CBRNE - Plague Treatment & Management

Updated: Apr 18, 2017
  • Author: Susan E Dufel, MD, FACEP; Chief Editor: Duane C Caneva, MD, MSc  more...
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Treatment

Prehospital Care

Provide supportive care. Crystalloid infusion to maintain normal vital signs and clinical hydration state may be necessary. Administer oxygen via nasal cannula, nonrebreather mask, or intubation as determined by the respiratory distress of the patient. Use pulse oximetry to monitor the degree of respiratory compromise.

Assume universal precautions, including goggles, gloves, and gown, when dealing with any patient with an infectious disease presentation. Masks should be worn if respiratory involvement is possible.

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Emergency Department Care

Depending on the stage of presentation, supportive care varies. Early presentation may require only crystalloid administration with monitoring of vital signs, clinical state, and urine output. [2]

Septic shock requires invasive hemodynamic monitoring with crystalloid and vasopressor agents. Airway management may require intubation and mechanical ventilation with positive end-expiratory pressure (PEEP).

Any patient with predisposing risk factors and signs and symptoms consistent with plague should receive empiric treatment with antibiotics that cover Yersinia pestis. Empiric antibiotic coverage is discussed in Medication.

Use strict isolation precautions. If respiratory symptoms are present, institute universal precautions with strict respiratory isolation for the first 96 hours of therapy. [21] If no respiratory symptoms are present, only 48 hours of isolation or isolation until purulent drainage from the bubo ceases is required. Incinerate or autoclave all contaminated material. Inform the laboratory of the possibility of handling plague infected material. Cases of laboratory-acquired plague have occurred.

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Consultations

See the list below:

  • Consult an infectious disease specialist.
  • Early notification of the CDC allows samples to be sent to the headquarters in Colorado for diagnosis by fluorescent antibody testing. The CDC, in conjunction with the Department of Health, will attempt to identify the source of the plague and implement early epidemiologic measures to control a potential epidemic.
  • Consult a medical intensivist as indicated. In most patients with plague, some degree of septic shock is present. Invasive hemodynamic monitoring and close observation of fluid and cardiac status requires admission to a medical intensive care unit.
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