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Infectious Diseases and Sepsis

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Title: Infectious Diseases and Sepsis


1
10
Infectious Diseases and Sepsis
2
Multimedia Directory
  • Slide 89 AIDS Video

3
Standard
  • Medicine (Infectious Diseases)

4
Competency
  • Integrates assessment findings with principles of
    epidemiology and pathophysiology to formulate a
    field impression and implement a comprehensive
    treatment/disposition plan for a patient with a
    medical complaint.

5
Introduction
  • Infectious diseases illnesses caused by
    infestation of body by biological organisms
    (bacteria, viruses, fungi, protozoans,
    helminths).
  • Most infectious disease states not life
    threatening.
  • Paramedics often first to encounter patients with
    communicable diseases.

6
Public Health Principles
  • Infectious agent "hazardous material" can
    affect large numbers of people.
  • Epidemiologists health professionals who study
    how infectious diseases affect populations.
  • Characteristics of host, infectious agent,
    environment yield clues to how infectious agent
    transmitted.

7
Public Health Principles
  • Demographics characteristics of certain
    population.
  • Index case individual who first introduced
    infectious agent to population.
  • Paramedics must evaluate host (patient),
    infectious agent, environment.

8
Public Health Agencies
  • Local agencies first line of defense in disease
    surveillance and outbreak.
  • At state level, an agency (health department or
    board of health) monitors infectious diseases.
  • U.S. Department of Health and Human Services
    (DHHS) Centers for Disease Control and Prevention
    (CDC) most visible federal agency.

9
Public Health Agencies
  • CDC monitors national disease data disseminates
    information to all health care providers.
  • CDC researches infectious diseases.
  • National Institute for Occupational Safety and
    Health (NIOSH) standards and guidelines to
    prevent infectious diseases in workplace.

10
Public Health Agencies
  • Federal Emergency Management Agency (FEMA)
  • National Fire Protection Association (NFPA)
  • U.S. Fire Protection Administration (USFPA)
  • International Association of Firefighters (IAFF)

11
Microorganisms
  • Majority of disease-causing organisms microscopic
    (visible only under microscope).
  • Normal flora help keep us disease free by
    creating environmental conditions not conducive
    to disease-producing microorganisms (pathogens).

12
Microorganisms
  • Opportunistic pathogens nonharmful bacteria that
    cause disease only under unusual circumstances.
  • Most opportunistic pathogens are normal flora.
  • Patients with weakened immune system or unusual
    stress susceptible to diseases caused by
    opportunistic organisms.

13
Microorganisms
  • Bacteria
  • Microscopic single-celled organisms 1 to 20
    micrometers prokaryotes.
  • Reproduce independently require host to supply
    food and environment.
  • Gram stain common method of differentiating
    bacteria.

14
Microorganisms
  • Bacteria
  • Cocci or spheres are round.
  • Rods are elongated.
  • Spirals are coiled.
  • Specific tissues and organs infected determine
    signs and symptoms.
  • Heavy colonization may result in direct damage to
    tissues as bacteria feed.

15
Microorganisms
  • Bacteria
  • Indirect damage by releasing toxic chemicals that
    have localized or systemic effects.
  • Exotoxins poisonous proteins shed by bacteria
    during bacterial growth.
  • Endotoxins proteins, polysaccharides and lipids
    released when bacterial cell destroyed.

16
Microorganisms
  • Bacteria
  • Most bacterial infections respond to antibiotics
    bactericidal (kill bacteria) or bacteriostatic
    (inhibit bacterial growth or reproduction).
  • Different antibiotics required to treat different
    bacteria.
  • Overuse of antibiotics has made some ineffective
    against disease.

17
Microorganisms
  • Viruses
  • Much smaller than bacteria only seen with
    electron microscope.
  • Cannot reproduce and carry on metabolism by
    themselves.
  • Obligate intracellular parasites grow and
    reproduce only within host cell.
  • Resist antibiotic treatment.

18
Microorganisms
  • Viruses
  • Enters host cell becomes part of host cell,
    making eradication of virus impossible, as any
    treatment that kills virus will kill host cell as
    well.
  • 400 types of viruses most viral diseases mild
    and self-limiting.

19
Microorganisms
  • Other Microorganisms
  • Prions disease-producing agents referred to as
    "slow viruses."
  • Cause progressive, untreatable dementia in Kuru,
    Creutzfeldt-Jakob disease, mad cow disease, fatal
    familial insomnia.

20
Microorganisms
  • Other Microorganisms
  • Fungi plantlike microorganisms, most not
    pathogenic.
  • Yeasts, molds, mushrooms are types of fungi.
  • Become pathogenic in patients with compromised
    immune function.

21
Microorganisms
  • Other Microorganisms
  • Protozoa single-celled parasitic organisms with
    flexible membranes and ability to move.
  • Most live in soil ingest decaying organic
    matter.
  • Opportunistic pathogens in patients with
    compromised immune function.
  • Enter body by fecaloral route or through
    mosquito bite.

22
Microorganisms
  • Other Microorganisms
  • Parasites common causes of disease where
    sanitation poor.
  • Roundworms live in intestinal mucosa may reach
    3050 cm in length.
  • Symptoms abdominal cramping, fever, cough.

23
Microorganisms
  • Other Microorganisms
  • Pinworms common in U.S. and civilized countries.
  • Tiny worms (310 mm long) live in distal colon.
  • Common cause of anal pruritus (itching) and
    infection.

24
Microorganisms
  • Other Microorganisms
  • Hookworms found in warm, moist climates.
  • Larvae passed in stool of infected animals
    contracted when barefoot person walks in
    contaminated area.
  • Epigastric pain and anemia.

25
Microorganisms
  • Other Microorganisms
  • Trichinosis contracted by eating raw or
    inadequately cooked pork products.
  • Gastrointestinal disturbances, edema, fever.
  • If worms invade heart, lungs, brain in large
    numbers, death may result.

26
Contraction, Transmission, and Stages of Disease
  • Infectious agents exist in animals, humans,
    insects, environment.
  • While inhabiting animal or insect reservoirs,
    they do not cause disease.
  • When host and infectious agent come together at
    right time and conditions, disease transmission
    takes place.

27
Contraction, Transmission, and Stages of Disease
  • Common direct transmission is from person to
    person through cough, sneeze, kiss, sexual
    contact.
  • Indirect transmission spreads organisms in number
    of ways.
  • Microorganisms transmitted via food products,
    water, soil.

28
Contraction, Transmission, and Stages of Disease
  • Bloodborne diseases transmitted by contact with
    blood or body fluids of infected person.
  • AIDS hepatitis B, C, D syphilis.
  • Assume every patient has infectious bloodborne
    disease take precautions.

29
Contraction, Transmission, and Stages of Disease
  • Some infectious diseases transmitted through air
    on droplets expelled during productive cough or
    sneeze.
  • Tuberculosis, meningitis, mumps, measles,
    rubella, chickenpox (varicella).
  • Other diseases such as common cold, influenza,
    respiratory syncytial virus (RSV) transmitted by
    airborne route.

30
Contraction, Transmission, and Stages of Disease
  • Some infectious diseases transmitted orally
    (eating) or by fecaloral route.
  • Risk of disease transmission rises if
  • Open wounds.
  • Increased secretions.
  • Active coughing.
  • Ongoing invasive treatment.

31
Contraction, Transmission, and Stages of Disease
  • Many EMS patient care activities occur in closed,
    poorly ventilated environment (back of
    ambulance).
  • Use protective clothing barrier devices.
  • Regular cleaning and sanitization of ambulance
    and equipment will help reduce exposure.

32
Contraction, Transmission, and Stages of Disease
  • Not all infectious agents and diseases
    communicable (transmitted to another host).
  • Penetration of host infection occurred, but
    never equated with disease.

33
Contraction, Transmission, and Stages of Disease
  • Factors in becoming infected
  • Correct mode of entry.
  • Virulence organism's strength or ability to
    overcome body's defenses.
  • Number of organisms transmitted (dose).
  • Host resistance host's ability to fight off
    infection.
  • Other host factors.

34
Contraction, Transmission, and Stages of Disease
  • Phases of the Infectious Process
  • Latent period once infected with infectious
    agent, host cannot transmit agent to someone
    else.
  • Communicable period host may exhibit signs of
    clinical disease can transmit infectious agent
    to another host.
  • Incubation period time between exposure and
    presentation.

35
Contraction, Transmission, and Stages of Disease
  • Viruses and bacteria have surface proteins
    (antigens) stimulate body to produce antibodies.
  • Antibodies in blood indicates exposure to disease
    that they fight.
  • Window phase time between exposure to disease
    and seroconversion.
  • Disease period duration from onset of signs and
    symptoms until resolution.

36
The Body's Defenses Against Disease
  • The Immune System
  • Fights disease by protecting body from foreign
    invaders.
  • Must be able to differentiate "self" from
    "nonself."
  • Inflammatory response involves selected
    leukocytes (white blood cells), functional units
    of blood in immune response.

37
The Body's Defenses Against Disease
  • The Immune System
  • Neutrophils and macrophages attack infectious
    agent by combination of digestive enzymes and
    ingesting it (phagocytosis).
  • Cell-mediated immunity does not result in
    formation of antibodies humoral immunity does.

38
Phagocytosis occurs when cells engulf infectious
agents.
39
The Body's Defenses Against Disease
  • The Immune System
  • Cell-mediated immunity generates various T
    lymphocytes react against specific antigens.
  • Humoral immunity immune system's properties of
    memory and specificity.
  • Antibodies (immunoglobulins) protect against
    most infectious agents to which body repeatedly
    exposed.

40
The Body's Defenses Against Disease
  • The Immune System
  • Five classes of human antibodies
  • IgG remembers antigen and recognizes repeated
    invasions.
  • IgM formed early in most immune responses.
  • IgA main immunoglobulin in exocrine secretions.

41
The Body's Defenses Against Disease
  • The Immune System
  • Five classes of human antibodies
  • IgD present on surface of B lymphocytes acts as
    antigen receptor.
  • IgE attaches to mast cells in respiratory and
    intestinal tracts.

42
The Body's Defenses Against Disease
  • The Complement System
  • Provides alternate pathway to react more quickly
    to foreign bodies.
  • At least 20 proteins works with antibody
    formation and inflammatory reaction to combat
    infection.
  • Starts cascade of biochemical events triggered by
    tissue injury.

43
The Body's Defenses Against Disease
  • The Lymphatic System
  • Secondary circulatory system.
  • Spleen, thymus, lymph nodes, lymphatic ducts.
  • Set of small, thin-walled vessels collects
    overflow fluid from tissue spaces and returns it
    to circulatory system.
  • Fluid (lymph) same composition as normal
    interstitial fluid.

44
The Body's Defenses Against Disease
  • The Lymphatic System
  • Important in disease prevention.
  • Lymph nodes filter lymph before returning it to
    circulatory system.
  • Spleen generates antibodies and produces B and T
    lymphocytes removes unwanted particulate matter.

45
The Body's Defenses Against Disease
  • Individual Host Immunity
  • Passive immunity received antibodies from
    maternal circulation via placenta or from
    inoculation.
  • Active immunity develops antibodies in response
    to inoculation by killed or modified form of
    infectious agent in attenuated vaccine.

46
The Body's Defenses Against Disease
  • Individual Host Immunity
  • Serotype determined by exposing microorganism
    to known antibody solutions.
  • Immunizing against tetanus common practice in
    emergency medicine.
  • Tetanus rare, but frequently fatal, disease
    results from wound infected with bacterium.

47
The Body's Defenses Against Disease
  • Individual Host Immunity
  • Generalized tetanus pain and stiffness in jaw
    muscles ("lock jaw") stiffness in trunk muscles.
  • Progresses to reflex convulsive spasms and tonic
    contractions of muscle groups.
  • Passive immunity provided by injection of tetanus
    immune globulin (TIG) (Hypertet).

48
Infection Control in Prehospital Care
  • EMS providers must protect themselves from
    infectious exposures.
  • Four phases of infection control in prehospital
    care
  • Preparation for response
  • Response
  • Patient contact
  • Recovery

49
Interruption of infectious disease transmission
is a role of prehospital personnel.
50
Infection Control in Prehospital Care
  • Preparation for Response
  • Establish and maintain written standard operating
    procedures (SOPs).
  • Prepare infection control plan.
  • Provide adequate original and ongoing infection
    control training.
  • Ensure all employees provided with personal
    protective equipment (PPE).

51
Infection Control in Prehospital Care
  • Preparation for Response
  • Ensure all EMS personnel treat and bandage all
    personal wounds before emergency response.
  • Use disposable supplies and equipment when
    possible.
  • Ensure all EMS personnel have access to
    facilities and supplies needed to maintain high
    level of personal hygiene.

52
Infection Control in Prehospital Care
  • Preparation for Response
  • Do not allow EMS personnel to deliver patient
    care if signs or symptoms of infectious disease.
  • Monitor EMS personnel for compliance with
    vaccinations and diagnostic tests.
  • Appoint designated infectious disease control
    officer (IDCO).

53
Infection Control in Prehospital Care
  • Preparation for Response
  • Identify specific job classifications and work
    processes in which possibility of exposure
    exists.
  • Provide hazmat (hazardous materials) education
    for employees.
  • Do not assume EMS agency can protect you from
    exposure to all infectious agents.

54
Infection Control in Prehospital Care
  • Response
  • Obtain information from dispatch regarding nature
    of patient's illness or injury.
  • Prepare for patient contact put on gloves and
    don eye and face protection before patient
    contact.
  • Prepare mentally for call think infection
    control.

55
Infection Control in Prehospital Care
  • Patient Contact
  • Isolate all body substances avoid any contact
    with them.
  • Take Standard Precautions.
  • Allow only necessary personnel to make patient
    contact.
  • Use airway adjuncts disposable items preferable.
  • Properly dispose of biohazardous waste.

56
Always use the personal protection recommended
for the degree of exposure anticipated.
57
Infection Control in Prehospital Care
  • Patient Contact
  • Use extreme caution with sharp instruments.
  • Never smoke, eat, or drink in patient compartment
    of ambulance.
  • Do not apply cosmetics or lip balm, or handle
    contact lenses.

58
Dispose of needles and other sharp objects
properly.
59
Infection Control in Prehospital Care
  • Standard Precautions
  • All health care workers should use appropriate
    barrier precautions to prevent exposure of skin
    and mucous membranes to any contact with blood,
    or body fluids, from any patient.
  • Wash hands/skin surfaces with soap and warm water
    after removal of gloves.

60
Infection Control in Prehospital Care
  • Standard Precautions
  • Prevent injuries caused by needles, scalpels,
    sharp instruments or devices when performing
    procedures and cleaning or disposing of
    instruments.

61
Infection Control in Prehospital Care
  • Standard Precautions
  • Although saliva not directly implicated in HIV
    transmission, use mouthpieces with one-way valves
    or filters, bag-valve-mask devices, ventilation
    devices to avoid mouth-to-mouth contact.

62
Infection Control in Prehospital Care
  • Standard Precautions
  • Do not put gloved hands close to your mouth
    avoid wiping face with forearms or backs of
    gloved hands.
  • If exudative or weeping skin lesions, refrain
    from direct patient care.

63
Infection Control in Prehospital Care
  • Standard Precautions
  • Pregnant health care workers familiar with, and
    adhere to, precautions to minimize risk of HIV
    transmission.
  • Disinfection of diagnostic or therapeutic
    equipment and supplies is mandatory.

64
Infection Control in Prehospital Care
  • Recovery
  • Decontaminating ambulance and equipment is
    essential.
  • Wash hands immediately after patient contact.
  • If you sustain wound and are exposed to body
    fluids of others, wash wound with soap and warm
    water immediately, before contacting employer or
    IDCO.

65
Hand washing is one of the most effective methods
of preventing disease transmission.
66
Infection Control in Prehospital Care
  • Recovery
  • Dispose of biohazardous wastes.
  • Place potentially infectious wastes in leakproof
    biohazard bags.
  • Decontaminate all contaminated clothing and
    reusable equipment.
  • Handle uniforms in accordance with agency's
    standard procedures.

67
Infection Control in Prehospital Care
  • Decontamination Methods/Procedures
  • Decontaminate infected equipment according to
    local protocol and SOPs established by EMS
    agency.
  • Low-level disinfection destroys most bacteria
    and some viruses and fungi.
  • Intermediate-level disinfection destroys
    Mycobacterium tuberculosis and most viruses and
    fungi.

68
Infection Control in Prehospital Care
  • Decontamination Methods/Procedures
  • High-level disinfection destroys all forms of
    microorganisms except certain bacterial spores.
  • Sterilization destroys all microorganisms
    required for all contaminated invasive
    instruments.

69
Infection Control in Prehospital Care
  • Infectious Disease Exposures
  • Immediately report exposures of EMS personnel to
    designated IDCO, according to local protocol.
  • Report all exposures to blood, blood products,
    potentially infectious material, regardless of
    perceived severity.

70
Infection Control in Prehospital Care
  • Infectious Disease Exposures
  • The Ryan White Act federal law, passed in 1990
    outlines rights and responsibilities of agencies
    and health care workers when infectious disease
    exposure occurs.
  • 2009, Congress passed Ryan White HIV/AIDS
    Treatment Extension Act.

71
Infection Control in Prehospital Care
  • Infectious Disease Exposures
  • Employers required to provide medical evaluation
    and treatment for paramedic or EMS provider
    exposed to infectious disease.
  • Treatment in line with U.S. Public Health Service
    recommendations.
  • IDCO maintains records of all exposures all are
    confidential.

72
Assessment of the Patient with Infectious Disease
  • Always maintain high index of suspicion that
    infectious agent may be involved.
  • Dispatch information, evaluate environment,
    maintain Standard Precautions.
  • Look for general indicators of infection.

73
Assessment of the Patient with Infectious Disease
  • Past Medical History
  • Patients who have AIDS or are taking
    immunosuppressant medications such as steroids
    susceptible to infection.
  • Chronic obstructive pulmonary disease (COPD)
    autoimmune diseases
  • Transplant recipients diabetes
  • Alcoholism malnutrition
  • IV drug abuse splenectomy
  • Cancer artificial heart valves or joints

74
Assessment of the Patient with Infectious Disease
  • The Physical Examination
  • Determine level of consciousness and vital signs
    early on increased temperature indicates
    infection.
  • Hypotension with infectious disease may result
    from dehydration, vasodilation, or both.
  • Dehydration common consequence of infectious
    diseases.

75
Assessment of the Patient with Infectious Disease
  • The Physical Examination
  • Dehydration tachycardia and hypotension thirst,
    poor skin turgor, shrunken and furrowed tongue.
  • Skin for temperature, hydration, color, or rash.
  • Sclera (white of eye) for icterus (jaundice).

76
Assessment of the Patient with Infectious Disease
  • The Physical Examination
  • Reaction to neck flexion.
  • Lymph nodes for swelling or tenderness.
  • Breath sounds.
  • Hepatomegaly.
  • Purulent (pus-filled) lesions.

77
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Human immunodeficiency virus (HIV)
  • Collection of signs and symptoms share
    anatomical, physiological, biochemical
    derangements in immune system.
  • Like other viruses, HIV utilizes host cell's
    reproductive apparatus to copy itself.

78
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Human immunodeficiency virus (HIV)
  • HIV is retrovirus.
  • Action of reverse transcriptase enables genetic
    material from retrovirus to become permanently
    incorporated into DNA of infected cell.
  • Two types HIV-1 and HIV-2.

79
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Human immunodeficiency virus (HIV)
  • Specifically targets T lymphocytes with CD4
    marker.
  • Correlation between disease progression and
    decrease in CD4 T lymphocyte count.
  • Physicians can predict development of specific
    clinical events as CD4 count decreases.

80
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Human immunodeficiency virus (HIV)
  • Measurement of viral load best indicator of
    response to therapy and long-term clinical
    outcome.
  • AIDS can now be treated.
  • Numerous medications (antiretroviral agents) have
    changed the face of AIDS.

81
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Human immunodeficiency virus (HIV)
  • Transmitted through contact with blood, blood
    products, body fluids, semen, vaginal secretions,
    breast milk.
  • Commonly contracted through sexual contact or
    sharing contaminated needles.

82
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Human immunodeficiency virus (HIV)
  • Persons at high risk
  • Men who have sex with men
  • African Americans
  • Urban dwellers
  • Infection of health care workers from
    HIV-positive patients exceedingly rare.

83
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Human immunodeficiency virus (HIV)
  • Blood most dangerous followed by fluids that may
    or may not contain blood.
  • Other diseases extrapulmonary and pulmonary
    tuberculosis, recurrent pneumonia, wasting
    syndrome, HIV dementia, sensory neuropathy.

84
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Human immunodeficiency virus (HIV)
  • Kaposi's sarcoma cancerous lesion quite rare
    until HIV appeared.
  • As AIDS progresses, involves central nervous
    system (CNS) dementia, psychosis,
    encephalopathy, peripheral neurologic disorders.

85
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Human immunodeficiency virus (HIV)
  • CD4 counts gives indication of how well immune
    system functioning.
  • Viral load is number of copies of HIV virus in
    patient's blood.
  • High viral load (gt10,000 copies) indicates virus
    reproducing disease progressing.

86
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Human immunodeficiency virus (HIV)
  • No cure or vaccine for AIDS.
  • Health care worker should immediately seek
    evaluation initiation of treatment.
  • Postexposure therapy regimen of antiretroviral
    drugs.

87
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Human immunodeficiency virus (HIV)
  • Counseling by ICDO or trained occupational
    infectious disease specialist.
  • HIV-positive patients generally do not present in
    life-threatening situations to EMS.

88
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Human immunodeficiency virus (HIV)
  • Important that care be compassionate,
    understanding, nonjudgmental.
  • Take appropriate precautions to prevent disease
    transmission.

89
AIDS Video
  • Click here to view a video on the topic of the
    pathology of AIDS.

Back to Directory
90
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Hepatitis
  • Inflammation of liver caused by viruses,
    bacteria, fungi, parasites, excessive alcohol
    consumption, medications.
  • Headache, fever, weakness, joint pain, anorexia,
    nausea, vomiting, right upper quadrant abdominal
    pain.

91
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Hepatitis
  • Patient may become jaundiced.
  • Hepatitis A, B, C, D, E greatest potential for
    communicable disease.
  • Hepatitis A (infectious or viral hepatitis)
    transmitted by fecaloral route hepatitis A
    virus.

92
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Hepatitis A
  • Infections asymptomatic.
  • Combination vaccine available for children for
    hepatitis A and B.
  • Incubation period 3 to 5 weeks.

93
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Hepatitis B
  • Hepatitis B (serum) virus transmitted through
    direct contact with body fluids substantial risk
    to EMS providers.
  • Much more contagious than HIV.
  • Health care workers infected by hepatitis B can
    develop acute hepatitis, cirrhosis, liver cancer.

94
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Hepatitis B
  • Effectiveness of immunizations 90.
  • Transmission sexual, transfusion, dialysis,
    needle sharing, tattooing, acupuncture,
    communally used razors and toothbrushes.

95
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Hepatitis B
  • Vaccination required before employment as health
    care provider safe and effective.
  • Incubation period 8 to 24 weeks.
  • Infections asymptomatic.

96
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Hepatitis C
  • Transmitted by IV drug abuse sexual contact.
  • Chronic condition 85 of infected people.
  • Ineffectiveness of antibodies attributed to
    virus's high mutation rate.

97
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Hepatitis C
  • Causes liver fibrosis progresses over decades to
    cirrhosis.
  • No effective vaccination.
  • Treatment with alpha interferon has limited
    success.

98
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Hepatitis D
  • Depends on surface antigen of hepatitis B virus
    (HBV) to produce structural protein shell.
  • Hepatitis D virus (HDV) infection exists only
    with coexisting HBV infection.
  • Immunization against HBV confers immunity to HDV
    no vaccine exists.

99
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Hepatitis E
  • Transmitted through fecaloral route.
  • Associated with contaminated drinking water.
  • Does not lead to chronic infection.

100
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Tuberculosis (TB)
  • Most common preventable adult infectious disease
    in world.
  • Cause bacteria known collectively as
    Mycobacterium tuberculosis complex.
  • Affects respiratory system.

101
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Tuberculosis (TB)
  • Multiple-drug-resistant tuberculosis (MDR-TB)
    drug-resistant bacteria outgrow drug-susceptible
    bacteria.
  • Transmission airborne respiratory droplets,
    through mucous membranes and broken skin,
    drinking contaminated milk.

102
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Tuberculosis (TB)
  • Purified protein derivative (PPD) skin test
    identifies candidates for prophylactic drug
    therapy.
  • Most EMS agencies skin test annually.
  • Incubation period 412 weeks.

103
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Tuberculosis (TB)
  • Development of disease 612 months after
    infection.
  • Reactivation in extrapulmonary sites (lymph
    nodes, pleura, pericardium) more common in
    HIV-infected persons.
  • Known to lead to subacute meningitis and
    granulomas in brain.

104
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Tuberculosis (TB)
  • Symptoms chills, fever, fatigue, productive or
    nonproductive chronic cough, weight loss, night
    sweats.
  • Hemoptysis (expectorating blood) very suggestive
    of active TB.

105
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Tuberculosis (TB)
  • Protecting yourself from M. tuberculosis
    important step in preventing disease
    transmission.
  • Risk of transmission increases if close and
    prolonged contact with patient.

106
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Tuberculosis (TB)
  • Use appropriate respiratory precautions while
    performing cardiopulmonary respiration (CPR) and
    intubation.

107
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Tuberculosis (TB)
  • Don protective respirator on contact with
    patient.
  • N95 masks designed to prevent contaminated air
    from reaching health care workers wearing them.

108
NIOSH/OSHA standards call for N95 masks when
caring for patients with tuberculosis.
109
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Tuberculosis (TB)
  • Ventilation systems in selected ambulances
    recycle and filter air to ensure expulsion of
    infected droplet.
  • Early identification of exposure and drug
    prophylaxis keys to preventing active TB in
    health care workers.

110
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Pneumonia
  • Acute lung inflammation not single disease but
    family of diseases result from respiratory
    infection by viruses, bacteria, fungi.
  • Spread by droplet nuclei, direct contact, linens
    soiled with respiratory secretions.

111
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Pneumonia
  • Always consider possibility of community-acquired
    pneumonia.
  • Signs and symptoms acute onset of chills,
    high-grade fever, dyspnea, pleuritic chest pain
    worsened by deep inspiration, productive cough
    with phlegm of various colors.

112
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Pneumonia
  • In children, fever, tachypnea, retractions
    ominous signs but not specific to pneumonia.
  • Triad of signs indicates respiratory distress
    secondary to infectious process in pediatric
    patients.

113
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Pneumonia
  • Support adequate ventilation and oxygenation.
  • Supplemental oxygen administered to correct
    hypoxia.
  • Consider TB possibility in patient with
    pneumonia place mask on yourself or patient.

114
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Pneumonia
  • Vaccination exists against most serotypes of S.
    pneumoniae.
  • Highly recommended for children 2 years and
    younger, adults over 65, those without spleens
    EMS workers not necessary.

115
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Severe acute respiratory syndrome (SARS)
  • Viral respiratory illness SARS-associated
    coronavirus (SARS-CoV).
  • Spread by close person-to-person contact via
    respiratory droplets touching contaminated
    object.

116
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Severe acute respiratory syndrome (SARS)
  • Incubation period 2 to 14 days.
  • Considered contagious as long as he has symptoms.
  • Quarantined to home for 10 days after fever
    abated and symptoms cleared.

117
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Severe acute respiratory syndrome (SARS)
  • All personnel should use PPE on every call or as
    directed by local health authorities.
  • Altered mental status, one- to two-word speech
    dyspnea, cough, cyanosis, hypoxia.

118
Severe acute respiratory syndrome (SARS) is a
viral respiratory illness that first appeared in
China in November 2002.
119
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Severe acute respiratory syndrome (SARS)
  • Sore throat, rhinorrhea, chills, rigors,
    myalgias, headache, diarrhea, cough, sputum
    production, respiratory distress, respiratory
    failure.
  • Administer oxygen to correct hypoxia.

120
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Severe acute respiratory syndrome (SARS)
  • Provide ventilatory assistance.
  • Establish IV access administer fluids.
  • If wheezing, consider administering nebulized
    bronchodilator.
  • Notify hospital if you suspect SARS.

121
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Chickenpox (Varicella)
  • Caused by varicella zoster virus (VZV)
    herpesvirus family.
  • Much more lethal in adults.
  • Infectious agent of shingles (herpes zoster)
    painful condition skin lesions along course of
    peripheral nerves and dermatome bands.

122
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Chickenpox (Varicella)
  • Respiratory symptoms, malaise, low-grade fever
    rash on face and trunk and progresses to rest of
    body, including mucous membranes.
  • Rupture, forming small ulcers scab over within 1
    week.

123
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Chickenpox (Varicella)
  • Transmission inhalation of airborne droplets
    direct contact with weeping lesions and tainted
    linen.
  • Incubation period 10 to 21 days.
  • In adults, common complication is varicella
    zoster virus (VZV) pneumonia.

124
Varicella (chickenpox). (Centers for Disease
Control/Joe Miller)
125
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Chickenpox (Varicella)
  • Important for unexposed or unvaccinated
    paramedics to be immunized.
  • Most people develop immunity for life after
    recovery from childhood chickenpox infections.
  • Chickenpox vaccine Varivax.

126
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Chickenpox (Varicella)
  • Observe Standard Precautions.
  • If patient only has chickenpox, remain home until
    lesions crusted and dry.
  • If susceptible paramedic exposed to chickenpox,
    postexposure vaccination may be warranted.

127
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Meningitis
  • Inflammation of meninges and cerebrospinal fluid
    caused by bacterial and viral infections.
  • Meningococcal meningitis (spinal meningitis)
    disease variant of greatest concern to EMS
    responders.

128
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Meningitis
  • Vaccines proven effective, especially in
    children.
  • Enteroviruses 90 of patients with viral
    (aseptic) meningitis.
  • Transmitted by respiratory droplets peaks in
    midwinter months with low temperature and
    humidity.

129
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Meningitis
  • For EMS responder, contact with secretions during
    mouth-to-mask ventilation, intubation, suctioning
    increases probability of transmission.
  • Incubation period 2 to 10 days.

130
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Meningitis
  • Fever, chills, headache, nuchal rigidity with
    flexion, arthralgia, lethargy, malaise, altered
    mental status, vomiting, seizures.
  • Rash may appear develop into hemorrhagic spots,
    or petechiae.

131
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Meningitis
  • Fever in newborns evaluated with high index of
    suspicion for meningococcemia.
  • Brudzinski's sign flexion of hips or knees when
    neck flexed considered positive finding
    suggestive of meningitis.

132
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Meningitis
  • Kernig's sign inability to fully extend knee due
    to meningeal irritation positive sign.
  • Effective vaccine developed against A, C, Y,
    W-135 serotypes.

133
Specific Infectious Diseases
  • Diseases of Immediate Concern to EMS Providers
  • Meningitis
  • Observe Standard Precautions.
  • Use masks on yourself and/or patients adequately
    protect yourself against all infectious agents of
    meningitis.
  • Postexposure prophylaxis primary means of
    preventing meningococcal disease in patients with
    significant exposures.

134
Specific Infectious Diseases
  • Other Job-Related Airborne Diseases
  • Influenza and colds, rubella, measles, mumps,
    respiratory syncytial virus (RSV) viral
    infections.
  • Pertussis highly contagious bacterial disease
    poses risk.
  • Transmitted by direct inhalation of infected
    droplets or exposed mucosal surfaces.

135
Specific Infectious Diseases
  • Other Job-Related Airborne Diseases
  • Influenza
  • Caused by viruses types A, B, C.
  • Identified on basis of where they were isolated,
    culture number, year of isolation.
  • Leading cause of respiratory disease worldwide
    various strains cause epidemics.

136
Specific Infectious Diseases
  • Other Job-Related Airborne Diseases
  • Influenza
  • Easily transmittable in crowded spaces.
  • High potential for transmission by
    autoinoculation.
  • Sudden onset of fever, chills, malaise, muscle
    aches, nasal discharge, cough.
  • More serious in very young, very old, and those
    with underlying disease.

137
Specific Infectious Diseases
  • Other Job-Related Airborne Diseases
  • Influenza
  • Incubation period1 to 3 days.
  • Fever 3 to 5 days.
  • Severe cases pneumonia, hemorrhagic bronchitis,
    death.
  • Determine hydration status early begin fluid
    replacement if indicated.
  • Everyone susceptible to influenza.

138
Specific Infectious Diseases
  • Other Job-Related Airborne Diseases
  • Influenza
  • Influenza viruses mutate so rapidly that
    protection effective only against particular
    strain or variant.
  • CDC recommends vaccination for EMS personnel.

139
Specific Infectious Diseases
  • Other Job-Related Airborne Diseases
  • Common cold (viral rhinitis)
  • Caused by rhinoviruses more than 100 serotypes.
  • Transmission direct contact, airborne droplets,
    hands and linen soiled with discharges from
    infected individuals.
  • Course mild, often without fever and muscle
    aching.

140
Specific Infectious Diseases
  • Other Job-Related Airborne Diseases
  • Avian influenza
  • Some avian viruses mutate or merge with human
    influenza virus to form virus that can infect
    humans.
  • Most human infections in those who worked with
    poultry or lived around domestic birds.
  • H5N1 virus called "bird flu" particularly
    pathogenic.

141
Specific Infectious Diseases
  • Other Job-Related Airborne Diseases
  • Avian influenza
  • Tends to affect younger people high mortality
    rate.
  • Vaccine available.
  • Influenza-like symptoms, pneumonia, acute
    respiratory distress, viral pneumonia, severe and
    life-threatening complications.

142
Specific Infectious Diseases
  • Other Job-Related Airborne Diseases
  • Measles (rubeola, hard measles)
  • Systemic disease caused by measles virus highly
    communicable.
  • Immunity following disease is lifelong.
  • Transmitted by inhalation of infective droplets
    and direct contact.
  • Incubation period 7 to 14 days.

143
Specific Infectious Diseases
  • Other Job-Related Airborne Diseases
  • Measles (rubeola, hard measles)
  • Fever, conjunctivitis, swelling of eyelids,
    photophobia, malaise, cough, nasopharyngeal
    congestion.
  • Fever increases, rising to as high as 104?106?F,
    when rash reaches its maximum.

144
Specific Infectious Diseases
  • Other Job-Related Airborne Diseases
  • Measles (rubeola, hard measles)
  • Before rash develops, Koplik's spots appear on
    oral mucosa.
  • Everyone should be immunized.
  • Immunization 99 effective in children
    vaccination mandatory.
  • Postexposure hand washing is critical.
  • Life-threatening sequela encephalitis.

145
Specific Infectious Diseases
  • Other Job-Related Airborne Diseases
  • Mumps
  • Virus transmitted through respiratory droplets
    and direct contact with saliva of infected
    patients.
  • Characterized by painful enlargement of salivary
    glands.
  • Most cases occur in 5- to 15-year age group 12-
    to 25-day incubation period.

146
Specific Infectious Diseases
  • Other Job-Related Airborne Diseases
  • Mumps
  • Occurs in epidemics lifelong immunity conferred
    after infection.
  • Generally benign and self-limiting.
  • Mumps live-virus vaccine available administered
    with measles and rubella vaccines to children
    over 1 year of age.
  • Mumps easily transmitted.

147
Specific Infectious Diseases
  • Other Job-Related Airborne Diseases
  • Rubella (German measles)
  • Systemic viral disease caused by rubella virus
    transmitted by inhalation of infective droplets.
  • Sore throat and low-grade fever, accompanied by
    fine pink rash on face, trunk, extremities lasts
    about 3 days.

148
Specific Infectious Diseases
  • Other Job-Related Airborne Diseases
  • Rubella (German measles)
  • Incubation period 1219 days.
  • Natural infection conferring lifelong immunity,
    as does immunization.
  • No specific treatment.
  • Devastating to developing fetus mothers infected
    during first trimester at risk for abnormal fetal
    development.

149
Specific Infectious Diseases
  • Other Job-Related Airborne Diseases
  • Rubella (German measles)
  • All females should be immunized against rubella
    before becoming pregnant.
  • Vaccines for measles, mumps, rubella (MMR
    vaccination) given safely with varicella
    vaccine.

150
Specific Infectious Diseases
  • Other Job-Related Airborne Diseases
  • Rubella (German measles)
  • Immunization 9899 effective.
  • Not recommended for pregnant women.
  • EMS providers required to receive MMR vaccination
    before being allowed to work.

151
Specific Infectious Diseases
  • Other Job-Related Airborne Diseases
  • Respiratory syncytial virus (RSV)
  • Cause of pneumonia and bronchiolitis in infants
    and young children.
  • In this age group, RSV may be fatal.
  • Associated with outbreaks of lower respiratory
    infections.
  • If patient with pneumonia or bronchitis
    simultaneously contracts virus, disease becomes
    more severe.

152
Specific Infectious Diseases
  • Other Job-Related Airborne Diseases
  • Respiratory syncytial virus (RSV)
  • Wheezing, tachypnea, respiratory distress.
  • Diagnosed by rapid assay using nasal washings.
  • High-risk children can be treated with antiviral
    agent ribavirin (Virazole).
  • Treatment expensive poses risk to unborn babies.

153
Specific Infectious Diseases
  • Other Job-Related Airborne Diseases
  • Pertussis (whooping cough)
  • Caused by bacterium affects oropharynx in three
    phases incubation 6 to 20 days.
  • Develops mild cough quickly becomes severe and
    violent.
  • Rapid consecutive coughs followed by deep,
    high-pitched inspiration ("whoop").

154
Specific Infectious Diseases
  • Other Job-Related Airborne Diseases
  • Pertussis (whooping cough)
  • Large amounts of thick mucus sustained coughing
    may lead to increased intracranial pressure and
    intracerebral hemorrhage.
  • Vaccination of children diphtheria-tetanus-pertus
    sis (DTP).

155
Specific Infectious Diseases
  • Other Job-Related Airborne Diseases
  • Pertussis (whooping cough)
  • Disease likely to confer immunity.
  • Previously immunized and exposed
    adolescents/adults may be at risk of infection.
  • Anticipate intubation for patients with
    respiratory failure.
  • Highly contagious.

156
Specific Infectious Diseases
  • Other Job-Related Airborne Diseases
  • Pertussis (whooping cough)
  • Transmission respiratory secretions or
    aerosolized form.
  • Mask patient observe Standard Precautions
    postexposure hand washing.
  • Everyone susceptible to B. pertussis infection.

157
Specific Infectious Diseases
  • Viral Diseases Transmitted by Contact
  • Mononucleosis
  • Caused by Epstein-Barr virus (EBV).
  • Affects oropharynx, tonsils, reticuloendothelial
    system.
  • 4- to 6-week incubation period begins with
    fatigue.
  • Fever, severe sore throat, oral dischar
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