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

EMplify - April 2021

Announcements

1. Traumatic Hemorrhage in the ED- with Dr Scott Weingart - April 13th, 8pm EST Free ! Register now: https://www.crowdcast.io/e/traumatic-hemorrhagic/register
2. Pandemic Preparedness publication is coming soon.
3. Mt Sinai COVID-19 Treatment Protocols have been updated and are available for free here: https://www.ebmedicine.net/topics/COVID-19/Protocols
4. The Clinical Decision Making in the Emergency Department conference is June 23-27 live and virtual. More information here: https://clinicaldecisionmaking.com

Management of Suspected Rabies Exposure in the Emergency Department - An Interview with Dr. Bess Storch

Epidemiology:

• Fatality rate of over 99%
• Half of cases occur in children
• 95% of cases are in resource limited countries, 35% in India
• 99% caused by infected dogs (worldwide)
• In the US, cases are predominantly bat variant

Why this topic?

• "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."

Pathophysiology:

• What causes it? The RNA virus Lyssavirus
• How is it transmitted?
• How does it reach the brain?

ED Evaluation:

• What does it look like clinically?
• 5 stages- incubation, prodrome, acute neurologic phase, coma death
• Why doesn’t everyone just get vaccinated?
• What patient medical history is important ? Steroids, chloroquine
• What animals are high risk?
• What about pets and quarantine?
• What about rodents ?
• Is there any role for labs or imaging ?
• What is the treatment regimen for those who are unvaccinated? And vaccinated?
• What about people who are immunosuppressed?
• Children?
• Pregnant?
• Recently traveled?