MDM //

_ with bat exposure who presents for immunoglobulin administration. Patient without obvious wound but given duration of exposure, high risk nature and possible incubation period (of up to 1-3 months), mutual decision making with patient re: R/B/A to give dose of RiG. Per most recent CDC/ACIP guidelines re: PEP for human rabies, patient with 1st of 4-dose rabies vaccination regimen prior to arrival (0, 3, 7, 14; HDCV or PCECV). Discussed need for subsequent doses. Patient without altered immune competence. No obvious inoculation wound, as such, will infiltrate weight based RIG IM_. Patient currently largely asymptomatic with non-focal exam with no symptoms of cerebral dysfunction, anxiety, confusion, agitation, delirium, abnormal behavior, hallucinations, and insomnia. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed.



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