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

EMplify - April 2021

Announcements

* Traumatic Hemorrhage in the ED- with Dr Scott Weingart - April 13th, 8pm EST Free ! Register now: https://www.crowdcast.io/e/traumatic-hemorrhagic/register

* Pandemic Preparedness publication is coming soon.

* Mt Sinai COVID-19 Treatment Protocols have been updated and are available for free here: https://www.ebmedicine.net/topics/COVID-19/Protocols

* 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?

 

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