當別人聽到我們冬天要去塔吉克斯走帕米爾公路時，都覺得我們瘋了！😆 的確這五天的溫度最暖 -30℃、最冷-50℃ 😬 也難怪在首都青旅待了三晚都找不到人願意跟我們分包車🤣
網誌➡️ https://www.travelwithwinny.com/zh/帕米爾公路-pamir-highway-塔吉克/
帕米爾公路是全世界海拔第二高的公路（4655M）⛰️ 途中經過烏茲別克、阿富汗、塔吉斯坦與吉爾吉斯🚘 在非冬季，是世界各地單車手最愛挑戰的路線 🚲
例如塔吉斯坦與吉爾吉斯兩海關位置距離二十公里，在中途的無國界地帶還有民宿給騎車的人露宿呢！
也許冬季有些著名的小村落不通，不過每天開車經過白茫茫的一片也是種體驗😌 再次證明旅遊是不分季節的！
這段旅程的前兩天，我們都沿著邊境河 Panj River 開車🏞️ 也許是受西方媒體的報導，對於河岸對面的小村莊就是阿富汗感到不可思議👀
這區的阿富汗也有「小帕米爾之稱」，是該國最安全的地區🙂 旅行社可以安排旅者從這邊進去阿富汗，只不過聽說需要從同個地方回到塔吉斯坦就是了😶
我們很湊巧的剛好碰到每禮拜六在帕米爾的主要城市 Khorog 舉辦的阿富汗市集🛍️ 人們會通過小橋，進來吉爾吉斯賣東西。他們都穿著傳統服裝，男人也用圍巾包住頭，很容易認出他們😲
只不過近期恐怖分子塔利班在阿富汗的活動增加，所以市集內一堆拿槍的軍警。一度還檢查我的相機，讓人很不舒服，於是沒待多久就離開了😕
接著我們前往塔吉斯坦最冷的村落 Bulunkul 😬 當天去的時候氣溫-49℃！這裡住了一百多人。看著他們在如此艱難地地方生存，不得不讚嘆人類的韌性以及生活的執著！
非冬季的 Bulunkul 村旁邊有座非常美麗的湖🏞️ 只是冬季的湖都蓋上一層厚厚的雪，我們居然肉眼找不到它在那裡🤣
當晚居住的小鎮 Alichur 溫度是 -50℃ ，夜晚的星星很美🌌 只是真的是太冷了無法久待在外面拍照😂
原本以為晚上會跟尼泊爾 EBC 一樣冷到爆！結果沒想到它們在房間使用碳及牛糞來取暖，效果比想像的好💩 除了半夜上廁所在很遠的戶外令人崩潰，摸到鐵製的門把手會痛以外。我們都有吃飽、睡飽😌
不過這裡海拔將近四千，York 人生第一次有了高山症症狀（以前都有吃藥所以他都沒得過）😅 隔天完全食慾不佳，趕緊吃顆 Diamox 😛
第四天早上的行程是尋找馬可波羅羊🐏 第一次紀錄是馬可波羅在十三世紀來亞洲的時候因而命名👀 這些羊擁有全羊界中最長的羊角！最長紀錄是1.9M、重27公斤！因而有許多人花一隻四萬多美金來打獵這些已經列為保護物種的羊兒🐑
冬季尋找牠們其實沒那麼難，因為山上積雪所以牠們都會下山吃草🌱 只要在雪中跟蹤牠們的腳印就可以找到👣
不過車子也只能開到一個程度，之後雪厚到輪子動不了就只能用走了😩 在海拔四千米、-45℃ 、在深雪中走兩小時真的蠻累人的😂
而且牠們又很敏感！遠到肉眼只能剛剛好看到牠們，再近牠們就會跑掉😲 跟非洲比起來，看得不是很過癮😝 不過至少讓整整五天的雪山行程增加了一點變化😛
冬季的帕米爾公路有幾座有名的村落/地方是無法到達的❄️ 例如Wakhan valley （冬季公路下雪基本封鎖）以及需要健行才能走到的 Jizev valley（這個天氣好也可能）🌄
最後一晚我們住在一座叫 Murgub 的小鎮🏚️ 冬季的帕米爾公路上的民宿時常都沒開。原因是碳太貴，人們只能暖一間房間讓全家共用，無法讓旅客自己睡一間😶
所幸司機的老婆的妹妹原因讓我們住她家，對於能夠住當地人的房子我們感到很興奮😆 一進門就感受到一陣溫馨，而給我們的房間雖然是打地鋪但感覺他們平常是睡這裡，只是今晚讓給我們😊
沒有想到睡覺的時候才發現原來她與唯一的高中兒子睡隔壁廚房！那間廚房說起來不算大，還有桌椅在中間，真的無法想像他們是如何在那擁擠的環境打地鋪😶
煮飯的鑿子可以用來燒火，也能夠溫暖廚房以及我們的房間，真的是很聰明😲
而且這裡冷到沒有自來水，他們都要到井裡打水！想要洗手的話他們會把水加熱讓你淋 😦 由於實在是太麻煩了，最後我們倆都用酒精消毒。回到文明世界才好好洗手...😭
必須說我們照片看起來雖然很快樂，可是其實這五天我過得壓力很大😣 主要是因為這家旅行社願意給我點折扣，如果我推薦他們的話。
我們一開始的司機是老闆，讓人感覺很低氣壓，只有收錢那幾秒才感覺到他的喜悅🙄 每次問他行程就說：「隨便你們！」不然就是叫我去翻 Lonely Planet📚 有幾次我有翻臉，說那本書資訊是偏向夏季又不是冬季！他才好一點。
結果第二天到主要城市 Khorog，他很不幸被警察攔下來👮 這時才發現他車子註冊的文件不見了！沒了文件就代表他無法跨國進去吉爾吉斯，於是隔天交棒給另一位不會說英文的司機，並說如果發生什麼事情都可以打給他 ☎️
離開前他說他會安排好尋找馬可波羅羊的行程，並說我們到那邊還可以重新講價。心裡 OS 是人都已經到那裡了，還講什麼價...🙄 結果當天晚上跟民宿老闆、司機處得很不愉快😠 而打電話給老闆僑他居然拒絕接電話！雖然最後一切圓滿落幕，但已經讓我氣死了😡
由於我們的團費是含所有吃住，當天中午我們午餐居然要自費！身上已經沒剩多少現金的我們當然很不爽，叫司機打給老闆他居然只說我們吃超過 budget 就掛電話並且拒接！
雖然後來兩個小時候我們開到今晚住宿的城鎮，馬上被餵了水餃、幾個小時後又吃了晚餐，才知道應該是溝通不良的關係😑 只是每發生事情都拒絕聽電話我覺得很不 ok！
最後一天又換給另一位司機，讓人感覺好多了！不只不時停下來讓我們拍照，也跟我們有說有笑😌 一切都好時直到過海關，一路上他都跟不同人做交易。雖然不清楚是什麼，但感覺很不正統🤔
讓我真正感覺怪怪的是過了吉爾吉斯海關，海關明明就已經蓋章了並歡迎我們入國🖊️ 司機卻在那之後開到另一棟樓，並讓我們等待超久。出來後說我們需要簽證。
由於我們持紐澳護照，可以百分之百知道不需要簽證。他看我們那麼確定，就說他馬上打給首度問看看。五分鐘後就說沒問題。 我覺得很詭異的是如果需要簽證，一開始就不會給入境章了...🤔 當時我就開始覺得這位司機可能也不是那麼單純...
最後一餐午餐，我們學聰明了，問說可以點什麼（雖然前一兩天老闆讓我們點超多，有點嚇到他😅 其實一人才一菜一湯...）那位司機居然說老闆是壞人，沒有給他錢，所以是他請客。
我覺得很不合理，理論上如果老闆沒有給他錢，他應該會叫我們自付，跟上個司機一樣，而不是請我們... 😕 種種第六感讓我覺得他也不太可信，也沒心情聯絡給我掛電話的老闆確認🙄
不過 Tours de Pamir 這家公司有在 Lonely Planet 上📚而且在還沒談合作之前，他已經是報價最低的公司了！雖然溝通上會氣死！但是實際上的行程，吃、住、去的地方，他並沒有讓我覺得偷工減料... 😶 因此我覺得如何做好心理建設，錢也很緊，那麼是可以用他們😆 只是我好希望錢比較多，就可以用到態度更好的😂
以上就是五天冬季帕米爾公路報告💁 剩下的影片就要上 IG 看即時動態唷 ➡️ www.Instagram.com/travelwithwinny 😁
#帕米爾公路 #吉爾吉斯 #塔吉克斯
Survived the 5 day Pamir Highway where the warmest temp was -30℃ and the coldest -50℃. It is no wonder ppl think we crazy doing this trip in winter 🤣
English Blog➡️ https://www.travelwithwinny.com/5-day-pamir-highway-itinerary-dushanbe-to-osh-in-winter/
The Pamir Highway is the second highest altitude international highway in the world (4655M)⛰️ Traversing through Afghanistan, Uzbekistan, Tajikistan and Kyrgyzstan👀
I think the most fascinating part of the trip on day 1 & 2 was looking at Afghanistan across the Panj River😲 That part of Afghanistan is known as little Pamirs and is one of the safest region in the country 👀
We were lucky enough to be in the main town of Pamirs- Khorog on a Saturday where we saw the Afghans crossing the bridge, in order to sell their goods in a local market😶 Although due to increase Taliban activities, there were heaps of army patrols which made the whole visit stressful...🙄
On our 3rd day we visited the coldest town in Tajikistan called Bulunkul, which measured at -49℃ when we were there😲 Surpringly it wasn't so bad cz there were no wind👀
There were around 100 ppl living there and it's just amazing seeing how resilient these ppl are given the harsh climate😬 There was suppose to be a lake near by and is beautiful in summer☀️ However it was covered by snow so we couldn't find it😂
We stayed in this town call Alichur which went down to -50℃ at night 🌌 I must admit they heat up the room quite well using coal & cow dump💩 So it was never as bad as EBC 😹
What kept me awake was the altitude though, heart was pumping very fast & York had to have a Diamox next day cz he was losing his appetite 😅
Next morning we set out to find Marco Polo sheep which first described by Marco Polo😁 These sheep has the longest horns out of all sheep🐏 Measured at 1.9M and weigh 27KG!!! They are currently critically endangered animals and people pay USD$40,000 to hunt them 😐
They were surprisingly easy to find as during winter they come down from the mountains to feed🌱 Though they quite sensitive animals so you can't get too close to them. I could JUST see them with my naked eyes🤓
Hiking in deep snow at 4000M in -45℃ for two hours definitely was type II fun🤣 Though we glad we paid extra USD$60 for it or else Pamir Highway was just endless snowy mountains where most hiking routes are inaccessible in winter (ie. Wakhan valley and Jizev valley) 🗻
On the last night we stayed in our driver's wife's sister's house in a town call Murgab🏚️ Apparently in winter many guest houses just simply doesn't have the capacity to warm up more than room due to how expensive coals are!!! So they just don't receive guests...
Originally we were pretty excited that we get to stay in a local's house only to find that we took over their only heated room and they had to sleep in the kitchen next to us😖
Till this day we still don't know how they slept or just uncomfortably on the floor with a mattress??? Cz it was a proper kitchen with tables and stoves 🍳
The toilet in this house requires us to go out from front door and enter the backyard. The metal bar lock actually hurts your hand when you touch it at that cold temperature 😧 There were no roof, only walls... So genuinely curious what do they do if it rains...🌧️ People certainly needs to control their bladders well😐
Also we didn't have running water to wash our hands from the taps, they had to heat up water from well so we can quickly wash it👐 Hence we didn't use soap for two days 😖 Totally disgusting by day 5...
The drive to Kyrgyzstan was quite nice as our new driver was a lot friendlier and actually speaks English 🚘
Although I grew suspicious of him cz after our passport got stamped at the Kyrgyzstan border, we waited in the car for him for awhile (along the way he was exchanging small packages with ppl which looked dodgy...🤔)
Half an hour later he said we needed visa. We were quite certain we didn't need any especially our passports were already stamped😕 He's like wait a moment he's going to call Bishkek to confirm, 5 mins later he's like we good to go.
As our tour included food and accommodation, at lunch place he said the owner didn't give him money to pay for our lunch🍴 So this meal was coming out from his own pocket.
Having to experience two meals that needed to be paid ourselves due to miscommunication or what so ever on this trip😕 I reckon there's no way he would paid for us if it wasn't included.
Overall I was very stressed with this tour operator and he kept hanging up on us when we encounter disagreements/ problems😠
Yes his price was cheap and in general he did a good job organizing the trip (happy with the food & accommodation provided) but I guess you get what you paid for💁
Company: Tour de Pamir (featured in Lonely Planet too)
#Pamirs #PamirHighway #winter #Tajikistan #Kyrgyzstan
soap紀錄法 在 Re: [問題] 護理紀錄- 看板Nurse 的推薦與評價
※ 引述《ZZCZZ (瀝瀝淅瀝瀝)》之銘言：
: 目前在長庚實習，我寫護理紀錄能否請各位學姐看哪邊不順
: 寫了三次都被老師退稿…我把老師圈起來有問題的內容用括號表示，
: 個案36歲，是兩年前車禍左腳踝骨折釘了骨釘，後來住院折除釘子。
: 目前是術後一天。
唔 怎麼不是用焦點護理紀錄法
: 0900
: 病人臥床休息中，意識清楚，生命徵象如上。左下肢腳踝外側傷口約8公分、
: 內側傷口約3公分，外側傷口有少量血液滲出，無紅腫，依醫囑傷口換藥，給
: 予生理食鹽水清潔，水溶性優碘消典，紗布覆蓋彈繃使用，未稍血循良好，評
: 估傷口疼痛指數為3分，性質抽痛，病人表示可忍受。左手有一21號IC針
: (寫留置針或是21號IC針都被劃圈)
: 留置，留置部位無紅腫。今教導傷口護理換藥及傷口注意事項，換藥前後要洗手，
: 先將棉枝用食鹽水沾濕清潔傷口，再優碘消毒，紗布覆蓋，需注意傷口有無感染情形，
: (誰？)
: 傷口感染有紅腫熱及分泌物等情形，要回門診檢查，傷口部位需保持乾燥，如擦澡時
: (紅腫熱) (門診) (燥我寫火部的被圈說是錯字)
: 傷口部位不能碰觸到水，病患及家屬可了解與配合。
我建議是這樣寫 不過如果醫院真的不是用焦點護理紀錄的話 這些也可以幫你理解一下
病人問題
傷口疼痛 0900 D:現臥床休息中,意識清楚，生命徵象如上，左腳踝外側縫線傷口8cm
，少量滲血，無紅腫，內側縫線傷口3cm，傷口外觀乾淨，無滲液紅腫
傷口疼痛，病人表示可忍受，疼痛指數3，紗布彈繃使用，末梢血循佳。
（其實這個ic可寫可不寫因為這比較像潛在性感染）左手有一21號靜脈
留置針，入針處無紅腫熱痛，管路順暢，n/s500cc滴注中#
A:予傷口換藥，紗布彈繃續使用，每2小時評估末梢血循以及紗布滲血情
形、疼痛情形#
T:衛教傷口疼痛時使用深呼吸轉移注意力，若傷口疼痛難耐需通知護理
人員評估疼痛情形，以及使用止痛劑之規定，止痛劑作用副作用，衛教
傷口換藥護理以及縫線傷口注意事項，給予傷口衛教單張，告知出院後
需定期回門診檢查以及拆線#
R:表接受# SNxxx/Nxxx
傷口疼痛 1100 R:現臥床休息中，表示傷口還有點抽痛，但可忍受，疼痛指數3，左踝
外側內側縫線，傷口皆外觀乾淨，無滲液，患肢末梢血循佳，皮膚溫熱
，無麻木感# SNxxx/Nxxx
: 1300
: 病人臥床睡覺中，呼吸平穩，傷口以彈繃包紮，未肢皮膚顏色粉紅、溫暖、感覺正常與
: 活動良好，無麻木感。無其它不適情形，家屬陪伴，續觀察。
1300 R:病人臥床休息中，呼吸平順，無疼痛情形，左踝內外側縫線傷口外觀
皆乾淨，無滲液，末梢血循良好，皮膚溫熱，家屬陪伴中#
A:續觀察病人傷口疼痛情形#
T:衛教家屬幫病人傷口換藥護理以及傷口注意事項，並回復示教#SNxxx/Nxxx
: 1500
: 病人臥於床上閱讀報紙，意識清楚，呼吸平穩。評值衛教內容，病人及家屬可正確
: 回覆示教，傷口護理換藥及說出傷口換藥的注意事項，如傷口部位需乾燥，及傷口若
: (傷口換藥)
: 出現感染徵象，需回門診。現病人臥床與家屬聊天。
1500 R:於臥床休息中，家屬陪伴，表示傷口疼痛能忍受，疼痛指數3分，左
踝內外側縫線傷口外觀皆乾淨，無滲液，末梢血循佳，無麻木感，活動
佳，皮膚溫熱。詢問衛教內容，病人及家屬表瞭解，並可回覆示教縫線
傷口換藥以及說出換藥注意事項# SNxxx/Nxxx
: 以上就是我的紀錄
: 不知道哪邊要改還是邏輯怪怪的
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