Samwise Gamgee presents to your Emergency Department after an ankle injury. He was in the Mines of Moria when a flock of bats flew all around him and he fell, twisting his ankle. He doesn’t think he got any bites or scratches from the bates. He is ottowa ankle negative (see here for review).
So, is he ready for discharge?NO!!!! Any close exposure to bats should prompt a concern for rabies. People can be bitten without even being aware of it.
What else does he need?
Rabies immunoglobulin (at least half at wound site, with rest IM), and Rabies Vaccine. He needs repeat dosing on days 3, 7, and 14
Want to learn more? See here and here
By Dr. Andrew Grock and Dr. Sally Bogoch
References
uptodate.com
WHO guidelines
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