Category: Infectious Disease

 

Author: Chris Holmes, M.D.

Educational Pearls

• “Sepo’ is a term from Homer (author of The Iliad and The Odyssey), and means “I rot”.
• Hippocrates in 400 BC identified sepsis as a “dangerous decay within the body”.
• Galen in 200 AD believed pus was “laudable”.
• The Greeks and Romans used the term “myasma” to describe the smell of swamp and rotting flesh.
• Dr. Emmanuel Rivers in Detroit did one of the the first big studies about sepsis and was an advocate for goal-directed therapy.
• Now, Vitamin C cocktails are in use, but new sepsis treatments should be investigated carefully before implementation.

References: Funk, Duane J. et al. Sepsis and Septic Shock: A History. Critical Care Clinics , Volume 25 , Issue 1 , 83 – 101

Author: Don Stader, M.D

Educational Pearls:

• It is important for providers to know how to use IV drugs properly so that they can instruct their patients on how to avoid injury. Heroin use is increasing.
• Hepatitis, HIV and infection are possible complications of improper IV drug use
• The first step of heroin use is to dissolve the solid heroin in water using heat – a spoon and lighter are often used for this step. Next, the heroin is drawn into the syringe through a filter (cotton is often used).
• Heroin concentration often varies widely – counsel patients to test their heroin first.
• Sterility of the needle, water, cooker, cotton and syringe is paramount. Refer patients to a needle exchange program where they can get clean supplies.
• Hepatitis C can live outside the body for 4 days – NEVER share ANY supplies.
• Sterile procedure is important – needles should not be licked.

References: http://drugsense.org/flyers/10_tips_for_safer_use.pdf

 

Run Time: 4 minutes

Author: Gretchen Hinson M.D.

Educational Pearls:

• The key imaging of a mumps patient is “chipmunk cheeks” or parotitis.
• The swelling can extend almost to the ears and can be extremely painful – in about 25% of cases the swelling is unilateral.
• Other organs can be involved as well including: testicles, ovaries, breast tissue, other salivary glands, and the brain/spinal cord.
• Mumps is transmitted through droplets in the air.
• Two immunizations will get you 88% probability immunity and one immunization will get you 78% probability of immunity. Yet, immunity can wane and there can be viral strains not covered by the immunization.
• Mumps outbreaks are common in the winter season because of close quarters.
• You can test for Mumps using an IGM blood test, (more likely to see a spike in this if the patient is not vaccinated) Buckle swabs, & Urine test.

References: https://www.cdc.gov/mumps/index.html

Run Time: 4 minutes

Author: Susan Brion M.D.

Educational Pearls:

• Rabies causes 61,000 deaths per year worldwide, mostly in Africa and Asia, and associated with dog bites. In the US there are 2 fatal rabies cases per year, all associated with bats.
• Dogs in the US: the only concern is if you are bitten along the US/Mexico border, there are actually more documented cases of rabies in cats in the US than in dogs.
• All 49 continental states have documented rabies cases with bats. Even if a patient woke up in a room with a bat, the patient is a child, has developmental delay, or is intoxicated they should be treated prophylactically.
• There are no documented case of rabies in small rodents, no documented transmission of rabies from infected patients to providers.
• Theoretically rabies can be transmitted from human to human, but it is not well documented.
• BOTH immunoglobulin AND vaccine are given for prophylaxis. Wound cleaning reduces chance of transmission by 90%. Dosing is 20 int units /kg.
• It is recommended to give as much of the immunoglobulin as feasible at the site of the wound, the rest is given IM. If there is no obvious wound the immunoglobulin is given IM.
• Prophylaxis is given on days 1, 3, 7, 14.

Link to Podcast: http://medicalminute.madewithopinion.com/rabies/ 

References: http://www.cdc.gov/rabies/medical_care/