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

EMplify - April 2021Announcements* 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 StorchEpidemiology:* 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 variantWhy 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?