Free Northman Reborn Posted October 18, 2014 Share Posted October 18, 2014 What is the absolute worst case outcome of this Ebola outbreak? Even if it spirals completely out of control, is there any chance that it could lead to a doomsday type of outbreak scenario? I honestly don't see it happening. A million deaths maybe, even 10 million, are a terrible human tragedy, but it is not going to be of Black Death proportions, no matter what happens from here on out. Ebola just does not seem to be that kind of fast spreading disease. Link to comment Share on other sites More sharing options...
daskool Posted October 18, 2014 Share Posted October 18, 2014 Norepinephrine does have significant beta agonist activity but its purpose in sepsis is as a vasopressor due to potent alpha1 agonism. Inotropes are useful in cardiogenic shock, but are generally counterproductive in sepsis. I've raised this point because you seem to be mixing terms. Um no, all inotropes are alpha and beta agonists, varied by degree. Norepinehirine is a catecholamine which is used for it's potent vasopressor affect in septic shock (causing peripheral vaso-constriction) titrated to MAP BP and, in combination with fluid resuscitation, is a primary treatment tool for ensuring adequate renal perfusion. So to say you'd be hooked up to inotropes if you were admitted to an ICU with Ebola is 100% correct. Sorry for being pedantic but there you go. Link to comment Share on other sites More sharing options...
Ser Scot A Ellison Posted October 18, 2014 Author Share Posted October 18, 2014 MED FIGHT!:grabs popcorn: Link to comment Share on other sites More sharing options...
Relic Posted October 18, 2014 Share Posted October 18, 2014 MED FIGHT!:grabs popcorn: is that popcorn laced with cocaine? Cuz that's about the only way this will be any fun =P Link to comment Share on other sites More sharing options...
Fez Posted October 18, 2014 Share Posted October 18, 2014 Hmmm... Frontier Airlines’ president Barry Biffle said Friday that Amber Joy Vinson, the Ebola patient who was on board their flight between Dallas and Cleveland, may have been at a much more advanced stage of infection than previously thought. The announcement came in an email sent by Biffle to the employees at the Denver, Col.-based airlines. Biffle updated his employees about the findings of the U.S. Centers for Disease Control and Prevention, or CDC, which assured the airline’s employees, who may have been on board the plane, that they are at a very low risk of contracting the disease, according to Associated Press. The assurance came despite the expectation that Vinson might have been in the advanced stages of the infection when she boarded the flight. The airline has given employees who worked on the flight a 21-day leave, equal to the quarantine period that people suspected of being exposed to the disease can be subject to. Not a ton of detail there, and its unclear exactly how sick the CDC now thinks she was, but, seriously, wtf? At this point, I think I understand how civil libertarian folks feel about the NSA, with the constant backpeddling, evasion, and goalpost-shifting, because I'm right there on the CDC. Link to comment Share on other sites More sharing options...
Ser Scot A Ellison Posted October 18, 2014 Author Share Posted October 18, 2014 Relic,My mom's an RN and liked to talk shop during dinner. Link to comment Share on other sites More sharing options...
Zar Lannister Posted October 18, 2014 Share Posted October 18, 2014 Did they ever clarify why Vinson was sent quickly to Emory and Pham was kept in Texas Presby until finally decidibg to send her to Bethseda?EDIT:Also, according to NBC news while a black market for blood from survivors seems have started, immunologists are speculating now "silent infections" (or for the laymen like myself, people who have been in contact with ebola patients in this outbreak and past outbreaks but never developed EVD). These are people that apparently never got sick but present antibodies in their blood. Can these help immunize other?http://www.nbcnews.com/storyline/ebola-virus-outbreak/what-if-lots-people-have-ebola-proof-blood-n228346 Link to comment Share on other sites More sharing options...
Andriy Czarchenko Posted October 18, 2014 Share Posted October 18, 2014 Hmmm... Not a ton of detail there, and its unclear exactly how sick the CDC now thinks she was, but, seriously, wtf? At this point, I think I understand how civil libertarian folks feel about the NSA, with the constant backpeddling, evasion, and goalpost-shifting, because I'm right there on the CDC. That could be the airline just covering it´s own ass without any new information. Link to comment Share on other sites More sharing options...
Aemon Stark Posted October 18, 2014 Share Posted October 18, 2014 Um no, all inotropes are alpha and beta agonists, varied by degree. Norepinehirine is a catecholamine which is used for it's potent vasopressor affect in septic shock (causing peripheral vaso-constriction) titrated to MAP BP and, in combination with fluid resuscitation, is a primary treatment tool for ensuring adequate renal perfusion. So to say you'd be hooked up to inotropes if you were admitted to an ICU with Ebola is 100% correct. Sorry for being pedantic but there you go.No, all inotropes are not alpha and beta agonists. Dobutamine has no alpha activity at all. Neither does Isuprel. Milrinone works through a completely different mechanism. If there is a concern about significantly depressed myocardial function, an inotrope might be added to Norepinephrine, phenylephrine, or vasopressin, all of which are used first line as vasopressors. We avoid pure inotropes due to the beta2 agonism which causes vasodilation in this setting, and we prefer norepinephrine to epinephrine as the latter has much more beta2 activity. So, no it is not correct to say that because a septic shock patient would receive vasopressors. True enough that norepinephrine increases cardiac output somewhat, but the next choices would be phenylephrine (pure alpha) and vasopressin (direct vasoconstriction). Some vasopressors are also inotropes, but most inotropes are not also vasopressors, and usually have the opposite effect when used in isolation. Link to comment Share on other sites More sharing options...
daskool Posted October 18, 2014 Share Posted October 18, 2014 No, all inotropes are not alpha and beta agonists. Dobutamine has no alpha activity at all. Neither does Isuprel. Milrinone works through a completely different mechanism. If there is a concern about significantly depressed myocardial function, an inotrope might be added to Norepinephrine, phenylephrine, or vasopressin, all of which are used first line as vasopressors. We avoid pure inotropes due to the beta2 agonism which causes vasodilation in this setting, and we prefer norepinephrine to epinephrine as the latter has much more beta2 activity.So, no it is not correct to say that because a septic shock patient would receive vasopressors. True enough that norepinephrine increases cardiac output somewhat, but the next choices would be phenylephrine (pure alpha) and vasopressin (direct vasoconstriction). Some vasopressors are also inotropes, but most inotropes are not also vasopressors, and usually have the opposite effect when used in isolation.I didn't mention alpha activity I stated that all inotropes are both alpha and beta agonists. In the case of Dobutamine the vaso-constricting and vaso-dilating effects of the stereoisomers cancel each other out. Even Isuprel is a partial alpha agonist, but so weak that it's considered a 'pure' beta agonist. But all that's an aside the actual criticism that "inotropes are not routinely used for septic shock" is patently wrong. Norepinephrine is an inotrope that is routinely used as a primary treatment, epinephrine is used in low doses as an add on and even dobutamine can be used to salvage microcirculation after prolonged norapinephrine infusions. Saying all that if you're arguing that intotropes are not routinely used to treat septic shock for their B1 agonist effect then sure. Link to comment Share on other sites More sharing options...
Balefont Posted October 18, 2014 Share Posted October 18, 2014 Okay, now I understand how my boss and I sound to others when we wax poetic about taxes. Link to comment Share on other sites More sharing options...
Ice Queen Posted October 18, 2014 Share Posted October 18, 2014 I'm talking about the country in general. How's this for hysterics? My partner works for a company in the health field. Her manager also works for the Health Department. She told her about a call she received where a person wanted their neighbor quarantined because he's African and he has a runny nose.My boss's daughter lives near Cleveland. Her son's school was closed yesterday because one of the teachers was in the same bridal shop as Amber Vinson. Not even at the same time, mind you. Link to comment Share on other sites More sharing options...
Tears of Lys Posted October 18, 2014 Share Posted October 18, 2014 Did they ever clarify why Vinson was sent quickly to Emory and Pham was kept in Texas Presby until finally decidibg to send her to Bethseda? EDIT: Also, according to NBC news while a black market for blood from survivors seems have started, immunologists are speculating now "silent infections" (or for the laymen like myself, people who have been in contact with ebola patients in this outbreak and past outbreaks but never developed EVD). These are people that apparently never got sick but present antibodies in their blood. Can these help immunize other? http://www.nbcnews.com/storyline/ebola-virus-outbreak/what-if-lots-people-have-ebola-proof-blood-n228346 That's very cool. Thinking of the poor little kids who have contracted this, having no one to hug them and comfort them is heartbreaking. The chance that those with Ebola antibodies in them could be helping out in this way is wonderful. Get those people identified and over there STAT. (Not to mention perhaps developing a vaccine.) Link to comment Share on other sites More sharing options...
Shryke Posted October 18, 2014 Share Posted October 18, 2014 Hmmm... Not a ton of detail there, and its unclear exactly how sick the CDC now thinks she was, but, seriously, wtf? At this point, I think I understand how civil libertarian folks feel about the NSA, with the constant backpeddling, evasion, and goalpost-shifting, because I'm right there on the CDC. Who is actually claiming this and why should anyone believe him? Cause it seems to just be a guy who runs an airline and I see no reason why I should take his word as at all meaningful. Link to comment Share on other sites More sharing options...
TerraPrime Posted October 18, 2014 Share Posted October 18, 2014 The CDC did report that they now believe Vinson was more suck than they thought before because upon admission to the care facility new details came to light. She was suffering from a mild flu (general aches and fatigue) symptom before she had the low fever that she reported prior to flying from Cleveland to Dallas. I didn't get the sense that the CDC deliberately suppressed this info. Rather, this is news to them because the patient didn't reveal this until now. Link to comment Share on other sites More sharing options...
Swordfish Posted October 18, 2014 Share Posted October 18, 2014 The fact that it's horrible evil stuff that gets absolutely everywhere if you give it half a chance?If Ebola spread half as readily as copy toner we'd all be fucked. Or glitter. Link to comment Share on other sites More sharing options...
The Fallen Posted October 18, 2014 Share Posted October 18, 2014 My boss's daughter lives near Cleveland. Her son's school was closed yesterday because one of the teachers was in the same bridal shop as Amber Vinson. Not even at the same time, mind you.I suspect we'll hear a lot more of these situations. Although I can't say that I blame them when it comes to kids.Daskool, Aemon StarkThe pick-and-roll can result in a lay-up or it can turn into a pick-and-fade if the 1 can draw the D, thus allowing the 3,4, and occasionally the 5, to fade away and get a clean look at the rim, giving the O a high percentage shot.Take that! Link to comment Share on other sites More sharing options...
daskool Posted October 18, 2014 Share Posted October 18, 2014 CDC procedure for the removal of protective equipment http://app1.unmc.edu/nursing/heroes/pdf/vhfppe/doffingBiologicalPPE-EbolaPatients-8.5x11-CC-v1.01.pdf Interesting to note, that the use of various individual item, booties, non permeable gowns, N95 mask and shield etc etc makes the decontamination and removal procedure very involved. If there's a breakdown in the isolation chain it will likely occur when this stuff is being taken off. Also in this the neck remains uncovered, why? Link to comment Share on other sites More sharing options...
Grand Moff Mithrandir Posted October 19, 2014 Share Posted October 19, 2014 A huge debate has erupted in my country & across the continent over Morocco's decision to pull out of hosting next year's AFCON football tournament.It's so disheartening to see how sports organisations, that have some much influence in the lives of many Africans, can be so ignorant to a plain threat.http://www.myjoyonline.com/opinion/2014/October-18th/please-ghana-do-not-take-the-cafs-ebola-bait.phpA news item by the GHANAsoccernet.com on October 16, 2014, says that the Confederation of African Football (CAF) has written to Ghana to "consider replacing Morocco as hosts for the 2015 Africa Cup of Nations finals.” Apparently, Morocco’s withdrawal from hosting the 2015 soccer event stems from its anxiety about the outbreak of the deadly Ebola disease in their country.The CAF has been long run by a bunch of greedy, power hungry old men who are notoriously stubborn. They should remove their blinders and be aware of the potential numbers of people they could be putting at risk. It will be February by the time this tournament comes around and according to the WHO the numbers of infected could be extremely high by then./rant Link to comment Share on other sites More sharing options...
Arkhangel Posted October 19, 2014 Share Posted October 19, 2014 What, so all large public events across the continent should be cancelled indefinitely? Do you think maybe that's a bit of an overreaction? Link to comment Share on other sites More sharing options...
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