CBRNE - Viral Hemorrhagic Fevers Treatment & Management

Updated: Mar 16, 2017
  • Author: David C Pigott, MD, RDMS, FACEP; Chief Editor: Zygmunt F Dembek, PhD, MPH, MS, LHD  more...
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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.


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

  • Minimize aerosol-generating procedures such as bilevel positive airway pressure (biPAP), intubation, bronchoscopy and sputum induction.

Infection control measures include the following:

  • Place patients in a single-patient room with a private bathroom

  • Avoid entry of nonessential staff and visitors; facilities should maintain a log of all people entering the patient’s room

  • All staff entering the room should wear appropriate personal protective equipment (PPE); see below

PPE should include the following:

  • Impermeable garment
  • Respiratory protection (N95 mask with single-use surgical hood or single-use full face shield) or powered-air purifying respirator (PAPR) with full face shield or hood
  • Single-use examination gloves with extended cuffs
  • Single-use boot covers
  • Single-use apron (if patients have vomiting or diarrhea)

For donning of PPE, a trained observer should read aloud to the healthcare worker each step in the procedure checklist and visually confirm and document that the step has been performed correctly.

A separate area should be designated for donning and doffing of PPE. The space and layout must allow for clear separation between clean and contaminated areas

Note that these infection control recommendations were developed for use with patients with suspected or confirmed Ebola virus disease, but may also be used for any patient with suspected VHF infection. For more details, see the US Centers for Disease Control and Prevention's Ebola infection control recommendations.