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CBRNE - Viral Hemorrhagic Fevers Treatment & Management

  • Author: David C Pigott, MD; Chief Editor: Zygmunt F Dembek, PhD, MPH, MS, LHD  more...
 
Updated: Mar 30, 2015
 

Prehospital Care

Supportive care is based on the patient's physiologic condition. Because most patients requiring prehospital evaluation and transport are in the early stages of the disease, universal precautions should be adequate. In patients with respiratory symptoms (eg, cough, rhinitis), use face shields and high-efficiency particulate air (HEPA) filter masks.

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Emergency Department Care

Fluid resuscitation and supportive care are the mainstays of emergency department therapy. Intravenous crystalloids, oxygen, and cardiac monitoring are the most appropriate initial steps in the treatment of patients in whom viral hemorrhagic fever (VHF) is suggested. Other measures include the following:

  • Administer blood and blood products as clinically indicated
  • Avoid intramuscular injections and the use of aspirin or other anticoagulants
  • Minimize invasive procedures because of the risk associated with viral transmission from sharp objects

Infection control measures include the following:

  • Place patients in a private room
  • A negative pressure room is not necessary during early stages of the disease but may be necessary if patients have prominent cough, vomiting, diarrhea, or hemorrhage
  • Prevent nonessential staff and visitors from entering the room
  • All staff entering the room should wear gloves and gowns
  • Persons coming within 3 feet of the patient should wear face shields or surgical masks with eye protection (including side shields); use HEPA filter masks if patients have prominent respiratory, GI, or hemorrhagic symptoms
  • If large amounts of blood or other body fluids are present in the environment, use leg and shoe coverings
  • Before exiting the room, discard all used protective barriers and clean shoes with a hospital disinfectant or solution of household bleach
  • If possible, use an anteroom for putting on and removing protective barriers and for storing supplies
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Contributor Information and Disclosures
Author

David C Pigott, MD RDMS, FACEP, Professor of Emergency Medicine, Co-Director of Emergency Ultrasound, Vice Chair for Academic Development, Department of Emergency Medicine, University of Alabama at Birmingham School of Medicine

David C Pigott, MD is a member of the following medical societies: American College of Emergency Physicians, Emergency Medicine Residents' Association, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Zygmunt F Dembek, PhD, MPH, MS, LHD Associate Professor, Department of Military and Emergency Medicine, Adjunct Assistant Professor, Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine

Zygmunt F Dembek, PhD, MPH, MS, LHD is a member of the following medical societies: American Chemical Society, New York Academy of Sciences

Disclosure: Nothing to disclose.

Additional Contributors

Jerry L Mothershead, MD Medical Readiness Consultant, Medical Readiness and Response Group, Battelle Memorial Institute; Advisor, Technical Advisory Committee, Emergency Management Strategic Healthcare Group, Veteran's Health Administration; Adjunct Associate Professor, Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences

Jerry L Mothershead, MD is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Drugs & Diseases gratefully acknowledge the contributions of previous author, Thomas W McGovern, MD, to the development and writing of this article.

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Ebola virus. Electron micrograph courtesy of the Centers for Disease Control and Prevention.
Marburg virus. Negative stain image courtesy of the Centers for Disease Control and Prevention.
Mastomys rodent, natural host of Lassa virus. Image courtesy of the Centers for Disease Control and Prevention.
Bunyavirus infection. Ecchymoses encompassing left upper extremity one week after onset of CCHF. Ecchymoses often are accompanied by hemorrhage in other locations: epistaxis, puncture sites, hematemesis, melena, and hematuria. Image provided by Robert Swaneopoel, PhD, DTVM, MRCVS, National Institute of Virology, Sandringham, South Africa.
Apodemus agrarius, the vector of Korean hemorrhagic fever caused by a hantavirus. Photo courtesy of David McClain, MD.
Bunyavirus infection - Hantaan virus. Patient with Korean hemorrhagic fever caused by Hantaan virus demonstrating typical 'sunburn flush' of cheeks, chin, and base of neck. Photo courtesy of John Huggins, PhD.
Bunyavirus infection. A patient with Korean hemorrhagic fever demonstrating conjunctival hemorrhages, facial petechiae, and "sunburn flush" of the cheeks. Photo courtesy of John Huggins, PhD.
Filovirus disease - Ebola fever. Patient with Ebola hemorrhagic fever during 1976 outbreak in Zaire demonstrating palatal petechiae and hemorrhage. Photo courtesy of Joel Breman.
Patient with morbilliform exanthem of dengue fever. Note islands of sparing characteristics for dengue. Photo courtesy Duane Gubler, PhD.
Patient with dengue hemorrhagic fever complicated by ecchymoses. Photo courtesy of Duane Gubler, PhD.
Dengue Virus Notice posted outside Maracanã Stadium, Rio de Janeiro, Brazil, 2012. Translation: This site is a strategic point for controlling Dengue.
Mastomys natalensis, natural host of Lassa virus. Photo courtesy of BioMed Central, originally published in Kelly JD, Barrie MB, Ross RA, Temple BA, Moses LM, Bausch DG. Housing equityfor health equity: a rights-based approach to the control of Lassa fever inpost-war Sierra Leone. BMC Int Health Hum Rights. 2013 Jan 2;13:2.
Table. Viral Families Causing Viral Hemorrhagic Fever
Virus FamilyDisease (Virus)Natural DistributionUsual Source of Human InfectionIncubation (Days)
Arenaviridae    
ArenavirusLassa feverAfricaRodent5-16
 Argentine HF (Junin)South AmericaRodent7-14
 Bolivian HF (Machupo)South AmericaRodent9-15
 Brazilian HF (Sabia)South AmericaRodent7-14
 Venezuelan HF (Guanarito)South AmericaRodent7-14
Bunyaviridae    
PhlebovirusRift Valley feverAfricaMosquito2-5
NairovirusCrimean-Congo HFEurope, Asia, AfricaTick3-12
HantavirusHemorrhagic fever with renal syndrome, hantavirus pulmonary syndromeAsia, Europe, worldwideRodent9-35
Filoviridae    
FilovirusMarburg and EbolaAfricaFruit bat3-16
Flaviviridae    
FlavivirusYellow feverTropical Africa, South AmericaMosquito3-6
 Dengue HFAsia, Americas, AfricaMosquitoUnknown for dengue HF, 3-5 for dengue
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