A client who has recently traveled to China comes to the emergency department (ED) with increasing shortness of breath and is strongly suspected of having a severe acute respiratory syndrome (SARS). Which of these prescribed actions will you take first?
A. Obtain blood, urine, and sputum for cultures
B. Infuse normal saline at 100ml/hr
C. Administer methylprednisolone (Solu-Medrol) 1 gram/IV
D. Place the client on contact and airborne precautions
Correct Answer: D. Place the client on contact and airborne precautions.
Since SARS is a severe disease with a high mortality rate, the initial action should be to protect other clients and health care workers by placing the client in isolation. If an airborne-agent isolation (negative pressure) room is not available in the ED, droplet precautions should be initiated until the client can be moved to a negative-pressure room.
Option A: SARS-CoV testing for diagnosis should be done via PCR from samples obtained from at least two sites and as early in the illness as possible and then repeated five to seven days later if symptoms continue.
Option B: There are potential agents for use against SARS. Lopinavir-ritonavir has shown some activity in vitro only thus far. Additionally, the experimental agent for Ebola, Remdesivir, has shown activity against both SARS and MERS coronaviruses.
Option C: There is no specific treatment for severe acute respiratory syndrome (SARS), and supportive care is emphasized. To date, no antiviral agents have been found to be beneficial, nor were glucocorticoids shown to have a beneficial effect.