Page 361 - 2021 IDMT Digital
P. 361
RABIES
Introduction:
• 5DELHV LV D YLUDO UKDEGRYLUXV HQFHSKDOLWLV WUDQVPLWWHG E\ LQIHFWHG VDOLYD WKDW JDLQV HQWU\
LQWR WKH ERG\ E\ DQ DQLPDO ELWH RU RSHQ ZRXQG
• PLOOLRQ FDVHV DUH UHSRUWHG HYHU\ \HDU ZLWK DQ HVWLPDWHG GHDWKV
o 0RVW FDVHV DUH LQ UXUDO $IULFD $VLD DQG ,QGLD
o RI FDVHV IURP GRJ ELWHV
• ,Q WKH 86, 25 cases reported over the past decade (2009-2018) per the CDC.
Subjective:
• 6LJQV DQG 6\PSWRPV
o 3DLQ DW WKH VLWH RI WKH ELWH
o )HYHU PDODLVH KHDGDFKH QDXVHD DQG YRPLWLQJ
o $HURSKRELD dR QRW OLNH DLU WRXFKLQJ VNLQ
o +\GURSKRELD patient ZLOO QRW EH DEOH WR GULQN ZDWHU
o &16 VWDJHV VWDUW DERXW GD\V DIWHU SURGURPH
'HOLULXP DOWHUQDWLQJ ZLWK SHULRGV RI FDOP
3DLQIXO pharyngeal VSDVPs RQ DWWHPSWLQJ WR GULQN
+\SHUVDOLYDWLRQ
6HL]XUHV
&RPD DQG GHDWK
Objective:
• 3K\VLFDO ([DP
o 8VH *ODVJRZ FRPD VFDOH WR WUDFN SURJUHVVLRQ RI PHQWDO VWDWXV FKDQJHV DQG KHOS
JDXJH QHHG IRU PHGLFDO HYDFXDWLRQ
o )HYHU UDSLG VKDOORZ UHVSLUDWLRQV RFFDVLRQDOO\ LUUHJXODU 55 DQG +5 LQ ODWHU
VWDJHV
o /RRN IRU HYLGHQFH RI ELWH VRPH SHRSOH PD\ QRW NQRZ LI WKH\ ZHUH ELWWHQ E\ EDWV
Assessment:
• 'LIIHUHQWLDO
o 3ROLR DV\PPHWULF DVFHQGLQJ SDUDO\VLV
o 9LUDO HQFHSKDOLWLGHV UHVSLUDWRU\ V\PSWRPV QRW DV SUHYDOHQW
o 0HQLQJLWLV: KLJK IHYHU DOWHUHG PHQWDO VWDWXV QR REYLRXV SRUWDO RI LQIHFWLRQ ELWH
Plan:
• )ROORZLQJ FUHGLEOH UDELHV H[SRVXUH
o ,PPHGLDWHO\ VFUXE ZRXQG RU EURNHQ PXFRXV PHPEUDQH ZLWK VRDS DQG ZDWHU
GHEULGH DQG LUULJDWH ZLWK VDOLQH
o 0HGLFDWLRQV
o +XPDQ UDELHV LPPXQH JOREXOLQ +5,* XQGHU SUHFHSWRU JXLGDQFH
$WWHPSW WR LQILOWUDWH WKH IXOO GRVH LQWR DQG DURXQG WKH ZRXQG
,QMHFW WKH UHPDLQGHU LQWR WKH JOXWHDO UHJLRQ ,0 ZLWK D FOHDQ QHHGOH
o +XPDQ GLSORLG FHOO YDFFLQH +'&9 RU UDELHV YDFFLQH DGVRUEHG 59$
o ,I VLJQV DQG V\PSWRPV RI UDELHV WKHQ (9$& RU WUDQVIHU
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