MEASLES – Rubeola, morbilli, English Measles
ISSN-1059-6518
Volume 28 Number 1
By Frank Hubbell, DO
The reason for this article is simple: there is currently an outbreak of a highly contagious viral illness – measles. This epidemic has been going on for the past several months, with over 80 cases being reported in more than 14 states.
Measles Case Study:
You are with a local ambulance squad and are asked to transport a 4yo child to the local emergency department who reportedly has a fever, chills, cough, and lethargy.
Upon arrival at the home, you are presented with a child who appears sick. She has a rash on her face and neck, conjunctivitis, and a runny nose, is feverish, and has a cough. Mom states that her daughter has been sick for the past several days, but seems to be getting worse. She developed the rash overnight.
S: SUBJECTIVE:
4yo female, whose mom states has been sick for 4 days and is getting worse. She is c/o a sore throat, cough, runny nose, fever, and conjunctivitis.
O: OBJECTIVE:
Vital Signs:
LOC: A & O x 3
RR & Effort: 20 and not labored
HR: 96 and regular
BP: 104/72
SCTM: + for a rash on her face and neck, feverish, and moist
Physical Exam:
Skin is + for erythematous macules on her face and neck
Eyes + for erythematous conjunctiva with mucopurulent material on the lashes
Throat is + for erythema with whitish spots on the buccal mucosa next to the back molars
Lungs + for crackles; she has a wet cough with deep breathing
Heart – RRR without murmur
Abdomen is + for bowel sounds, soft, and non-tender
You can see images of Measles rash at the CDC website.
AMPLE HX:
A: NKDA
M: ibuprofen and Tylenol for the fever
P: none; mom denies any childhood immunizations
L: light dinner last night
E: home from school sick
A: ASSESSMENT
Viral exanthem – measles
P: PLAN
Rest, liquids, supportive care
Quarantine to minimize spread
Receive recommended childhood immunizations
MEASLES:
Measles is one of the leading causes of death in children worldwide.
Worldwide: 2013 – 145,700 deaths (down from millions prior to vaccinations)
USA: 2014 – 644 cases reported in 27 states
2015 – so far, >80 cases in 14 states
It is caused by a virus: Paramyxovirus, Morbillivirus.
Transmission is via airborne/droplet-spread.
Incubation: 10 – 12 days
Signs and Symptoms of Measles:
Fever – lasts 4 – 7 days
Coryza (runny nose)
Cough
Conjunctivitis (red, goopy eyes)
Koplik’s spots – white spots on the buccal mucosa (short-lived) next to the back molars
Rash – starts on the face and neck, then speads to the trunk and extremities
4 D’s and 3 C’s ⇒ 4 Days with the 3 C’s – Cough, Coryza, and Conjunctivitis before the rash occurs.
