tuberculosis question
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DesertMedic66
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Treatment wise or safety wise?
treatment wise..all i really can find is just have patient wear a pr mask and have good ventilation in ambulance
DesertMedic66
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There isn't much to do. If their vitals are stable then it's just position of comfort and a nice transport to the hospital (call early for the hospital, they may need to place the patient in a special room). If their vitals are unstable treat accordingly. Low SpO2 and correlating skin signs then you should probably place the patient on some O2.
ok thanks for the info ill probably be on here alot asking questions for stuff i cant find on my own or dont know yet and i cant think of anyone better to ask than those on the job with experience
mycrofft
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Health care providers have what's called "standard precautions". If someone is coughing we remind them to cover with their elbow and we put on a mask. If someone is bleeding or leaking snot or blood or anything else we always wear gloves, but we can and do put on disposable gowns and maybe goggles. If they are infectious, we might also put a gown on them as well as a mask.
We also wash our hands very well. A lot.
Health care providers also need to get TB tests at a certain frequency.
Many people are exposed to TB and develop some antibodies, but not many in America go on to develop the full blown disease compared to other countries sphere the bacteria has become more resistant to treatment. That means tho will be around people with the germ on board but by practicing standard precautions, you can keep pretty safe from most infections.
We also wash our hands very well. A lot.
Health care providers also need to get TB tests at a certain frequency.
Many people are exposed to TB and develop some antibodies, but not many in America go on to develop the full blown disease compared to other countries sphere the bacteria has become more resistant to treatment. That means tho will be around people with the germ on board but by practicing standard precautions, you can keep pretty safe from most infections.
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We're supposed to get TB tests every 6 months. It kinds sorta happens. More like yearly. Patients get one chance to cover their mouth when they cough otherwise they're wearing a mask. If I think you're TB positive we're both wearing a mask as well, no questions asked.
ThadeusJ
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If they require oxygen therapy, you could try nasal cannula with a mask over top. Higher levels of oxygen are possible using one of several masks that offer filtration. Since the SARS outbreak, they are standard issue in Ontario, Canada paramedic kits. They are not meant to replace your PPE, but are used as an extra layer of containment of respiratory borne pathogens.
As has been said, treatment-wise, give supportive treatment, including 02 as required, but make sure to call ahead as far as possible so the ER can get a negative pressure room ready (Including transferring a pt out of a negative pressure room if needed, since they're usually just used as regular rooms.)
Safety wise, every ambulance I've ever worked on (In the US), including the poorly equipped service I work for now, has at least 3 N95 masks (Not to be confused with surgical masks) on the rig, one for your partner, one for you and one for your pt (Remember, it's not just about keeping you and your partner safe, it's about keeping everyone in the hallway safe, too.). Supposedly N95 is effective against TB (I don't actually have any evidence to the contrary, I'm just suspect of anyone who tells me "This product will protect you!").
If you have a pt who you suspect of TB, and you feel they need high-flow O2, you won't have any real luck with throwing a NRB over a N95, the constriction of gas flow and the non-conformity of the masks will be too high, you'll need to throw a nasal cannula under the N95, but not up the nares, and crank it up high. You won't have a reservoir bag, which will limit the O2 delivered to the lungs, but it's better than nothing, and you'll sacrifice some of the seal on the N95, and with positive pressure to boot, you might want to seal around the tubing with some tape, but it's your best compromise.
All that being said, I've had exactly one pt in my career I went ahead and called suspected TB on, he was a nursing home pick up, complaining of coughing x 3 days, sitting in the middle of the TV room (Of course), and when I asked him, he said he was bringing up frank blood (I never saw it myself.) and that he had a hx of TB. Apparently within about 15 minutes of my getting him to the ER, they cleared him. (They also wondered what was keeping me it seems, since I called the very moment I heard about the blood and hx, rather than waiting until I actually was on the road.) As far as I'm concerned, I would rather cry wolf 100 times rather than miss crying the real deal once.
Safety wise, every ambulance I've ever worked on (In the US), including the poorly equipped service I work for now, has at least 3 N95 masks (Not to be confused with surgical masks) on the rig, one for your partner, one for you and one for your pt (Remember, it's not just about keeping you and your partner safe, it's about keeping everyone in the hallway safe, too.). Supposedly N95 is effective against TB (I don't actually have any evidence to the contrary, I'm just suspect of anyone who tells me "This product will protect you!").
If you have a pt who you suspect of TB, and you feel they need high-flow O2, you won't have any real luck with throwing a NRB over a N95, the constriction of gas flow and the non-conformity of the masks will be too high, you'll need to throw a nasal cannula under the N95, but not up the nares, and crank it up high. You won't have a reservoir bag, which will limit the O2 delivered to the lungs, but it's better than nothing, and you'll sacrifice some of the seal on the N95, and with positive pressure to boot, you might want to seal around the tubing with some tape, but it's your best compromise.
All that being said, I've had exactly one pt in my career I went ahead and called suspected TB on, he was a nursing home pick up, complaining of coughing x 3 days, sitting in the middle of the TV room (Of course), and when I asked him, he said he was bringing up frank blood (I never saw it myself.) and that he had a hx of TB. Apparently within about 15 minutes of my getting him to the ER, they cleared him. (They also wondered what was keeping me it seems, since I called the very moment I heard about the blood and hx, rather than waiting until I actually was on the road.) As far as I'm concerned, I would rather cry wolf 100 times rather than miss crying the real deal once.
NomadicMedic
I know a guy who knows a guy.
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N95 masks are for the providers, not the patients. If you to need to mask your patient for droplet prevention, a surgical mask or NRB, if indicated, is just fine.
ThadeusJ
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DEmedic is correct in that N95 are designed to protect the wearer, not the other way around. Because of the high work of breathing associated with them, there are concerns about patient use. Post SARS research discovered that wearing up to 5 layers of surgical masks had limited effect against smaller particles. NRB's by themselves have minimal infection control properties for respiratory particles. In fact, they have been associated with contributing to the spread of potentially contagious particles due t the continuous gas flow and open exhalation ports. TB particles are droplet borne and therefore larger, however I wouldn't bet money that they would protect against the spread.