Friday, June 11, 2010

One of my most annoying pet peeves is individuals who wear pajamas out in public. Nothing quite says "I don't give a crap" more than donning fuzzy pajama bottoms and going out to the market, the pharmacy, Chile's....unless said individuals find it necessary to also don fuzzy slippers. Apparently the rules of polite society don't apply anymore.

I am equally annoyed when seemingly able bodied individuals come the the ER in pj's. If you drive to the ER, and also come in with a coffee from Dunks, you will be deserving of my scorn. Apparently, America's sick and stupid run on Dunkins also.

Of course, there are exceptions to this rule. I am perfectly willing to be accommodating to people with actual emergencies; chest pain, cutting off a finger in the snow blower (why they were snow blowing in pj's is a story for another time), children under age 9. Generally the elderly, anyone who arrives by get the picture.

I assume that anyone without major hemorrhage or an actual emergency who arrives in jammies and slippers is just being dramatic. Or an idiot. Or both.

So it was with a significant amount of effort to prevent the eyes from rolling right out of my head that I triaged an ENTIRE FAMILY of 5 wearing pajamas at 9 PM on a Friday night.

The emergency?

"There was a bat in the house....I think".

Nobody could say for certain; and nope, it didn't bite anyone. But good old family provider thought it was good idea to go to the ER for rabies prophylaxis. Immediately.

Post-exposure rabies prophylaxis is not terribly complicated, but it requires a LOT of calculations. For starters, everyone gets a 1 CC dose of rabies vaccine. This is the easiest part, and actually kind of fun to mix 'cause it produces a reeealy pretty magenta solution.

OK, enough of the fun part. Next, the patient also gets rabies immune globulin which is weight based; the more you weigh, the more shots you get.

Now, nurses really don't like to give a ton of shots, so the calculations involve squeezing as much of the medicine in as few shots as possible. If you are a big person, say, 250 lbs., let's figure this out together, and

The does is 20 IU's (international units) per kilogram. At 250 lbs., the patients weight is 113 kg. The total dose is 2260 IU.
Since the immune globulin comes 150 IU/ml and there are 300 IU per ampule, you will need you will get a grand total of 7.5 ampules of immune globulin.

Now, that is a total of 15 ml's to be divided into less than 3 mls per shot.
So, a 250 pound individual gets 5 shots of immune globulin and one shot of rabies vaccine on the first day. They have to come back three more times for more of the vaccine as well.

Wasn't that fun? And clear as mud?

But wait! Naturally, there is an app for that!

I don't have it, so using a standard calculator the old fashioned way is the only option. I still laughed my butt off when I read the description for the u-Rabid XL application for calculating rabies IG doses and followup scheduling:

"uRabid XL is the fastest & easiest way to calculate the Rabies Immune Globulin dose & Rabies Vaccine schedule.

Using standard US dosage calculation just enter the patients weight to determine the correct dose and use the division tool to calculate how many injections to give!

The bottom half of the program provides the standard Rabies Vaccine schedule for all return visits.

No calculators, no calendars - No hassle! uRabid will finally take all the guesswork out of injection administration for patients exposed to the deadly rabies virus"

It was a LOT of shots for 5 people, and we didn't have enough IG to accommodate both overweight parents and their pudgy children. The parents decided they didn't want it anyway when they found out how many shots were involved. I guess they probably went out to dinner and a movie in their jammies.