Rabies vaccines and immunoglobulins: WHO position

PEP consists of the following steps:

  1. All bite wounds and scratches should be attended to as soon as possible after the exposure; thorough washing and flushing of the wound for approximately 15 minutes, with soap or detergent and copious
    amounts of water, is required. Where available, an iodine-containing, or similarly viricidal, topical
    preparation should be applied to the wound.
  2. RIG should be administered for severe category III exposures. Wounds that require suturing should be
    sutured loosely and only after RIG infiltration into the wound.
  3. A series of rabies vaccine injections should be administered promptly after an exposure.

Nose Bleeding…evidence based practice

  1. Gauze ribbons, nasal tampons and nasal balloon catheters all appear to be equally effective in controlling epistaxis, however, the nasal tampons and balloon catheters appear to be less time consuming and easier to insert. 
  2. Most patients discharged with nasal packing should follow-up with an  ENT physician within 48-72 hours to reduce potential complications. Most patients with anterior nasal packing do not require antibiotic prophylaxis as the incidence of Toxic shock syndrome is very low.
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Start Peripheral Vasopressors Early in Shock!

It has been dogmatically believed that prolonged infusion of any vasopressor mandates placement of a central line.  However, available evidence doesn’t support this.

  1. Diluted solutions of all catecholamines are safe (except Vasopressin) to be administered peripherally via a well functioning 18-20G IV or larger in forearm (no hand/wrist/AC) .
  2. No old IVs (>72 hrs)
  3. Know how to treat extravasation
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Spinal stabilisation of adult trauma patients

A strong recommendation against spinal stabilisation of patients with isolated penetrating trauma; a weak recommendation against the prehospital use of a rigid cervical collar and a hard backboard for ABCDE-stable patients; and a weak recommendation for the use of a vacuum mattress for patient transportation. Finally, our group recommends the use of our clinical algorithm to ensure good clinical practice.