關於 intravenous fluid ，我們在網路上蒐集到這些相關的討論、資訊與評價

《玻璃皮救星=Micropore》

由做紅衫魚開始，我就養成左要帶好多裝備去出Placement：鉸剪，Artery Forceps，四色筆，一卷Micropore掛係身到。雖然廣大cluster的ICN ( Infection Control Nurse)會叫我地唔好掛咁多野係身，但唔掛係身真係好唔方便！要用起上黎，又要周圍搵～ （此為不正確示範）

果卷Micropore除左可以用黎正常痴下d IVF ( Intravenous Fluid )等佢地唔會鬆黎鬆去之外

係洗傷口方面都好有幫助
以前Miss出ward就教過
好多老人家皮膚好fragile好薄好乾燥
如果用透明防水膠布去痴，一撕果下真係成層皮都同你撕鬼左出黎～
所以我地好多時候都會用Micropore黎做外層敷料，撕走的時候唔單止唔會痴皮膚，又無咁容易痴得耐敏感😂
3M Micropore真係個個Nurses都想掛一卷係袋口位到😂
（Ps: 就算唔掛衫上，都仲有一卷在左近，而家仲有升級版嘅Micropore S﹐質地更溫和防敏感，更有效地對付玻璃皮)

除此之外，你地仲有無其他Micropore的用法推介下呢？

3M
#3mhk
#醫療用紙質膠帶
#3mmicropore陪伴醫護60年

COVID 19 –靜脈營養重點(British Dietetic Association)
2020.04.07營養師趙強譯

1. 靜脈營養(PN)應是萬不得已的方法，在此期間，應在給予PN之前進行腸道營養的嘗試。若需使用PN，即使很少量，也要盡可能與PN一起餵食。

2. 使用一同補充維生素與微量元素的多室袋(Multi-Chamber Bag, MCB)作為一線方式，或單獨輸注靜脈注射維生素和微量元素。此外，若患者能藉由腸胃進食與吸收這些營養素，則可開立處方補充微量營養素，例如Forceval。此時，PN就不需給予。

3. 從每公斤供應熱量的最少量開始，然後進行監控。遵循PENG的準則進行餵食、估計營養需求和監測。

4. 每天監測尿素和電解質(U＆E)、鎂、磷、鈣、肝功能檢查(LFT)，CRP與全血細胞計數(FBC)，直至穩定。

5. 每四個小時監測血糖直至穩定。

6. 密切監測體液平衡，尤其是排泄物、嘔吐物/鼻胃抽吸物和造口/瘻管的損失。

7. 不要過量攝取葡萄糖或脂質，特別是重症患者。

8. LFT的異常可能是由於藥物，包括抗生素和/或敗血症，而不是短期PN引起的。考慮給予以魚油為基礎的MCB。

9. 如果代謝穩定，週期性PN(12-16小時)，對LFT紊亂有幫助。

10. 我們目前無法給予出院患者居家靜脈營養(Home Parenteral Nutrition, HPN)，因此應嘗進行所有可能使用的腸道途徑(包括由鼻胃管給予經口的水分補充）的嘗試。

11. 如果HPN患者入院，請聯繫平時照顧他們的團隊以尋求建議。

＝＝ 原文 ＝＝
COVID 19 – Parenteral Nutrition Top Tips

1. Parenteral Nutrition (PN) should be a last resort and all attempts at enteral nutrition should be tried before PN during this time. If PN needs to be used feed enteral alongside PN if at all possible, even if a small volume.

2. Use Multi-Chamber Bag (MCB) supplemented with vitamins and trace elements as first line or separate infusion of intravenous vitamins and trace elements. Alternatively, a micronutrient supplement such as Forceval could be prescribed if the patient is able to eat and drink and absorb these enterally. There will be limited compounding for PN during this time.

3. Start at lower end of kcals/kg and monitor. Follow PENG guidelines for refeeding, estimating nutritional requirements and monitoring.

4. Monitor Urea & Electrolytes (U&E), Magnesium, Phosphate, Calcium, Liver Function Tests (LFTs), C-reactive protein (CRP) and full blood count (FBC) daily until stable.

5. Monitor blood glucose every four hours until stable

6. Close monitoring of fluid balance especially losses from drains, vomit/nasogastric aspirates and stoma/fistulae.

7. Don't overfeed glucose or lipid especially in the critically ill.

8. Deranged LFTs may be due to medications including antibiotics and/or sepsis and not short term PN. Consider fish oil-based lipid MCB.

9. Cyclical feeding (12-16 hours) of PN can help with deranged LFTs if metabolically stable.

10. We are currently unable to discharge patients on Home Parenteral Nutrition (HPN) therefore all attempts to use enteral routes (which may include nasogastric tube for oral rehydration solutions) should be tried.

11. If a patient on HPN gets admitted to your hospital please contact the team who normally look after them for advice.)

Source: https://www.bda.uk.com/resource/covid-19-parenteral-nutrition-top-tips.html

如果你的狗狗超過25kg重，
可以考慮加入捐血行列，拯救更多狗狗的生命！

以下是一隻受惠於輸血的狗狗的故事：

Dodge is a 3 year old cocker spaniel from our Flitwick branch he was bought in in September with a swollen neck, the vet suspected that this was due to a foreign body so dodge was sedated and two grass blades were removed from near his tonsils. There was no other obvious wounds so the vet sent dodge home with antibiotics and anti- inflammatories.
Over the next few days dodge started drooling blood at first this was thought to be an abscess that was draining, but due to the significant amount of blood that started draining dodge was admitted for intensive treatment to our Hendon branch.
A CT scan (hundreds of x-rays are taken at once to build a 3d view of the area) was performed. The CT scan showed two large structures one by the right tonsil and one by the right parotid gland. The vet performed a exploratory surgery and found these structures were pockets of clotted blood. This was removed and packed. After surgery dodge was still bleeding and his blood results showed that his red blood cell count was extremely low. Dodge needed an emergency blood transfusion as he had lost so much.
The practice rang vet blood supplies and ordered a bag of packed cells which were sent to Hendon urgently and the blood transfusion was performed.
A further CT scan was performed and a piece of wood was noticed adjacent to the internal carotid (major artery). Dodge underwent a further surgery to remove this piece of wood. Whilst in recover dodge started to bleed so had to have another anaesthetic at 4am to suture and pack the area. Due to the nature of the wound there was a chance the bleeding would continue.
Dodge then needed another blood transfusion due to the continued blood loss so again vet blood supplies were called this time the packed cells had to be the correct type. (e.g. positive or negative) as only the first transfusion a dog has can be either, the second and subsequent ones have to be correctly typed as there could be a reaction to the blood. Dodge needed positive blood so this was sent urgently to Hendon and another transfusion was performed.
The next day dodge had an endoscopy to look at the area and the bleeding had stopped but there was a small amount of oozing.
Dodge stayed on intravenous fluid therapy and also had a plasma transfusion that was ordered from vet blood supplies this was due to his blood levels being extremely low still.
After a lengthy stay in hospital and a couple of set backs dodge has now been able to go home. He's on some medication and is having regular check ups at Flitwick but currently he is doing very well.
The blood that dodge received was from two of our donors Tommy and Henry, their blood was collected on a donor day at our Welwyn garden city branch. As you can see with dodge, blood donation is a life saving process, dodges owners have now been able to take their baby home due to the blood transfusions he has had.
Currently we are in high demand for blood and have a shortage of donors. Which we are trying to rectify with education and advertisement of our blood donor days.