{"id":80657,"date":"2020-05-21T18:20:56","date_gmt":"2020-05-21T15:20:56","guid":{"rendered":"http:\/\/www.btv.md\/?p=80657"},"modified":"2020-05-21T18:20:56","modified_gmt":"2020-05-21T15:20:56","slug":"medicii-de-la-spitalul-republican-moartea-o-placere-pentru-pacientii-gravi-covid-19-ii-salvam-in-pofida-dorintei-lor","status":"publish","type":"post","link":"https:\/\/www.btv.md\/ro\/medicii-de-la-spitalul-republican-moartea-o-placere-pentru-pacientii-gravi-covid-19-ii-salvam-in-pofida-dorintei-lor\/","title":{"rendered":"Medicii de la Spitalul Republican: \u201eMoartea, o pl\u0103cere pentru pacien\u021bii gravi COVID-19. \u00cei salv\u0103m \u00een pofida dorin\u021bei lor\u201d"},"content":{"rendered":"

Victor Cojocaru este absolvent al Academiei de medicin\u0103 militar\u0103 din Sankt-Petersburg are grad de colonel \u0219i o experien\u021b\u0103 de medic practician de 45 de ani. Este \u0219eful clinicii Anestezie \u0219i Terapie Intensiv\u0103 de la Spitalul Republican, sec\u021bie \u00een care sunt transfera\u021bi cei mai gravi pacien\u021bi infecta\u021bi cu COVID-19, relateaz\u0103 deschide.md<\/a>.<\/strong><\/p>\n

Sub tutela doctorului Cojocaru au lucrat medicii militari rom\u00e2ni care au avut o misiune de voluntariat \u00een Republica Moldova. \u00centr-un interviu pentru Deschide.MD, doctorul colonel, pneumologul C\u0103t\u0103lin Ioni\u021b\u0103, a descris experien\u021ba sa de lucru sub \u00eendrumarea lui Victor Cojocaru: profesionalism \u0219i reac\u021bie.<\/p>\n

\u00cel \u00eent\u00e2lnesc pe doctorul Cojocaru \u00een cabinetul s\u0103u, \u00een compania \u0219efilor de sec\u021bii ATI, dup\u0103 ce a avut loc un consiliu medical. Aici, discut\u0103m, \u00een cadrul unui interviu mai cur\u00e2nd colectiv, despre cum e s\u0103 fii \u00een prima linie \u00een lupta cu COVID-19, despre eroizarea medicilor \u0219i c\u00e2t, de fapt, de eroi se simt ei.<\/p>\n

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\u201eBolnavul vrea s\u0103 moar\u0103, moartea e o pl\u0103cere pentru el!\u201d<\/strong><\/p>\n

Fiind medic militar, Victor Cojocaru impune un regim milit\u0103resc \u00een clinica pe care o conduce. Nu este loc de emo\u021bii, ci doar de ac\u021biune, spune doctorul. Oamenii nefamiliariza\u021bi cu munca \u00eentr-o sec\u021bie ATI ar spune c\u0103 medicii de aici sunt lipsi\u021bi de emo\u021bii, c\u0103 sunt duri \u0219i de ne\u00eenduplecat. Vor avea dreptate, pentru c\u0103 doar adopt\u00e2nd un stil nesentimental, coleric, de a lupta cu moartea, po\u021bi izbuti.<\/p>\n

De ce? Pentru c\u0103 moartea este \u00een\u0219el\u0103toare, pentru c\u0103 pacientul infectat cu COVID-19, acuz\u00e2nd hipoxie, insuficien\u021b\u0103 de oxigen, are o stare de bine, de relaxare. Moartea \u00eel ademene\u0219te ca \u00eentr-un somn pl\u0103cut, iar c\u00e2nd medicii \u00eencearc\u0103 s\u0103-l \u021bin\u0103 cu con\u0219tiin\u021ba treaz\u0103, muribundul, deseori, se opune.<\/p>\n

\u201eAv\u00e2nd pacien\u021bi gravi \u0219i ultragravi, mul\u021bi dintre ei sunt necooperan\u021bi, ei sunt \u00een hipoxie, unii \u00een delir. Bolnavul vrea s\u0103 moar\u0103, moartea e o pl\u0103cere pentru el! Procesul de moarte \u00een hipoxie e ca o mole\u0219eal\u0103. Tu vrei s\u0103-l treze\u0219ti, el \u00eens\u0103 se sup\u0103r\u0103 c\u0103 nu-i dai voie s\u0103 moar\u0103. Devine agresiv, te \u00eenjur\u0103. Majoritatea recunosc apoi c\u0103 au fost agresivi, \u00ee\u0219i cer scuze, sau nu-\u0219i aduc aminte\u201d, spune Victor Cojocaru.<\/p>\n

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C\u00e2nd un pacient este scos de la aparatul de ventila\u021bie mecanic\u0103 a pl\u0103m\u00e2nilor el nu este cooperant, medicul \u00eens\u0103 vrea o reac\u021bie, vrea s\u0103 vad\u0103 dac\u0103 pacientul are o urm\u0103 de discern\u0103m\u00e2nt \u0219i \u00eei strig\u0103: \u201edeschide gura!, tu\u0219e\u0219te, mama ta eu, tu\u0219e\u0219te!\u201d.<\/p>\n

\u201eNu avem emo\u021bii c\u00e2nd lucr\u0103m, emo\u021biile apar dup\u0103, moare sau supravie\u021buie\u0219te pacientul. Atunci apar emo\u021biile. \u00cen proces, medicii lucreaz\u0103 \u00een regim automat. Uneori, avem o rezerv\u0103 de 10-15 secunde pentru a intuba pacientul, dac\u0103 satura\u021bia cu oxigen a creierului scade drastic, pierdem pacientul. C\u00e2nd suntem \u00een ac\u021biune, ai impresia c\u0103 suntem ca ni\u0219te organisme mecanice, automate. De fapt, un reanimatolog trebuie s\u0103 fie prompt. Noi lucr\u0103m cu droguri puternice, supradoza poate fi letal\u0103, iar dac\u0103 administrezi insuficient, tratamentul este inutil. Emo\u021bia noastr\u0103 e dup\u0103, \u0219i vine atunci c\u00e2nd reu\u0219im s\u0103 salv\u0103m pe cineva\u201d, spune doctorul Cojocaru.<\/p>\n

\u201eNe bucur\u0103m de fiecare dat\u0103 c\u00e2nd salv\u0103m pe cineva chiar dac\u0103 suntem \u00eenjura\u021bi. Este o bucurie pentru noi c\u00e2nd pacientul ne \u00eenjur\u0103, \u00eenseamn\u0103 c\u0103 au ap\u0103rut func\u021biile creierului. Am avut un pacient, un doctor de 71 de ani, operat la cap, cu trei infarcturi, s-a \u00eens\u0103n\u0103to\u0219it, ast\u0103zi a plecat acas\u0103. El m-a \u00eenjurat pe mine, l-a \u00eenjurat pe \u0219eful de sec\u021bie. Dar noi ne-am bucurat!\u201d, spune Victor Cojocaru.<\/p><\/blockquote>\n

Protocolul ATI \u00een COVID-19, elaborat \u00een timp record<\/strong><\/p>\n

Experien\u021ba lui Victor Cojocaru se pliaz\u0103 perfect pe munca pe timp de criz\u0103. Teza de doctor habilitat, scris\u0103 dup\u0103 ce timp de trei ani a condus spitalul de boli infec\u021bioase din Kabul, Afganistan are titlul: \u201eConcep\u021bia de terapie intensiv\u0103 a patologiilor \u00een condi\u021bii extreme\u201d.<\/p>\n

De altfel, medicul spune c\u0103 \u00een cei 45 de ani de munc\u0103, criza COVID-19 nu este cea mai grav\u0103 experien\u021b\u0103. Provocarea cea mai mare au fost anii petrecu\u021bi \u00een Afganistan, unde a condus un spital cu 3000 de paturi.<\/p>\n

O situa\u021bie similar\u0103 cu cea a crizei COVID-19 a fost \u00een 2009 \u00een pandemia H1N1. De fapt, atunci, singurul spital care a lucrat cu bolnavii gravi infecta\u021bi cu H1N1 a fost Spitalul Republican. Situa\u021bia pe \u021bar\u0103 este mai complicat\u0103 \u00een cazul COVID-19 \u00een compara\u021bie cu H1N1, \u00eens\u0103 pentru Spitalul Republican volumul de lucru este la fel de mare ca \u0219i atunci. De altfel, practica \u00een tratarea gripei porcine a fost folosit\u0103 \u00een elaborarea Protocolului terapiei intensive a complica\u021biilor \u00een COVID-19. Apropo, acest protocol a fost creat \u00een timp record – \u0219apte zile, patru zile s-a lucrat non-stop la corpul protocolului, iar trei zile a durat aprobarea – trei catedre, seminarul de profil, comisia de exper\u021bi a Ministerului S\u0103n\u0103t\u0103\u021bii. Protocolul a fost semnat pe 27 martie, c\u00e2nd \u00een R. Moldova erau 200 de cazuri confirmate.<\/p>\n

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Doctorul explic\u0103 cum experien\u021ba \u00een lupta cu H1N1 a ajutat \u00een elaborarea protocolului COVID-19, el fiind \u0219i coordonatorul echipei care a lucrat la documentul medical. \u201eNoi nu am pornit de la criteriul \u201eo boal\u0103 nou\u0103\u201d, ci de la cel al \u201eorganismului uman\u201d. Organismul uman r\u0103spunde la agresiuni cu acelea\u0219i mecanisme compensatorii. Ori \u00een cazul COVID-19, ori vine COVID-23, organismul uman r\u0103spunde cu acelea\u0219i mecanisme de ap\u0103rare, indiferent de agresiune. Cu c\u00e2t e mai violent\u0103 agresiunea, cu at\u00e2t r\u0103spunsul e mai violent. Deseori, r\u0103spunsul este mai grav dec\u00e2t agresiunea. De exemplu, acum, \u00een \u0219edin\u021b\u0103 noi nu am discutat COVID-19, ci am discutat pneumotorax, pleurezie, insuficien\u021b\u0103 hepatic\u0103 – afec\u021biunile patologice propriu-zise\u201d, explic\u0103 doctorul.<\/p>\n

Laud\u0103 protocolul \u0219i succesele RM \u00een lupta cu COVID-19<\/strong><\/p>\n

Doctorul deschide pe desktop un protocol \u00een COVID-19 \u00een limba rus\u0103. I l-au expediat colegii din Rusia, de fapt este o traducere a protocolului care este aplicat \u00een SUA.\u00a0\u201eAdineaori am discutat acest proiect. Cu toat\u0103 stima \u0219i respectul, dar stima\u021bi colegi, care este diferen\u021ba dintre protocolul nostru \u0219i cel american? Nu este diferen\u021b\u0103, ba chiar al nostru este mai amplu\u201d, spune Cojocaru ca un tat\u0103 ce-\u0219i laud\u0103 copilul.<\/p>\n

\u201eDiferen\u021ba esen\u021bial\u0103 c\u0103 noi mergem cu doi pa\u0219i \u00eenainte \u00een tratarea cazului grav. M\u0103surile luate \u00een cazul bolnavului ultra-critic, noi le lu\u0103m cu patru-cinci zile \u00eenainte. De aceea avem \u0219i succes\u201d.<\/p>\n

Orice pacient grav care este adus la Spitalul Republican este imediat conectat la terapie intensiv\u0103, apoi, dup\u0103 ce vin analizele, dup\u0103 3-4 ore, se decide tratamentul medicamentos. Respectiv, pacientul nu este l\u0103sat niciun minut f\u0103r\u0103 terapie.<\/p>\n

Vorbind de succes, Victor Cojocaru spune c\u0103 sistemul medical din Republica Moldova face fa\u021b\u0103 cu brio \u00een gestionarea cazurilor grave, iar mortalitatea este chiar mai mic\u0103 \u00een compara\u021bie cu unele state cu sisteme medicale mult mai performante. \u201ePrivi\u021bi: \u00een R. Moldova avem 228 cazuri letale \u0219i 2953 de trata\u021bi, acestea sunt cazurile \u00eenchise. Un simplu calcul arat\u0103 c\u0103 din totalul de cazuri \u00eenchise, mortalitatea a constat 7,1%. F\u0103c\u00e2nd acela\u0219i calcul \u00een cazul Fran\u021bei, avem o mortalitate de 30,7% din totalul de cazuri \u00eenchise, iar \u00een Suedia – 43%\u201d, spune Victor Cojocaru.<\/p>\n

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Datorit\u0103 regulilor stricte de protec\u021bie, \u00een spital nu a fost depistat dec\u00e2t un singur caz de infectare cu COVID-19 printre lucr\u0103torii medicali. \u201eAvem un singur caz din 180 de cadre medicale care lucreaz\u0103 \u00een clinica ATI. Nu contabilizez medicii care au fost infecta\u021bi pe timpul fostului director. Atunci, au fost doi pacien\u021bi bolnavi cu COVID-19, dar s-au infectat 14 lucr\u0103tori medicali, nu e corect a\u0219a. De c\u00e2nd am adoptat un stil sever, nu mai avem cazuri de infectare printre medici\u201d, explic\u0103 Victor Cojocaru.<\/p>\n

Unii medici nu \u0219i-au v\u0103zut de dou\u0103 luni copiii<\/strong><\/p>\n

\u00cen managementul clinicii ATI, din care fac parte cinci sec\u021bii ATI, Victor Cojocaru a abordat stilul militar. Ziua de munc\u0103 a unui \u0219ef de sec\u021bie \u00eencepe la ora 5:30 diminea\u021ba cu efectuarea unui raport despre pacien\u021bi: starea fiec\u0103ruia, intubare, compensare, cine este gata pentru transfer \u00een alt\u0103 institu\u021bie, procedurile care urmeaz\u0103 s\u0103 fie aplicate fiec\u0103rui pacient \u00een parte. Raportul trebuie s\u0103 fie gata cel t\u00e2rziu la ora 6:30. O zi de munc\u0103 a unui \u0219ef de sec\u021bie poate s\u0103 dureze cu 3-4 ore peste program. Timp de o lun\u0103 \u0219i jum\u0103tate \u0219efii de sec\u021bii au lucrat ne\u00eentrerupt, f\u0103r\u0103 s\u00e2mbete \u0219i duminici libere. Personalul clinicii ATI este cazat \u00een hotelul din incinta spitalului sau \u00een c\u0103minul spitalului care ofer\u0103 condi\u021bii semihoteliere.<\/p>\n

\u201eMarea majoritate a doctorilor nu merge acas\u0103. Unii dintre noi de dou\u0103 luni nu \u0219i-au v\u0103zut copiii. Cineva, din 29 martie p\u00e2n\u0103 acum, nu a fost dec\u00e2t de dou\u0103 ori acas\u0103. Avem pielea m\u00e2inilor cr\u0103pat\u0103, p\u0103rul deteriorat din cauza bonetelor, doctori\u021bele au uitat c\u00e2nd s-au machiat ultima dat\u0103\u201d, spune Corina Gutium, \u0219ef interimar Sec\u021bia Terapie Intensiv\u0103 3.<\/p>\n

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Ajutorul medicilor medicali rom\u00e2ni a contat<\/strong><\/p>\n

De aceea, ajutorul medicilor militari rom\u00e2ni, \u00een condi\u021biile unui regim de criz\u0103, a fost de un mare folos. \u201eAm avut norocul c\u0103 la noi \u00een spital a venit o echip\u0103 foarte bine \u00eenchegat\u0103 de medici militari din Rom\u00e2nia. Printre ei a fost un medic pneumolog, un medic terapeut, un medic anestezist, specialist \u00een terapie intensiv\u0103 \u0219i un medic de urgen\u021b\u0103. A fost \u0219i o echip\u0103 de medici plutonieri, care activeaz\u0103 ca asisten\u021bi medicali. To\u021bi s-au \u00eencadrat \u00een activitate din prima zi, imediat\u201d, spune Corina Gutium.<\/p>\n

Clinica face o munc\u0103 colosal\u0103, av\u00e2nd acum \u00een jur de 60 de pacien\u021bi la terapie intensiv\u0103. Exist\u0103 \u0219i pacien\u021bi post-COVID. Ace\u0219tia sunt pacien\u021bii care s-au tratat de coronavirus, \u00eens\u0103 r\u0103m\u00e2n \u00een stare grav\u0103 din cauza altor afec\u021biuni. \u00cen cazul \u00een care unul dintre ace\u0219ti pacien\u021bi moare, el va fi inclus \u00een statistica celor uci\u0219i de coronavirus.<\/p>\n

Pentru a face fa\u021b\u0103 crizei, \u0219efii de sec\u021bii au lucrat al\u0103turi de 39 de medici reziden\u021bi \u00een terapie intensiv\u0103. Au fost antrenate asistente medicale din alte sec\u021bii, f\u0103r\u0103 experien\u021b\u0103 \u00een terapie intensiv\u0103. \u00cen paralel, s-au f\u0103cut traininguri.<\/p>\n

\u201e\u00cen medicin\u0103 e bine c\u00e2nd ai o p\u0103rere venit\u0103 de la persoane ter\u021be. Mai ales atunci c\u00e2nd lucrezi cu pacien\u021bii critici, fiecare acuz\u00e2nd o multitudine de comorbidit\u0103\u021bi pe fundalul COVID-19. A fost foarte binevenit ajutorul colegilor din Rom\u00e2nia. Am lucrat cu ei f\u0103r\u0103 a sim\u021bi c\u0103 sunt din alt\u0103 \u021bar\u0103. Nu au venit s\u0103 ne fac\u0103 observa\u021bii, pov\u0103\u021buiri, pur \u0219i simplu am lucrat cot la cot\u201d, adaug\u0103 Corina Gutium.<\/p>\n

\u00cen fiecare zi, la terapia intensiv\u0103 de la SCR sunt adu\u0219i de la 3 la 11 pacien\u021bi infecta\u021bi cu COVID-19, to\u021bi \u00een stare grav\u0103.<\/p><\/blockquote>\n

\u201eNu am ajuns \u00een situa\u021bia de a selecta pacien\u021bii agonali\u201d<\/strong><\/p>\n

Cu c\u00e2t reanimarea este mai dotat\u0103, cre\u0219te num\u0103rul de pacien\u021bi gravi interna\u021bi. \u201eDac\u0103 pacientul grav ajunge \u00eentr-un spital cu reanimare slab\u0103, el moare imediat. Aici \u00eens\u0103 pacientul se men\u021bine. Chiar dac\u0103 pacientul este muribund, noi nu avem dreptul s\u0103 \u00eenchidem aparatul, s\u0103-l ucidem. Noi nu avem concept de eutanasiere\u201d, explic\u0103 Victor \u021aurcanu, \u0219ef interimar Sec\u021bia Terapie Intensiv\u0103 1.<\/p>\n

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Totu\u0219i o situa\u021bie extrem\u0103 poate schimba triajul pacien\u021bilor. \u201e\u00cen timp de r\u0103zboi exist\u0103 conceptul de pacien\u021bi agonali, pacien\u021bi f\u0103r\u0103 perspectiv\u0103. Noi nu am ajuns \u00een situa\u021bia de a selecta pacien\u021bii agonali, noi nu avem situa\u021bie ultra-critic\u0103, \u0219i lupt\u0103m pentru fiecare pacient p\u00e2n\u0103 la ultima suflare. Nu am economisit aparataj, nu am economisit medicamente. Nu suntem \u00een situa\u021bia de a alege – pe acesta \u00eel scoatem de la aparat, iar pe \u0103sta \u00eel punem\u201d, l\u0103mure\u0219te Victor \u021aurcanu.<\/p>\n

\u201eNu suntem eroi: sp\u0103la\u021bi-v\u0103 pe m\u00e2ini!\u201d<\/strong><\/p>\n

Doctorii privesc cu mult scepticism fenomenul de eroizare a cadrelor medicale ap\u0103rut acum \u00een societatea din R. Moldova.<\/p>\n

\u201eDa, noi lucr\u0103m pentru salariu, lucr\u0103m pentru familie, dar avem \u0219i obrazul de medic. Privi\u021bi-m\u0103! Am v\u00e2rsta de 67 – pot s\u0103 stau liber acas\u0103. Am \u0219i unele patologii legate de v\u00e2rst\u0103. Nu este secret c\u0103 sunt colegi care au dezertat, dar sunt foarte pu\u021bini, ei au g\u0103sit motive ca s\u0103 stea acas\u0103\u201d, explic\u0103 Victor Cojocaru.<\/p>\n

\u201e\u00cen primul r\u00e2nd suntem doctori. A\u0219 fi acceptat c\u0103 sunt erou dac\u0103 asta se spunea despre mine \u00eenainte de pandemie. \u00cenainte, s-a turnat foarte mult\u0103 zoaie peste noi. \u0218i dup\u0103 o s\u0103 toarne. Eu nu m\u0103 simt erou, fac ceea ce am \u00eenv\u0103\u021bat \u0219i nu voi renun\u021ba. Sim\u021bul datoriei prevaleaz\u0103 prevaleaz\u0103 \u00een fa\u021ba altor chestii\u201d, spune Corina Gutium.<\/p>\n

Medicii concluzioneaz\u0103 c\u0103 nu au nevoie de aplauze \u0219i osanale, cel mai bun lucru pe care ar putea s\u0103-l fac\u0103 fiecare dintre noi este respectarea regulilor de protec\u021bie: igiena, purtarea m\u0103\u0219tilor, evitarea aglomera\u021biilor publice.<\/p>\n

Sursa: deschide.md<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Victor Cojocaru este absolvent al Academiei de medicin\u0103 militar\u0103 din Sankt-Petersburg are grad de colonel \u0219i o experien\u021b\u0103 de medic practician de 45 de ani. Este \u0219eful clinicii Anestezie \u0219i Terapie Intensiv\u0103 de la Spitalul Republican, sec\u021bie \u00een care sunt transfera\u021bi cei mai gravi pacien\u021bi infecta\u021bi cu COVID-19, relateaz\u0103 deschide.md. Sub tutela doctorului Cojocaru au […]<\/p>\n","protected":false},"author":4,"featured_media":80658,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[6349,6377],"tags":[7975,11156,14413],"class_list":["post-80657","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-social","category-stiri","tag-medici-ro","tag-moartea","tag-pacienti-gravi"],"yoast_head":"\nMedicii de la Spitalul Republican: \u201eMoartea, o pl\u0103cere pentru pacien\u021bii gravi COVID-19. \u00cei salv\u0103m \u00een pofida dorin\u021bei lor\u201d - BTV<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.btv.md\/ro\/medicii-de-la-spitalul-republican-moartea-o-placere-pentru-pacientii-gravi-covid-19-ii-salvam-in-pofida-dorintei-lor\/\" \/>\n<meta property=\"og:locale\" content=\"ro_RO\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Medicii de la Spitalul Republican: \u201eMoartea, o pl\u0103cere pentru pacien\u021bii gravi COVID-19. \u00cei salv\u0103m \u00een pofida dorin\u021bei lor\u201d - BTV\" \/>\n<meta property=\"og:description\" content=\"Victor Cojocaru este absolvent al Academiei de medicin\u0103 militar\u0103 din Sankt-Petersburg are grad de colonel \u0219i o experien\u021b\u0103 de medic practician de 45 de ani. Este \u0219eful clinicii Anestezie \u0219i Terapie Intensiv\u0103 de la Spitalul Republican, sec\u021bie \u00een care sunt transfera\u021bi cei mai gravi pacien\u021bi infecta\u021bi cu COVID-19, relateaz\u0103 deschide.md. 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