Ebola emergency department evaluation

Jump to navigation Jump to search

Ebola Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Ebola from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Algorithm for the Evaluation of the Returned Traveler

Emergency Department Evaluation

Case Definition

History and Symptoms

Physical Examination

Laboratory Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Hospital Preparedness

Checklists

Air Medical Transport

Monitoring and Movement Following Exposure

Primary Prevention

Future or Investigational Therapies

Postmortem Care

Postmortem Care

Case Studies

Case #1

Ebola emergency department evaluation On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Ebola emergency department evaluation

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Ebola emergency department evaluation

CDC on Ebola emergency department evaluation

Ebola emergency department evaluation in the news

Blogs on Ebola emergency department evaluation

Directions to Hospitals Treating ebola

Risk calculators and risk factors for Ebola emergency department evaluation

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: : Yazan Daaboul, M.D.

Overview

Triage and evaluation processes in the ED should consider and systematically assess patients for the possibility of Ebola virus disease. Healthcare facilities should be able to rapidly identify and triage patients with relevant exposure history and signs or symptoms compatible with Ebola virus disease, immediately isolate any suspected patient, and immediately notify the hospital/facility infection control program, other appropriate facility staff, and the state and local public health agencies. Healthcare facilities must implement administrative and environmental controls and provide onsite management and oversight on the safe use of personal protective equipment (PPE).[1]

Triage Recommendations

  1. Immediately upon entrance to the ED, or in advance of entry if possible, a relevant exposure history should be taken including exposure criteria of whether the patient has resided in or traveled to a country with widespread Ebola transmission or had contact with an individual with confirmed Ebola Virus Disease within the previous 21 days. Because the signs and symptoms of Ebola Virus Disease may be nonspecific and are present in other infectious and noninfectious conditions that are more frequently encountered in the United States, relevant exposure history should be first elicited to determine whether Ebola Virus Disease should be considered further. If the patient is unable to provide history due to clinical condition or other communication barrier, history should be elicited from the next most reliable source (e.g. family, friend or EMS provider).[1]
  2. Patients who meet the exposure criteria should be further questioned regarding the presence of signs or symptoms compatible with Ebola Virus Disease. These include: fever (subjective or ≥100.4°F or 38.0°C) or headache, weakness, muscle pain, vomiting, diarrhea, abdominal pain, or hemorrhage (e.g., bleeding gums, blood in urine, nose bleeds, coffee ground emesis or melena).[1] All patients should be routinely managed using precautions to prevent any contact with blood or body fluids. If an exposure history is unavailable, clinical judgment should be used to determine whether to empirically implement the following protocol. If a relevant exposure history is reported and signs or symptoms consistent with Ebola Virus Disease are present, the following measures should be implemented IMMEDIATELY:[1]
  3. Isolate the patient in a private room or separate enclosed area with private bathroom or covered, bedside commode and adhere to procedures and precautions designed to prevent transmission by direct or indirect contact (e.g. dedicated equipment, hand hygiene, and restricted patient movement). If the patient is arriving by EMS transport, the ED should be prepared to receive the patient in a designated area (away from other patients) and have a process in place for safely transporting the patient on the stretcher to the isolation area with minimal contact with non-essential healthcare workers or the public.[1] To minimize transmission risk, only essential healthcare workers with designated roles should provide patient care. A log should be maintained of all personnel who enter the patient’s room. All healthcare workers who have contact with the patient should put on appropriate PPE based on the patient’s clinical status. If the patient is exhibiting obvious bleeding, vomiting, copious diarrhea or a clinical condition that warrants invasive or aerosol-generating procedures (e.g., intubation, suctioning, active resuscitation), PPE designated for the care of hospitalized patients as outlined in CDC guidance should be used. If the patient requires active resuscitation, this should be done in a pre-designated area using equipment dedicated to the patient. If these signs and symptoms are not present and the patient is clinically stable, healthcare workers should at a minimum wear: 1) face shield, 2) surgical face mask, 3) impermeable gown and 4) two pairs of gloves. All equipment used in the care of these patients should not be used for the care of other patients until appropriate evaluation and decontamination.[1]
  4. Notify the Hospital Infection Control Program and other appropriate staff and report to the relevant local health department immediately of patients with Ebola Virus Disease exposure history regardless of symptoms.[1]
  5. Once appropriate PPE has been put on, continue obtaining additional history and performing physical examination and routine diagnostics and interventions which may include placement of peripheral IV and phlebotomy. The decision to test patient for Ebola Virus Disease should be made in consultation with the relevant local health department. Patient evaluation should be conducted with dedicated equipment as required for patients on transmission-based precautions.[1]

Algorithm for the Emergency Department Evaluation and Management of Patients with Possible Ebola Virus Disease

Shown below is the Centers for Disease Control and Prevention (CDC) algorithm for the emergency department evaluation and management for patients who present with possible Ebola virus disease.[1] Click here to access the PDF version of the CDC algorithm and print it.

 
 
 
 
 
 
Patient encounter in emergency department (ED)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Has the patient lived in or traveled to a country with widespread Ebola transmission or had contact with an individual with confirmed Ebola Virus Disease within the previous 21 days?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Does the patient have FEVER (subjective or ≥ 100.4 °F or 38.0 °C) OR Ebola-compatible symptoms (listed below)?
  • Headache
  • Weakness
  • Muscle pain
  • Vomiting
  • Diarrhea
  • Abdominal pain
  • Hemorrhage
 
Continue with usual triage and assessment
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  • Continue with usual triage and assessment
  • Notify relevant health department
  • Monitor for fever and symptoms for 21 days after last exposure in consultation with the relevant health department
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Isolate and determine personal protective equipment (PPE) needed
  • Place patient in private room or separate enclosed area with private bathroom or covered, bedside commode.
  • Only essential personnel with designated roles should evaluate patient and provide care to minimize transmission risk.
 
Inform:
  • IMMEDIATELY notify the hospital infection control program and other appropriate staff
  • IMMEDIATELY report to the health department
  •  
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
    The use of PPE should be determined based on the patient's clinical status

    Is the patient exhibiting obvious bleeding, vomiting, copious diarrhea, or a clinical condition that warrants invasive or aerosol-generating procedures (e.g. intubation, suctioning, active resuscitation)?
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
    Yes
     
    No
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
    • Use PPE designated for the care of hospitalized patients
    • If the patient requires active resuscitation, this should be done in a pre-designated area using pre-designated equipment

     
    For clinically stable patients, healthcare worker should have a minimum wear:
  • Face shield and surgical face mask
  • Impermeable gown
  • Two pairs of gloves
  • If patient's condition changes, re-evaluate PPE
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
    Further evaluation and management
    • Complete history and physical examination; decision to test for Ebola should be made in consultation with relevant health department
    • Perform routine interventions (e.g. placement of peripheral intravenous phlebotomy for diagnosis) as indicated by clinical status
    • Evaluate patient with dedicated equipment (e.g. stethoscope)
     
     
     
     
     
     
     

    Algorithm adapted from the Centers for Disease Control and Prevention - Identify, Isolate, Inform: Emergency Department Evaluation and Management for Patients Who Present with Possible Ebola Virus Disease.[1]

    References

    1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 "Identify, Isolate, Inform: Emergency Department Evaluation and Management for Patients Who Present with Possible Ebola Virus Disease". www.cdc.gov. Centers for Disease Control and Prevention (CDC). October 27 2014. Retrieved October 28 2014. Check date values in: |accessdate=, |date= (help)

    Template:WH Template:WS