Hupert et al reported a checklist for evaluating a patient following exposure to an anthrax mass event. The first part of the evaluation is an assessment of signs and symptoms. The authors are from the Centers for Disease Control and Prevention, Weill Cornell Medicine, New York-Presbyterian Hospital, Johns Hopkins University, George Washington University and Inova Fairfax Hospital.
Patient selection: exposure to anthrax during a mass exposure
Parameters:
(1) heart rate in beats per minute
(2) breathing rate in breaths per minute
(3) body temperature in °C
(4) orientation to person
(5) orientation to place
(6) orientation to time (day of week)
(7) heavy sweating
(8) shortness of breath
(9) pain anywhere
(10) pain in the head
(11) severe headache
(12) skin rash, scab or pimple appearing after exposure
Parameter |
Finding |
Points |
heart rate |
>= 110 per minute |
1 |
|
< 100 per minute |
0 |
breathing rate |
> 20 per minute |
1 |
|
<= 20 per minute |
0 |
orientation to person |
no |
1 |
|
yes |
0 |
orientation to place |
no |
1 |
|
yes |
0 |
orientation to day of week |
no |
1 |
|
yes |
0 |
severe headache |
no |
0 |
|
yes |
1 |
score for starting IV therapy =
= SUM(points for all 6 findings)
Parameter |
Finding |
Points |
heart rate |
>= 110 per minute |
0 |
|
100 to 109 per minute |
1 |
|
< 100 per minute |
0 |
temperature |
> 38°C |
1 |
|
<= 38°C |
0 |
heavy sweating |
no |
0 |
|
yes |
1 |
shortness of breath |
no |
0 |
|
yes |
1 |
skin rash, scab, etc |
no |
0 |
|
yes |
1 |
score for performing a medical exam =
= SUM(points for all 5 findings)
Parameter |
Finding |
Points |
heart rate |
>= 100 per minute |
0 |
|
< 100 per minute |
1 |
breathing rate |
> 20 per minute |
0 |
|
<= 20 per minute |
1 |
temperature |
> 38°C |
0 |
|
<= 38°C |
1 |
orientation to person |
no |
0 |
|
yes |
1 |
orientation to place |
no |
0 |
|
yes |
1 |
orientation to day of week |
no |
0 |
|
yes |
1 |
heavy sweating |
no |
1 |
|
yes |
0 |
shortness of breath |
no |
1 |
|
yes |
0 |
severe headache |
no |
1 |
|
yes |
0 |
skin rash, scab, etc |
no |
1 |
|
yes |
0 |
score for oral therapy and post-exposure prophylaxis =
= SUM(points for all 10 findings)
Interpretation:
• Intravenous antibiotic therapy is started if the score for starting IV therapy is >= 1.
• A physical exam is performed if the score for performing a medical exam is >= 1.
• Oral antibiotic therapy for post-exposure prophylaxis is given if the score for all therapy equals 10.
Specialty: Infectious Diseases