Moderator True Anomaly Posted September 30, 2014 Moderator So proud of my hometown.... http://www.dallasnews.com/news/metro/20140929-dallas-ebola-case-confirmed-by-cdc-first-diagnosis-in-u.s..ece
GetMeOuttaThisMess Posted September 30, 2014 Used to work in that ED a couple of times a year to cover for others.
Moderator True Anomaly Posted September 30, 2014 Author Moderator I'm not looking forward to work tomorrow
GetMeOuttaThisMess Posted September 30, 2014 Fits with the demos of the area. A lot of lower income, immigrant housing in several square miles. Really impacted my first ED job up the highway. Not tacky, just an epi observation. Many, many apartments. Liberian nat'l visiting family in area says CDC.
medic25 Posted September 30, 2014 Some PA in Dallas is about to become all-time champion of the "Fast Track Disasters" thread.....
GetMeOuttaThisMess Posted September 30, 2014 Went to ED twice. First walk-in (prob fast track knowing their setup if having "flu-like" symptoms assuming they arrived during fast track hours). Sent home. Came back via EMS several days later. Wouldn't want to be first provider since questions already being asked by press how pt was allowed to go home. Local ID rep at hospital stressing only spread by fluids, not air.
Moderator True Anomaly Posted September 30, 2014 Author Moderator Now no one will go to the Presby ER- they'll come to mine instead. Gonna be really curious to see how it impacts flow of other hospitals in the area
cbrsmurf Posted October 1, 2014 guess we are going to be asking patients this coming flu season whether theyve been to w africa. or Dallas.
ToppDog Posted October 1, 2014 A female relation is also now in the hospital with symptoms, & five children related to the patient are being kept home & monitored, but they all attended classes at five different schools last week.
GetMeOuttaThisMess Posted October 1, 2014 Now saying breakdown in communication was with triage nurse it would seem.
ToppDog Posted October 1, 2014 Several of the hospital staff & ambulance crew are being put under quarantine for 21 days.
Acebecker Posted October 1, 2014 Had a patient ask me today if it was safe to travel to Dallas. I said, frankly, "If it's not critical that I go there, I will elect to stay away." I feel like I'm going to incite a panic, but honestly... If I wouldn't go, knowing what I know, then how can I recommend anyone else go?
GetMeOuttaThisMess Posted October 1, 2014 Seems a tad bit excessive. Only one individual with known exposure is displaying symptoms and is already quarantined. Close contacts already being observed. EMS unit out of service as well (threw up in box). Folks don't get the concept of the important medical issues and the associated treatment. Hydration for volume loss, hydration, and did I mention hydration?
Acebecker Posted October 1, 2014 I don't know how careful to be with ebola. My thinking on this is that it's not possible to be too careful. And if we aren't careful enough, a lot of people have a problem. Admittedly I may be influenced by the county health officer who sits next to me at work; we're all a little concerned about what it could mean if this thing takes off.
GetMeOuttaThisMess Posted October 2, 2014 With my former employer, a shadow would cause them to be in full hazmat gear (county as well). In this case, in a typical ED before anyone figures anything out definitively, face mask, gloves, gown. This raises an interesting question that I'll post in a new thread.
cbrsmurf Posted October 2, 2014 It's easy to say that it's not contagious with proper protective equipment/universal precautions, but when you are treating a disease that has >50% mortality in 1-2 weeks, it's difficult not to go to extreme measures.
GetMeOuttaThisMess Posted October 2, 2014 You need to consider the source of this mortality rate. We're not talking Johns Hopkins here. Sanitary conditions are horrific where this virus is native to.
Acebecker Posted October 2, 2014 GMOTM - keep in mind that the mortality rate in poor conditions actually exceeds 70% for this outbreak and the literature I've read. 50% mortality is perhaps an overestimate, but it may be closer to reality in the US than you or I would like to admit.
GetMeOuttaThisMess Posted October 2, 2014 We'll see. While they have initially thrown the triage nurse under the bus it will not surprise me at all if it is revealed that this pt. presented during fast track hours at this facility and seen by the PA there. This facility has a separate FT from the main ED, and if it was open and still staffed as it used to be during my few shifts there a decade ago, the predominant care is from a PA, with serial physician oversight as the physicians round out their respective sequential shifts throughout the day/evening. I have yet to see/hear any information with regard to the time of the initial walk-in presentation from the first visit. EM service is contracted to an outside agency at this facility, as well as it's member facilities in the region (DFW and surrounding communities).
Acebecker Posted October 2, 2014 If you ask me, ebola is a fast track/UC disaster waiting to happen. It sounds like anything else that could be going around. Unless we are doing strict travel histories, we will miss it. Unless, of course, you get the case where they're bleeding from their eyes.
polarbebe Posted October 2, 2014 http://www.latimes.com/nation/nationnow/la-na-ebola-texas-20141001-story.html#page=1 He sought care on Friday at Texas Health Presbyterian Hospital, where an emergency room nurse asked whether he had traveled to West Africa and was told that he had, Dr. Mark C. Lester, a hospital network executive, told reporters “Regretfully, that information was not fully communicated throughout the full team,” Lester said. “As a result, the full import of that information wasn’t factored into the clinical decision-making.”
GetMeOuttaThisMess Posted October 2, 2014 This is the initial visit and the time in which I would suspect that he would have been triaged to fast track, IF he presented during fast track hours (daytime/evening hours). If this is the case then most likely he was seen by a PA that contracts with the ED group that provides the Texas Health Resources ED coverage. Quite frankly, he has a traditional English name, may not have a foreign accent which would be appreciated by the provider, and as the patient he knows that he has already relayed the travel information to the nurse and thus assumes that it is passed along to the provider(s). This facility sees just about every ethnic and racial entity that you can imagine so it just may not have registered with the provider, especially if they were getting hammered at the time.
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