Monday, October 27, 2014

Ebola 101 For Anesthesiologists. Bring Duct Tape.

The American Society of Anesthesiologists has released its recommendations for anesthesiologists who might come in contact with the much feared ebola virus. It starts out with a quick FAQ on the nature of the virus. For instance, did you know that even though the virus can be easily eliminated on a dry surface with household bleach, it can live on your skin for up to 6 days? If you live long enough it can survive in breast milk for two weeks, urine and stool for a month, and semen for over 100 days.

The diagnostic criteria for ebola infection is a fever of at least 38.6 C. That partly explains why that one nurse from Texas was allowed to board an airplane after treating an ebola patient; she had a low grade temperature of less than 38 C at the time of her cross country trip. Initial symptoms include headache, GI symptoms, and easy bruising. This eventually leads to DIC and multisystem organ failure. The only treatment is symptomatic and possibly some experimental vaccines and serums. 

The ASA's suggestions for doctors who are treating ebola patients is simple--wear personal protective equipment (PPE) religiously. That means training in how to safely don and doff (their words) the astronaut suits precisely without contaminating yourself or anyone around you. The space suits that we sometimes see orthopedic surgeons wear are not good enough. They circulate air inside the suit with simple fans on the top of the head. These fans blow unfiltered air directly on the operator's face, thereby actually concentrating the amount of virus that the wearer might come in contact with. It's also a good idea to use duct tape to seal off all open spaces between clothing.

Patients will be in isolation for the duration of the illness. They should not be transported anywhere in the hospital. All equipment and personnel will come to the bedside, including anesthesia and surgical equipment in the unlikely event a patient needs an emergency operation. Once in a PPE, the doctor must stay in the suit until the procedure is finished. So don't have that last cup of vente Starbucks before donning the PPE. 

The anesthesiologist in an ebola procedure room will have to be self sufficient. Nobody is going to run in and out of the room because the correct size intubation blade is not present. The anesthesia cart will be taken out of the room and a bare supply cart with the minimum amount of equipment and drugs will be made available. No anesthesia machine either so better get used to using total IV anesthesia. If a patient is coding, no crash team will be able to quickly put on their PPE's to assist with resuscitation. If a patient needs an emergency intubation, personnel may not be able to put on a PPE fast enough before he suffers anoxic brain injury.

These are just some of the issues that all doctors and patients in the future will have to confront in this small cross contaminated world of ours.

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