎瘫痪。 In the end, my single-center, unblinded experience made me feel like doing nothing was not the best course of action. The six-hour treatment went well without complications. They built a makeshift neonatal ICU in the medical ICU in the adjoining room, a grim reminder that things could still deteriorate rapidly. This patient became the center of the ICUs consciousness. Every day I would be stopped by nurses, technicians, and staff wondering how the patient was progressing and was the baby doing well. The entire situation reminded me that it is overwhelming hopelessness more than the pain of the workload that crushes caregivers’ collective souls. As the saying goes: You can live three weeks without food, three days without water, three minutes without air, but less than three seconds without hope. I am happy to report the patient and baby recovered and were discharged from intensive care. There are still a few months until the baby’s due date. At least for today, I can take an exuberant exhale and keep hope alive.
布莱恩·里夫金是一个肾脏。
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