|
Need to consider rabies as a diagnosis in any case presenting with the acute onset and rapid progression of compatible neurologic signs, regardless of the patients report of an animal bite
If animal not available, must decide on Rx by probability of exposure
leads to overtreatment
Really have to play Dirty Harry.....So, ---- , do you feel lucky today ??
if patient not previously vaccinated:
local wound cleansing with soap and water
HRIG (human rabies immune globulin)
20 IU/kg :as much as possible infiltrated into and around the wound, rest IM distant from vaccine site (different syringes)
Vaccine: 1 mL IM deltoid on days 0, 3, 7, 14, 28
If previously vaccinated:
local wound cleansing
No HRIG
Vaccine: 1 mL IM deltoid on day 0 and 3
these regiments include children
Symptoms:
Prodromal period of malaise, fatigue, fever, headache, irritability, depression, nausea, sore throat, anorexia, pain or paresthesia at bite site
progression of symptoms
hyper, seizures, aggression
progressive lethargy, ascending paralysis, cranial nerve palsies
Severe spasms of pharyngeal and respiratory muscles
Odynophagia = hydrophobia
Aerophobia = choking and pharyngeal spasm when air blown in face
Changes in behavior: bad to good, good to bad
Excessive salivation
__________________
'Revel in action, translate perceptions into instant judgements, and these into actions that are irrevocable, monumentous and dreadful - all this with lightning speed, in conditions of great stress and in an environment of high tension:what is expected of "us" is the impossible, yet we deliver just that.
(adapted from: Sherwin B. Nuland, MD, surgeon and author: The Wisdom of the Body, 1997 )
Education is the anti-ignorance we all need to better treat our patients. ss, 2008.
The blade is so sharp that the incision is perfect. They don't realize they've been cut until they're out of the fight: A Surgeon Warrior. I use a knife to defend life and to save it. ss (aka traumadoc)
|