Hello, med students. My name is Zach Olson and thank you for downloading this week's episode of the EM Clerkship Podcast.

This week, we are talking about rabies.

Rabies is a rare, really bad, aggressive encephalitis that pretty much is universally fatal.

It's not in the UK or Australia that I'm aware of, but it is in North America, South America, and pretty much everywhere else.

Rabies hides in bats and other carnivorous animals. So skunks, dogs, cats,

foxes, coyotes. Of note, it is not in rodents. It's not in reptiles, not in birds.

Again, it's really all in bats and carnivorous animals where you are seeing this.

It grows in their salivary glands and is transmitted when those bats and other carnivorous animals

break the skin with their claws or their teeth.

That's rabies.

And what you really need to focus on today is how we do post-exposure prophylaxis in the emergency department.

Similar to how we are giving tetanus shots to open wounds, we frequently are giving rabies shots when somebody has been bitten or scratched by bats or other big carnivorous animals,

dogs, that type of thing. So that's what you're going to need to know for your rotation.

When do we give rabies prophylaxis, both the immunization and the immune globulin? Because unlike

Tetanus, most people don't have a baseline immunization status to rabies.

So just like we would give both a tetanus shot and a tetanus immune globulin to somebody who had never been vaccinated with like a laceration.

With rabies, we're always giving a rabies shot in immunoglobulin because very few people have been vaccinated against

this, except some animal workers maybe. So how do we do this? A patient comes in and on all bites

or scratches from a bat or dogs or cats or other big carnivorous animals, you put them into this rabies pathway.

And they either will or will not get a rabies shot in rabies immunoglobulins.

So here's this pathway.

Step one.

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