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

EMplify – April 2021


  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


  • 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.”


  • 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?


Last Updated on April 29, 2022

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