Severe Febrile Respiratory Illnesses As a Cause of Mass Critical Care

Febrile respiratory illnesses with respiratory failure are one of the most common reasons for admission to the intensive care unit. Most causes of febrile respiratory illness are bacterial and viral agents of community-acquired pneumonia. However, a small number of rare and higly contagious agents can initially present as febrile respiratory illnesses, which can lead to an epidemic that can greatly impact the health care system. This impact includes sustained mass critical care, with potential scarcity of critical resources (eg, positive-pressure ventialtors), spread of disease to health care workers, sustained spread within the community, and extensive morbidity and mortality. The main agents of febrile respiratory illness that would lead to an epidemic include influenza, the coronavirus that causes severe acute respiratory syndrome, smallpox, viral hemorragic fever, plague, tularemia, and anthrax. Recognition of these agents ocuurs largely based on epidemiological clues, and management consistis of antibiotics, antivirals, supportive care, and positive-pressure ventilation. Acute respiratory failure and acute respiratory distress syndrome occur with these agents, so a lung-protective (low tidal volume) ventilation strategy is indicated. Additional respiratory care measures, such as nebullized medications, bronchoscopy, humidified oxygen, and airway suctioning, potentiate aerosolization of the virus or bacteria and increase the risk of transmission to health care workers and patients. Thus, appropiate personal protective equipment, including an N95 mask or powered air-purifying respirator, is indicated. A basic understanding of the epidemiology, clinical findings, diagnosis, and treatment of these agents will provide a foundation for early isolation, evaluation, infection control, and public health involvement and response in cases of a febrile respiratory illness that causes respiratory failure. (AU)

The 1987= mil novecientos ochenta y siete forest fire disaster in California : Assessment of emergency room visits

During a 5-d period that commenced on August 30, 1987, dry lightning strikes ignited more than 1500 fires that destroyed in excess of 600000 acres of California forests. To evaluate the public health impact of the smoke on the general population, all hospital emergency rooms located in the six counties most sevely sffected by smoke or fire were surveyed. Selected hospital information was abstracted for a 2 1/2-wk period during the fires and during two reference periodds. During the period of major forest fire activity, visits of persons with asthma and chronic obstructive pulmonary disease increased in number (observed/expected ratios of 1.4 and 1.3, respectively), as did visits of persons with sinusitis, upper respiratoey infections, and laryngitis. A few patients with acute respiratory or eye irritation also visited the emergency rooms. Even recognizing the limited sensitivity of emergency room surveys, the overall public health impact was relatively modest. The increased respiratory moribidity detected in this survey, however, supports the notion that persons with pre-existing respiratory disease represent a sensitive subpopulation, who should be targeted for purposes of public health intervention when exposure to forest fire smoke is likely.(AU)

A four - year prospective study of the respiratory effects of Volcanic ash from Mt. St. Helens

This report describes the 4-yr follow-up of 712 loggers exposed over an extended period to varying levels of fresh volcanic ash from the 1980 eruptions of Mt. St. Helens. Our findings are consistent with the hypothesis that the inhaled ash caused mucus hypersecretion and/or airway inflammation that reversed when the exposure levels decreased. The ash levels to which the loggers were exposed were low compared with permissible occupational levels for nuisance dusts, but generally higher than the total suspended particulate levels permissable in ambient air

Inhalation studies of Mt. St. Helens volcanic ash in animals : Respiratory mechanics, airway reactivity and deposition

This study was conducted to improve speculation of changes in breathing which might be expected while inhaling a dust like Mt. St. Helens volcanic ash. Effects of fine volcanic ash aerosol on pulmonary mechanical properties of awake Guinea pigs were evaluated during exposure by in halation. Ash penetration into the lung as well as tissue response to ash were determinated by transmission electron mycroscopy. The reactivity of airway epithelial irritant receptors following ash exposure was assessed using a histamine bronchoprovocation test. Airways of Guinea pigs exposed to ash were significantly less responsible to histamine tan were the airways of animals exposed only to air (AU)

Assessment of respiratory hazards associated with air pollutants from volcanic eruptions, Kilauea Volcano, Hawaii, Hawaii

The most recent series of eruptions of Kilauea Volcano, Hawaii, Hawaii, began on January 3, 1983, and has continued to the present, Causing potentially hazardous human exposures to lava flows and volcanic gases, primarily sulfur dioxide (so2). A retrospective study of the records of outpatient visits and hospital admissions revealed no evidence for excessive mortality or clinically significant respiratory morbidity due to noncommunicable chronic respiratory diseases (NCRD'S) in the first 2 weeks of Kilauea's January 1983 eruptions compared with the 2 weeks before the onset of that volcanic activity. This investigation provided an opportunity for centers for disease control representatives and local health officials to develop epidemiological approaches for recognizing, Evaluating, and preventing hazardous exposures to volcanic and other non occupational air pollutants (AU)

Interaction of Mount St. Helens' volcanic ash with cells of the respiratory epithelium

Respirable-sized dust from the Mount St. Helens (MSH) eruption of spring 1980, and minerals similar to the major components of the volcanic ash were examined comparatively for interactions with ephitelial cells of rodent respiratory airway in vitro. The results of these studies suggest that volcanic ash from MSH interacts minimally with cells of the respiratory mucosa

Health effects of Mount St. Helens Volcano : Task 01 : Life span inhalation exposures of rats to Mount St. Helens volcanic ash : Final report

The objectives of the study were to investigate biological effects of chronic inhalation exposure to volcanic ash in the ratas a funtion of dose and cumulative exposure in summary there was no marked regression of lesions in the subgroups withdrawn from exposure at various intervals exception of lymphoreticular proliferation, which regressed in quartz exposed rats volcanic ash retained in the lungs of the rats at sacrifice clearly reflected the two different dose levelsand cumulative exposure

Mount St. Helens eruptions : The acute respiratory effects of volcanic ash in a North American community

After the May 18, 1980 volcanic eruption of Mount St. Helens, increases were observed in the number of patients who, because of asthma or bronchitis, sought medical care at emergency rooms of major hospitals in areas of ashfall. An interview study of 39 asthma and 44 bronchitis patients who became sick during the 4 wk following the eruption and who attended the emergency rooms of two major hospitals in Yakima, Washington, and of healthy matched controls indicated that a history of asthma, and possibly of bronchitis, were risk factors for contracting respiratory problems. The interview study also indicated that the main exacerbating factor was the elevated level of airborne total suspended particulates (in excess of 30,000 ug/m3) after the eruption. An interview study of 97 patients who had chronic lung disease and who lived in the same area as the abovementioned patients, but who did not go to a hospital, showed that ashfall exacerbated the condition in about one-third of these. Emergency planners and their geologist advisers should be aware that special preventive measures are justified for people with a history of asthma or chronic lung disease who live in communities at risk to volcanic ashfalls (AU)