CICM SAQ 2015.2 Q22
Question
A health care worker, recently returned from West Africa, presents to the Emergency Department with fevers, vomiting and diarrhoea. Her vital signs are normal on presentation. Blood tests have not been taken, and venous access has not been established.Your state and hospital’s Ebola response plan has been activated, and the patient is due to be transferred to the state quarantine hospital. For logistic reasons this cannot occur for 24 hours, and you (with approval from ICU medical and nursing directors) have agreed to admit the patient to your ICU as this is the site of your hospital’s only suitable isolation rooms.
Your state and hospital’s Ebola response plan has been activated, and the patient is due to be transferred to the state quarantine hospital. For logistic reasons this cannot occur for 24 hours, and you (with approval from ICU medical and nursing directors) have agreed to admit the patient to your ICU as this is the site of your hospital’s only suitable isolation rooms.
Outline your management for this first 24-hour period.
Answer
Answer and interpretation
Ensure appropriate isolation prior to transfer:
- negative pressure room with appropriate venting activated checked, and operational
- ante-room with facilities for donning and doffing of PPE,
- separate toilet and hygiene facilities,
- adequate PPE supplies
- ideally staffed by an “opt-in” model
- rehearse donning and doffing procedures with observed and guided doffing
Ensure appropriate staff safety:
- intervention and observations to a minimum,
- blood tests are contraindicated unless sent to a designated laboratory with appropriate containment
facilities
Specific Patient Management:
- focussed clinical examination to determine both physiologic disturbance and to look for other diagnoses
(malaria, typhoid) - empiric antibiotics for typhoid etc. and antimalarials
- strategy to maintain adequate fluid intake (oral, or iv with appropriate precautions)
- active symptom management of nausea & vomiting, diarrhoea (often profuse), pain
- no blood tests unless logistics allow
Other:
- staff welfare and de-brief
- family support
- Pass rate: 8%
- Highest mark: 6.5
Additional Examiners’ Comments:
- Most answers were very superficial, lacking consideration of the detail needed to describe adequate isolation practices and were not at specialist level.
Examination Library
CICM
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
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