Approach to the Critical Patient

Immediate stabilization

Airway and breathing

Circulation and hemorrhagic shock

Biosafety and containment

PPE requirements for all personnel

Immediate notification

Critical escalation triggers

Features indicating ICU-level care

History

Epidemiologic exposure

Travel and contact history

Symptom characterization

Onset and timeline

Core symptoms

Hearing symptoms

Alarm symptoms

Risk stratification history

Highest-risk features

Physical Exam

Vital signs

Hemodynamic assessment

Head, eyes, ears, nose, and throat

HEENT findings

Systemic findings

Abdominal exam

Neurological exam

Skin and mucosal exam

PITFALLS

Common examination errors

Differential Diagnosis

Life-threatening mimics

Other viral hemorrhagic fevers

Severe bacterial infections

Common tropical infections

Malaria (ICD-10 B54)

Dengue fever (ICD-10 A90)

Influenza (ICD-10 J11)

Rickettsial infections (ICD-10 A79)

Other considerations

Acute HIV seroconversion (ICD-10 B23.0)

Hepatitis A or E (ICD-10 B15, B17.2)

Meningitis/encephalitis (ICD-10 G03)

Symptom combination predictors

Laboratory Tests

Confirmatory diagnostic tests

LASV RT-PCR (plasma)

LASV antigen detection

Serology (LASV-specific IgM and IgG)

Viral isolation in cell culture

Hematologic and metabolic labs

Complete blood count

Comprehensive metabolic panel

Liver function tests

Coagulation and infection workup

Coagulation studies

Blood cultures

Malaria smear and rapid diagnostic test

Additional point-of-care labs

Diagnostic Tests

Scoring Systems

Clinical severity classification

Prognostic markers (no validated scoring tool)

MRI

MRI head indications

MRI inner ear

CT

CT head

CT chest

CT abdomen/pelvis

Ultrasound

Point-of-care ultrasound indications

Disposition

Isolation requirements

Mandatory isolation for all confirmed or suspected cases

Mandatory public health notification

ICU admission criteria

Indications for ICU-level care

Transfer and specialty considerations

Transfer to high-biocontainment unit

Specialist consultations

Discharge criteria

Criteria for discharge

Treatment

Antiviral therapy

Ribavirin IV (preferred route)

Ribavirin oral (alternative if IV unavailable)

Favipiravir (investigational)

Supportive care

Fluid and electrolyte management

Antipyretics and symptom management

Seizure management

Hemorrhage and blood product management

Blood transfusion indications

Avoid

Respiratory support

Supplemental oxygen escalation

Renal replacement therapy

Indications

Recovery of renal function is crucial for survival

Concurrent infection treatment

Malaria co-treatment

Bacterial superinfection

Dexamethasone (adjunctive)

Post-exposure prophylaxis

Oral ribavirin for high-risk contacts

Special Populations

Pregnancy

Maternal and fetal risk

Treatment considerations in pregnancy

Neonatal considerations

Geriatric

Risk profile in older adults

Management modifications

Pediatrics

Epidemiology in children

Diagnostic considerations

Treatment in children

Background

Epidemiology

Global burden

Geographic distribution

Disease severity spectrum

Seasonal and demographic patterns

Seroprevalence

Pathophysiology

Causative agent

Transmission routes

Viral pathogenesis

Immune response

Therapeutic Considerations

Ribavirin evidence base

Investigational therapeutics

Vaccines

Contraindicated and nephrotoxic drugs

BSL classification

Patient Discharge Instructions

copy discharge instructions

Discharge criteria confirmed

Medications

Hearing follow-up

Sexual activity

Activity and nutrition

Return to emergency department immediately if

Contact tracing

Mental health

References

Guidelines and key sources

Wohl DA et al.

Elsinga J et al.

Asogun DA et al.

Okokhere P et al.

Strampe J et al.

Cheng HY et al.

Ochu CL et al.

CDC Yellow Book 2025

Boisen ML et al.

Rigby I et al.

Anesi JA, Silveira FP

Holmes GP et al.