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<< Ebola Virus Disease: Epidemiology, Clinical Presentation, and Diagnostic and Therapeutic Modalities (Pharmacology CME)

Risk Management Pitfalls For Ebola Virus Disease In Children

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Risk Management Pitfalls For Ebola Virus Disease In Children

Risk Management Pitfalls For Ebola Virus Disease In Children

  1. “We don’t need to screen for Ebola since there have been only a few cases in the United States.”
    EVD should be considered in anyone with a fever who has traveled to or lived in an area where EVD is present or anyone who has been in contact with someone exposed to EVD. Not screening appropriately for Ebola exposure and risk factors increases the risk of transmission.
     
  2. “I do not need to place a suspected EVD case in isolation or on contact and droplet precautions.”
    Ebola virus is extremely contagious. Delaying initiation of infection control measures could result in multiple people being exposed to EVD. Infection control is considered a critical part of management and should consist of PPE covering of all skin and mucous membranes, airborne precautions, and placement of the patient in a single-patient room with a private bathroom with the door closed.
     
  3. “It takes too much time to put on PPE, I’ll just skip it this time.”
    One of the most effective measures for reducing the risk of transmission is the appropriate use of PPE. Unprotected exposure to blood or body fluids of patients with EVD through contact with skin, mucous membranes of the eyes, nose, or mouth increases the risk of transmission. Due to the high risk of transmission to healthcare workers and the severity of EVD, it is imperative that healthcare workers take the time to appropriately don and doff PPE.
     
  4. “Since almost all of the cases of Ebola are in Africa, I do not need to train my staff on proper infection control measures or triage protocols.”
    Adequate training of staff is vital. Untrained staff would not be prepared to limit unnecessary exposure to Ebola. Proper training is also important to protect against injuries with contaminated needles or other sharp objects. Also, possible aerosol-generating procedures should be avoided, especially in the prehospital setting.
     
  5. “I think that patient has Ebola, but it should be okay for all of the residents to be involved in his care, especially since Ebola is rare and they may not see this again.”
    Contact with patients with EVD should be limited to essential personnel. To protect laboratory personnel, only essential laboratory specimens should be sent. All workers who might be at risk for exposure should be adequately informed and prepared beforehand.
     
  6. “This child has been to an Ebola-endemic area, but his symptoms are more consistent with malaria.”
    While malaria is more common, early recognition of the signs and symptoms of EVD on presentation may reduce morbidity and mortality. Both malaria and EVD should be worked up and ruled out since many of the signs and symptoms overlap. During an EVD epidemic (such as the 2014 outbreak in Africa) clinicians need to maintain a high index of suspicion regarding EVD, but not lose sight of other diseases in the differential, such as malaria or influenza.
     
  7. “Our hospital is not equipped to handle a patient with Ebola, but I’m worried this child might have Ebola. What should I do?”
    When working in a front-line facility, it is important to ensure proper isolation of a patient in the child’s own room (with a bathroom, if possible) with the door closed. The local health department should be contacted immediately to assist with diagnosis and coordination with the CDC.
     
  8. “He should be fine since he doesn’t look so bad. I think he can go home.”
    Patients with EVD can deteriorate quickly. EVD has a high rate of morbidity and a high case-fatality rate. Patients with suspected EVD should be admitted to the hospital for further care and observation. This allows supportive treatment to be initiated quickly.
     
  9. “NSAIDs can’t hurt; her fever is pretty high and she looks uncomfortable.”
    In patients who look uncomfortable, antipyretics are appropriate. However, NSAIDs and aspirin should be avoided. Ebola virus causes dysfunction of platelets and coagulation pathways and those specific medications may exacerbate the problem. Acetaminophen is the preferred medication.
     
  10. “Wow, this kid has Ebola. I don’t know how to treat that. I’ll just wait for the CDC to tell me what to do.”
    Ebola virus is known to cause endothelial damage and increased vascular permeability. The cornerstone of treatment is simple resuscitative efforts, such as those used in sepsis or shock. It is important that aggressive supportive care, such as fluid resuscitation, be initiated, especially in children who show signs of dehydration or who present with vomiting and diarrhea.
 
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Publication Information
Authors

Marlie Dulaurier, MD;Katherine Moyer, DO;Rebecca Wallihan, MD

Publication Date

July 2, 2016

CME Expiration Date

August 2, 2019

CME Credits

4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAFP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits.
Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 0.5 Pharmacology CME credits

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CME Information

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