2021年10月9日 星期六

一波三折的諾魯行

這是我本人第一次來到諾魯這個全世界第三小的國家~~~

出發前因為受到Covid-19疫情的影響

華航、長榮班機相繼被取消....

最誇張的是,原本預計9/14要搭乘長榮航空,當天我已經在起飛前2.5小時抵達機場,結果到了長榮櫃台被通知小姐您的班機被取消了啊!!!

緊急聯絡旅行社後,旅行社說沒接到任何班機取消的通知~~

進一步詢問長榮航空,他說因為是透過旅行社代訂,航空公司只會通知旅行社,不會通知我本人!!並且問到班機是起飛前三天突然取消的!(算了一下,我是禮拜二的飛機,等於禮拜六航空公司突然取消,又剛好遇到六日兩天休假,如果禮拜一旅行社上班沒有特別follow就miss掉了)

經過緊急與中榮、台灣駐諾魯大使館聯絡後,

最後一波三折,於9/22搭乘長榮航空『商務艙』先到澳洲布里斯本,再從布里斯本轉機到諾魯

(沒錯!因為當前澳洲日趨嚴格的邊境政策,每架飛往澳洲的班機只能有15個乘客!!以航空公司角度飛一趟虧一趟,所以現在基本上買不到任何經濟艙了,飛機上商務艙乘客比經濟艙多很多,由此可見航空公司的銷售策略也跟著轉向,而且班機紛紛取消....)

當然我也在一陣驚嚇後,又提著行李返回我溫暖可愛的家,多了一個禮拜好好與家人相擁道別的寶貴時光

所以各位台灣準備前往諾魯執行任務的醫師們,行前務必『再三』提醒旅行社幫忙追蹤班機取消狀況喔!即使起飛前班機都可能被取消~~

接下來就是好好享受華航商務艙的艙內設施與美食~~~








當然這是最後幾天可以好好進食的狀況,所以各位在商務艙吃飽一點囉!





2021年9月19日 星期日

Fundoscope開箱


白袍巫師最近有點忙,


從另外一個次元傳送了傳說中的神話道具

Fundoscope(字面上Fun-do-scope歡樂做)

其實是可以 看穿眼底 的神奇道具!

裝備之後 邪眼透視特殊能力可以+999

還可以使用內建魔鏡拍照留念

將影像傳送回福爾魔沙島

諮詢更高專科等級巫師的建議

進行後續魔法治療!

寶箱打開之後

發現神奇道具如圖:




 其實 白袍巫師自從200年前

實習巫師訓練結束之後,

就再也沒有練習過這屬性的特殊道具👀

況且之前拿的魔杖 🪄

跟這種等級99的道具 根本完全沒得比⋯

經過多次與魔法道具開發部Acer+晉弘科技

遠端魔鏡連線/消耗大量Digicel點數,

終於搞懂這套裝備要如何使用了👌

(不需要散瞳)使用邏輯小技巧如圖

提供給各位參考看看~





2021年9月12日 星期日

Nauru Rx List

https://extranet.who.int/ncdccs/Data/NRU_D1_Nauru_PEN_Chart_Version_4.pdf

[ RoNH Rx list] 

1. ANAESTHETICS

1.1 General Anaesthetics and Gases

Isoflurane Inhalation

Ketamine 100mg/mL Injection

Nitrous Oxide Inhalation

Oxygen Inhalation

Propofol 200mg/20mL Injection

Sevoflurane Inhalation

1.2 Local Anaesthetics

Bupivacaine 0.50% Injection

0.5%+8% Glucose Injection

Lignocaine 1% Injection

2% Injection

2% Gel

Lignocaine + Adrenaline 2%+1:200,000 Injection

2%+1:80,000 Injection

Lignocaine 4% Spray

Mepivacaine 3% Injection

1.3 Preoperative Medication and Sedation for Short Term Procedures

Atropine Sulphate 0.6mg/mL Injection

1mg/mL Injection

Diazepam 5mg Tablets

5mg/mL Injection

Midazolam 5mg/mL Injection

Morphine Sulphate 10mg/mL Injection

2. ANALGESICS, ANTIPYRETICS, NON-STEROIDAL ANTI-INFLAMMATORY MEDICINES,

MEDICINES USED TO TREAT GOUT AND DISEASE MODIFYING AGENTS USED IN RHEUMATOID DISORDERS

2.1 Non-Opioids and NSAIDS

Acetylsalicylic Acid 300mg Tablets

Diclofenac Sodium 100mg Suppository

25mg Tablets

50mg Tablets

75mg/3mL Injections

1% Gel

Ibuprofen 200mg Tablets

400mg Tablets

100mg/5mL Suspension

Naproxen 250mg Tablets

Paracetamol 500mg Tablets

125mg Suppositories

500mg Suppositories

120mg/5mL Oral Liquid

240mg/5mL Oral Liquid

Paracetamol + Codeine 500mg + 8mg Tablets

2.2 Opioid Analgesics

Codeine Phosphate 30mg Tablets

Fentanyl 50mcg/mL Injection

Morphine 10mg Tablets SR

1mg/mL Oral Liquid

10mg/mL Injection

Pethidine 50mg/mL Injection

100mg/2mL Injection

2.3 Medicines Used To Treat Gout

Allopurinol 100mg Tablets

300mg Tablets

Colchicine 0.5mg Tablets

3. ANTIALLERGICS AND MEDICINES USED IN ANAPHYLAXIS

Adrenaline 1mg/mL Injection

Chlorpheniramine 4mg Tablets

Dexamethasone 4mg/mL Injection

Dexchlorpheniramine Maleate 2mg/5mL Oral Liquid

Hydrocortisone 100mg Injection

Loratidine 10mg Tablets

1mg/1mL Oral Liquid

Prednisolone 5mg Tablets

20mg Tablets

25mg Tablets

Promethazine 25mg Tablets

5mg/5mL Oral Liquid

25mg/mL Injection

4. ANTIDOTES AND OTHER SUBSTANCES USED IN POISONING

4.1 Non-Specific

Atropine Sulphate 0.6mg/mL Injection

Charcoal, Activated 50g Oral Liquid

125mg Tablets

4.2 Specific

Acetylcysteine 2g/10mL Injection

Calcium Gluconate 10% Injection

Naloxone 0.4mg/mL Injection

5. ANTICONVULSANTS/ANTIEPILEPTICS

Carbamazepine 200mg Tablets

Diazepam 5mg/mL Injection

Magnesium Sulfate 50% Injection

Phenobarbitone 30mg Tablets

200mg/1mL Injections

15mg/5mL Oral Liquid

Phenytoin 100mg Tablets

50mg/mL Injection

30mg/5mL Oral Liquid

Sodium Valproate 200mg Tablets

200mg/5mL Oral Liquid

6. ANTI-INFECTIVE MEDICINES

6.1 Anthelminthics

6.1.1 Intestinal Anthelminthics

Albendazole 400mg Tablets

200mg/5mL Oral Liquid

Mebendazole 100mg Tablets

100mg/5mL Oral Liquid

Pyrantel 250mg Tablets

50mg/mL Oral Liquid

6.2 Antibacterials

6.2.1 Betalactam Medicines

Amoxycillin 250mg Capsules

500mg Capsules

125mg/5mL Oral Liquid

250mg/5mL Oral Liquid

Amoxycillin + Clavulanic Acid 125mg/5mL + 31.25mg/5mL Oral Liquid

600mg Tablets

Ampicillin 500mg Injection

1g Injection

Benzathine Penicillin 0.9g (1.2MU) Injection

Benzylpenicillin 600mg (1MU) Injection

Cefotaxime 1g Injection

Ceftriaxone 500mg Injection

1g Injection

Cephalexin 250mg Capsules

500mg Capsules

125mg/5mL Oral Liquid

250mg/5mL Oral Liquid

Cloxacillin/Flucloxacillin 250mg Capsules

500mg Capsules

500mg Injection

125mg/5mL Oral Liquid

Phenoxymethyl Penicillin 250mg/5mL Oral Liquid

250mg Tablets

500mg Tablets

6.2.2 Other Antibacterials

Azithromycin 500mg Tablets

1000mg Tablets

40mg/mL Oral Liquid

Chloramphenicol 250mg Capsules

125mg/5mL Oral Liquid

1g Injection

Ciprofloxacin 250mg Tablets

Clarithromycin 250mg Tablets

Clindamycin 150mg Capsules

150mg/mL Injection

Doxycycline 100mg Tablets/Capsules

Erythromycin 250mg Tablets

500mg Tablets

25mg/mL Oral Liquid

Gentamicin 80mg/2mL Injection

20mg/2mL Injection

Meropenem      RESTRICTED - AUTHORITY REQUIRED 1g Powder

Metronidazole 200mg Tablets

400mg Tablets

125mg/5mL Oral Liquid

200mg/5mL Oral Liquid

500mg/100mL Injection

Sulphamethoxazole + Trimethoprim 400mg + 80mg Tablets

240mg/5mL Oral Liquid

Vancomycin     RESTRICTED - AUTHORITY REQUIRED 500mg Powder

6.3 Antifungal Medicines

Clotrimazole 500mg Pessaries

Itraconazole 100mg Capsules

Nystatin 100,000 I.U./mL Oral Liquid

100,000 I.U. Tablets

Terbinafine 250mg Tablets

6.4 Antiviral Medicines

6.4.1 Antiherpes Medicines

Acyclovir 200mg Tablets

Valacyclovir 500mg Tablets

6.5 Antiprotozoal Meidicnes

6.5.1 Antiamoebic and Antigiardiasis Medicines

Metronidazole 200mg Tablets

400mg Tablets

125mg/5mL Oral Liquid

200mg/5mL Oral Liquid

500mg/100mL Injection

6.5.2 Antimalarial Medicines

Chloroquine Phosphate 250mg Tablets

Doxycycline 100mg Tablets/Capsules

6.5.3 Antipneumocytosis and Antitoxoplasmosis Medicines

Sulphamethoxazole + Trimethoprim 400mg + 80mg Tablets

240mg/5mL Oral Liquid

7. ANTIMIGRAINE MEDICINES

7.1 For Treatment of Acute Attack

Acetyl Salicylic Acid 300mg Tablets

Paracetamol 500mg Tablets

Sumatriptan 50mg Tablets

7.1 For Prophylaxis

Propranolol 40mg Tablets

8. ANTINEOPLASTIC, IMMUNOSUPPRESSIVE AND MEDICINES USE IN

PALLIATIVE CARE

8.2 Cytotoxic Medicines

Methotrexate 2.5mg Tablets

8.3 Hormones and Antihormones

Dexamethasone 4mg/mL Injection

Hydrocortisone 100mg Injection

Prednisolone 5mg Tablets

20mg Tablets

25mg Tablets

8.3 Medicines used in Palliative Care

Morphine Sulphate 10mg Tablets

9. ANTIPARKINSONISM MEDICINES

Benztropine 2mg Tablets

1mg/mL Injection

Biperiden hydrochloride 2mg Tablets

Levodopa + Carbidopa 250mg + 25mg Tablets

10. MEDICINES AFFECTING THE BLOOD

10.1 Anti-Anaemia Medicines

Darbapoetin alfa 40mcg/0.4mL Injection

Folic Acid 5mg Tablets

Ferrous Sulphate 200mg Tablets

Iron + Folic acid 270mg + 0.3mg Tablets

Iron 30mg/mL Oral Liquid

50mg/mL Injection

Pyridoxine (Vitamin B6) 25mg Tablets

Vitamin B12 1mg/mL Injection

10.2 Medicines Affecting Coagulation

Heparin 1,000 I.U./mL Injection

5,000 I.U./mL Injection

Heparinised Saline 50 I.U./5mL Injection

Phytomenadione (Vitamin K) 10mg/mL Injection

1mg/mL Injection

2mg/0.2mL Injection

Protamine 10mg/mL Injection

Streptokinase 1,500,000 I.U. Injection

Tranexamic acid 1000mg/10mL Injection

Warfarin 1mg Tablets

2mg Tablets

3mg Tablets

5mg Tablets

11. BLOOD PRODUCTS AND PLASMA SUBSTITUTES

11.1 Plasma Substitutes

Mannitol 20% IV Infusion

Modified Fluid Gelatin (Gelofusine™) 4% IV Infusion

12. CARDIOVASCULAR MEDICINES

12.1 Antianginal Medicines

Acetyl Salicylic Acid 100mg Tablets

Amlodipine 5mg Tablets

10mg Tablets

Atenolol 50mg Tablets

Glyceryl Trinitrate 600mcg Tablets

400mcg/dose Spray

Isosorbide Mononitrate SR 60mg Tablets

Nifedipine SR 20mg Tablets

Propranolol 40mg Tablets

Verapamil 40mg Tablets

12.2 Antiarrhythmic Medicines

Adenosine 3mg/mL Injection

Adrenaline 1mg/mL Injection

Amiodarone 50mg/mL Injection

200mg Tablets

Atenolol 50mg Tablets

Atropine Sulphate 0.6mg/mL Injection

Digoxin 250mcg Tablets

62.5mcg Tablets

Lignocaine 1% Injection

2% Injection

Magnesium Sulfate 50% Injection

Verapamil 2.5mg/mL Injection

40mg Tablets

12.3 Antihypertensive Medicines

Amlodipine 5mg Tablets

10mg Tablets

Atenolol 50mg Tablets

Hydralazine 20mg/mL Injection

Lisinopril 5mg Tablets

10mg Tablets

20mg Tablets

Methyldopa 250mg Tablets

Nifedipine SR 20mg Tablets

Propranolol 40mg Tablets

Ramipril 1.25mg Tablets

5mg Tablets

10mg Tablets

12.4 Medicines Used In Heart Failure

Adrenaline 1mg/mL Injection

Bisoprolol 5mg Tablets

Digoxin 250mcg Tablets

62.5mcg Tablets

Dobutamine 12.5mg/mL Injection

Dopamine 40mg/mL Injection

Lisinopril 5mg Tablets

10mg Tablets

20mg Tablets

Metaraminol 10mg/mL Injection

Metoprolol 25mg Tablets

50mg Tablets

Perindopril 4mg Tablets

12.5 Antithrombotic Medicines

Acetyl Salicylic Acid 100mg Tablets

Clopidogrel 75mg Tablets

Enoxaparin Sodium 40mg/0.4mL Injection

Heparin Sodium 1000 I.U./mL Injection

Streptokinase 1,500,000 I.U. Injection

12.6 Lipid-Lowering Agents

Atorvastatin 10mg Tablets

Simvastatin 20mg Tablets

13. DERMATOLOGICAL MEDICINES (TOPICAL)

13.1 Antifungal Medicines

Benzoic Acid + Salicylic Acid 6% + 3% Ointment

Clotrimazole 1% Cream

Miconazole 2% Cream

13.2 Anti-infective Medicines

Acyclovir 5% Cream

Chlorhexidine + Cetrimide 1mg/g + 5mg/g Cream

Neomycin + Bacitracin 0.5% + 500 I.U. Ointment

Silver Sulphadiazine 1% Cream

Solugel Gel

13.3 Anti-inflammatory and Antipruritic Medicines

Betamethasone 0.10% Cream

Calamine Lotion

Hydrocortisone 1% Cream

Sorbolene with Glycerin Lotion

13.4 Scabicides and Pediculicides

Benzyl Benzoate 25% Emulsion

Permethrin 5% Cream

1% Lotion

13.5 Astringent Medicines

Zinc Oxide Cream

14. DIAGNOSTIC AGENTS

14.1 Ophthalmic Medicines

Fluorescein 1% Eye Drops

1mg Strips

14.2 Radiocontrast Media

Barium Sulphate 100%w/v Suspension

15. DISINFECTANTS AND ANTISEPTICS

15.1 Antiseptics

Alcohol 70% Solution

70% Gel

Chlorhexidine Gluconate + Cetrimide 1.5% + 15% Solution

Chlorhexidine Gluconate [Obstetric] 1% Lotion

Hydrogen Peroxide 6% Solution

Povidone Iodine 10% Solution

15.2 Disinfectants

Alcohol 70% Solution

Chloramine 500mg Tablets

Hydrogen Peroxide 6% Solution

Povidone Iodine 10% Solution

16. DIURETICS

Frusemide 40mg Tablets

500mg Tablets

10mg/mL Injection

Hydrochlorothiazide 25mg Tablets

Mannitol 20% Injection

Spironolactone 25mg Tablets

17. GASTROINTESTINAL MEDICINES

17.1 Antacids and Other Antiulcer Medicines

Misoprostol 200mcg Tablets

Mylanta Original Tablets

Omeprazole 20mg Tablets

Ranitidine 10mg/mL Injection

150mg Tablets

17.2 Antiemetic Medicines

Dexamethasone Sodium Phosphate 4mg/mL Injection

Haloperidol 5mg/mL Injection

Metoclopramide 10mg Tablets

5mg/mL Injection

5mg Suppositories

Prochlorperazine 5mg Tablets

12.5mg/mL Injection

17.3 Laxative Medicines

Bisacodyl 10mg Enemas

5mg Tablets

5mg Suppositories

10mg Suppositories

Coloxyl 100mg/mL Drops

Coloxyl with Senna 50mg + 8mg Tablets

Lactulose 3.3g/5mL Solution

Sodium Citrate + Sodium Lauryl Sulfoacetate + Sorbitol (Micolette™) 90mg/mL + 9mg/mL + 625mg/mL Enemas

17.4 Antispasmodic Medicines

Hyoscine Butylbromide 10mg Tablets

20mg/mL Injection

17.5 Medicines Used in Diarrhoea

Codeine Phosphate 30mg Tablets

Loperamide 2mg Tablets

Oral Rehydration Salt Powder

17.6 Medicines for Perianal Disorders

Anti-haemorrhoid Ointment

Suppositories

18. HORMONES

18.1 Adrenal Hormones and Synthetic Substitutes

Dexamethasone Sod Phosphate 4mg/mL Injection

Hydrocortisone 100mg Injection

5mg

25mg

Triamcinolone 10mg/mL Injection

18.3 Contraceptives

18.3.1 Hormonal Contraceptives

Levonorgestrel + Ethinyloestradiol 30mcg + 150mcg Tablets

Levonorgestrel 750mcg Tablets

30mcg Tablets

18.4 Oestrogens

HRT - conjugated equine oestrogen 0.625mg Tablets

18.5 Insulins and Other Antidiabetic Agents

Glibenclamide 5mg Tablets

Gliclazide 80mg Tablets

Insulin, Isophane  100U/mL Injection

Insulin, Mixed 100U/mL Injection

Insulin, Neutral 100U/mL Injection

Metformin 500mg Tablets

18.7 Progestogens

Medroxyprogesterone acetate 150mg/mL Injection

Misoprostol 100mcg Tablets

200mcg Tablets

Norethisterone 5mg Tablets

18.8 Thyroid Hormones and Antithyroid Medicines

Carbimazole 5mg Tablets

Thyroxine 100mcg Tablets

19. IMMUNOLOGICALS

19.2 Sera and Immunoglobulins

Tetanus Immunoglobulin 250 I.U. Injection

19.3.2 For Specific Group of Individuals

Tetanus Toxoid Injection

20. MUSCLE RELAXANTS (PERIPHERALLY ACTING) AND CHOLINESTERASE INHIBITORS

Atracurium Besylate 10mg/mL Injection

Neostigmine Methylsulphate 2.5mg/mL Injection

Suxamethonium Chloride 50mg/mL Injection

Vecuronium 10mg Ampoule

21. OPHTHALMOLOGICAL PREPARATIONS

21.1 Anti-infective Agents

Acyclovir 3% Eye Ointments

Chloramphenicol 0.50% Eye Drops

1% Eye Ointments

Framycetin 0.50% Eye Drops

Gentamicin 0.30% Eye Drops

Tetracycline 1% Eye Ointments

21.2 Anti-inflammatory Agents

Dexamethasone Phosphate 0.10% Eye Drops

Prednisolone Sodium Phosphate 0.5% Eye Drops

21.3 Local Anaesthetics

Amethocaine 0.5% Eye Drops

21.4 Miotics and Antiglaucoma Medicines

Acetazolamide 250mg Tablets

Mannitol 20% Injection

Pilocarpine 2% Eye Drops

Timolol 0.25% Eye Drops

0.50% Eye Drops

21.5 Mydriatics

Atropine Sulphate 1% Eye Drops

Cyclopentolate 1% Eye Drops

21.7 Anti-infective + Anti-inflammatory Combination Agents

Neomycin Sulphate + Polymyxin B Sulphate + Dexamethasone 3500 I.U./mL + 6000 I.U./mL + 0.1% Eye Drops

21.8 Antihistamines

Azelastine 0.05% Eye Drops

21.9 Drugs for Dry Eyes

Carbomer 2mg/g Eye Gel

Carmellose 0.50% Eye Drops

22. EAR, NOSE AND THROAT MEDICINES

22.1 Topical Otic Medicines

22.1.1 Drugs for Acute Otitis Externa/Swimmer's Ear

Benzocaine+Phenazone [Auralgan™] 14mg+54mg Ear Drops

22.1.2 Anti-infectives

Chloramphenicol 0.50% Ear Drops

Ciprofloxacin 0.30% Ear Drops

Framycetin 0.50% Ear Drops

Framycetin + Gramicidin + Dexamethasone [Sofradex™] 5mg/mL + 50mcg/mL + 500mcg/mL Ear Drops

22.1.3 Drugs for Ear Wax

Dichlorobenzene + Chlorbutol [Cerumol™] 2% + 5% Ear Drops

22.2 Intranasal Decongestants

Xylometazoline 0.05%/0.1% Nasal Drops

0.1% Nasal Spray

23. OXYTOCICS AND ANTIOXYTOCICS

23.1 Oxytocics

Ergometrine 500mcg/mL Injection

Magnesium Sulfate 50% Injection

Nifedipine SR 20mg Tablets

Oxytocin + Ergometrine Maleate 5 I.U. + 500mcg Injection

Oxytocin 10 I.U./mL Injection

25. PSYCHOTHERAPEUTIC MEDICINES

25.1 Medicines Used in Psychotic Disorders

Benztropine 1mg/mL Injection

2mg Tablets

Chlorpromazine HCL 25mg Tablets

100mg Tablets

Fluphenazine Decanoate 25mg/mL Injection

Haloperidol 5mg/mL Injection

5mg Tablets

Olanzapine 5mg Tablets

Risperidone 2mg Tablets

4mg Tablets

25.2 Medicines Used in Mood Disorders

Amitriptyline HCL 25mg Tablets

Carbamazepine 200mg Tablets

Fluoxetine 20mg Capsules

Sodium Valproate 200mg Tablets

25.3 Medicines Used in Generalized Anxiety and Sleep Disorders

Diazepam 5mg Tablets

5mg/mL Injection

26. MEDICINES ACTING ON RESPIRATORY TRACT

26.1 Antiasthmatic Medicines

Aminophylline 25mg/mL Injection

Beclomethasone Dipropionate 50mcg/dose Inhaler

Hydrocortisone 100mg Injection

Ipratropium Bromide 250mcg(500mcg)/mL Respirator Solution

Salbutamol 4mg Tablets

2mg/5mL Oral Liquid

100mcg/dose Inhaler

5mg/mL Respirator Solution

500mcg/mL Injection

Theophylline SR 250mg Tablets

26.2 Antitussives

Codeine Phosphate 30mg Tablets

Pholcodine 1mg/mL Oral Liquid

26.3 Mucolytics

Bromhexine 8mg Tablets

4mg/5mL Oral Liquid

27. SOLUTION CORRECTING WATER, ELECTROLYTES AND ACID-BASE

DISTURBANCES

27.1 Oral

Calcium Carbonate 600mg Tablets

Oral Rehydration Salt Powder

Potassium Chloride 600mg Tablets

Polystyrene Sulfonate Resins (Resonium A™) Powder

Zinc Sulphate 20mg Tablets

27.2 Parenteral

Dextrose 5% isotonic Injection

50% hypertonic Injection

Magnesium Sulfate 50% Injection

Potassium Chloride 1g/10mL Injection

Sodium Bicarbonate 8.40% Injection

Sodium Chloride 0.90% Injection

Sodium Chloride + Dextrose 4% + 0.18% Injection

Sodium Lactate Compound Injection

27.3 Miscellaneous

Water for Injection 10mL Injection

28. VITAMINS AND MINERALS

Ascorbic Acid 500mg Tablets

Calcitriol 0.25mcg Capsules

Calcium Carbonate 600mg Tablets

Calcium Carbonate+Vitamin D 300mg+60IU Tablets

Calcium Gluconate 10% Injection

Multivitamin Tablets

Oral Liquid

Pyridoxine (Vitamin B6) 25mg Tablets

50mg Tablets

Thiamine (Vitamin B1) 100mg Tablets

100mg/mL Injection

Vitamin B Complex Tablets

29. BABY FORMULAS

S-26 Step 1 Powder

30. GENITOURINARY MEDICINES

30.1 Urinary Alkalinisers and acidifiers

Ural 4g Effervescent Powder

30.2 Drugs for Benign Prostatic Hyperplasia

Terasozin 1mg Tablets


2021年9月5日 星期日

「螞蟻世界的權力戰爭」

「螞蟻國的權力戰爭」
Ant Game of Throne

南太平洋的未知世界裡
一個叫做諾魯的遙遠島上
藏著神秘數字217的異次元空間
住了來自福爾摩沙的白袍巫師
(巫師平時的工作我們另篇敘述)

這個神秘的時空洞窟裡
還另外住了幾個種族,
幾個世紀以來
偶爾會造成巫師的困擾:
小矮鼠一族的鼩鼱、蟲族之中長得很像台灣大蟑螂但是笨很多的蜚蠊、以及
其實看起來就像是螞蟻的三種不同品種螞蟻家族🐜:
按照三個螞蟻家族的規模大小
排列介紹如下

黑頭慌蟻 ( Tapinoma melanocephalum ) 

狂蟻 ( Paratrechina longicornis )

小黃家蟻  ( Monomorium pharaonis )

為什麼要特別介紹他們呢?
因為 小矮鼠偶爾會出現到處啃咬挖洞破壞珍貴物資與巫師得來不易的各種魔法裝備!
不過是否因為島上野貓家族開始增加之後,就很少看到小矮鼠家族出沒了~
至於不討喜的蟲族蜚蠊,原本每天都要被迫打怪數次,自從巫師把天花板上的空調維修孔直接用膠帶整個封起來之後就大量減少,可見蟲族應該是從這個維修孔突破防線入侵的!
但是 不管有沒有食物,
螞蟻三家族總是會在洞窟的地上桌上牆壁上甚至天花板上到處爬來爬去,
甚至肚子餓沒有食物吃的時候
 還會莫名其妙跑來咬白袍巫師!
真的是品行不良的家族!
後來經過仔細研究發現
「三大螞蟻家族的窩 」
其實就在217洞窟的牆壁裡!
因此 不管怎麼消滅屠殺螞蟻家族
都會有另外一個螞蟻家族趁機崛起彼此互相消長~
簡單講就是
「削弱其中一種螞蟻家族之後,
另外一種就會增加起來」
基於這個理論基礎
我們先分析一下
這三種不同螞蟻家族的習性:

「小黃家蟻」
就是我們俗稱的小紅螞蟻,
跑得慢+會咬人!最令人討厭!
巫師一開始發現此家族時
就直接使用劇毒魔法撲殺整窩!
目前已經幾乎看不到此家族出沒了~

「黑頭慌蟻」
超級小的螞蟻,捏死會臭臭的!
綽號 嗜糖蟻,巫師一開始撲滅小黃家蟻之後大肆崛起的螞蟻家族!
台灣本島的種類不太咬人,
但是不知道為什麼諾魯的偶爾會咬人!
非常喜歡到處爬+到處鑽!
見縫插針跑進各種食物的包裝裡面亂咬一通,非常不討喜的個性!
跟其他兩種螞蟻家族也是水火不容,每天在巫師的地盤上打架爭奪食物與空間~

「狂蟻」
是唯一個性比較好一點的家族,
就是台灣俗稱不會咬人的黑螞蟻,
名稱聽起來很狂,其實戰鬥力很弱~
個性非常敏感+神經質,
風吹草動緊張起來跑得非常快!
就像是「發狂」了一樣~
非常害羞+絕對不會咬人!
因為狂蟻家族普遍攀爬能力不好,
不太會像其他兩種螞蟻家族一樣沒禮貌
常常沒事無聊跑到沙發上桌上來打擾巫師吃飯!

然後 巫師觀察了一下這三大螞蟻家族的互動與歷史文化之後,就召喚Google魔鏡搜尋了一下,看看有沒有什麼好辦法可以處理這三個螞蟻家族令人困擾的問題?
過去螞蟻家族百年來的戰爭與互鬥,
小黃家蟻只有對付巫師比較厲害而已~
與其他兩種螞蟻1:1幹架都是輸!
搶地盤搶食物都輸!
目前已經差不多消失了~
結果黑頭慌蟻家族大舉攻城掠地,
讓巫師覺得非常煩⋯⋯
因為慌蟻家族爬得到處都是!
還會從天花板空降掉下來巫師身上!

後來巫師也嘗試用魔法撲殺慌蟻,
並且開始默默用食物碎屑贊助一下狂蟻家族,
結果其他種類的螞蟻
竟然大量減少 甚至幾乎消失了!
這個結果 真是令人震驚啊!
因為這些狂蟻沒事就會在地板上瘋狂的衝刺巡邏,結果竟然連蜚蠊家族都減少了!
甚至發現 狂蟻不太喜歡吃麵包屑,
反而比較喜歡群起攻擊那些受傷的蟲族,難怪網路上描述有些人會養這種不會咬人的螞蟻在家裡面驅逐其他小蟲,真的是非常有趣的一件事情啊!

最近甚至發現
狂蟻之中誕生了一位「龍后」,
幾百隻的狂蟻竟然制伏了小壁虎龍!
不知道狂蟻們沒有勇猛的大額獠牙是怎麼辦到的?巫師這兩天週末休息就看著幾百隻的狂蟻戰士團簇擁著龍后與她的龍,來來去去炫耀非常威風!甚至 還到處攻擊蟲族蜚蠊家族並且運走所有的屍體!(變成異鬼?)

總之 經過多方征戰之後,
如果沒有辦法斷絕所有困擾的話,就幫助最討喜的那種黑螞蟻,他們會全天候24小時攻擊其他令人討厭的小蟲蟲,還會順便清除一些小屑屑,真的是很不錯的種族統戰組合策略!
螞蟻不同家族之間的戰爭
不同種族之間的消長
歷史的軌跡 
不也是這個樣子嗎?



「圖片說明」
第二次世界大戰紀念碑


2021年8月25日 星期三

tPA治療STEMI

急性心肌梗塞Tx
在台灣最近十幾年來
就是衝PCI治療
快快做診斷 早早衝治療
當初什麼MONA t-PA早就快過時了~
但是在諾魯共和國這個島上
糖尿病胖子一大堆
AMI患者是沒有PCI這種選擇的!
原本也沒有t-PA這種選擇!
只能禱告上帝保佑沒事平安就好~
自從2021年初RoNH藥局購買了t-PA之後,感謝Dr.翁Taiwan心臟專科醫師協助製作STEMI標準治療流程與病患須知簡章(電子檔置放於ER)供當地醫院工作人員使用!(ER有ECG機器)



STEMI與t-PA緊急治療
NSTEMI/UA與Heparin治療
(NSTEMI請勿使用tPA治療因為可能有害)
(Heparin/Enoxaparin變得很重要)

更新一下 

2021年8月15日 星期日

血絲蟲病Filariasis

巨卵頭家-血絲蟲病
Home Visit case


這位老先生早年住在PNG,
原本以為是左側腹股溝疝氣,
檢查後發現應該是膨大的睪丸,
此症狀已經幾十年了!
而且他的兒子有三個都瞎掉了~
令人懷疑是否有血絲蟲病症的可能性!
畢竟 諾魯島上
也是偶爾會看到象皮病的患者~



金門日報的「血絲蟲病抗疫史」

老先生因為年老體邁
拖延多年終於想要開刀,
但是擔心島上外科技術堪憂,
(多年來一直以為是疝氣?!)
而且 三個瞎眼的兒子沒有人可以幫忙日常照顧⋯加上目前COVID-19國際緊張情勢,所以希望能諮詢台灣醫師的專業建議!
無論如何 OverSeas Medical Referral
或許是一條可行的方法~

2021年8月5日 星期四

痲瘋病Leprosy

這一天來了一個年輕男患者


全身不癢不疼的紅斑不規則丘疹樣皮膚炎,各位要知道一件事情:
會造成全身慢性皮膚病變
但是不癢不疼的疾病不多見!
其中一個歷史上(聖經中)赫赫有名的疾病:
痲瘋病Leprosy
一個從慢性皮膚症狀開始表現,逐步侵襲感覺神經病變造成全身組織感染與壞死變形的傳染病!

痲瘋病的人文醫學史總整理
一問之下
這個病患果然一年之前在Fiji被診斷出Leprosy!用藥完治之後,經過將近一年又復發皮膚症狀!幸好目前感覺神經尚未明顯受損~

對於這種台灣罕見的熱帶傳染病實在是沒什麼治療經驗,東找西找拼拼湊湊
終於在RoNH藥局湊齊了三種抗生素!
按照CDC guideline治療準則
並且跟病患留下聯絡電話號碼
確保他能夠完成藥物療程!
我也發現Nauru島上自從May 2021之後聘請了一位專門處理Communicable disease的斐濟籍Dr.Mere
經過三方聯絡後,就交給Dr.Mere協助完成治療啦!🙏