Ebola

New Amsterdam: Prioritizing Epinephrine Over Oxygen

/ Jordyn Redwood / Leave a comment

New Amsterdam is a new medical drama on NBC this year. You can see my first post about it here. Today, I wanted to review a medical scenario with you and the problems with they way it’s presented.

As I discuss the scenario remember that all medical providers are taught this from the very moment they step into medicine: A, B, C— Airway, Breathing, Circulation.

Here’s the setup: A man travels from Liberia where he begins to exhibit signs of Ebola. They place him in isolation (a good move). A big lecture is given by Dr. Max Goodwin, the new medical director, that no one is EVER to enter the isolation room without the proper PPE (Personal Protective Equipment). From there, it gets a little bit strange.

The first issue is that it’s stated that the isolation room is “stocked with every available medication should the patient need to self medicate.” A few problems. A sick and deteriorating patient is going to have the wherewithal to find a drug and give it to himself? This is later proven to be a bad idea when the patient can’t even reach for an easily accessible oxygen mask without falling out of bad.

Also, everything in the isolation room is going to get thrown out and likely charged to the patient so for a medical director who is so concerned about minimizing costs for the patient . . . well, you can see where I’m going with this.

The patient begins to cough up blood, bleeding profusely from his mouth, and has difficulty breathing. As the doctor is getting into her PPE, she instructs him to give himself oxygen which he is unable to do and then falls out of bad. Without getting into full PPE, she enters the room to help.

I actually like this aspect of the show. As I’ve said all along, medical people can make bad choices, as long as the writer shows repercussions for them which they do in the show.

The doctor immediately begins to work to aid his breathing. This is the right choice. She believes the airway is too obstructed so she immediately moves to a needle cricothyrotomy. This is generally done as a rescue measure when other attempts to secure an airway have failed— it is not the first choice.

However, as the doctor inside the isolation room is generally doing most of the right things, Dr. Goodwin (the new medical director) is telling her to give the patient an IV dose of Epinephrine before she gives him oxygen. He tells her to prioritize the epinephrine over the oxygen. At the screen shot to the right, what’s obvious is that the blood pressure (82/40) is low and that the patient’s oxygen levels are REALLY low at 64% (normal is generally considered above 90%).

There really isn’t an indication for epi IV (as in a code dose) in this scenario. The first two reasonable thoughts for this patient’s low blood pressure are sepsis (low blood pressure caused by overwhelming infection) and blood loss from the obvious hemorrhage. Epi can be given in this situation (for low blood pressure related to sepsis) as a continuous drip, but not as a push medication.

Most importantly in this situation, epi would not be prioritized over the patient’s alarmingly low oxygen levels.

Facing Darkness: Fighting Ebola in Liberia Part 2/2

/ Jordyn Redwood / Leave a comment

Recently, I viewed the movie Facing Darkness produced by Samaritan’s purse highlighting their response to the Ebola outbreak in Liberia. I highly recommend seeing this movie. It is having an encore event in limited theaters on April 10th, 2017. Click this link for showings near you.

You can view Part I here that takes a medical view on how Ebola spread so easily and quickly through Liberia.

This post, I’ll be discussing some of the spiritual aspects of the movie. As a Christian myself, it was hard not to be amazed at some of the incidents (or miracles) that I’ll talk about here.

Samaritan’s Purse is a Christian organization run by Franklin Graham, the eldest son of famed evangelist Billy Graham. Samaritan’s Purse had a presence in Liberia before the Ebola outbreak. The American physician, Kent Brantly, was serving there as a missionary with his family at the onset of the outbreak.

When Ebola hit the region, there were only two organizations that responded despite the Liberian government’s cry for help. They were Samaritan’s Purse and Doctors Without Borders. Since Samaritan’s Purse already had a presence in Liberia, they were asked by DWB to respond to the Ebola crisis.

They agreed but had no training to do so, but they did begin to respond by caring for the sick and dying.

Dr. Kent Brantly eventually headed up the Ebola response in Liberia. He and nurse, Nancy Writebol, worked closely together. Nancy was mainly in charge of getting medical personnel in their protective gear before entering the hospital. To this day, it is not exactly clear how Kent or Nancy were infected with Ebola.

Many Christians believe there is a battle in the spiritual realm between good and evil. That these forces are at play on earth even if we don’t physically perceive them. When the movie Facing Darkness opens, they comment on a feeling of oppression in the area. “The sea had never seemed so angry.” There was an unrelenting rain that few had seen in many years. The country was still shrouded in the darkness of two civil wars.

I believe there are miracles still happening today. These are some of the things I consider miracles from Facing Darkness. There are spoilers here so stop reading if you plan on seeing the movie.

1. Kent Brantly contracted Ebola within days of his wife and children leaving Liberia for a wedding in Texas. This event likely saved them from contracting the disease.

2. ZMapp was used for the first time in humans— and it worked. ZMapp is a drug that is used specifically to treat Ebola. Up until that point, it had never been used in humans, only in monkeys.

3. Dr. Brantly was going to be life-flighted out of Liberia, but the plane broke down and had to return to the US. This event likely saved his life. At the time the flight started, Kent was feeling pretty well and deferred the first dose of ZMapp to nurse Writebol. However, as she was literally warming up the medication under her arm for administration, Kent’s health took a dramatic turn for the worse and they took the drug away from Writebol to administer to Brantly. If he’d been on that flight, he likely would have died.

4. Brantly’s survival and testimony as to what was happening in Liberia finally garnered some international support that enabled Samaritan’s purse to turn the tide via education to combat the spread of Ebola. The movie is pretty clear on how little the world provided aid during the Ebola crisis. Doctors Without Borders and Samaritan’s Purse were the only two organizations combating the disease and they were drowning. Their personnel were way overextended and they didn’t have the supplies they needed. Only the media attention after Brantly’s US return pushed the issue where finally financial support and supplies were offered.

Sometimes, it’s hard to understand God’s view when you’re in the middle of a crisis. Brantly’s infection was one of the worst things that happened in his life, but it also ended up saving a country.

Many people featured in the film continue to serve the people of Liberia.

So many lessons in this one film— medically and spiritually. Please, go see it.

Facing Darkness: Fighting Ebola in Liberia Part 1/2

/ Jordyn Redwood / Leave a comment

On May 30th, I attended a limited showing of the movie Facing Darkness which is a documentary produced by the Christian organization Samaritian’s Purse about how they assisted with the Ebola crisis in Liberia. It is a fascinating piece of film and I highly encourage all to go and see it. There will be more showings on April 10th so check your local theaters for viewings. Honestly, I cannot recommend this movie enough.

What’s interesting as a nurse medically is why did Ebola take such hold in Liberia? What factors contributed to it being so widespread? What was the tipping point as they say— or those circumstances that when combined cause something to take on a life of its own.

There were several factors that aided the spread of Ebola in Liberia and I’ll discuss a few here. I often hear people say that widespread disease and outbreaks couldn’t possibly happen in the US— that our medical system could easily handle the onslaught of victims and prevent the spread quickly. I am not so convinced. After events like Katrina it’s easy to see how any local healthcare system could be overwhelmed.

Here are some factors that aided the spread of Ebola in Liberia.

1.  Liberia’s infrastructure was devastated by civil war. Liberia had been rocked by two civil wars. One lasting from 1989-1996 and the other lasting from 1999-2003. Because of the wars, much of their infrastructure, including healthcare, was limited. The Ebola outbreak in Liberia started in March, 2014. It would seem that a decade would be long enough for a nation to recover, but think about how long it took to rebuild Ground Zero after the 9/11 attacks. Liberia is an economically depressed emerging nation. It’s in the top ten of poorest countries. Before the outbreak, 4 million people were being cared for by fifty physicians (yes, 5-0.) 

2. Cultural practices spread the disease easily. Liberians have a very affectionate culture. Ebola is spread by direct contact with an infected person. Culturally, Liberians prolong touch via handshakes and hugging. Also, their care of the dead includes direct handling and washing of the body. In some instances, the bath water used to bathe the deceased family member is drunk. If a person dies from Ebola, their corpse is teaming with virus and these practices will infect family members.

3. People lived in close proximity to one another.  Ebola in Liberia was both an urban and rural issue. When the disease hit urban centers, its spread happened much more quickly.

4. Liberians didn’t believe Ebola was real. Early in the outbreak, people believed Ebola was merely a myth. That it didn’t exist.

5. There was distrust of the medical profession. As the Ebola outbreak became more prolonged, many Liberians began to believe that medical people were proactively spreading the disease instead of trying to stop it. They wouldn’t bring sick family members to the hospital which led to more infection. In fact, medical professionals were physically attacked in some instances because of this belief.

The Atlantic did a follow-up piece on Ebola in Liberia in its July/August 2016 issue. If you think Ebola cannot happen again to such a degree, where 11,000 Liberians were infected, think again.

As the article highlights, several factors that added to the outbreak are still present.

1. People still eat bushmeat. Bushmeat is a concern as an origin for Ebola infecting humans.

2. There remains little understanding among the Liberian population of how Ebola is spread.

3. There have been three small outbreaks since Liberia was declared Ebola free in May, 2015.

4. It is possible that Ebola could spread via sexual transmission months after victims are symptoms free.

5. The poverty is worse.

I highly recommend viewing Facing Darkness on April 10, 2017. It is an eye-opening experience.