Derbingle Posted October 2, 2014 Share Posted October 2, 2014 Personally, if the triage nurse did have any information about travel to Africa, and he was presenting bc he felt ill, she should be in trouble. What bothers me a lot, is that someone can be infected and may not get sick for up to 3 weeks, but that virus, during that time, is traveling with the person. In their bodily secretions/blood. That is one reason why its so dangerous. I dont believe that an infected, asymptomatic person, is not contagious and that is what CDC is trying to say. The virus can live on fomites from what I have read. Like airplane seats and door knobs? Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted October 2, 2014 Share Posted October 2, 2014 Influenza is no different, asx but infectious for 24 hours prior to symptom onset. Rug rats, once they get over the illness (flu) and are sx free, remain contagious for approximately 72 hours. If you really think about it, how many URI/GI sx pts. are you exposing yourself to regarding their bodily secretions (based on what we know present day about the disease process)? I would say very few. Link to comment Share on other sites More sharing options...
Derbingle Posted October 2, 2014 Share Posted October 2, 2014 Fomites. Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted October 2, 2014 Share Posted October 2, 2014 A local station today is saying that he arrived "late Friday" at the ED so maybe he bypassed FT. Found it interesting this morning that FOX News had an EM NP on for discussion/comment (didn't watch the video). Link to comment Share on other sites More sharing options...
whoRyou Posted October 2, 2014 Share Posted October 2, 2014 Link to comment Share on other sites More sharing options...
wanderso17 Posted October 2, 2014 Share Posted October 2, 2014 Man, I know it is stupid to read comment sections on news stories. What did I do?....read the comments section on a Dallas Morning News story about the Ebola case in Dallas, specifically more detailed story about how patient had been seen and discharged. There is this one person, who has repeatedly, in troll like fashion, brought up the question "did the pt see a PA/NP", how we are going to be stuck with sub standard care from wannabe providers in PA/NPs because of obamacare, blah, blah, blah. This seems to be coming from one commenter. I addressed this politely, and professionally, but it is obvious this specific person has one goal, and that is basically to spread seeds of doubt wherever possible, even in the bowels of written word....the comments section of a paper's web presence. The person's full name is posted by her comments. It looks as if this person may be a pathologist. I know this is kind of pointless, and I don't usually get ticked off by these things, but to see one person with their own nasty little agenda, even if it is somewhere stupid like a comments section, is still a bit annoying. Link to comment Share on other sites More sharing options...
polarbebe Posted October 13, 2014 Share Posted October 13, 2014 Closed the ER? "Varga says the health care worker reported a fever Friday night as part of a self-monitoring regimen required by the Atlanta-based Centers for Disease Control and Prevention. He said another person also remains in isolation, and the hospital has stopped accepting new emergency room patients." http://www.nbcnews.com/storyline/ebola-virus-outbreak/close-home-neighbors-dallas-ebola-patient-concerned-n224136 Link to comment Share on other sites More sharing options...
mlsclm Posted October 13, 2014 Share Posted October 13, 2014 Q: Do you think it likely that this nurse had treated other patients since Duncan (or during), and if so, what might their exposure risk be? Link to comment Share on other sites More sharing options...
ToppDog Posted October 13, 2014 Share Posted October 13, 2014 Q: Do you think it likely that this nurse had treated other patients since Duncan (or during), and if so, what might their exposure risk be? Well, according to the doctor at the press conference today, she was working up until two days before the day of her diagnosis. She had been self monitoring her temperature twice daily, & called to let them know she was coming in. Whether or not she was seeing actual patients was not discussed, but since she was on the low risk list, it's possible. Link to comment Share on other sites More sharing options...
cinntsp Posted October 13, 2014 Share Posted October 13, 2014 Q: Do you think it likely that this nurse had treated other patients since Duncan (or during), and if so, what might their exposure risk be? It would be fairly low during the incubation period. Link to comment Share on other sites More sharing options...
Maynard Posted October 14, 2014 Share Posted October 14, 2014 So the nurse is now receiving plasma from Dr. Kent Brantly, who had previously been infected. According to the news, Brantly had offered his plasma to Thomas Eric Duncan, but the transfusion was precluded by a blood type mismatch. Can someone explain this to me? My understanding is that “blood types” refer to RBCs which are not present in plasma. I suppose that Brantly’s plasma might have had antibodies against Duncan’s RBCs (e.g. if Brantly is type O and Duncan is type AB), yet those sorts of mismatches don’t prevent blood transfusions in patients who are bleeding out. What am I missing? Link to comment Share on other sites More sharing options...
polarbebe Posted October 15, 2014 Share Posted October 15, 2014 Ebola Test Is Positive in Second Texas Health Worker By ALAN COWELL OCTOBER 15, 2014 The authorities in Texas reported on Wednesday that a second health care worker involved in the treatment of a patient who died of the Ebola virus had tested positive for the disease after developing a fever. Link to comment Share on other sites More sharing options...
Guest Paula Posted October 15, 2014 Share Posted October 15, 2014 ^^^^^ Is anyone surprised? There will be more who will test positive. Link to comment Share on other sites More sharing options...
Acebecker Posted October 15, 2014 Share Posted October 15, 2014 Nurse flew from Cleveland to Dallas with temp 99.5. So how are you guys doing your travel histories? I have felt confident up to this point because we know where the virus is and where it is not... But if a whole planeload of people were exposed (or even the 20 within 3 feet of her) how are we going to rule it out when doing a history? Just thinking out loud here... Link to comment Share on other sites More sharing options...
Guest Paula Posted October 15, 2014 Share Posted October 15, 2014 My collaborating physician just returned from a trip to Italy. He flew through Paris and Brussels and Minneapolis. He spoke of the many languages he heard on the plane as he is coughing his lungs out. I asked him if he was exposed to Ebola and we laughed but then we stopped and gazed in each others saucer shaped eyes in fear. He's called in sick the last two days. I've been taking travel histories this week. Yikes! Link to comment Share on other sites More sharing options...
db_pavnp Posted October 16, 2014 Share Posted October 16, 2014 So the nurse is now receiving plasma from Dr. Kent Brantly, who had previously been infected. According to the news, Brantly had offered his plasma to Thomas Eric Duncan, but the transfusion was precluded by a blood type mismatch. Can someone explain this to me? My understanding is that “blood types” refer to RBCs which are not present in plasma. I suppose that Brantly’s plasma might have had antibodies against Duncan’s RBCs (e.g. if Brantly is type O and Duncan is type AB), yet those sorts of mismatches don’t prevent blood transfusions in patients who are bleeding out. What am I missing? Plasma antibodies are the reason we type patients and the reason blood must be compatible. Plasma is matched according to the antigens present on a patient's red cells. Not sure about your bleeding-out comment, you'll have to explain the anecdote. It isn't done intentionally. Link to comment Share on other sites More sharing options...
Maynard Posted October 16, 2014 Share Posted October 16, 2014 Not sure about your bleeding-out comment, you'll have to explain the anecdote. What I mean is that if a type AB patient is bleeding out, they can receive blood from a type O, even though type O blood has anti-A and anti-B antibodies (or do they just receive the centrifuged RBCs?). Link to comment Share on other sites More sharing options...
db_pavnp Posted October 16, 2014 Share Posted October 16, 2014 Type O blood has neither A or B antigens. That is why it is the universal donor (ignoring Rh). Link to comment Share on other sites More sharing options...
Maynard Posted October 16, 2014 Share Posted October 16, 2014 I said type O blood has anti-A and anti-B antibodies. Link to comment Share on other sites More sharing options...
cinntsp Posted October 17, 2014 Share Posted October 17, 2014 What I mean is that if a type AB patient is bleeding out, they can receive blood from a type O, even though type O blood has anti-A and anti-B antibodies (or do they just receive the centrifuged RBCs?). I said type O blood has anti-A and anti-B antibodies. Whole blood donation isn't a thing...at least in most modern nations. Donations are separated into several products(primarily PRBCs, PLT, and FFP). The concern when transfusing PRBCs is how the recipient's plasma antibodies will react to the donor unit's antigens. Type O has neither the A or B antigen and therefore can be given to anyone. The amount of plasma left in a unit of PRBCs is very minimal and so the donor unit causing major problems for the recipient's RBCs is not an issue(which is where I think you're confused). Blood banks will always try to match blood types directly if possible but can fall back on O units if supply is inadequate. Plasma donation is the reverse. AB becomes the universal donor because they have neither anti-A or anti-B antibodies and therefore it can be given to anyone. The above is simplified as there are other Ag/Ab considerations like Rh, duffy, kidd, kell, and so on that are also addressed when doing the type and screen. Link to comment Share on other sites More sharing options...
db_pavnp Posted October 17, 2014 Share Posted October 17, 2014 Yes, I assumed the blood "antibodies" was a typo because they largely do not exist in modern transfusion practice. It never occurred to me you might be referring to straight whole blood. I see you had a line about centrifuged blood and that is exactly the case, yes. Link to comment Share on other sites More sharing options...
mlsclm Posted December 7, 2014 Share Posted December 7, 2014 It was a physician! http://www.dallasnews.com/ebola/headlines/20141206-er-doctor-discusses-role-in-ebola-patients-initial-misdiagnosis.ece?hootPostID=9bd31030c8055e111486bf901ecd6695 Link to comment Share on other sites More sharing options...
winterallsummer Posted December 7, 2014 Share Posted December 7, 2014 I sympathize with that doc. Think of all the things your PTs don't mention to you, even when you do a good h and p. PTs who come in with gerd that don't mention their hx of four stents. Pt w a cough who neglects to mention they have HIV and have been intubated. PTs who don't mention their bleeding disorder or alcoholism and this is learned later when the spouse arrives. I commend him for talking about this openly. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted December 7, 2014 Moderator Share Posted December 7, 2014 this was a failure on so many levels. Pt lied about his exposure hx Nurse entered travel hx in EPIC (EPIC kills!) , but did not tell doc specifically about travel hx. On a paper chart the c/c from triage would have been " fever, h/a, and abd pain. Just arrived from Africa". Doc didn't have Ebola on his radar. with no US cases, this is understandable. I think with a lying pt and a poor EMR triage, many of us would have missed this as well. Link to comment Share on other sites More sharing options...
Guest Paula Posted December 8, 2014 Share Posted December 8, 2014 Yet if it was a PA or NP the article would have highlighted our poor training and education and that we don't know what we don't know. Just saying........ Link to comment Share on other sites More sharing options...
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