Critical care clinics
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The US Department of Homeland Security, and other state and federal agencies, continues to express concern over the potential use of radioactive isotopes as a weapon of terror. Few emergency medicine and critical care physicians are familiar with the care and treatment of an accidentally or intentionally irradiated patient who is contaminated externally or internally. ⋯ Preparation for patient receipt and emergency care, followed by definitive diagnosis using biodosimetry is also presented. Therapeutic measures continue to evolve for externally and internally exposed victims, including those with combined injuries caused by burns and trauma.
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This article reviews the epidemiology, pathophysiology, and clinical management of patients with suspected or confirmed viral hemorrhagic fever infection. The focus is on clinical management based on case series from naturally occuring outbreaks of viral hemorrhagic fever infection as well as imported cases of viral hemorrhagic fever encountered in industrialized nations. The potential risk of bioterrorism involving these agents is discussed as well as emergency department and critical care management of isolated cases or larger outbreaks. Important aspects of management, including recognition of infected patients, isolation and decontamination procedures, as well as available vaccines and therapies are emphasized.