SCENARIO SOM State of Michigan天花的场景SOM 密歇根州课件.pptVIP

SMALLPOX SCENARIO Tabletop Judicial Exercise December 14, 2004 Lansing, Michigan Sunday, Day 0 – 1900 hrs. Mr. Xray, a 38 year old male, is delivered by ambulance into a negative flow Emergency Department (ED) room at Gratiot Hospital (100 bed), located in Port Huron, Michigan. He has a three-day history of high fever (100.1o-102.5oF), malaise, body aches, vomiting and a one-day history of rash on his hands and feet. Family reports that patient has slight cough from a recent upper respiratory infection, and is a heavy smoker with a history of heart disease. Family believes Mr. Xray may have chickenpox. He had been exposed two weeks earlier to a niece with chickenpox and stated to family he has no recollection of having had chickenpox as a child. The ED physician orders a test for chickenpox and admits Mr. Xray for dehydration, citing possible complications from chickenpox. In the past few weeks, all hospitals have been extremely busy with influenza and other upper respiratory patients. Mr. Xray is held in the ED for several hours until a room is available. He is later placed in the Intensive Care Unit, in isolation, until chickenpox is ruled out. A consult is requested from the Detroit Medical Center (DMC)-(Gratiot Hospital is part of DMC system) with an Infectious Disease (ID) physician and dermatologist. The DMC is located 60 miles south of Port Huron, thus consultation is not expected until later that night or tomorrow. Monday, Day 1 – 1200 hrs. Mr. Xray’s condition has worsened. A dermatologist from DMC visits Mr. Xray and expresses concern about the rash, which has now become pustular and has spread from the hands to his forearms. The dermatologist is a member of the DMC HealthCare Worker Smallpox Response Team. (She is a Canadian citizen and, therefore, was not vaccinated as part of the US National Vaccination program.) The dermatologist agrees that the rash could be atypical chickenpox rash, however, she suspects smallpox and orde