rabies.
Let me tell you about a really scary emergency case.
I received a 27-year-old male patient who had a fever and thought it was AIDS.
But suddenly he found out that he was afraid of water and was in a state of rabies.
I wasn’t in ICU, in E.R. In the evening, there was a young man.
Patients are normal when they come in, they have a fever, they’re weak, they’re weak and they have headaches.
But he says that the fever has been going on for days, but it’s not too high, but it’s intermittent, it’s measured its own temperature, about 38.5 degrees C.
Heating is too common, with thousands of cases of fever, and emergency doctors are most afraid of fever, abdominal pain and chest pain.
After a brief inquiry into the history of the disease, I think it’s an upper respiratory infection. The checks were performed and the results showed normality.
The blood routine of the blood sample is also available, and white cell count is normal.
Other indicators are not too unusual.
Overall, upper respiratory infections are high.
“I gave you some cold medicine, went home to rest and drank more water. I’ll tell him when I’m ready.
He hesitated and said, “Doctor, there’s something I don’t know if to tell you. I’m sorry.
He’s a little down.
“Go ahead, what’s up. “I’m still in the middle of a medical order and I’m not looking up at him.
It took him a while before he told me that he had been talking to her for over a year, and that it had happened a little while after that.
My thoughts were fascinated by him.
“What do you mean, make it clear. I’m looking at him.
“That’s the one I met with a girl on the Internet a month ago, and had sex, had sex, and then started to have a fever, and I didn’t know if there was an epidemic or something. I’m sorry.
He’s a little uncomfortable.
“But I’m sure it’s a safety measure. We all have condoms. * He looks at me and laughs. *
“I’m worried about getting sexually transmitted, AIDS or something. So come see the emergency today. I’m sorry.
I’d like to laugh, but I can’t.
Because he’s still worried.
As a professional doctor, no matter how funny the patient’s history may be, I can’t laugh in front of others. Well, I’m a trained professional, a serious, calm face is important.
I said you don’t have to be afraid. First you wear a condom, it’s almost safe.
But it is important to be vigilant, considering that you have a history of metallurgical (i.e. a history of impure sex, and then think about it, it is not necessarily impure sex, but it is risky to have sex with a girl.
During the acute period of AIDS, symptoms can occur in about one month of infection, i.e. fever and inactivity.
“If you don’t feel comfortable, you can’t do this in emergency cases if you go to the clinic’s dermatological section tomorrow to consult on questions related to AIDS testing. I gave him advice.
All I can do with testing for AIDS-related tests is check four immunizations and look at anti-AIDS bodies, but they take time to produce and cannot be diagnosed very early.
And I’ve never seen AIDS before, I’ve never had experience, and it’s his responsibility to send him to dermatology.
I am right that early AIDS may be just a fever and a lack of energy, and it looks no different from a common cold.
His fear, actually, makes sense.
Explain to him a few things, put out some antics, gave him more water, he understood, and went back.
I can’t believe he came back the next day.
He’s wearing more clothes today than yesterday.
“Is it cold?” I asked him.
He smiled and said it was okay.
He then said that after he returned yesterday, he had a bad effect on his medication, that he had a fever last night and had a bad sleep, and that he was not feeling well.
That makes me wary.
It can’t really be AIDS, my God!
All of the symptoms of AIDS are unique, and when human immunity is compromised, the disease becomes a mess, so it is very easily misdiagnosed at an early stage of the epidemic, which must be eliminated through a secondary examination.
In fact, there is little evidence of support for him as AIDS, a mere ” history of unclean sexual behaviour” and the possibility of being infected with AIDS is low when he says that he has good security.
“Did you buy the condoms yourself or did they give you them? I asked him.
“I prepared it myself. I always have it in my bag, so I’m afraid it’ll be of use. He smiled a little.
“So, condoms are completely safe. There is no risk of broken condoms. I’m sorry.
Thinking of this level, my thoughts have opened up, and think of any other possibility.
Yesterday’s chests, electrocardiograms and blood patterns were normal, and patients now have non-specific symptoms such as heat, inactivity and discomfort, and new breakthroughs must be found for further identification.
So I looked him in the body, from head to toe, and I didn’t find anything unusual.
In order to rule out STDs, I closed the door, put on my gloves, pulled the curtains, and prepared to look at his genitals and vagina.
At first, he was a bit awkward and reluctant to take his pants off.
I said there’s nothing you have and we both have.
He’s willing to cooperate.
In addition to skepticism about his AIDS, it was more important to look at the possibility of syphilis, gonorrhoea, etc., which could also lead to fever and fatigue.
I took a closer look, and I didn’t find anything unusual like a soft rash, ulcer, etc.
“Did you vomit?” I asked him after the check.
“None. But the appetite wasn’t very good. I’m sorry.
His eyes are a little tired, his lips are dry, and it looks like he really didn’t get any rest last night.
“What do you do? I asked him.
That question should have been clear yesterday, but it was too busy yesterday, and I took it for granted that he had a common cold.
The nature of the patient ‘ s work is sometimes the key to diagnosis.
“I’m a salesman. He says:
“Sale what?” I asked.
“Agent XX beer. He says:
I didn’t ask anything. I don’t usually drink, I don’t even know the name.
At that time, the nurse pushed in, but he was surprised.
Such a strong man, so timid, his pants were pulled and so easily frightened. I feel strange.
He pulled the collar up a bit, it seemed a little cold, and he asked the nurse to close the door, which was very windy.
The nurse didn’t say anything, asked me for something and closed the door.
“Are you cold?” I asked him.
“A little. He says:
“Wasn’t it cold? I think.
Patients are hot, cold and uncomfortable. It does not look like a common cold.
But yesterday’s blood routine didn’t see high white cells.
And I didn’t find any abnormal signs such as pain in the liver, nor did the patient himself say abdominal pain, chest pain, cough, etc., which I was wondering.
If the infection is serious and the patient has sepsis, it can be similar, and if it is not a visible infection, could it be a more hidden infection, such as a deep tissue infection, or a blood system disease? Leukemia? lymphoma?
I began to have a brainstorm, and these blood diseases can have similar manifestations, and it can be heavy, bad, and even life-threatening in the short term.
I’m getting scared.
He was remeasured at 38.0°C, low heat.
“Is there a problem with piss? Is there a problem with urine? I asked him.
He said no, so I could basically rule out the problem of urinary infections.
And just now, the abdominal is normal, unlike the abdominal inflammation.
“You look like an infectious disease, but I don’t have an infection stove that can explain it well. Further examination is required. I told him.
“Today we’re going to have a chest and a CT look, reblood, do blood training and other routine tests. This could cost some money. I’m sorry.
He asked me.
“To be 1,000 more. I’m sorry.
I know it’s not a small amount for him.
But there is no way. These are all the tests that have to be done, and without them, I can’t get the evidence, I can’t get the correct diagnosis, and I can’t use the medicine.
“Do it, do it.” He whispered, “I’ll do it as long as it helps to cure the disease, even if it does.” I’m sorry.
I can feel a strange sense of fear in his words, and he needs too much now.
And I, for the time being, was his life-saving straw.
What’s his problem? I think fast, but slow.
I’ve been busy all day without much water, and I’ve picked up the thermostat on the table, opened the lid, and grunted for two.
Something happened to me!
As soon as I drank, he stood up and walked back.
I’ve been acting like this, and I’ve been staring at him and asking him what’s going on.
But when I saw the horrors on his face, I felt cool behind it.
He was staring at the thermostat in my hand, and he didn’t speak, and he was twitching under his throat, and his face began to get iron.
It all happened so fast that I couldn’t think.
“What’s wrong with you? I asked him.
I’m surprised too.
“No, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no.
I don’t want to see the thermostat in my hand. It’s like a child who’s done something wrong, hiding in the corner, tightening up.
Suddenly, my thoughts were like lightning.
“Isn’t he afraid of the thermostat in my hand? He’s not afraid of me drinking water, is he? I’m sorry.
He’s afraid of water!
If an experienced doctor had seen my description, he would have guessed the patient’s illness.
He began today with an anomaly when he was wearing two clothes on a hot day, and his collar was so high that he was afraid of the wind and I began to think he was afraid of the cold.
He’s got a bad appetite. I’m starting to think it’s the heat.
But why is his lips so dry? I told him to go home and drink more water. Why doesn’t he drink it?
But it’s all just my guess.
What I know in the disease spectrum is that there’s only one disease, and that’s:
rabies!
I don’t want him to be rabies. If he really is rabies, he’s basically sentenced to death.
But he was really afraid of me drinking water. I can’t change the fact that I don’t want him to be rabies anymore.
All I can do now is find a way to prove my hypothesis.
To confirm my guess, I hesitated and drank two more sips in front of him.
When I swallowed the water, I made a bigger sound, and I looked at him and looked at his reaction.
When I saw his reaction, I regretted it.
Because he is extremely uncomfortable and his face is distorted and very painful and afraid.
His dry lips are extremely pale, as if they had just come out of the desert, and very water is scarce.
I’m gonna swallow those two waters and put the thermostats in.
And he’s also been consciously vigilant, and if he’s a rabies disease, it’s supposed to be an exciting period, and the patient at this stage may be hallucinating, and if he’s out of his mind and attacks me, I’ll be able to deal with it, and I’ve even figured it out.
After I put it in the warmth cup, he came back, but never dared to come near me again.
I suddenly felt so sad, so sad, so weak that I came. I wish he wasn’t rabies.
I have so much in mind, he certainly doesn’t know.
“Have you been bit by a dog lately? I asked him carefully.
He thought about it a little bit, and then he said, “Yes, at the end of the month, the dog bit him in the country.”
He said, “When he came here, his lips began to tremble, and he supported us, and he did not continue.”
“Did you treat the wounds and inject rabies? I asked him urgently.
He said he used some chili to treat the wounds and the vaccine had no balls.
My mood fell to the ice.
I pacified him and went out to the chief.
When the director happened to be absent that day, I had to call him and tell him that a patient suspected of rabies came to the clinic and asked him to come back.
The director is in a meeting, and he can’t come back. I told Ma about this case.
Ma says if there is a clear manifestation of fear of water, it’s highly suspicious of rabies.
The rabies virus, which enters from wounds and follows the nerves into the brain, may damage parts of the brain, in particular the locomotive nerves, the larvae and the nerve nuclei under the tongue, leading to muscle swallowing and respiratory muscle spasms.
As soon as they see water, the patient is self-inflicted to choke and thus to express fear of water.
Patients are miserable at this time, very poor in their bodies, very eager to drink, but extremely afraid of water, not to drink it, even if they hear it, can go mad.
So patients hate water, it’s a paradox.
The old horse groaned and said to contact the infected section first.
Once a rabies disease occurs, it goes through a few days of pre-disposal, like a cold, and then goes into an excretion period, which usually lasts for two to three days.
This is the exciting period, and after two days, it’s going to go paralyzing, and the respiratory cycle is going to die soon, and it won’t last a day.
The more I hear, the more I’m scared, the more I can’t help it.
“Is there really no cure? I asked the horse.
Of course I know that rabies happen, 100% die, but I still hope the horse gives me hope.
The old horse is shaking his head, saying there’s no special medicine, and everything’s dead.
If the patient were to go to rabies immediately, he might have escaped. Otherwise, there would have been no way to get a rabies.
“Go back and deal with the patient, contact his family, and do nothing. “The horse says,
I pull my leg and run.
When I returned to the clinic, the patient was gone.
The nurse at the emergency counter was interviewed and said the patient had just left in a hurry.
I lost my mind.
Ma came and said if he really had rabies, he wouldn’t be long.
I tried to call the patient, tried to contact him and sent him back to the hospital, but the phone couldn’t reach him.
After that I contacted the Infection Section and told them that they also believed that rabies were highly likely to be diagnosed, but it was uncertain that if there was an antiviral, antibody examination, it would have been good.
But the patient has gone. I don’t know why he left, but he left without saying anything.
He may be aware of the problem, even knowing that the big time is coming, especially when I asked him if he had been bit by a dog.
He may not want to die in the hospital, or he may want to go home for partial treatment, no one knows.
This is the second rabies I’ve seen since I was treated, and, of course, it’s just a high level of suspicion, not diagnosed.
I remember yesterday when he told me that he was so scared and I thought it was funny and now I’d rather be AIDS.
AIDS is terrible? Scary. But the average period of incubation for AIDS is as long as nine years, and from the initial to the final stage of infection, it is a long process that may last 10 years or more.
And there are more and more anti-HIV drugs, and many can even survive with the same conditions as common chronic diseases.
And rabies are different, and if they happen, not more than six days, they die.
Science-based rabies
How long was rabies in?
It is generally considered to be 1-3 months, most of which occur within 3 months of the bite. But there is also a case where there are reports of a period of more than 10 years. The duration of the incubation period is related to age, the extent of the wound, the depth of the wound, the number of invasive viruses and the virulent force.
How’s rabies coming along? How many days will he die?
Once rabies occur, most of them have typical three-stage clinical performance.
First, there is a pre-emission period, which is low heat, powerlessness, headaches, nausea and discomfort; then there is fear, insomnia and sensitivity to sound, wind, light, etc. This phase lasts 2-4 days.
It then enters a period of high excitement, fear, fear of water, fear of wind, high fever, which may not be available to every patient. The patient’s spirit is clear, and a few are hallucinating, and this period lasts for one to three days.
Finally into paralysis, muscle convulsions stopped, completely paralysed, unconscious, and eventually respiratory cyclic failure ended in death, a period that was generally 6-18 hours, not exceeding 1 day.
The above shall normally not exceed six days.
Once a rabies disease occurs, a real death rate of 100%?
Our national medical schoolbook Epidemiology (8th edition) makes it clear that rabies are the most dangerous viral disease of all infectious diseases, with a 100 per cent death rate if they occur.
You got bit by a dog. Under what circumstances?
This is one of the most important concerns and one of the most critical. This involves a professional concept: exposure.
The exposure to rabies is defined as the bite, scratch, licking of a mucous membrane or defaced skin by rabies, suspected rabies, or failure to determine whether a resident active person suffering from rabies has a rabies disease, or the direct contact with an open wound, a mucous membrane with saliva or tissue that may contain rabies.
It’s called rabies. Not all of them are exposed to rabies, suspected rabies, or the fact that they are not rabies. If a dog bites his own, the dog is always home, never outside, never touching another dog, it can’t have rabies, it bites at this time, most of them bites, no rabies, which does not require rabies vaccination, provided you make sure your dog is innocent.
Exposure to rabies is classified into three levels according to the nature and severity of exposure:
Excerpts from the rabies prevention and control technical guide (2016 edition)
For those exposed in Level II and Level III, the vaccination procedure is generally 5 needles, i.e. 0 (on the day), 3, 7, 14 and 28 days of one shot, for a total of 5 shots.
A lot of people say. What’s a 10-day observation? What’s appropriate?
Every time there’s the importance of a doctor’s vaccine, there’s a lot of people in the comment area who say the 10-day observation of WHO, and they mean it doesn’t matter if the dog bites, just watch if the dog dies within 10 days.
If the dog dies within 10 days (possibly due to rabies), then drop it and get vaccinated. If the dog has been alive for 10 days, then it’s okay, no vaccination.
This is inappropriate.
The 10-day observation method recommended by WHO and the United States DC does exist, internationally recognized, but with many limitations:
(1) 10 Day Watch is limited to domestic dogs, cats, etc., and wounded animals need to have a clear record of effective rabies vaccinations two times, or else do not joke about their lives;
(ii) Can I isolate the animals? If it’s a dog, it can be observed for 10 days. If it’s a stray dog, it bites me, it’ll stay there for 10 days.
(3) This is of paramount importance and should be vaccinated immediately after exposure and not wait 10 days to decide whether or not to do so, otherwise the opportunity may be missed. But if in 10 days we can see that the perpetrator is still alive, then the next two needles (14th, 28th) will not have to fight.
In the light of the above, you must be careful with the 10-day observation method. Daywatch is scientific, but there must be a precondition, not to be bitten by a dog for 10 days to see it die. If it isn’t, we won’t be vaccinated. If it’s not, we’ll be vaccinated.
Some question the rabies vaccine abuse.
This is a big problem and a very wide-ranging one. Dr. Lee is not well-researched and is unable to make recommendations for specific analysis of specific problems, when he is bitten by a dog, for a comprehensive analysis, or for a vaccine.
Record number: YX11XbX2qda
I don’t know.
Keep your eyes on the road.
