Treatment of Ebola Virus Disease with Low Systolic Blood Pressure (< 90 mm Hg) or Signs of Shock
Ebola virus disease patients who develop haemodynamic shock — defined by a systolic blood pressure below 90 mm Hg in adults or by clinical signs of inadequate perfusion in children — require immediate, structured resuscitation. This protocol addresses that specific presentation.
Clinical Scenario
Shock is present when:
- Adults: Systolic blood pressure < 90 mm Hg, or other clinical signs of hypoperfusion
- Children: Delayed capillary refill > 3 seconds, cold extremities, weak rapid pulse, or hypotension for age
Treatment Overview
Immediate management centres on restoring oxygen delivery and tissue perfusion. The approach involves oxygen supplementation, intravenous fluid resuscitation with isotonic crystalloids, and early empiric antimicrobial therapy — with structured reassessment repeated at regular intervals.
Key perfusion targets:
- Systolic BP > 90–100 mm Hg in adults (age-appropriate in children)
- SpO₂ > 94%
- Urine output > 0.5 ml/kg/hr in adults; > 1 ml/kg/hr in children
- Normal respiratory rate, mental status, strong pulse, and brisk capillary refill
- Reassessment every 30 minutes
Specific fluid volumes, administration sequences, and the full resuscitation algorithm are in the structured protocol.
References
- Shock in adult: SBP < 90 mm HG, mean arterial blood pressure < 65 mm Hg or other clinical signs of hypoperfusion.
- Shock in child: delayed capillary refill > 3 seconds, cold extremities, weak rapid pulse or hypotension for age (SBP < 70 + (age in years x 2)).
- Give oxygen therapy immediately to maintain SpO2 > 94%
- Use isotonic crystalloid fluid for fluid resuscitation; 0.9% saline or Ringer's lactate (RL) solution.
- Give empiric antimicrobials (within 1st hour).
- SBP > 90–100 mm Hg for adult, or age-appropriate for child
- Urine output > 0.5 mL/kg/hr for adult; > 1 mL/kg/hr for child
- Re-assess vital signs every 30 minutes for fluid responsiveness, markers of perfusion and fluid losses
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