Treatment of Viral Hemorrhagic Fever in a Well-Resourced Environment

Abstract

Evaluation and management of a patient with a potentially highly infectious disease, such as Ebola Virus Disease, requires a structured and thoughtful approach. The differential diagnosis in such cases will include potentially life-threatening diseases that require rapid diagnosis and early initiation of therapy. However, these goals must be balanced with the need to preserve the safety of providers and other patients.

During known outbreaks, active screening for compatible symptoms and exposure history can allow early isolation of potentially contagious individuals, and thus limit the exposure to providers and other patients. If clinical suspicion remains, evaluation can be carried out under appropriate isolation precautions, by providers who have been trained in those precautions.

For the most part, the management strategy will not be dramatically different than in other critical illnesses: resuscitation to support organ function while targeted therapies address the underlying cause. However, some aspects of critical care may be significantly altered by the necessary safety precautions. Some examples include specimen collection and handling, decontamination of equipment, waste management, team structure, bedside assessment, hemodynamic and respiratory monitoring, diagnostic imaging, and invasive procedures. Deviations from regular workflow can potentially represent a risk to the patient and providers. Thus, advance development of clinical protocols and using drills with simulation to refine practice can mitigate risk to providers.