Polio From EM Quick Hits 42 – Subsegmental PE, Trauma Analgesia, Near-Drowning, Polio, Head-up CPR

In this post, I link to and review the section on Polio from EM Quick Hits 42 – Subsegmental PE, Trauma Analgesia, Near-Drowning, Polio, Head-up CPR.*

*Helman, A. Rezaie, S. Petrosoniak, A. Khatib, N. Reid, S, Swaminathan, A. EM Quick Hits 42 – Subsegmental PE, Trauma Analgesia, Near-Drowning, Polio, Head-up CPR. Emergency Medicine Cases. September, 2022. https://emergencymedicinecases.com/em-quick-hits-42-september-2022/Accessed September 18, 2022

All that follows is from the above resource.

Topics in this EM Quick Hits podcast

Salim Rezaie on venous thromboembolism recurrence in subsegmental pulmonary embolism (1:23)

Andrew Petrosoniak on pain management in the polytrauma patient (6:44)

Nour Khatib on rural case on management of near-drowning patient (17:09)

Sara Reid on polio primer (24:30)

Anand Swaminathan on head-up cardiopulmonary resuscitation (32:20)

Polio primer – polio is back!

  • Background – undervaccinated populations are at risk for paralytic polio
    • Polio is an enterovirus spread via fecal-oral route with a 1-3 week incubation time, and communicability is highest at the time of symptom onset
    • The oral polio vaccine contains an attenuated virus, which can be excreted into stool and transferred to other children; in rare cases and undervaccinated populations, this can spread continuously, allowing for mutation that may result in a strain with paralytic polio.
    • The COVID pandemic has led to polio-undervaccinated populations in North America
  • Clinical Features – a wide clinical spectrum
    • Most patients are asymptomatic
    • Mild disease: fever, fatigue, headache, and vomiting, which is self-limiting after a few days
    • Moderate-to-severe disease: muscle pain, stiffness of back and neck +/- paralysis which usually onsets 1-3 weeks after infection. Recovery is possible but becomes increasingly irreversible with longer duration of paralysis.
    • Acute paralytic polio: asymmetric paralysis that begins proximally then descends, with fever, meningeal irritation, bulbar involvement, reduced tone and loss of reflexes and sometimes muscle atrophy, flaccid paralysis, and respiratory insufficiency.
  • Diagnosis in ED – acute flaccid paralysis + poor vaccination status = polio until proven otherwise
    • Consider polio in anyone with acute weakness or flaccid paralysis in the context of incomplete or unvaccinated status and recent travel to areas with polio activity
    • Lumbar puncture shows elevated CSF protein and pleocytosis
    • 2 x Stool samples 24 hours apart for polio
    • NP swab for polio

Bottom line: Polio is back due to undervaccinated populations in North America; consider polio in anyone with acute weakness or flaccid paralysis in the context of incomplete or unvaccinated status and recent travel to areas with polio activity

  1. Center for Disease Control. (2021, October 20). Poliovirus diagnostic methods. Centers for Disease Control and Prevention. https://www.cdc.gov/polio/what-is-polio/lab-testing/diagnostic.html
  2. Center for Disease Control. (2022, Aug 10). Poliomyelitis: For Healthcare Providers. Centers for Disease Control and Prevention. https://www.cdc.gov/polio/what-is-polio/hcp.html 
  3. Howard, R. S. (2005). Poliomyelitis and the postpolio syndrome. BMJ330(7503), 1314-1318.
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