Management of Suspected Rabies Exposure in the Emergency Department

Show Notes

Management of Suspected Rabies Exposure in the Emergency Department: An Interview With Dr. Bess Storch

Announcements

1. Pandemic Preparedness publication available now.
2. Mt Sinai COVID-19 Treatment Protocols have been updated and are available for free.
3. The Clinical Decision Making in the Emergency Department conference is June 23-27, both live and virtual.

Episode

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 women?
• Recent travelers?

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