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-Signs, Portents, and the Weather- | |
Docs ponder the extent to which they should go on critical Ebola patients | |
2014-10-17 | |
Oct 16 (Reuters) - The infection of two U.S. healthcare workers who cared for a dying Ebola patient in Dallas is challenging assumptions about how to protect Western medical workers who perform advanced, life-saving procedures that may increase their risk of exposure...Workers at the [Dallas] hospital also performed invasive procedures on Duncan such as inserting a breathing tube and filtering his blood through a dialysis machine, procedures that are unprecedented in the care of an Ebola patient in the last throes of the disease. But those same procedures make it more likely that a healthcare worker will come into contact with bodily fluids at their most infectious. "The thing we don't know is, was it truly a breakdown in personal protective equipment or was it because we were instrumenting the patient by intubation or dialysis?" said Dr Peter Hotez, a tropical disease expert at Baylor College of Medicine in Houston. In West Africa, where the worst Ebola outbreak on record has killed more than 4,000 people, the use of advanced lifesaving measures is rarely an option. But in the United States, they are routine...In most places in Africa, Ebola patients are only able to get supportive care, said CDC spokeswoman Abbigail Tumpey. "Now that we're treating patients with Ebola in the U.S., we are using modern Western medicine that has not ever been used in field studies in Africa," she said. Treatment approaches such as dialysis and intubation "certainly have not been happening." Never happened before? Dr. Jesse Goodman of Georgetown University Medical Center said that despite the fact Ebola has been around for decades, it is "entirely new to Western healthcare," and it is important to not be overly reliant on what has worked in prior outbreaks, especially when the healthcare systems are so dissimilar. Ebola is different [from AIDS] in some very important ways. It rapidly turns off the body's innate ability to fight viruses, multiplying unchecked as the disease progresses until patients' bodies are filled with billions of virus particles. "Towards the last days of infection, that patient is basically a bag of virus," [Dr.] Hotez said. When a patient with Ebola is reaching the stage in the disease where there is need for intubation or dialysis, the risk becomes greater to the healthcare worker than the benefit to the patient because they are "crashing" and near death... Dr. Marc Napp, deputy chief medical officer and senior vice president for medical affairs at Mount Sinai Health System in New York, said that as a general rule "any patient that comes in, no matter what the condition, if they require certain medical therapy based upon clinical judgment and they want that therapy, we are obligated to provide it." Physicians are not obligated to provide useless therapy, e.g., a patient already on the verge of death from metastatic cancer probably won't be put on artificial ventilation even if they stop breathing altogether.
"I'm a general surgeon. I've stuck myself with a needle. I've cut my finger on a broken bone from a person with hepatitis. We're exposed to this regularly," he said. "What's different here is there is the panic factor. It's a highly lethal infection." Panic factor, or the risk/reward-benefit ratio? | |
Posted by:Anguper Hupomosing9418 |
#13 Yeah, a plane flight is cheaper than tricking out a hospital do to serious infection control. Besides, it's not like the patients were doing anything else... |
Posted by: SteveS 2014-10-17 20:06 |
#12 Once you're in the air, where you go doesn't make much difference in the overall time spent. There's not hundreds of cases, or even dozens. One national center would do. Say, at the CDC in Atlanta. |
Posted by: KBK 2014-10-17 19:53 |
#11 I take it that thistle tea will not help a clogged kidney; time to go to the vodka and cranberry juice? Balvenie 12 is good for the kidneys as well, no? I figure by the time if/when I (family) get Ebola, or Entero, or Bird, or Swine, or Chimney, or whatever, hospitals have become tombs and Camp FEMA is where people disappear. |
Posted by: swksvolFF 2014-10-17 17:56 |
#10 So we are talking kidney failure, due to dehydration? That's one way to get kidney failure, but there are many others. Ebola attacks blood vessels directly, &/or may be filtered by the kidneys to get into the urine & so may simply clog up the circulation into the kidneys to such an extent they stop working. There are other possibilities. |
Posted by: Anguper Hupomosing9418 2014-10-17 13:56 |
#9 The CDC (AFAICT, IIRC) has never been charged with running patient care facilities. Hence, Emory University Hospital & the DC NIH facility were the places the 2 infected nurses have been transferred to. A "system of facilities" can be organized using existing facilities. Those staffers will have to be paid to participate in all the trainings & may also have to be paid to 'stand by' in case of need. CDC is presently offering 3-day introductory courses for US medical personnel intending to go into the Hot Zone to help out. They're booked up for the next 2 weeks. However, the CDC is NOT training any domestic medical personnel to work at home -- they leave that up to the local authorities. |
Posted by: Anguper Hupomosing9418 2014-10-17 13:53 |
#8 OK. So we are talking kidney failure, due to dehydration? Intubation on account of no vein to find, dehydration? For us DIYers, which direction are we talking about with the intubation, or current best fit? Also, IV solutions and quantities? |
Posted by: swksvolFF 2014-10-17 13:52 |
#7 They call for creating a new system of regional facilities fully equipped and staffed with workers trained to safely handle such cases Which will require billions of $ and thousands of bureaucrats.......and since Ebola, et al are rare they'll be busy "treating" and "studying" those serious health threats obesity, climate change, GLTB anxieties, second hand smoke and Tea Party syndrome. I thought that this would be in the remit of several existing orgs starting with the CDC. |
Posted by: AlanC 2014-10-17 10:22 |
#6 "Because long term, they're all dead anyway." |
Posted by: ed in texas 2014-10-17 08:09 |
#5 Ebola: Top Federal Docs Dispute CDC Breaking ranks with the US Centers for Disease Control and Prevention’s Director Thomas Frieden, three federal doctors at two of the nation’s four biocontainment care facilities and a fourth physician at a military hospital said allowing community hospitals to care for patients with Ebola and similar pathogens is too risky. They call for creating a new system of regional facilities fully equipped and staffed with workers trained to safely handle such cases “Caring for patients with filovirus and arenavirus infections in a conventional setting presents enormous challenges,” they wrote in an article published online today in the Annals of Internal Medicine. |
Posted by: Anguper Hupomosing9418 2014-10-17 07:46 |
#4 The left is a culture of death. Too many people in the world. Abortion, end of life decisions made easier and easier. My long term opinion of the world health organization. Triage, had to kick in at some point anyway. |
Posted by: Dale 2014-10-17 06:52 |
#3 Dallas County's top epidemiologist potentially exposed to EbolaDallas County’s top public health epidemiologist confirmed Thursday that she spent time at Ebola patient Thomas Eric Duncan’s bedside and that she is among those potentially exposed to the virus. |
Posted by: Anguper Hupomosing9418 2014-10-17 03:38 |
#2 Good judgment comes from experience. Experience comes from bad judgment. 'Bad' is determined after the facts are in. |
Posted by: Anguper Hupomosing9418 2014-10-17 03:35 |
#1 "Towards the last days of infection, that patient is basically a bag of virus," [Dr.] Hotez said. I doubt Dr. Hotez will be quoted in a White House presser. |
Posted by: Besoeker 2014-10-17 01:55 |