MERSCoV suspected ? what type of precaution !? (WHO) advice is ….

 

 

 

Salam

Hi dear emerg folks!!

  You are resuscitating a patient who came to your ED with a history of acute dyspnea, cough, preceded by flu-like illness for the last 5-7 days and he is febrile > 38.5 C . The patient is extremely tachypnic, desating on 15 L NRM, septic and started to be agitated as he is removing the Oxygen non-rebreather mask!!  So you decide to go to maintain the patient’s airway and you are doing your checklist for RSI. BUT nowadays with the clusters of MERSCoV reported in our region you think: what type of (Personal Protective Equipments – PPE) should be used ? Standard ? Droplet ? Airborne precautions ?

mmmmm 😕 ?? 

Middle East Respiratory Syndrome coronavirus or MERSCoV is a disease that has arisen in the last couple of  years in the Middle East with majority of cases in our country, Saudi Arabia. It is a threat to both, the community and healthcare workers. Knowledge about MERSCoV is evolving and lots of information is still lacking!! Many researches and reports are ongoing by WHO and Saudi Ministry of Health.

We are, as front liners emergency physicians, should be aware of all threat to both community and health care providers .

While reading the World Health Organization (WHO) update on MERSCoV that was released yesterday, 10 April 2014. I noticed that the (WHO) advice is “Airborne precautions should be applied when performing aerosol generating procedures” (along with Standard and droplet precaution).  Although its not clear yet but less likely MERSCoV is an airborne transmitted disease!  Here is the link for WHO update on MERSCoV :

http://who.int/csr/don/2014_04_10_mers/en/ or click here 

The summary of ” what type of precautions ? ” is advised by WHO :

  • Droplet precautions should be added to the standard precautions when providing care to all patients with symptoms of acute respiratory infection.
  • Contact precautions and eye protection should be added when caring for probable or confirmed cases of MERS-CoV infection.
  • Airborne precautions should be applied when performing aerosol generating procedures.

 

merscov1

 

 

merscov2

 

merscov3

 

merscov4

 

Hereby, I focused on the precautions for the healthcare workers. Yet it is as important also to educate the community.  So please do not forget that we should care about what’s threatening not only our community but the whole world. We as emergency physicians, with other healthcare providers, should have a role to educate and increase the awareness of  our community about this evolving threat. 

May ALLAH protect all humanity and make a speed recovery for those who are infected. Peace and mercy for those who passed away.

References:

– Word Health Organization – Global Alert and Response. Middle East respiratory syndrome (MERSCoV) – Update. 10 April 2014.    click here

– http://www.cdc.gov/

 

Regards

 

Educational day pearls A-1

Hi folks,  these are the main points of our discussion in the last academic activity day, enjoy!

  • Kayexalate,, Never think about it in the ED. Its effect -If any- only starts after 4 hours .
  • There is some published evidence on severe GI complications secondary to the administration of Kayexalate such as colonic necrosis or perforation, whether accompanied with the administration of Sorbitol or not.
  • Insulin with dextrose and Albuterol nebulizer have synergistic effect when treating hyperkalemia.
  • In case of hypernatremia: Start with correcting the underlying shock, hypoperfusion or significant hypovolemia with normal saline.
  • Most patients presenting to the ED with hyponatremia are stable and require NO emergent therapy.
  • For asymptomatic patients with sodium values of 115 to 135 mEq/ L, free water restriction is typically the single most important treatment in ED.
  • For Asymptomatic hyponatremia cases send: Serum and Urine osmolality, TSH, Random cortisol level, Uric Acid and urine electrolytes before starting fluids.
  • Many case reports addressed fatality from iatrogenic hypermagnesemia in elderly ( with or without renal impairment). Dose and infusion rate should be reviewed cautiously.

 

Journal club Extra session

Greetings. After getting an approval from Dr. Majed Alsalamh, we are going to have an extra-session of our journal club on Monday 17th March 2014 @ 7 – 9 p.m. This will take place in Radisson Blu Hotel-Riyadh. We are going to have a tutorial session of miscellaneous EBM concepts, for 1 hour, then we are going to have a 10 minute presentation by the sponsoring company representative. Then we will have Dinner at the end of the session. The aim of this extra-session is to refresh our EBM knowledge and to have an enjoying social gathering. Hope that everyone will attend and enjoy. For any inquiries, please don’t hesitate to contact me at any time.