1. Chapter 26 Infectious Diseases

2. Part 1 You are dispatched to a private residence for an older woman who is “not feeling well.” You are greeted by a family member who identifies herself as the 9-1-1 caller. She tells you that she found her 70-year-old grandmother, Laverne, lying on the bathroom floor complaining of “feeling sick and hurting all over.” She thinks that her grandmother has been on the floor since sometime yesterday.

3. Part 1 (cont’d) You are unable to bring all of your bags and equipment into the bathroom because of the cramped space, and your patient is wedged behind the bathroom door. Before entering, you peek around the door to perform a quick initial assessment. After you squeeze through the doorway, you must close the door to gain complete access to the patient’s face and head.

4. Part 1 (cont’d) Primary AssessmentRecording Time: 0 minutes Appearance Fetal position, appears tired Level of consciousness A (Alert to person, place and day) Airway Patent, occasional cough Breathing Rapid and shallow Circulation Flushed face, sweaty skin, rapid pulse

5. Part 1 (cont’d) 1.Given your initial findings, what can you infer about the patient’s overall condition? 2.What are your immediate concerns?

6. Part 2 Because of the problem with access, you decide to carry the patient to the stretcher in the next room using the front cradle method (patient’s arms around your neck, your arms under her torso and legs). During your carry, you notice that your patient is quite warm and coughs occasionally. When you ask about her flulike symptoms, she says that she has had chills and a dry cough for a few days.

7. Part 2 (cont’d) Vital SignsRecording Time: 7 minutes Level of Consciousness A (Alert to person, place, and day) Skin Flushed, warm, and sweaty Pulse 110 beats/min, weak radial pulse Blood Pressure 118/72 mm Hg Respirations 36 breaths/min, shallow SaO 2 90% on room air

8. Part 2 (cont’d) 3.List a few possible infectious diseases that could cause these signs and symptoms. 4.Of those, which are the most serious and why?

9. Part 3 To gather more information about the patient, you request that her granddaughter ride with you in the ambulance on the way to the hospital. She reveals that her grandmother has recently returned home from a nursing care facility. After a fall, the patient had required several weeks of full-time nursing care that her family was unable to provide. She has been in her own home for about 7 days, and the first flulike symptoms occurred a few days ago. The patient now complains of headache, weakness, and some difficulty breathing.

10. Part 3 (cont’d) As you consider her signs, symptoms, and history, you begin to form your differential diagnosis, and immediately apply additional PPE. You administer supplemental oxygen and establish a 20-gauge IV of normal saline in her right hand, giving a 150-mL NS bolus.

11. Part 3 (cont’d) ReassessmentRecording Time: 17 minutes Skin Flushed, warm, and sweaty Pulse 110 beats/min, weak radial pulse Blood Pressure 118/68 mm Hg Respirations 36 breaths/min, shallow SaO 2 94% Temperature 38°C Pupils Inspiratory crackles (bilateral lower lobes) Blood Glucose 80 mg/dL ECG Sinus tachycardia

12. Part 3 (cont’d) 5.Why is it important to periodically reconsider your differential diagnosis throughout the call? 6.Given your updated differential, what would be considered “high-risk” procedures for this patient?

13. Part 4 When you arrive at the emergency department, you are met by the staff as you open your ambulance doors. They are wearing full PPE, including gloves, gowns, goggles, and N95 masks. With the information you provided in your radio report, the hospital staff confirmed your suspicions (due to other recent admissions from this same nursing care facility) that your patient likely has SARS and will have to be placed in isolation.

14. Part 4 (cont’d) ReassessmentRecording Time: 25 minutes Skin Flushed, warm, and sweaty Pulse 108 beats/min, weak radial pulse Blood Pressure 116/56 mm Hg Respirations 36 breaths/min, shallow SaO 2 94% ECG Sinus tachycardia

15. Part 4 (cont’d) 7.After the transfer of care, what steps must be taken with regard to exposure? 8.Will this alter your immediate lifestyle or work habits? If so, how? 9.What are some other considerations with respect to this patient’s family?