Vaccine for the Masses

                                                       
So, this last week it was announced that a produce stocker at a local grocery store had been diagnosed with Hepatitis A;  by far, the least serious of the Hepatitis viral illnesses.  Anyone who had eaten raw fruits or vegetables from about the prior three weeks was being advised about the potential exposure, and the county and state health authorities were offering the vaccine or immunoglobulin to anyone who thought they might be at risk.  Oh yeah, btw, the store had over 80,000 purchases of potentially affected fruits and vegetables.

So, this weekend, as part of the SMART (Specialized Medical Assistance Response Team) Team I helped do medical screening as part of the process.  Close to 3000 people came during the first day, about as many on the second, and they opened a third clinic today, and I haven't heard the numbers yet.  But, there were enough that we ran out of immunoglobulin and are having another clinic tomorrow and most likely on Wednesday.

The risk of someone actually contracting Hep A.  Very small.  However, this was a great test of the disaster system, especially since it has been training for mass innoculations should there be a smallpox or anthrax outbreak.  From that stand point, it's been a very interesting experience.  At least it gets me out of Anesthesia.

Yes, good old adult anesthesia.  I was forewarned that you could have up to 6 intubations in a shift at Children's Hospital and be luckily to get that many intubations in the other 2 weeks spent at BGH.  It's just that you're competing with students, anesthesiology residents, and student nurse anesthetists.  So you have a very short amount of time to have an attending be comfortable enough with you to allow you to intubate.  Plus, the cases are much longer.  The short cases are all staffed by CRNA's who put in LMA's for the most part, and there's no great challenge in stuffing something down someone's throat.

At least my attending today, out of the two cases, did allow me to attempt an intubation on the second case.  It was a rather larger patient with a big head and neck, and I could only see the very bottom corner of their vocal cords when I lifted with the blade.  I didn't feel bad when I stepped back and the attending took a look because he had to struggle for a few moments as this patient's trachea was very forward located, and they did have a very big head.  Eventually, they were intubated and the case proceeded, but this is the perfect situation to have this happen in.  Again, if this patient came into the ED and needed to be urgently intubated, at least now I have an appreciation of the difficulty, and the attending talked me through the steps of the intubation and gave me a lot of pointers on how to make things easier.

More of the same tomorrow.  Still cranking out wedding programs and favors.  The days are passing WAY too fast...

Tags: hepatitis A, immunoglobulin, SMART medical team, vaccination