The defeat of cholera

Here in Guayaquil, Ecuador, bring car or ambulance to cholera patients for treatment. For when the patient arrived at the hospital, he had lost 10% of their body weight by diarrhea and vomiting. This woman of 50 kilograms, this becomes 5 liters. She’s in shock, you can not stop, not even sit. The skin loses its normal turgor. Sunken eyes. Her mouth and dry tongue except who has just vomited. This patient is conscious and not lose orientation, but has mental dullness. No radial pulse and brachial pulse is weak. Cholera may reduce a person to such a state in a few hours, but usually takes between 12 and 18 hours. In extreme cases, patients may lose consciousness and be close to death. If water and salts lost through diarrhea are replaced swiftly, survival is assured. This same young woman is now well. With proper treatment, cholera patients recover quickly.
When cholera attacks areas where doctors do not know the modern methods of treatment, many people die. Mortality rates exceeded 30% in some populations. This unnecessary loss of life creates panic, which seriously interferes with the implementation of effective control measures. With proper treatment, even severely ill patients can be saved and panic is avoided.
Most people infected with the cholera bacterium have mild diarrhea or have no symptoms. Only about 7% of people infected with biotype El Tor cholera bacteria present a picture that requires treatment at a health center, but these are the biggest challenge for the physician.
Cholera patients come to the clinic referring diarrhea that is watery and profuse vomiting and often severe leg cramps resulting from electrolyte disturbances. Patients have signs of dehydration: the skin becomes slowly when it is pinched, the eyes are sunken and mouth and tongue are dry unless the patient has vomited or drunk anything recently. The toes and hands are wrinkled and cold. Usually, patients are very thirsty and drink eagerly. However, you may severely dehydrated patients can not drink anything. Typically, patients are restless and irritable, but severely dehydrated patients may be lethargic or even unconscious. You need to take your pulse and blood pressure. The pulse is rapid and weak or not detectable in cases of severe dehydration. Blood pressure is very low or not can it be detected. The rapid replacement of fluids and salts lost avoids death and is the primary goal of treatment. Dehydrated patients who can sit and drink should receive oral rehydration solution immediately and should encourage them to drink. If the patient has been vomiting, oral rehydration solution is generally effective. Although the patient vomits during treatment, the solution usually is absorbed than is vomited.
The oral rehydration solution is prepared by mixing water with a special combination of salt and sugar. The salts replace the sodium, potassium and bicarbonate lost because of diarrhea. Sugar helps sodium and quickly absorb water. If possible, the solution should be prepared with water that has been chlorinated or boiled. However, lack of clean water should not prevent health workers are given this fluid that saves lives. It is important to offer oral rehydration solution frequently the patient, measuring the amount he drank and measure the fluid lost as diarrhea and vomiting.
The choleric cot, which has a hole in the middle, is a practical method for collecting liquid stool, as channeled into a receptacle under the cot.
In patients with moderate dehydration, you should re-evaluate the hydration after 1 hour of therapy and every 1 to 2 hours until rehydration is complete. The patient is adequately rehydrated when the skin turgor is normal, thirst subsided, the pulse is strong and the person could urinate.
It should allow the patient to drink plain water in addition to oral rehydration solution. If it is kept in the health facility for more than six hours, the patient should be offered food once you have stopped vomiting.
Patients with severe dehydration, stupor, coma, uncontrollable vomiting, or extreme fatigue that prevents drinking should be rehydrated intravenously. Patients who can drink a little, give oral rehydration solution while the drip is organized.
Placing a large needle, 18 gauge, is necessary to achieve adequate flow. In rare cases, you need to administer the infusion into two veins. The Ringer lactate solution is the best choice for severe dehydration. If not available, acceptable normal saline or half normal saline (0.45%) with 5% glucose.
NO solution normal glucose (dextrose) should be used because it lacks the necessary salts.
Intravenous therapy should be administered only the experienced and using needles, tubes, flasks and liquid are sterile. For a 60 kg, it is often necessary to two liters of fluid in the first 30 minutes of treatment. It is useful to mark the bottle to see the level at which the liquid should fall within a specified period. Patients with dehydration threatening his life should be reassessed after the first thirty minutes of treatment. Should continue rapid intravenous therapy until a strong radial pulse is found. Patients should then be assessed every 1 to 2 hours to determine the fluid is
administering to the appropriate speed. Do not reuse the same needles and infusion sets for another patient.
All patients must also take oral rehydration solution as soon as they can drink without difficulty. After three hours, the majority of patients are completely rehydrated. They can drink and no longer need the application of fluid intravenously. The loss of fluids that continues can then be treated with oral rehydration solution. Stop infusion if the patient can drink and is no longer severely dehydrated avoid overhydration, venous thrombosis and sepsis. If no intravenous equipment available, or if doctors do not have expertise in management, patients with severe dehydration can receive oral rehydration solution administered by gavage for skilled workers. In a simple picture, you must record the volume of stool and vomiting and volume of oral rehydration solution and administered intravenous fluid. Patients with cholera can purge over one liter of fluid per hour. Cholera diarrhea feature, looking rice water, aqueous fluid is a pale yellow with a slightly fishy smell not of fecal nature. Once rehydration is started, a rectal swab can be done for laboratory diagnosis. The swab is placed in Cary-Blair medium and transported to the laboratory at room temperature in order to farm in the middle of TCBS.
Antibiotics administered orally reduce the volume and duration of diarrhea. Injectable antibiotics used no advantage and also expensive. Antibiotic therapy can be initiated once the vomiting has stopped.
The currently recommended antibiotics include tetracycline, doxycycline, azithromycin, erythromycin, ciprofloxacin. Do not give any medicine to treat diarrhea or vomiting.
In some places, the cholera bacterium has developed resistance to certain antibiotics, so to be monitored resistance patterns in each affected area.
Note that a cholera can be successfully treated with fluid replacement only if antibiotics are not available.
Hospital workers who care for patients with cholera or handle their fluids or bedding should not fear for their safety. They almost never get sick with cholera. Transmission of the cholera bacterium directly from one person to another is very rare. Wash hands with soap after touching contaminated areas prevents hands from contaminating food, wherein the microorganism could grow. The bedding and patient equipment can be disinfected by washing procedures and routine cleaning. If the system of hospital sewage is not treated, stool can be decontaminated by treating with creosol or Lysol.
When the patient is recovering, it can instruct this and their families about ways to prevent the spread of cholera and other diarrheal diseases. Everyone should wash their hands after defecation and before preparing or eating food. You can make the water safe to drink by boiling or treating it with chlorine in the house. Shellfish and other seafood should be well cooked. Any leftover cooked food should be reheated before eating.
In remote areas may be established treatment centers in the country. You can manage a successful therapy with simple supplies. The only true essentials for cholera treatment are a person with experience in evaluating and replacing lost fluids, oral solutions and intrave