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Docs ponder the extent to which they should go on critical Ebola patients
Oct 16 (Reuters) - The infection of two U.S. healthcare workers who cared for a dying Ebola patient in Dallas is challenging assumptions about how to protect Western medical workers who perform advanced, life-saving procedures that may increase their risk of exposure...Workers at the [Dallas] hospital also performed invasive procedures on Duncan such as inserting a breathing tube and filtering his blood through a dialysis machine, procedures that are unprecedented in the care of an Ebola patient in the last throes of the disease. But those same procedures make it more likely that a healthcare worker will come into contact with bodily fluids at their most infectious."The thing we don't know is, was it truly a breakdown in personal protective equipment or was it because we were instrumenting the patient by intubation or dialysis?" said Dr Peter Hotez, a tropical disease expert at Baylor College of Medicine in Houston. In West Africa, where the worst Ebola outbreak on record has killed more than 4,000 people, the use of advanced lifesaving measures is rarely an option. But in the United States, they are routine...In most places in Africa, Ebola patients are only able to get supportive care, said CDC spokeswoman Abbigail Tumpey. "Now that we're treating patients with Ebola in the U.S., we are using modern Western medicine that has not ever been used in field studies in Africa," she said. Treatment approaches such as dialysis and intubation "certainly have not been happening." Never happened before? Dr. Jesse Goodman of Georgetown University Medical Center said that despite the fact Ebola has been around for decades, it is "entirely new to Western healthcare," and it is important to not be overly reliant on what has worked in prior outbreaks, especially when the healthcare systems are so dissimilar. Ebola is different [from AIDS] in some very important ways. It rapidly turns off the body's innate ability to fight viruses, multiplying unchecked as the disease progresses until patients' bodies are filled with billions of virus particles. "Towards the last days of infection, that patient is basically a bag of virus," [Dr.] Hotez said. When a patient with Ebola is reaching the stage in the disease where there is need for intubation or dialysis, the risk becomes greater to the healthcare worker than the benefit to the patient because they are "crashing" and near death... Dr. Marc Napp, deputy chief medical officer and senior vice president for medical affairs at Mount Sinai Health System in New York, said that as a general rule "any patient that comes in, no matter what the condition, if they require certain medical therapy based upon clinical judgment and they want that therapy, we are obligated to provide it." Physicians are not obligated to provide useless therapy, e.g., a patient already on the verge of death from metastatic cancer probably won't be put on artificial ventilation even if they stop breathing altogether.
"I'm a general surgeon. I've stuck myself with a needle. I've cut my finger on a broken bone from a person with hepatitis. We're exposed to this regularly," he said. "What's different here is there is the panic factor. It's a highly lethal infection." Panic factor, or the risk/reward-benefit ratio? Posted by: Anguper Hupomosing9418 2014-10-17 |
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