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

EMplify - April 2021AnnouncementsTraumatic Hemorrhage in the ED- with Dr Scott Weingart - April 13th, 8pm EST Free ! Register now: https://www.crowdcast.io/e/traumatic-hemorrhagic/registerPandemic 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/ProtocolsThe 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 children95% of cases are in resource limited countries, 35% in India99% 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 LyssavirusHow 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 deathWhy doesn’t everyone just get vaccinated?What patient medical history is important ? Steroids, chloroquineWhat 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?