List Archives

Fri Apr 13 14:35:16 BST 2007

Dr. Hardcastle,

Thank you for all your help. I do understand that the information is for
rabies in general. I agree, unfortunately, our society is forcing us to
do the CYA more and more. I think you'll be interested to know that when
I presented the information I've received from you and our state
epidemiologist to the trauma surgeon involved, he completely blew my
off. His comment was something to the effect that it was overkill to
treat this patient as he's never heard of a rabid bear before.

I did access the CDC website and printed the information available
there. 

I saw in the paper yesterday that it wasn't an elk carcass but a moose
carcass that was nearby. The patient didn't know it was around. Fish and
Game said it looked like a natural death.

The patient had a degloving scalp injury, lacerations on the forehead,
back and buttocks from claw marks. The patient apparently curled up and
played dead. The bear went away after the initial mauling and he got up
to go back to the house, but the bear apparently wasn't too far away and
came after him and mauled him again. He was smart enough to play dead
again, and when the bear was finished with him, he belly crawled back to
the house.

Karla 

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Hardcastle, Tim, Dr
<tch at sun.ac.za>
Sent: Thursday, April 12, 2007 23:00
To: Trauma &amp; Critical Care mailing list
Subject: RE: Rabid bears

Karla

My pleasure to assist. Realise the references are NOT specific to bears
- just rabies - the virus is the same anyhow! Unlike Charles Krin, I
cannot access the CDC site (semi-restricted for non US-subscribers?), so
could not get you that data. I agree with Pret - if in doubt, give the
prophylaxis. I don't think the issue here is that they know it is
rabies, rather they are being cautious -it may just be good old CYA!

Tim
Dr T C Hardcastle
M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU) ATLS
instructor and DSTC Cape Town Course Director Intern program
Coordinator: Surgery M.Med (Emergency Medicine) Executive Committee
member Clinical Head (Director): Diana Princess of Wales Trauma Unit
Division of Surgery (General) Room 4064 Department of Surgical Sciences
Tygerberg Hospital / University of Stellenbosch PO Box 19063 Tygerberg
7505 Western Cape South Africa
e-mail: tch at sun.ac.za
Cell: +27824681615
Office: +27219389281 or 4911 pager 0302

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]On Behalf Of Bryan Karla
Sent: Thursday, April 12, 2007 8:43 PM
To: Trauma &amp; Critical Care mailing list
Subject: RE: Rabid bears

Thank you Dr. Hardcastle,

I will look up the reference. This was a grizzly bear. A man heard his
dog barking, went out to check on it, and there was the bear! The bear
attacked and did not leave, even when EMS got there. Apparently, there
was a fresh elk kill nearby that he was protecting. Fish & Game left the
kill and set a trap. We haven't yet heard if the bear has been trapped.

I spoke with our state epidemiologists--one an MD, the other a vet. Both
agreed that the patient should be treated prophylactically until the
bear is caught and tested (even though there have been no known cases in
Idaho or Wyoming). I passed the information on to the trauma surgeon
involved.

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Hardcastle, Tim, Dr
<tch at sun.ac.za>
Sent: Thursday, April 12, 2007 08:14
To: Trauma &amp; Critical Care mailing list
Subject: RE: Rabid bears

Karla

Did a Medline search - surprisingly little re: protocols, but
identifying the virus early is possible by rapid PCR testing. This can
identify infected patients early.

The swab DNA needs to go to the conservation service research labs - to
identify the bear -   they should have such laboratories!

Look also at: Vet Clin North Am Small Anim Pract. 2001 May;31(3):557-72,
Rabies postexposure prophylaxis. Human and domestic animal
considerations, by Fearneyhough MG. This may help.

Regards
Tim
Dr T C Hardcastle
M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU) ATLS
instructor and DSTC Cape Town Course Director Intern program
Coordinator: Surgery M.Med (Emergency Medicine) Executive Committee
member Clinical Head (Director): Diana Princess of Wales Trauma Unit
Division of Surgery (General) Room 4064 Department of Surgical Sciences
Tygerberg Hospital / University of Stellenbosch PO Box 19063 Tygerberg
7505 Western Cape South Africa
e-mail: tch at sun.ac.za
Cell: +27824681615
Office: +27219389281 or 4911 pager 0302

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]On Behalf Of Bryan Karla
Sent: Thursday, April 12, 2007 3:30 PM
To: trauma-list at trauma.org
Subject: Rabid bears

Last night we had a patient come in who had been mauled by a grizzly
bear--no, not the first we've ever had. Today we had a call from a fish
and game conservation officer who asked us if we have a policy for
testing for rabies on these patients (we do not). He also stated that
there are pending lawsuits all over the country on behalf of patients
who have been mauled by rabid bears and died. Families are suing fish
and game and the hospitals because their loved one was not tested for
rabies. He would also like us to swab these patients for possible DNA
testing to help them in identifying the bears when/if they are caught.
My questions: how soon can a patient be tested for rabies and have a
positive test? What type of test is there (other than IgG)? Does anyone
have any kind of policy or protocol for testing these patients that they
would share? If you swab the wounds, to whom do you send the swabs for
analysis? Any other suggestions you can give me would be greatly
appreciated.
Karla Bryan, RN, BSN
Trauma Services Coordinator
Eastern Idaho Regional Medical Center
3100 Channing Way
Idaho Falls, ID. 83403-2077
208-227-2027
Fax: 208-227-2032
This e-mail and any files transmitted with it may contain PRIVILEGED or
CONFIDENTIAL information and may be read or used by the intended
recipient. If you are not the intended recipient of the e-mail or any of
its attachments, please be advised that you have received this e-mail in
error and that any use, dissemination, distribution, forwarding,
printing, or copying of this e-mail or any attached files is strictly
prohibited. If you have received this e-mail in error, please
immediately purge it and all attachments and notify the sender by reply
e-mail or contact the sender at the number listed.

Karla Bryan, RN, BSN
Trauma Services Coordinator
Eastern Idaho Regional Medical Center
3100 Channing Way
Idaho Falls, ID. 83403-2077
208-227-2027
Fax: 208-227-2032

This e-mail and any files transmitted with it may contain PRIVILEGED or
CONFIDENTIAL information and may be read or used by the intended
recipient.  If you are not the intended recipient of the e-mail or any
of its attachments, please be advised that you have received this e-mail
in error and that any use, dissemination, distribution, forwarding,
printing, or copying of this e-mail or any attached files is strictly
prohibited.  If you have received this e-mail in error, please
immediately purge it and all attachments and notify the sender by reply
e-mail or contact the sender at the number listed.

--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/index.php?/community/
--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/index.php?/community/
--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/index.php?/community/
--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/index.php?/community/

List Archives

For your convenience, find the Trauma List Archive Below

Rabid bears