ISSN-1059-6518
Volume 28 Number 1
By Frank Hubbell, DO
The reason for this article is simple: there is currently an outbreak of a highly contagious viral illness – measles. This epidemic has been going on for the past several months, with over 80 cases being reported in more than 14 states.
Measles Case Study:
You are with a local ambulance squad and are asked to transport a 4yo child to the local emergency department who reportedly has a fever, chills, cough, and lethargy.
Upon arrival at the home, you are presented with a child who appears sick. She has a rash on her face and neck, conjunctivitis, and a runny nose, is feverish, and has a cough. Mom states that her daughter has been sick for the past several days, but seems to be getting worse. She developed the rash overnight.
S: SUBJECTIVE:
4yo female, whose mom states has been sick for 4 days and is getting worse. She is c/o a sore throat, cough, runny nose, fever, and conjunctivitis.
O: OBJECTIVE:
Vital Signs:
LOC: A & O x 3
RR & Effort: 20 and not labored
HR: 96 and regular
BP: 104/72
SCTM: + for a rash on her face and neck, feverish, and moist
Physical Exam:
Skin is + for erythematous macules on her face and neck
Eyes + for erythematous conjunctiva with mucopurulent material on the lashes
Throat is + for erythema with whitish spots on the buccal mucosa next to the back molars
Lungs + for crackles; she has a wet cough with deep breathing
Heart – RRR without murmur
Abdomen is + for bowel sounds, soft, and non-tender
You can see images of Measles rash at the CDC website.
AMPLE HX:
A: NKDA
M: ibuprofen and Tylenol for the fever
P: none; mom denies any childhood immunizations
L: light dinner last night
E: home from school sick
A: ASSESSMENT
Viral exanthem – measles
P: PLAN
Rest, liquids, supportive care
Quarantine to minimize spread
Receive recommended childhood immunizations
MEASLES:
Measles is one of the leading causes of death in children worldwide.
Worldwide: 2013 – 145,700 deaths (down from millions prior to vaccinations)
USA: 2014 – 644 cases reported in 27 states
2015 – so far, >80 cases in 14 states
It is caused by a virus: Paramyxovirus, Morbillivirus.
Transmission is via airborne/droplet-spread.
Incubation: 10 – 12 days
Signs and Symptoms of Measles:
Fever – lasts 4 – 7 days
Coryza (runny nose)
Cough
Conjunctivitis (red, goopy eyes)
Koplik’s spots – white spots on the buccal mucosa (short-lived) next to the back molars
Rash – starts on the face and neck, then speads to the trunk and extremities
4 D’s and 3 C’s ⇒ 4 Days with the 3 C’s – Cough, Coryza, and Conjunctivitis before the rash occurs.
Read more
Life-Threatening Tick-borne Disease
/in Bites and Stings, Lyme disease, Tick bites, Uncategorized/by WMN EditorsISSN-1059-6518
Volume 28 Number 2
POWASSAN VIRUS
By Frank Hubbell, DO
Illustrations by T.B.R. Walsh
Powassan virus is an arbovirus, Read more
Chechen, Chaca and a Mayan Legend
/in Allergies, Blisters, Burns, Environemtal Injuries, Poisons, Uncategorized/by WMN EditorsISSN-1059-6518
Volume 28 Number 2
Chechen, Chaca and a Mayan Legend
By Jeff Toorish NREMT-P, WEMT, GeoMEDIC, I/C –A SOLO Instructor
The Chechen tree is native to various jungle areas on Mexico with a prized wood that has been compared to teak. It can also be found in other parts of Central America, the Caribbean and the West Indies. The wood itself has a range of colors with contrasting streaks and presents with a slightly oily sheen. It takes a bit of work to refine it but it is highly rot resistant and extremely durable. It is also called Black Poison Wood, among other things, and that is the problem.
As its nickname suggests, Chechen (Metopium Brownie or Metopium Toxiferum of the family Anacardiaceae) can cause skin irritation and even the potential for an anaphylactic reaction in some people. Chechen is so toxic that its dark, runny sap can actually cause second degree burns and painful blisters lasting for weeks or longer.
Often the rash from Chechen doesn’t manifest for days or even weeks later. For tourists this presents a real difficulty because the treatment for Chechen poisoning is the Chaca (Gumbo Limba) Tree, which is only found near the Chechen tree.
The Legend of Two Brothers
And that brings us to the Mayan legend of two brothers who were both great warriors but very different in other ways. Kinich, the younger brother was much loved for his kindness and mercy. In contrast, the older brother, Tizic, had a heart full of hate. Then they met a beautiful Mayan princess named Nicte-Ha. She was so kind she melted Tizic’s heart, making him see the goodness in the world.
The brothers both wanted to wed Nicte-ha so they agreed to fight an epic battle for her love; a battle the likes of which had never before been seen in heaven or earth. The gods were not pleased about all this and colored the sky with dark clouds. The moon hid for many nights and the earth itself turned away.
In the end, the brothers both died in the arms of each other and were transported to the underworld where they realized the humiliating folly of their actions. They begged the gods to let them return to earth to once again see their beloved Nicte-Ha.
The gods agreed, returning the brothers to the world of the living. Tizic, because of this nature became Chechen, the Black Poison Wood Tree with the dark sap that burns and hurts. Kinich became the Chaca Tree with the white sap that heals the pain. That is why both trees are always found near each other.
Read more
The Clinical Pharmacy in a Disaster or Austere Environment
/in Disaster Response, Medical Response, Medications, Natural Disater, Treatment/by WMN EditorsISSN-1059-6518
The PRINCIPLES of CLINIC DESIGN in the DISASTER ENVIRONMENT
“THE PHARMACY”
The Principles of a Clinic Design in a Disaster or Austere Environment:
By Frank Hubbell, DO
Finding a workable and safe space to erect the clinic.
Having the supplies: ropes, tarps, cots, chairs, as well as medical equipment and medications.
Establishing security for the clinic and clinic personnel.
When creating and building the clinic, keep in mind that the area has to be clean, free of debris, dry, bug-free, able to provide shade and privacy.
Required areas include:
– Reception and waiting areas with shade, seating, water, and possibly music.
– Bathrooms
– Examination rooms with privacy, a chair, and cot for the patient to lie on.
– A pharmacy area for the dispensing of medications, education, and expectations.
Basic Clinic Design for a post Disaster or Austere Environment
THE PHARMACY:
Is the last stop on the way out of the clinic area.
Needs table and chairs, so the person running the pharmacy can spend time educating the patient.
Needs the essential medications that are going to be prescribed to the patients.
Setting up a Pharmacy in Haiti after the earthquake
THE PHARMACY
In this article we will focus of the pharmacy portion of the clinic.
Read more
MEASLES – Rubeola, morbilli, English Measles
/in Measles, Rash/by WMN EditorsISSN-1059-6518
Volume 28 Number 1
By Frank Hubbell, DO
The reason for this article is simple: there is currently an outbreak of a highly contagious viral illness – measles. This epidemic has been going on for the past several months, with over 80 cases being reported in more than 14 states.
Measles Case Study:
You are with a local ambulance squad and are asked to transport a 4yo child to the local emergency department who reportedly has a fever, chills, cough, and lethargy.
Upon arrival at the home, you are presented with a child who appears sick. She has a rash on her face and neck, conjunctivitis, and a runny nose, is feverish, and has a cough. Mom states that her daughter has been sick for the past several days, but seems to be getting worse. She developed the rash overnight.
S: SUBJECTIVE:
4yo female, whose mom states has been sick for 4 days and is getting worse. She is c/o a sore throat, cough, runny nose, fever, and conjunctivitis.
O: OBJECTIVE:
Vital Signs:
LOC: A & O x 3
RR & Effort: 20 and not labored
HR: 96 and regular
BP: 104/72
SCTM: + for a rash on her face and neck, feverish, and moist
Physical Exam:
Skin is + for erythematous macules on her face and neck
Eyes + for erythematous conjunctiva with mucopurulent material on the lashes
Throat is + for erythema with whitish spots on the buccal mucosa next to the back molars
Lungs + for crackles; she has a wet cough with deep breathing
Heart – RRR without murmur
Abdomen is + for bowel sounds, soft, and non-tender
You can see images of Measles rash at the CDC website.
AMPLE HX:
A: NKDA
M: ibuprofen and Tylenol for the fever
P: none; mom denies any childhood immunizations
L: light dinner last night
E: home from school sick
A: ASSESSMENT
Viral exanthem – measles
P: PLAN
Rest, liquids, supportive care
Quarantine to minimize spread
Receive recommended childhood immunizations
MEASLES:
Measles is one of the leading causes of death in children worldwide.
Worldwide: 2013 – 145,700 deaths (down from millions prior to vaccinations)
USA: 2014 – 644 cases reported in 27 states
2015 – so far, >80 cases in 14 states
It is caused by a virus: Paramyxovirus, Morbillivirus.
Transmission is via airborne/droplet-spread.
Incubation: 10 – 12 days
Signs and Symptoms of Measles:
Fever – lasts 4 – 7 days
Coryza (runny nose)
Cough
Conjunctivitis (red, goopy eyes)
Koplik’s spots – white spots on the buccal mucosa (short-lived) next to the back molars
Rash – starts on the face and neck, then speads to the trunk and extremities
4 D’s and 3 C’s ⇒ 4 Days with the 3 C’s – Cough, Coryza, and Conjunctivitis before the rash occurs.
Read more