Ebola in my hospital

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Good luck.

Seriously, I doubt you'll even come close to seeing him. I would expect them to be able to intubate on their own, if needed.
 
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You can't fix stupid.
The patient, Thomas Eric Duncan, had been visiting the US from Liberia. He left Monrovia on September 19 and traveled through Brussels, arriving in the US on September 20. He had no symptoms when he was departing Liberia or entering the US, which means he wouldn't have been infectious at the time.

Four days later, he started to feel ill. Two days after that, he sought care at Texas Health Presbyterian Hospital. Hiswas diagnosed with a "low grade viral infection" and sent home with an antibiotic.

The patient's sister said that Duncan told a nurse that he had just been to Liberia, where the New York Times reports he had recently quit his job at a Monrovia shipping company. That nurse failed to communicate this vital information to the rest of the team, and Ebola was not suspected.

CDC guidance not followed
If this is correct, the hospital did not follow CDC guidance. In advance of Ebola ever reaching America, the CDC put out guidance for health workers, including this recommendation: "Treat all symptomatic travelers returning from affected West African countries as potential cases and obtain additional history."

A thorough medical history can help health professionals diagnose between 70 and 90 percent of illnesses.

By September 28, Duncan had fallen gravely ill. He was sent to Texas Presbyterian in an ambulance. At that point, he was running a high fever and vomiting. This time, hospital staff suspected Ebola and the patient was placed in an isolation unit. On September 30, the CDC confirmed that he has Ebola.
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http://www.vox.com/2014/10/1/6881735/ebola-virus-US-liberian-patient-outbreak-dallas
 
FFP said:
You can't fix stupid.
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I'll cut those involved in the initial visit some slack. The RN elicited the travel history but this apparently did not get communicated effectively (for whatever reason, very well could have been "Doctor not paying attention to RNs report"). The illness at this time was low-grade and non-specific. There might not have been the index of suspicion for the doctor to take a thorough exposure history if the 99%+ likely diagnosis was viral syndrome and treatment supportive care. (I will critique the antibiotic prescription, a less than useless treatment for this.)
 
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Viral syndrome in patient with recent travel to Liberia... Now what should one rule out? :bang:

This should have been reason for termination (for the RN), no excuses. It is about the same level of incompetence as not suspecting PE in a patient with SOB and recent transcontinental flight. This is what a triage nurse's job is.

Information doesn't "get lost" between providers. It is either written down in their note, or not.
 
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FFP said:
Viral syndrome in patient with recent travel to Liberia... Now what should one rule out? :bang:

This should have been reason for termination (for the RN), no excuses. It is about the same level of incompetence as not suspecting PE in a patient with SOB and recent transcontinental flight. This is what a triage nurse's job is.

Information doesn't "get lost" between providers. It is either written down in their note, or not.
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Why is it the RN's fault? Didn't a physician interview this patient and ask the same question? Talk about throwing someone under the bus. Now, yes, a triage nurse should identify someone in an ED and isolate them ASAP so they don't sit in the waiting room and contaminate countless people. But, to insinuate that this was a nurse's fault is a bit ludicrous.
 
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If a physician is seeing the patient and doing an H&P part of the pertinent history is whether or not there has been recent travel. Period. No excuses. No throwing a nurse under the bus. Let's raise the bar. Not try to have our cake and eat it too, just like some nurses.
 
As many as a hundred people might have come into contact with U.S. Ebola patient Thomas Eric Duncan or one of his family members before he was hospitalized, Dallas County health officials said Thursday. However, not all of them were necessarily in close physical contact with the Liberian national, Dallas County’s Health and Human Services director Zachary Thompson said. That number is in addition to the 12-18 people who had direct contact with Duncan, including some school-age children, Texas Gov. Rick Perry said Wednesday.
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http://www.nbcnews.com/storyline/eb...tact-ebola-patient-thomas-eric-duncan-n216521
 
FFP said:
Viral syndrome in patient with recent travel to Liberia... Now what should one rule out?
Click to expand...

Other than the patient's friends reporting that she told the ED nurse about recent travel to Liberia, and then the media picking up on this statement, has anyone read or personally heard proof that this information was actually given by the patient or his friends to the hospital staff? This individual patient knowingly lied to the Liberian screeners at the airport, and maybe he lied to the emergency department staff?

For all the attendings out there, consider how many frank lies you've heard, and how many patients knowingly refuse revealing important information to you. My most recent personal example is a man from Mexico with a know history of HIV and Hep-C coming in for a brain abscess. He did not reveal these diagnoses to anyone from the paramedics through to the OR. For many reasons, patients lie.

Maybe this is just another example of a patient failing to actually reveal important travel history? Maybe out of ignorance, he did not consider it relevant to his symptoms. Did he specifically state he travelled to Liberia, maybe he said, Africa? Maybe he lied about contact with sick friends or family? Regardless of what actually happened, now that the press has seized the story, the hospital and the staff are going to be burned at the stake, regardless of whether they actually did anything inappropriate.
 
And there's another one as of today. News reports are saying that he's the sickest patient transported so far, which doesn't bode well for his recovery. :(
 
If you're referring to ZMapp, there isn't any, and per a recent New Yorker article, it almost killed Nancy Writebol from an anaphylactic reaction. If this is about plasma donation, it's always possible that he's not a match for any of the other American survivors.

Dr. Brantly's probably thinking :bag: right about now, even though he wasn't the donor for Dr. Spencer; Ms. Writebol was.
 
And suddenly the chest banging about the irrelevance of Ebola when fought with modern medicine becomes a $500,000 hospital bill/patient. So how many patients can we afford, when the federal government hasn't paid for even two, yet? ;)

Back to paranoia mode...
 
FFP said:
And suddenly the chest banging about the irrelevance of Ebola when fought with modern medicine becomes a $500,000 hospital bill/patient. So how many patients can we afford, when the federal government hasn't paid for even two, yet? ;)

Back to paranoia mode...
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Bah

Hospital math is like cop math.

You can take that $500K bill about as seriously as three marijuana plants with a "street value" of $75,000.
 
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Random Resident said:
Doesn't DWB or whatever program they're working for have health insurance ?
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My guess is that they're independent contractors, but I just can't imagine a physician not having health insurance, especially if they're going into a dangerous area.

SIM and Samaritan's Purse have insurance policies that pay for their missionaries and immediate family members to be air-evaced in the event of a serious illness or family emergency, and that company refused to pay for the first two flights when they found out they had Ebola.:mad: I understand that NBC was going to foot the bill for Ashoka Mukpo's flight (he's the freelance cameraman) and implied that they were going to pay his hospital bill too. Several of the victims took private flights (i.e. Learjets) home; I do wonder who paid for that.

I recently saw an interview of Dr. Sacra from a local TV station, and he said that he's had several incidents where people have recognized him in public and said, "EWWWWW, there's that other doctor who got Ebola" and pulled their kids away from him or backed off themselves. :whoa: He also said that while he was the sickest he'd ever been in his life and had several really miserable days, he never thought his life was in danger until he saw his chart. He said, "My platelets were LOOOOOW! Wow, I really WAS sick." :wow:
 
I don't see this disease spreading worldwide, beyond isolated cases like we've seen here in the States.

And if I was a 33-year-old American man doing aid work in west Africa, I'd be terrified of being the next one. Three of the 10 U.S. victims have indeed fit this description.
 
This morning, six American Ebola survivors, including the one mentioned in the OP, appeared on the "Today" show, because they're examples of people who definitely have plenty to be thankful for this year. Warning: At 2:15, Matt Lauer asks an extremely cringe-worthy question. And truthfully, they are all people with a deep religious faith; Ashoka Mukpo, the cameraman, is a devout Buddhist (and there's a lot more to THAT story, but I won't go into it here).

http://www.today.com/health/us-ebola-survivors-meet-today-show-give-thanks-angel-kent-1D80318755
 
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