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Went to the ER in Taiwan

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发表于 3-11-2019 12:13:11 | 显示全部楼层 |阅读模式
本帖最后由 choi 于 3-11-2019 15:11 编辑

Kevin Bozeat, Went to the ER in Taiwan. Facebook, Feb 17, 2019.
https://www.facebook.com/kevin.bozeat/posts/10216454452372840

My comment:
(a) "My Taiwanese roommate called a taxi and took me to the ER at NTU [National Taiwan University] Hospital 台大醫院. I was immediately checked-in by an English speaking nurse. Within 20 minutes I was given IV [intravenous] fluids and anti-emetics. They took blood tests and did an ultrasound to ensure it wasn't gall stones [all online English dictionary spell gallstoneor appendicitis. From there I was given a diagnosis: a particularly severe case of Acute Viral Gastroenteritis (aka the stomach flu). After about 3 hours on an IV, I began to feel slightly better, my nausea disappeared and my stomach began to calm down."
(i) emetic (n; First Known Use 1657; Latin emetica, from [per Wiktionary: Ancient] Greek emetikē, from feminine of emetikos causing vomiting, from emein to vomit): "an agent that induces vomiting"
https://www.merriam-webster.com/dictionary/emetic
(ii)
(A) Huang ME, Sonography and Computed Tomography in Diagnosing Acute Appendicitis. Radiologic Technology, 89: 224 (2018)
https://www.ncbi.nlm.nih.gov/pubmed/29298941

Sonography is more formal than ultrasound, though both terms are used in medicine.

sensitivity and specificity
https://en.wikipedia.org/wiki/Sensitivity_and_specificity
are two parameters important to evaluate medical diagnostic methodology or tool.
(B) Alice Chao and Laleh Gharahbaghian, Tips and Tricks: Ultrasound in the Diagnosis of Acute Appendicitis. American College of Emergency Physicians   (under the heading "Emergency Ultrasound")
https://www.acep.org/how-we-serv ... acute-appendicitis/
("The diagnosis of acute appendicitis can be challenging, with a significant portion of patients initially misdiagnosed due to atypical clinical presentations and nonspecific laboratory tests [indeed lab tests are not helpful a all]. A delay in diagnosis increases the risk of perforation [bursting] and, as a result, mortality rates.  The role of bedside ultrasound (US [for ultrasound]) by emergency physicians [as opposed by radiologists] in the evaluation of appendicitis continues to evolve. Once appendicitis moved away from being a purely clinical diagnosis [without medical diagnosis at all -- ie, press right lower abdomen and patient says pain, that is it when that may be caused by many other diseases, especially in women (such as pelvic infection, ectopic pregnancy); pelvic infection should be treated with medication, not operation; but the healthcare providers in Taiwan in 1980s, in part for lack of diagnostic tool, was to operate in face of uncertainty, to avoid a burst appendix -- even if operation failed to find anything, appendix was removed, sent to pathology, and surgeon told patient he had appendicitis], physicians looked for the appropriate imaging modality that would be accurate, safe, cost-effective, and completed in a timely fashion. While computed tomography (CT) has been used most frequently due to its accuracy and availability, it falls short in other dimensions. The radiation from CT scanning is not ideal for pediatric or pregnant patients, and it is a costly imaging study. Ultrasound is thus an obvious alternative. One use of US in evaluating for acute appendicitis is to perform an US and, if equivocal, either discharge the patient with close follow-up or consult the surgical service depending on level of suspicion. Another approach is a 2-step imaging protocol, which starts with an US, then moves to CT if the US has equivocal results. In some institutions recently, this 2-step protocol has been replaced with focused magnetic resonance imaging (MRI), * * * Sonographic criteria for a diagnosis of appendicitis include a tubular structure that is > 6mm in diameter, noncompressible, and lacks peristalsis. Click Here for Video")

Following the name of the second author is "MD, FACEP." The first indicates his medical doctor degree, and the second, Fellow of ACEP.
(iii)
(A) Viral Gastroenteritis ('Stomach Flu'), Narional Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institute of Health (NIH), undated
https://www.niddk.nih.gov/health ... ral-gastroenteritis
("People commonly call viral gastroenteritis 'stomach flu,' but the term is not medically correct. Flu viruses do not cause viral gastroenteritis.  Doctors often diagnose viral gastroenteritis based on your symptoms. If your symptoms are mild and last only a short time, you typically won't need tests")
(B) Nathan D Stuempfig and Justin Seroy, Viral Gastroenteritis. StatPearls, NIH, last update Jan 20, 2019
https://www.ncbi.nlm.nih.gov/books/NBK518995/
("Isolated cases can occur, but viral gastroenteritis more commonly occurs in outbreaks within close communities such as daycare centers, nursing facilities, and cruise ships. Many different viruses can lead to symptomatology, though in routine clinical practice the true causative virus is generally not identified. Regardless of the viral cause, treatment is generally uniform and directed toward symptomatic improvement with a focus on hydration status. * * * Several different viruses including rotavirus, norovirus, adenovirus, and astroviruses account for most cases of acute viral gastroenteritis. Most are transmitted via the fecal-oral route, including contaminated food and water")

(b) The author has "No insurance. * * * And if I had NHI, it would have been a fraction of that."

National Health Insurance (NHI) 中央健康保險 (健保) -- administered by National Health Insurance Administration Ministry of Health and Welfare 衛生福利部中央健康保險署)
(c) I know nothing about NHI. Ideologically I lean toward Republicans, so I am disinclined toward NHI.
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