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
- 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
- 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
- Howard, R. S. (2005). Poliomyelitis and the postpolio syndrome. BMJ, 330(7503), 1314-1318.