foaming at the mouth - post exposure rabies tx

[reddirtgirl]

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Has anyone out there ever received/given post exposure treatment for rabies (w/in 10 days of exposure)? If so, what does it consist of?

Is there a more efficient way to go about it other than to start w/ a visit to the ED? Esp if the PCP won't touch this & the ED can be such a bottomless time suck.

Thanks!

 

[southerndoc]

Yes, I've given it twice two months ago.

You give the rabies vaccine in the opposite arm of the injury/bite.

You give a total of 10 mL of rabies immunoglobulin. As much as feasible should be locally infiltrated at the injury/bite site. The remainder should be given in the deltoids and glutes, but not in the same extremity as the vaccine.

I'm still not certain that giving the vaccine in a different arm makes that much of a difference, but that's what we were recommended.

The CDC has a protocol available on their website. Do a search for it.

 

[southerndoc]

Oh yea, recommended days: time of injury, 3 days, 7 days, 14 days, 28 days...

 

[Apollyon]

Is there a more efficient way to go about it other than to start w/ a visit to the ED? Esp if the PCP won't touch this & the ED can be such a bottomless time suck.

Way to endear yourself to a bunch of...emergency physicians.

The reason why you need to see a doctor and can't just get it for yourself is evident by your question - you don't know that you even need it. Oh, and, friends and the internet are not nearly as reliable.

ED, office/clinic, urgent care - that's about the size of it. Even if you DO need PEP/immunization, you need to be observed somewhere that can treat you immediately if you have an allergic reaction. The HDCV (human diploid cell vaccine) is of human origin, but there can still be some reactivity. (Incidentally, the "human diploid cell" is a fibroblast.)

As far as the real risk of the RIG and the vaccine binding each other by giving it in the same location, theoretically I can see it, I don't know about in vitro data, and yet, would you let your kid be the one to test it on?

 

[docB]

the ED can be such a bottomless time suck.

Way to endear yourself to a bunch of...emergency physicians.

We may not want to hear it but it's sure as Hell true.

 

[Apollyon]

We may not want to hear it but it's sure as Hell true.

I'm not doubting it - I live it, as do you - but, at the same time, it's like saying, "Wow - you have a ****ing huge nose! By the way, will you look at my rash?"

Even you, the burgeoning cynic that you are, MUST appreciate that telling someone that their workplace is a ****hole, then asking for advice from those same people is not exactly the most tactful.

 

[docB]

I'm not doubting it - I live it, as do you - but, at the same time, it's like saying, "Wow - you have a ****ing huge nose! By the way, will you look at my rash?"

Even you, the burgeoning cynic that you are, MUST appreciate that telling someone that their workplace is a ****hole, then asking for advice from those same people is not exactly the most tactful.

That's true but I hear it from literally half my patients. I think it actually better that the ER is a malignant environment for many patients because it discourages the primary care crap. I hate the nights that a slow enough that the "Foot fungus x 1 year" actually gets a bed.

 

[Sessamoid]

That's true but I hear it from literally half my patients. I think it actually better that the ER is a malignant environment for many patients because it discourages the primary care crap. I hate the nights that a slow enough that the "Foot fungus x 1 year" actually gets a bed.

If it's me, they won't have enough time to get comfortable in that bed. DISCHARGED!

 

[mustangsally65]

So why did older vaccinations have to be given in the abdomen?

 

[southerndoc]

Even you, the burgeoning cynic that you are, MUST appreciate that telling someone that their workplace is a ****hole, then asking for advice from those same people is not exactly the most tactful.

Good grief Apollyon, when's the last time you got a piece? You've been awful cranky lately!

No, I wouldn't test it on my own kid. I doubt you'll test it period.

I thought the OP was a resident. Is the OP wanting info personally? If so, I wouldn't have posted in this thread.

 

[reddirtgirl]

I'm not doubting it - I live it, as do you - but, at the same time, it's like saying, "Wow - you have a ****ing huge nose! By the way, will you look at my rash?"

Even you, the burgeoning cynic that you are, MUST appreciate that telling someone that their workplace is a ****hole, then asking for advice from those same people is not exactly the most tactful.

easy there...

it's more like going to a restaurant, knowing that the service will be slow, for a dish that you can't get anywhere else.... I'm not exactly blaming the chef.

 

[Annette]

You can get rabies followup at many local health departments. Don't know if the wait is any less, though.

 

[ERMudPhud]

Don't bother getting prophylaxis. The disease is treatable now


Willoughby RE Jr, Tieves KS, Hoffman GM, Ghanayem NS, Amlie-Lefond CM, Schwabe MJ, Chusid MJ, Rupprecht CE.
Survival after treatment of rabies with induction of coma.
N Engl J Med. 2005 Jun 16;352(24)




Just kidding but hopefully everyone knew that

 

[southerndoc]

Haha, coma for treatment? I think I'd rather have the vaccination.

I'll have to pull that article.

 

[Apollyon]

Good grief Apollyon, when's the last time you got a piece? You've been awful cranky lately!

No, I wouldn't test it on my own kid. I doubt you'll test it period.

I thought the OP was a resident. Is the OP wanting info personally? If so, I wouldn't have posted in this thread.

Huh? Sorry, didn't hear you - I was at ACEP. This year was loot. Next year is ass.

 

[Apollyon]

So why did older vaccinations have to be given in the abdomen?

Those were serum (which had immunoglobulin in it). Now, it's recombinated vaccine.