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

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

EMplify – April 2021

Announcements

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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?

Last Updated on July 3, 2022

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