Emergency Preparedness

Kern Medical Bioterrorism Response Guide Section 2-C-1 – Smallpox

Fluid and Electrolyte Balance During the vesicular and pustular stages of smallpox, patients may experience significant fluid losses and become hypovolemic or develop shock. Fluid loss results from fever, vomiting, decreased fluid intake due to pharyngeal lesions, fluid shifts from the vascular bed to subcutaneous tissue and massive skin desquamation in patients with extensive skin lesions. Fluid and electrolyte balance should be monitored and appropriate oral and intravenous fluids administered. Skin Care The skin should be kept clean with warm water or normal saline and efforts should be made to avoid rupturing the vesicles and pustules. No creams or slaves should be applied. Hemorrhage Minor hemorrhages, especially conjunctival occur commonly in smallpox patients and no specific therapy is recommended. If signs of more extensive hemorrhage are evident such as mucosal bleeding, bleeding into the lesions, ecchymosis, hematemesis, or hematuria the patient should be evaluated for disseminated intravascular coagulopathy (DIC) and treated appropriately. Patients with hemorrhagic smallpox have a poor prognosis and, because of the sustained viremia coupled with mucosal hemorrhaging, these patients are highly infectious. Secondary Bacterial Infection Bacterial superinfections can include abscesses of skin lesions, p neumonia, osteomyelitis, joint infections and sepsis. Blood and other cultures including sensitivities should be obtained to guide in appropriate therapy. Corneal ulceration and/or Keratitis These complications occur more frequently in hemorrhagic-type smallpox but may also be associated with ordinary smallpox. The ulcerations generally occur about the 2 nd week of illness and begin at the corneal margins. The ulcer may heal rapidly, leaving a minor opacity or, on occasion, severe corneal scarring. Respiratory Viral bronchitis and pneumonitis are common complications and are considered part of the normal disease syndrome. Treatment is symptomatic with measures to treat hypoxemia with supplemental oxygen or intubation and mechanical ventilation as indicated. Secondary bacterial pneumonia should be treated with appropriate antibiotics. Pulmonary edema is common in the severe forms of smallpox and should

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