Spreading Emergency Medicine Across the Globe ..
emmedonline
Dr. Ajith Kumar J MD
Dept. of Emergency Medicne
Travancore Medicity, Kollam
India
editor
Middle East Respiratory Syndrome (MERS) is an illness caused by coronavirus MERS-CoV.
MERS primarily affects respiratory system.
Incubation Period : 2 – 14 days
Clinical Features
Fever, chills/rigors
Headache
non productive cough, dyspnea
Myalgia
Sore throat, coryza
Nausea, vomiting, diarrhea, abdominal pain
Patients can progress rapidly to respiratory failure, ARDS, refractory hypoxemia
Extrapulmonary complications including AKI, hepatic inflammation, septic shock has been reported.
CASE DEFINITIONS Patient under investigation
Confirmed Case
Probable Case
|
Investigations
Chest X-Ray
Unilateral or bilateral patchy densities or opacities
Interstitial infiltrates
Consolidation
Pleural effusions
Respiratory specimen
Nasal/Nasopharyngeal/ throat swabs from upper respiratory tract.
Sputum, endotracheal aspirate, bronchoalveolar lavage from lower respiratory tract.
Testing is done by RT-PCR.
Testing is done for Influenza A,B, RSV parainfluenza virus, rhinovirus, adenovirus, coronavirus.
Treatment
Oxygen
Give supplemental oxygen therapy to patients with signs of severe respiratory distress, hypoxaemia (Spo2 < 90%) or shock.
Fluid resuscitation
IV fluids should be used judiciously.
Aggressive fluid resuscitation may lead to respiratory impairement.
Steroids are not recommended. May used when patient requires multiple inotropic support.
ARDS
Consider NIV for mild ARDS.
In mechanically ventilated patients, lung protective strategy is used.
Tidal volume : 6 ml/kg predicted body weight.
Pplat < 30 cmH2O
PaO2 : 55 – 80 mmHg
Neuromuscular blockers and sedation is used for initial 48 hours.
Prone ventilation.
Recruitment maneuver and high PEEP improves oxygenation.
Prevention
Currently there is no vaccine.
All health care workers should use standard Personal Protective Equipment.
N95 mask should be used by the healthcare workers performing aerosol generating procedures.
CDC Recommends to
Wash your hands with soap and water for 20 seconds.
Covering nose and mouth with tissue while coughing or sneezing.
Avoid touching eye, nose and mouth with unwashed hands.
Avoid personal contact, such as kissing or sharing cups or eating utensils.
Clean and disinfect frequently touched surface.
Updated on 3/3/2015
Reference
Clinical Management of Severe Acute Respiratory Infections when novel coronavirus is suspected : What to do and what not to do. Interim Guidance Document. WHO.2013
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emmedonline
Dr. Ajith Kumar J MD
Dept. of Emergency Medicne
Travancore Medicity, Kollam
India
editor