Clinicians should be alert for persons with onset of illness after February 1, 2003 with:

Washington Hospital Center Surveillance And Management of

Severe Acute Respiratory Syndrome (SARS) in the Emergency Department – May 26, 2003

Case-finding definitions
+Signs/Symptoms: -and-	· Fever > 38° C (100.4 F) -and- · respiratory symptoms including cough, shortness of breath, difficulty breathing

+Exposure:	· Travel to SARS transmission area* within 10 days of symptoms -or- · Close contact with a person diagnosed with SARS * SARS Transmission areas (WHO): Mainland China, Taiwan, Hong Kong, Inner Mongolia, Singapore, and Canada (Toronto)

ED Management

Triage Area

· Evaluate Signs and Symptoms and Exposure ASAP.

· If patient is symptomatic and an exposure risk, and either respiratory symptoms or fever, put surgical or N95 mask on patient and escort him/her to the negative pressure rooms. (Patient may remove the mask when he/she is in negative pressure room.)

ER Exam Bay

· Maintain Airborne and Contact Precautions

· Negative Pressure

· N-95 Respirator for all who enter room

· Goggles or face shield, gowns, gloves

· Obtain CXR, CBC; Check pulse ox.

· Leukopenia, thrombocytopenia, elevated LDH, CPK, and hepatic transaminases strengthen the suspicion

Follow “Factor-Based Approach” below:

Factor-Based ED Approach
Signs and Symptoms	+	+	+	-
Exposure confirmed	+	+	-	+
Infiltrates on CXR	+	-	+	-
Assessment	Probable SARS Case	Suspect SARS Case	Unlikely SARS Case	Exposed Unlikely SARS Case
Work-up	· Admit · Isolate (Airborne and Contact) · ID/Pulmonary Consult · Notify Infection Control · Order sputum culture, blood culture · Order rapid flu test	· Consider admission · Consider ID/Pulmonary Consult · Isolate if admitted · Notify Infection Control · If d/c/ home, instruct to return if symptoms worsen	· Case by case determination if further workup needed.	· Give advice: report immediately to physician or medical provider if fever or respiratory symptoms develop · Do not go to work until cleared by health authority · Avoid public places until advised by health authority · Minimize contact with family and friends

The ID/Pulmonary consult will coordinate additional testing per CDC/WHO recommendations

The Infection Control Department will:

· Report the case to the public health department as needed

· Coordinate isolation

· Notify the nursing supervisor on duty

Prepared by:

Daniel Lucey, MD (Center for Biologic Counter Terrorism and Emerging Diseases),

Christopher Wuerker, MD, and Mark Smith, MD (WHC Department of Emergency Medicine), Margo Smith MD (WHC Infectious Disease), Ligia Pic-Aluas, MD (WHC Hospital Epidemiologist), Nancy Donegan (WHC Infection Control)