Special ED Situations/Protocols

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Dog bites are relatively common in this region. A “[[Rabiesinvestigation.pdf|rabies investigation report]” from our Office of Environmental Health (OEH) department must be completed on every patient with a dog bite.
Rabies prophylaxis: if the dog can’t be found, the bite wasn’t provoked or if the dog was behaving strangely, rabies prophylaxis should be administered and the State of Alaska, section of epidemiology notified: 907-269-8000 or 800-478-0084.
The order for the rabies immune globulin and vaccination are in RAVEN and have attached references in the reference tab of the order.
Link to the web site from the State of Alaska: Rabies
Link to the post-exposure prophylaxis recommendations from the State of Alaska
YKHC Clinical Guideline for Rabies

Food borne botulism is very common in our region as the consumption of fermented traditional foods is very common. Bethel is one of the repositories of botulism anti-toxin from the CDC and we have several kits here that we can use to treat patients. Botulism should be suspected in any patient with a history of consuming traditional fermented foods and symptoms such as weakness, dry mouth, blurred vision, urinary retention, ileus, diarrhea or dyspnea (especially without gasping or rapid respiratory rate.)
All suspected cases of botulism MUST be reported immediately to State of Alaska section of epidemiology 907-269-8000 or 800-478-0084. The state of Alaska has a very nice booklet on botulism that outlines symptoms and case recognition and appropriate treatment that can be found on the following web site. There are also *hard copies in the ED and on NW.
Link to: State of Alaska website on botulism
Patients with suspected exposure to botulism should be treated with the anti-toxin and hospitalized. Measured Forced Vital Capacity needs to be measured and repeated hourly and if less than ____% predicted or a decreased in ____%, intubation should be considered. There is a special kit with the anti-toxin in the ED that you need to look over with information on administration and dosage. This paperwork MUST be completed and returned to the State of Alaska.

This is a common occurrence in our region. Many times the patient overdoses in a village. This doesn’t always mean they are medevac’d in, so most patients are started on oral Mucomyst in the village clinic. The Health Aides can draw a 4-hour post-ingestion level of acetaminophen to send in with the patient, while continuing the oral protocol. Once they arrive in Bethel, the level can be run and the Mucomyst can be continued or not depending on the level. This can be switched to an IV protocol once they arrive as well.
Poison control number is 800-222-1222
YKHC Clinical Guideline for Acetaminophen Overdose

see SART page for detailed information