Ebola: WHO says death rate has increased to 70 per cent

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A woman wears protective clothing during a tour of one of the Ebola Centers in Harare, Zimbabwe Tuesday, Sept. 23, 2014. (AP / Tsvangirayi Mukwazhi)
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GENEVA — WHO says there could be up to 10,000 new cases of Ebola per week in 2 months.

GENEVA – A World Health Organization official says the death rate in the current Ebola outbreak has increased to 70 per cent.

WHO assistant director-general Dr. Bruce Aylward gave the figure during a news conference Tuesday.

Aylward said that the 70 per cent death rate was “a high mortality disease” in any circumstance and that the U.N. health agency was still focused on trying to get sick people isolated and provide treatment as early as possible.

Previously, WHO had said the death rate was around 50 per cent.

THIS IS A BREAKING NEWS UPDATE.

A World Health Organization official says there could be up to 10,000 new cases of Ebola per week within two months.

WHO assistant director-general Dr. Bruce Aylward says if the response to the Ebola crisis isn’t stepped up within 60 days, “a lot more people will die” and there will be a huge need on the ground to deal with the spiraling numbers of cases. He said WHO estimated there could up to 10,000 cases per week in two months.

Aylward said for the last four weeks, there have been about 1,000 new cases per week, though that figure includes suspected, confirmed and probable cases. He said WHO is aiming to have 70 per cent of cases isolated within two months to reverse the outbreak.

WHO increased its Ebola death toll tally to 4,447, nearly all of them in West Africa, and the group said the number of probable and suspected cases was 8,914.

Sierra Leone, Guinea and Liberia have been hardest hit. Aylward said WHO was very concerned about the continued spread of Ebola in the three countries’ capital cities —Freetown, Conakry and Monrovia. He noted that while certain areas were seeing cases decline, “that doesn’t mean they will get to zero.”

He said the agency was still focused on trying to treat Ebola patients, despite the huge demands on the broken health systems in West Africa.

“It would be horrifically unethical to say that we’re just going to isolate people,” he said, noting that new strategies like handing out protective equipment to families and setting up very basic clinics — without much treatment — was a priority.

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Role of N-Acetyl Cysteine in Acute liver failure

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21-hour regimen: Consists of 3 doses; total dose delivered: 300 mg/kg

Loading dose: 150 mg/kg (maximum: 15 g) infused over 60 minutes

Second dose: 50 mg/kg (maximum: 5 g) infused over 4 hours

Third dose: 100 mg/kg (maximum: 10 g)infused over 16 hours

21-hour regimen: Consists of 3 doses; total dose delivered: 300 mg/kg

Loading dose: 150 mg/kg (maximum: 15 g) infused over 60 minutes

Second dose: 50 mg/kg (maximum: 5 g) infused over 4 hours

Third dose: 100 mg/kg (maximum: 10 g)infused over 16 hours

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Dallas Ebola Patient Dies

DALLAS — Thomas Eric Duncan, 42, the patient with the first case of Ebola diagnosed in the United States and the Liberian man at the center of a widening public health scare, died in isolation at a hospital here on Wednesday, hospital authorities said.

Mr. Duncan died at 7:51 a.m. at Texas Health Presbyterian Hospital, more than a week after the virus was detected in him on Sept. 30. His condition had worsened in recent days to critical from serious as medical personnel worked to support his fluid and electrolyte levels, crucial to recovery in a disease that causes bleeding, vomiting and diarrhea. Mr. Duncan was also treated with an experimental antiviral drug, brincidofovir, after the Food and Drug Administration approved its use on an emergency basis.

“The past week has been an enormous test of our health system, but for one family it has been far more personal,” Dr. David Lakey, the commissioner of the Texas Department of State Health Services, said in a statement. “Today they lost a dear member of their family. They have our sincere condolences, and we are keeping them in our thoughts.”

The mayor of Dallas, Mike Rawlings, also offered some assurance to Dallas residents. “I remain confident in the abilities of our health care professionals and the medical advances here in the U.S.,” Mr. Rawlings said, “and reassure you we will stop the Ebola virus in its tracks from spreading into our community.”

After Mr. Duncan arrived at the Dallas/Fort Worth International Airport on Sept. 20, he set off a chain of events that raised questions about health officials’ preparedness to detect and contain the deadly virus. His case spread fear and anxiety among those he encountered, however briefly, and turned the places, vehicles and items he touched into biohazardous sites that were decontaminated, dismantled, stored or, in some cases, incinerated.

Mr. Duncan went to the airport in Liberia on Sept. 19 for his flight to the United States, landed in Dallas the next day and first went to the emergency room at Texas Health Presbyterian Hospital feeling ill on Sept. 25. He was released by the hospital, which had failed to view him as a potential Ebola case for reasons that remain unclear. He returned there and was admitted Sept. 28 after his condition worsened.

Mr. Duncan spent nearly two decades separated from the woman he had traveled to Dallas to be with, Louise Troh, 54, with whom he had a son. The couple were apparently rekindling their relationship. Yet in the last days of Mr. Duncan’s life, Mr. Duncan and Ms. Troh remained more apart than together. Each had been quarantined because of the risk of spreading Ebola, Mr. Duncan in virtually his own hospital ward and Ms. Troh in a four-bedroom home on a remote property that state health officials prohibited her, her 13-year-old son and two others from leaving, under threat of prosecution.

Mr. Duncan had been a driver at a cargo company in Monrovia, the Liberian capital, living alone in a small room he rented from the parents of Marthalene Williams, 19. A simple act of kindness probably exposed him to the virus that has killed more than 3,000 people in West Africa. In Monrovia, neighbors and Ms. Williams’s parents said Mr. Duncan helped the family take Ms. Williams to and from a hospital on Sept. 15, shortly before she died of Ebola. Some of the men and women who had direct contact with Ms. Williams, and who were also in contact with Mr. Duncan, have also died, including Ms. Williams’s brother, Sonny Boy Williams, 21.

Mr. Duncan helped carry her while she was sick with the virus and convulsing. The disease is contagious only if the infected person is experiencing active symptoms.

“He was holding her by the legs, the pa was holding her arms and Sonny Boy was holding her back,” said Arren Seyou, 31, who witnessed the scene and is a neighbor of Mr. Duncan.

Local, state and federal officials have expressed confidence that they have been able to limit the spread of the disease in Dallas and said that none of the people they were monitoring had shown any symptoms of Ebola.

Officials are monitoring 48 people in the Dallas area, most of whom have not been quarantined but are instead staying home while they are under observation. Ten of those are considered high risk, including seven health care workers and three relatives and community members who had contact with Mr. Duncan. The other 38 are considered low risk, and include people who may or may not have had direct or indirect contact with Mr. Duncan. One of those 38 is Michael Lively, a homeless man who rode in the ambulance that took Mr. Duncan to the hospital after the vehicle dropped Mr. Duncan off but before it was taken out of service and disinfected.

Mr. Lively briefly disappeared on Sunday before he was found by law enforcement officers, an indication of the unease being felt by some of those being monitored.

Source : NY Times

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CPR Guidelines – Adults

AHA CPR Guidelines 2010

NOTE: Sequence has changed from airway, breathing, chest compressions (ABC) to chest compressions, airway, breathing (CAB) per the 2010 AHA Guidelines

Untrained lay rescuers should do compression-only CPR; whereas, trained lay rescuers and healthcare providers (HCP) should include compressions and breathing

Compressions

check pulse at carotid
compression landmarks: lower half of sternum, between nipples
compression method: heel of one hand, other hand on top
compression depth: at least 2 inches (5 cm)allow complete chest recoil after each compression
compression rate: at least 100/min compression-ventilation ratio: 30:2 (1 or 2 rescuers)
minimize interruptions in compressions; limit interruptions to <10 seconds avoid excessive ventilation

Airway

head tilt-chin (HCP suspected trauma: use jaw thrust)

Breathing

ventilation with advanced airway: 1 breath every 6-8 seconds (8-10 breaths/min)
asynchronous with chest compressions
about 1 second per breath
visible chest rise

Defibrillation

attach and use AED as soon as available
minimize interruptions in chest compressions before and after shock
resume CPR beginning with compressions immediately after each shock