Ebola: Your Clinical Questions Answered
Ebola: Your Clinical Questions Answered
Does the type or amount of PPE differ according to the patient's condition or diagnosis? Let's say a patient comes in to the ED reporting a 101ºF fever and a positive travel history. The patient is put into an isolation room. The ED staff must talk to the patient and get more history. Do they need to be in full PPE to do so?
Dr Srinivasan responds to this scenario. "A patient who has a fever is, by definition, not asymptomatic. Fever is a symptom, and along with the travel history, this patient could have Ebola. A person who has a travel history and is truly asymptomatic is like any other patient in the ED. You would use standard precautions and whatever transmission-based precautions you might use in the care of that patient."
However, for the patient who is symptomatic with a travel history, CDC offers two options for EDs. In a situation in which the patient is not having any gastrointestinal symptoms or bleeding, CDC recommends that PPE include a gown, face shield, surgical mask, and two pairs of gloves.
In a situation in which the patient is having symptoms that pose a risk for splashing (bleeding, vomiting, or diarrhea), CDC recommends that ED staff wear the same type of PPE that is recommended for the care of a hospitalized patient with Ebola. These options are outlined in CDC's ED algorithm.
Dr Talbot adds that his hospital's ED staff also avoid having prolonged contact during the evaluation of a patient. Vanderbilt replicates the "super-team" model. In other words, a small cadre of physicians, nurses, and a few others are trained fully in every aspect of PPE and care for the Ebola patient. "If the patient is going to be in the ED longer than 15 minutes, we mobilize the team and the team goes to the ED to take over."
Most experts have predicted that we will see more people infected with Ebola in the United States, so most hospitals are preparing for this possibility. If we are lucky and see few or even no more cases of Ebola, Dr Sprecher believes that US-based healthcare clinicians still have a role in moving the Ebola crisis toward resolution. "Some healthcare professionals have gone to West Africa to assist in controlling the epidemic and taking care of patients. This is great, but it is not for everyone. Those who do not go can educate their patients and their communities. The fear and misunderstanding surrounding Ebola are causing us problems. Returned volunteers are not welcomed home by their families, friends, and coworkers. State public health agencies take unnecessary precautions in an effort to demonstrate their engagement to a fearful public. This makes everything more difficult."
For up-to-date information on Ebola, go to the Medscape Ebola Resource Center.
What About the ED?
Does the type or amount of PPE differ according to the patient's condition or diagnosis? Let's say a patient comes in to the ED reporting a 101ºF fever and a positive travel history. The patient is put into an isolation room. The ED staff must talk to the patient and get more history. Do they need to be in full PPE to do so?
Dr Srinivasan responds to this scenario. "A patient who has a fever is, by definition, not asymptomatic. Fever is a symptom, and along with the travel history, this patient could have Ebola. A person who has a travel history and is truly asymptomatic is like any other patient in the ED. You would use standard precautions and whatever transmission-based precautions you might use in the care of that patient."
However, for the patient who is symptomatic with a travel history, CDC offers two options for EDs. In a situation in which the patient is not having any gastrointestinal symptoms or bleeding, CDC recommends that PPE include a gown, face shield, surgical mask, and two pairs of gloves.
In a situation in which the patient is having symptoms that pose a risk for splashing (bleeding, vomiting, or diarrhea), CDC recommends that ED staff wear the same type of PPE that is recommended for the care of a hospitalized patient with Ebola. These options are outlined in CDC's ED algorithm.
Dr Talbot adds that his hospital's ED staff also avoid having prolonged contact during the evaluation of a patient. Vanderbilt replicates the "super-team" model. In other words, a small cadre of physicians, nurses, and a few others are trained fully in every aspect of PPE and care for the Ebola patient. "If the patient is going to be in the ED longer than 15 minutes, we mobilize the team and the team goes to the ED to take over."
Most experts have predicted that we will see more people infected with Ebola in the United States, so most hospitals are preparing for this possibility. If we are lucky and see few or even no more cases of Ebola, Dr Sprecher believes that US-based healthcare clinicians still have a role in moving the Ebola crisis toward resolution. "Some healthcare professionals have gone to West Africa to assist in controlling the epidemic and taking care of patients. This is great, but it is not for everyone. Those who do not go can educate their patients and their communities. The fear and misunderstanding surrounding Ebola are causing us problems. Returned volunteers are not welcomed home by their families, friends, and coworkers. State public health agencies take unnecessary precautions in an effort to demonstrate their engagement to a fearful public. This makes everything more difficult."
For up-to-date information on Ebola, go to the Medscape Ebola Resource Center.
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