1. VHF PREVENTION AND CONTROLTRAINING
MODULE 3
CASE DEFINITIONS, TRIAGE AND
MANAGEMENT
Updated: April 2014
1

2. Case Definition
Based on 4 factors
1. History of contact with
confirmed or probable
case
2. Fever
3. Bleeding
4. Three (3) or more
general symptoms
2

3. No
Contact
Not a case
Yes
Probable Suspect
EVD OUTBREAK Triage Decision-making Flowchart
Alert case
Unexplained deathFever
3 of the
symptoms*
Unexplained
Bleeding
Unexplained
Death
OR
Yes
*Symptoms include: headache, vomiting, nausea, loss of appetite, diarrhoea, intense fatigue, abdominal pain,
general muscular or articular pain, difficulty in swallowing, difficulty in breathing, hiccoughs
Note: Confirmed cases requires positive laboratory test Liberia, 2014
NoYes
Yes
OR
No
NoYes
No
No
3 of the symptoms*
Yes
Fever
3

4. 4
Triage: required for all ALERT cases
• Done by a trained heath worker.
• Done with standard precautions from
distance of 2 meters and avoiding
unnecessary examinations.
• Extra precautions if needed.
• Not all “alert” cases will become
“suspected” cases
• If the case is re-classified as
“suspected,” the triage team will
undertake the proper response
(transport, disinfect, etc).

5. Actions Based on Categorization of Patient:
Complete:
1. Ebola Case Report Forms
2. List all close contacts
3. Isolate patient and use barrier nursing
4. Notify higher level Authority immediately
Refer to Isolation Unit for further assessment, testing and
management
Probable Case
5

6. Actions Based on Categorization of Patient:
Complete:
1. Ebola Case Report Forms
2. List all close contacts
3. Isolate patient and use barrier nursing
4. Notify higher level Authority immediately
Keep in ‘Holding Area’ if no isolation unit is near (Fever
Observation Ward) where patient will be monitored & tested,
treated empirically for other conditions, and referred to
Isolation Ward if s/he tests positive
Suspect Case
6

7. Actions Based on Categorization of Patient:
• Mark as a Contact
• List on the Tracing Form
Educate contracts on symptoms and need for early
reporting
Alert Case
7

8. Recommended medications for the care of patients with Confirmed, Probable or
Suspected Ebola
Antibiotics In case the patient has a
bacterial infection eg
typhoid +/- ebola
Ceftriaxone 2g daily iv
Or Ampicillin 2 g q6h + gentamicin 5mg/kg as a stat dose then review
need/renal function
Or oral ciprofloxacin (not in children)
Antiemetic Symptom relief for
nausea or vomiting and
assist with hydration
For adults give
chlorpromazine 25-50 mg Q6H IM or orally
or metoclopramide 10 mg IV/ orally q8h until vomiting stops. For children
give promethazine
Anti diarrheals Symptom relief and assist
with hydration
imodium
analgesics Relieve pain Paracetomol, codeine, morphine especially if palliative phase
Avoid aspirin and NSAIDs eg diclofenac, ibuprofen due to their antiplatelet
effects
anxiolytics To ease anxiety or stress Always try communication and education before drug approaches.
Diazepam – adults: 5-15 mg/day in 3 divided doses If more severe: give
haloperidol 5 mg oral or IM
antipruritics For itch Calamine lotion or antihistamines
antipyretics Reduce high fever Paracetomol
Avoid aspirin and NSAIDs eg diclofenac, ibuprofen due to their antiplatelet
effects
Antacids Relieve Dyspepsia Omeprazole 20mg daily
or magnesium trisilicate, 2 tabs q8h until symptoms resolved. In children 5-
12 years, give magnesium trisilicate: 5-10 mls, q8h
Anticonvulsants Treatment of epileptic fit Test glucose
Diazepam iv or rectal
Adult upto 20 mg, child 0.5mg/kg
Antimalarial Treatment of Malaria ACT recommended. Avoid Amodiaquine containing antimalarial as an adjoin
treatment.
8

9. Recommended approach to fluid administration
in a patient presenting with Probable or Suspected Ebola
Give ORAL REHYDRATION SOLUTION (ORS)
if:
• The patient can tolerate oral fluids AND
• The patient is not deemed to be severely
dehydrated
9

10. Recommended approach to fluid administration
in a patient presenting with Probable or Suspected Ebola
Give IV FLUIDS rapidly if severely dehydrated or
oral fluids not practical
First give an initial 1000 ml IV
• Then continue Ringers lactate (LR) or Normal
saline (NS) at 20 ml/kg/hour, not to exceed a
maximum of 60 ml/kg in the first 2 hours (including
the initial bolus).
• Monitor systolic blood pressure (SBP) and clinical
signs of perfusion (urine output, mental status).
• Consider adding vasopressors (dopamine or
epinephrine) if SBP remains <90 and signs of poor
perfusion continue after fluid resuscitation
(estimated 60 ml/kg) even within first 2 hours.
10

11. Recommended approach to fluid administration
in a patient presenting with Probable or Suspected Ebola
At 2–6 hours:
• If SBP remains below 90 and signs of poor
perfusion, continue fluids at 5–10 ml/kg/hour.
• If SBP rises above 90, continue fluids at
2 ml/kg/hour. However, if the pulse is still high and
there are other signs of poor perfusion, patient may
still be volume-depleted and need more fluids.
• Watch carefully for signs of fluid overload (increased
jugular venous pressure, increasing crepitation on
auscultation). If present, decrease the rate of fluid
administration. Call for help from more senior
clinician to further evaluate overload and decide
fluids.
11