Hemorrhagic Fevers for Certified Emergency Nursing (CEN)

Hemorrhagic Fevers

Definition/Etiology:

Viral hemorrhagic fevers (VHFs) are a group of illnesses caused by four families of viruses. These include the Ebola and Marburg, Lassa fever, and yellow fever viruses. VHFs have common features: they affect many organs, they damage the blood vessels, and they affect the body’s ability to regulate itself. Some VHFs cause mild disease, but some, like Ebola or Marburg, cause severe disease and death.

Pathophysiology:

Ebola virus infects at a mucosal surface and infects macrophages and dendritic cells which migrate to lymph nodes. The infection suppresses innate and adaptive immune responses, allowing the virus to disseminate systemically. This systemic spread leads to damage in a variety of tissues, excessive cytokine responses, vascular leakage and disseminated intravascular coagulation. So basically, these are bad bugs that turn your blood to sludge.

Clinical Presentation:

Primary signs and symptoms of Ebola often include some or several of the following:

• Fever

• Aches and pains, such as severe headache and muscle and joint pain

• Weakness and fatigue

• Sore throat

• Loss of appetite

• Gastrointestinal symptoms including abdominal pain, diarrhea, and vomiting

• Unexplained hemorrhaging, bleeding or bruising

Other symptoms may include red eyes, skin rash, and hiccups (late-stage). If patients present in respiratory distress with suspicion of a HF, chances of survival are very low.

Collaborative Management:

the most important factor here is your personal safety. This is a full Haz-mat, space suit PPE situation. For those that were nurses during the Ebola outbreak in 2016, you may remember the drills we did. That being said, we are going to test. Basic labs, cultures, lactate. These patients may present similarly to a flu or septic patient, and we will treat accordingly. Unfortunately for HF, the primary treatment at this time is supportive care.

Evaluation | Patient Monitoring | Education:

Honestly, if this is a true hemorrhagic fever, the best evaluation is whether they are alive or not. If the progression is not that bad, then our evaluations are as always… our ABCs.

Cardiac monitoring, O2, ventilator management if we have gotten to that point. If there is a confirmed HF, the most important factor is isolation and the safety of the staff and the patient.

Linchpins: (Key Points)

• Safety first
• Supportive care
• Identification