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splenectomy and vaccination

Krin135 at aol.com Krin135 at aol.com
Tue Nov 23 18:49:47 GMT 2010


when I was practicing in Louisiana, we tried to give ours their first dose  
of pneumovax by the time they were 13...and that was in the days *before*  
it was mandated....but then, we had a high percentage of folks with at least 
 Sickle Cell Trait...
 
ck
 
 
In a message dated 11/23/10 12:46:56 Central Standard Time,  
nmcswai at tulane.edu writes:

Should  all our drug dealer get prophylactic vaccine. Should this be
included in  their first jail sentence?

Norman
Norman McSwain MD,  FACS
Professor, Tulane School of Medicine
Trauma Director, Spirit of  Charity Trauma Center, ILH/MCLNO 
norman.mcswain at tulane.edu
504 988  5111


-----Original Message-----
From:  trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On  Behalf Of Gross, Ronald
Sent: Tuesday, November 23, 2010 8:21 AM
To:  'Trauma-List [TRAUMA.ORG]'
Subject: RE: splenectomy and  vaccination

Nikahat,

Your questions are good, but unfortunately  have no really good answers.
Having said that, most folks would agree that  the vaccines work best
prior to splenectomy, and so to answer your 2rd  question first one could
assume that if you think that a patient has a high  likelihood of failing
non-operative management (NOM) you could/should  vaccinate the patient;
whether there is enough time for the vaccine to be  effective prior to
the (emergency) splenectomy in the face of failed NOM is  still
questionable.

As to the timing of giving the vaccines  post-operatively, there is
literature out there that says they should be  given at 2 weeks post-op,
but it is not Class I evidence.  I tend to  give the vaccines in the
recovery room (sorry PACU) because (1) our trauma  population can be less
than "reliable" for follow-up, and I know that they  have gotten the
vaccines prior to discharge, (2) we don't forget to give  the vaccine
prior to discharge, and lastly (3) the patient doesn't have a  fever from
the vaccine that delays discharge and increases their hospital  LOS.

Not really good science, but I think it is good medicine,  IMHO.

Ron

-----Original Message-----
From:  trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On  Behalf Of Nikahat Jahan
Sent: Tuesday, November 23, 2010 9:06 AM
To:  Trauma-List [TRAUMA.ORG]
Subject: splenectomy and vaccination

Dear  All
1. What is the current guideline on immunizations after  emergency
splenectomy. (Pneumococcal, menigococcal, H Infuenza B) and the  timing
and
type of vaccine- heptavalent conjugated Pneumococcal vaccine  Vs 23
valent?
2. Should a trauma patient with splenic injury who is  being managed
conservatively- but might end up with a splenectomy later-  also recieve
Pneumococcal vaccine?
3. How long should the antibiotic  prophylaxis be continued and what
drugs
should be  used?
thanks
nikahat
-- 
Lt Col Nikahat Jahan
Classified Spl  (Anaesthesiology)
Indian Army
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