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

EMplify - April 2021

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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?