Episode 56 - Management of Suspected Rabies Exposure in the Emergency Department

<p><b>EMplify - April 2021</b></p> <p><b>Announcements</b></p> <ol> <li>Traumatic Hemorrhage in the ED- with Dr Scott Weingart - April 13th, 8pm EST Free ! Register now: https://www.crowdcast.io/e/traumatic-hemorrhagic/register</li> <li><b>Pandemic Preparedness publication is coming soon.</b></li> <li>Mt Sinai COVID-19 Treatment Protocols have been updated and are available for free here: https://www.ebmedicine.net/topics/COVID-19/Protocols </li> <li>The Clinical Decision Making in the Emergency Department conference is June 23-27 live and virtual. More information here: https://clinicaldecisionmaking.com </li> </ol> <p> </p> <p><b>Management of Suspected Rabies Exposure in the Emergency Department - An Interview with Dr. Bess Storch</b></p> <p>Epidemiology:</p> <ul> <li>Fatality rate of over 99%</li> <li>Half of cases occur in children</li> <li>95% of cases are in resource limited countries, 35% in India</li> <li>99% caused by infected dogs (worldwide)</li> <li>In the US, cases are predominantly bat variant</li> </ul> <p>Why this topic?</p> <ul> <li>"In a recent survey of licensed physicians, less than half could identify rabies transmission routes, the correct PEP schedule, and the correct anatomic administration sites."</li> </ul> <p>Pathophysiology:</p> <ul> <li>What causes it? The RNA virus Lyssavirus</li> <li>How is it transmitted?</li> <li>How does it reach the brain? </li> </ul> <p>ED Evaluation:</p> <ul> <li>What does it look like clinically? </li> <li>5 stages- incubation, prodrome, acute neurologic phase, coma death</li> <li>Why doesn’t everyone just get vaccinated? </li> <li>What patient medical history is important ? Steroids, chloroquine</li> <li>What animals are high risk? </li> <li>What about pets and quarantine? </li> <li>What about rodents ?</li> <li>Is there any role for labs or imaging ?</li> <li>What is the treatment regimen for those who are unvaccinated? And vaccinated? </li> <li>What about people who are immunosuppressed? </li> <li>Children? </li> <