Infectious Diseases Infectious Diseases

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Infectious Diseases Infectious Diseases Powered By Docstoc
					Infectious Diseases

   Provena Regional EMS
In the movie Independence Day
   Will Smith and Jeff Goldblum destroy the
    alien invaders by inserting a ―virus‖ into
    their system.
   Same with humans, it is frequently a
    foreign pathogen that does us in.
Best Advice

   ―If it is wet and its not yours. .‖
   Don’t touch it!‖
   Infectious Material = Hazardous Material
Infectious Diseases in the News
What makes you sick?
   Bacteria –1 cell organism, produces toxins,
              sensitive to antibiotics

   Viruses -- intracellular parasites,
              Forces cell’s RNA to produce viral DNA
              Not sensitive to antibiotics

   Fungi– plants that grow in warm moist places
            Usually skin infections but
           can occur in lungs

   Parasites – foreign animals
                   From one cell in size to many feet
Good Guys vs Bad Guys
   Normal flora – good bacteria that live in
               Live in the intestine (E coli) and on the skin (staph)

   Pathogens – disease producing organisms
               Or a normal flora in the wrong place

   Opportunistic Pathogens –ordinarily harmless but produce
    illness because the person’s immune system is not working well
What keeps you healthy?
   Immune System and Response
       Anatomical Barriers – skin, mucus membranes
       Inflammation – initial response to invasion (redness, swelling, heat, pain)
       White blood cells – fight off invading pathogens
       Humoral immunity – B cells – Antibodies – specific to the
        invading pathogen

       Cell mediated immunity -- T cells – trained in childhood to
        recognize the body’s cells as ―self‖ and infected or diseased cells as ―not self‖

       Lymph system – extra fluid system to wash away debris
Disease Transmission
   How do pathogens get into the body?
    (past the defenses)
   Blood borne
   Airborne
   Fecal Oral
   Food borne
Determination of Risk

   How likely will it make you sick?
   Type of organism – bacteria, virus, fungus, parasite
   Virulence – how strong is the pathogen
   Dosage – a lot vs a little bit
   Host resistance – how healthy is the person, how likely to get sick

   Passive Immunity -                     Injection of antibodies for short term
    response to a pathogen.: Annual inoculation vaccines , immunity passed on by
    mother during birth

   Active Immunity – Injection of or exposure to a modified version of
    pathogen or a small amount of the pathogen to allow the body to build up antibodies
    for long term protection
Are you ready?

   BSI – body substance isolation
   Protocols
   Are you healthy?
   The best protection against any disease is
    good hand washing.
What to do when things go wrong
   Decontamination
   Report exposures to blood or body fluid
Disinfecting Techniques
   Low probability of exposure – wipe down with
    disinfectant (routine call)
   Moderate probability of exposure – clean all
    surfaces with an antiviral or bleach (viruses, TB,
    chicken pox)
   High probability of exposure – all reusable
    equipment esp. anything that goes in the airway,
    soak in solution according to procedure
    (Laryngoscope blades, Magill forceps)
Assessment of Patient with
Potential Infectious Disease
   High Index of Suspicion –Why is this person sick?
    Could it be passed on?

   SAMPLE History – Can tell you a lot!
   Changes in ABCs– Rapid pulse, rapid respirations, hot
    dry skin

   Hypotension: dehydration vs sepsis
   Skin: rashes, color changes, lymph nodes
Colds and Flu
   Causes – virus -- air borne
   Signs and symptoms
            Fever, general aches, cough
            Sore throat, runny nose

   Treatment -- symptoms
   Risk to EMS – high
       very contagious, wearing a
        mask is a good idea
Influenza and Pandemics
   How could that happen?
Influenza Virus Changes Constantly
   Antigenic Drift – genetic changes
    (mutations) in the Human Influenza Virus
       Continuous process
       Immunity against one strain can be limited
       Vaccine strains must be updated each year.
       Vaccine development 6-8 month process
       #1 respiratory disease each winter – always
        slightly different
Danger of Avian Influenza A
   Can survive in low temperatures and low
    humidity for weeks
   Can survive in water
   Can survive on surfaces
   Disinfection of environment is needed to
What Is A Pandemic?
   The news is full of fears of pandemics.
    What are they talking about?
   Epidemic: serious outbreak of a disease in a
    single community, population or region (normal
    seasonal influenza).
   Pandemic: epidemic spreading around the world
    affecting hundreds of thousands of people across
    many countries.
Pandemics Are Not Myths
   Three major Pandemics of a newly
    emerged strain of Human Influenza A in
    the 20th Century
       1918-1919 Spanish Flu
          20-50 million deaths

          500,000 deaths in USA

       1957-1958 Asian Flu
          70,000 deaths in USA

       1968-1969 Hong Kong Flu
          34,000 deaths in USA
What Causes Pandemic Flu?
   Emergence of a new Human Influenza A Virus—
    ‖Novel Virus‖
   Virus passes easily form person to person
   Few, if any people have any immunity to virus
   So, the virus easily spreads widely and causes
    more serious illness
   This was the fear last year with H1N1
Pandemic Waves
   Pandemics occur in multiple waves of disease
   The first wave in a local area could last 6-8 weeks
   The time between pandemic waves varies and
    cannot be easily predicted.
Meningitis – infection of covering of the brain and spinal

      Causes – can be either bacterial or viral – transmitted air borne
      Signs and symptoms– headache and neck ache, fever, dark rash
      Treatment – symptoms
                Antibiotics
                Can be fatal

      Risk to EMS –high
                Wear a mask
Tuberculosis (TB)
   Cause -- bacteria
   Signs and symptoms
             Chills, night sweats, fatigue
             Cough (blood) weight loss

   Treatment long term antibiotic treatment
   Risk to EMS – high
             EMS wears a mask when around the patient
             The patient should wear a mask when being transported through public
Pneumonia – infection of the lungs (bronchioles and alveoli)
   Causes – bacteria, virus, fungus
   Signs and Symptoms
         Chills, fever, cough, chest pain

   Treatment – symptoms
         May need antibiotics

   Risk to EMS –
         If patient is coughing wear
     a mask
Childhood Diseases
   Treat symptoms
    Measles – rough red rash from air borne virus
    Mumps – inflammation of salivary glands, air borne virus
    Chicken pox (Varicella) – pustule rash, very contagious air
    borne virus, may be fatal to adults. Be sure to disinfect everything within range of

    RSV – air borne virus causing pneumonia type symptoms in small children
STD (sexually transmitted diseases)
   Syphilis -- bacteria
   Gonorrhea --bacteria
   Chlamydia -- bacteria
   Herpes -- virus
   HIV – virus (kills off T cells)
   Low risk to EMS (from patients)
Skin Infections
   Scabies – parasites
    Lice -- parasites
    Impetigo – bacteria
Highly contagious
Pass easily from person to person.
Good decontamination of EMS personnel and
West Nile Virus
   Causes – virus from mosquito bites
   Signs and Symptoms –
       Fatigue, fever, body aches

   Treatment -- symptoms
   Risk to EMS –low
   Biggest risk to the frail and those with
    compromised immune systems
Lyme’s Disease

   Causes – bacteria from tic bite
   Signs and Symptoms
        Flat painless lesion, bulls eye rash, pain in joints, loss of sleep,
         depression, cardiac symptoms

   Treatment – recognize the problem early and give antibiotics,
    need to think about the possibility

   Risk to EMS – low from patients
Mega Bugs: MRSA
methalocillen resistant staph aureus
   Causes– bacteria that are resistant to most antibiotics
        Seen in patients with compromised immune system and open
         wounds and/or multiple tubes

   Signs and Symptoms– may have no additional signs and
    symptoms other than chronic problems

   Treatment -- symptoms
   Risk to EMS – Low
   but high risk to the next patient
   You are a greater risk to the MRSA
   Patient than they are to you!!
   Overwhelming systemic infection -- bacteria
   Hemodynamic instability
       Systemic inflammation
       Leaking capillaries
       Hypotension
       Tachycardia
       Life and death situation
   Management
       100% Oxygen
       Ventilation support
       Fluid replacement
       BP/perfusion maintenance -- dopamine
       ―Kill off the Bug‖
       Outcome is usually fatal
Case Studies
   For each case, read the entire scenario
       Scene Size Up
       A, B, C s
       SAMPLE History
   What do you think is wrong with the patient
   How would you manage the patient based on
    your training
   What BSI do you need
Case Study 1
   You are called to an apartment for a 19
    year old ―man down‖
   You find Lou lying prone in bed. He is
    pale and looks to be sleeping. His chest is
    barely moving
   His roommate says he came home from
    work and found Lou like this.
   Lou moans when you stimulate him, He
    does not wake up and does not follow
    commands. He will not open his eyes
   His airway is open and clear
   He is breathing 28 per minute with rales
    and rhonchi in his lungs
   His skin is pale, hot and dry, pulse is fast
    and weak
What do you think?
   Sick or not sick?
   Lou’s roommate said he was complaining of a
    sore throat and a massive headache this morning
    and decided not to go to class at the community
    college. He has been studying and working 2
   He has no known allergies, no medical history.
    He has been taking Tylenol cold pills for 2 days
    for his symptoms
   His roommate just found him and called 911
   BP 88/60, P. 140, R. 28, Temp hot
   Pulse Oximetry 99% on room air
   Blood sugar 100
   When you examine Lou you find a fine
    petechial rash on his chest, back and arms.
    Lou cries out whenever you move him,
    particularly his neck and back
   What do you think is wrong?

   BSI do you need??

   How will you manage this?
   What do you think is wrong?
       Meningitis
   BSI do you need??
       EMS use gloves and face mask
   How will you manage this?
Case Study 2
   You get a call to an old apartment house in
    poor condition. You find 58 year old Jose
    lying in bed. He looks much older than his
    reported age.
   Jose is awake and pale with a harsh
    productive cough
   Jose is awake, alert and able to follow commands
   Airway is open and clear
   Breathing 22, speaks in phrases only, lung sounds
    have rales and wheezes in the left side
   Pale warm dry skin, with poor turgor Radial
    pulse 98 and regular
   He complains of being too tired to get out of bed
What do you think?
   Sick or not sick?
   No allergies
   Taking over the counter cough medicine
   He has had a gradual weight loss over the last 6
    months. He has not felt well during that time. He
    has had a cough for a year. He has not seen a
    doctor for 20 years. He just came to this country
    2 years ago.
   Jose smokes about a pack a day of cigarettes
   BP 100/78, P.98, R. 22, Temp. hot (BP
    drops to 90/60 when he sits up
   Pulse oximetery 86%
   Blood sugar 260
   Jose looks malnourished. He has a
    frequent productive cough. His sputum is
    yellow and blood streaked. He complains
    of dull left sided chest pain
   He does not trust cities or doctors.
   What do you think is wrong?

   BSI do you need??

   How will you manage this?
   What do you think is wrong?
       At least pneumonia, possibly TB
   BSI do you need??
       Gloves and mask for EMS personnel and a
        mask on the patient if he is coughing
   How will you manage this?
Case Study
   Dispatched at 1000 for elderly person sick
    for 2 days with a urinary tract infection.
   You respond to a large assisted living

   Your patient is 82 year old Mrs. Schmidt,
    who is sitting in a recliner in her apartment.
Initial Assessment
Mental Status: lethargic, moans when
Airway has large amounts of mucus in mouth
  and rattling in her throat
Breathing is labored and shallow.
Skin is very pale and warm, moist to touch,
  poor radial pulses, very weak and irregular
What do you think?
   Sick or not sick?
   Allergies: None
   Medications: Capoten 25 mg TID,
    Diabinese 100 mg daily, pyridium 200 mg
    TID, Gantrisin 1 gm. TID
   Previous Illnesses: Breast cancer 7 years
    ago, completed radiation and
    chemotherapy, hypertension and type II
   Current Health Status: Mrs. Schmidt has
    been in good health. She has been at this
    facility for 2 years. She is up and dressed
    every day and eats her meals in the dining
    room. She is very active in social
   Events: Mrs. Schmidt went to see her
    doctor 2 days ago for a urinary tract
    infection. He put her on pyridium and
    gantrisin, which she has been taking. Mrs.
    Schmidt told the staff that she did not feel
    well yesterday and that she ached all over.
    She wanted only tea for supper last night.
    They found her this morning in her recliner
    in this condition.
What has happened to Mrs.
   What more information do you need?
Focused Physical
   BP 80/60
   Pulse 88 irregular
   Respirations 20, she breathes fast, then slows
    down to a period of apnea and then speeds up
   Blood sugar 190
   Pulse oximetry: 86% on room air
   Monitor shows atrial fibrillation with unifocal
Head to Toe
   Responds only by moaning when spoken to
   Jugular veins distended
   Breath sounds have soft crackles in bases
   Abdomen soft and not tender
   Gross edema of legs, arms and face
   What do you think is wrong?
       The patient is in septic shock, probably from
        urinary tract infection
   BSI do you need??
       gloves
   How will you manage this?
   Answer the following questions as a group.
   If doing this CE individually, please e-mail
    your answers to:
   Use ―Dec 2010 CE‖ in subject box.
   You will receive an e-mail confirmation.
    Print this confirmation for your records,
    and document the CE in your PREMSS CE
    record book.
Post Lesson Quiz
   Name 3 types of pathogen that can cause
       1.
       2.
       3.
   4. True/False Flu is caused by bacteria.
   5. What is the best way to prevent the
    spread of infection?
   6. What is appropriate BSI for all EMS
   What can cause meningitis?
       7.
       8.
   9. What sign/symptom is specific to
   10 What causes tuberculosis?
    What special BSI precautions are taken
    with a patient you think or know has TB?
   13. True/False. Sepsis is an overwhelming
    infection in the blood.
   14. True/False. People with sepsis usually
    are almost back to normal in 48 hours.
   15. True/False. EMS providers are a
    greater risk to MRSA patients than MRSA
    patients are to EMS providers.
   1. Bacteria         2. Virus
   3. Fungus           Parasites
   4. False -- Flu is caused by a virus
   5. Wash your hands
   6. Gloves (mask if there is a risk of air
    borne infectious disease)
   7. Bacteria        8. Virus
   9. Headache and stiff neck
   10. TB is caused by a bacteria
   11. EMS providers wear a mask
   12. The patient wears a mask when being
    transported through public areas.
   13. True
   14. False, most patients with sepsis die.
   15. True, patients with MRSA have
    compromised immune systems.

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