Rabies is a deadly viral zoonosis with global disease burden. Following exposure to a rabid animal, postexposure prophylaxis (PEP) is the standard of care for unvaccinated persons. Despite the large proportion of pediatric cases, limited safety and efficacy data exist for use in pediatric patients. We report the safety, efficacy, and immunogenicity of a phase 4, prospective, 2-center, open-label, single-arm clinical trial evaluating human rabies immunoglobulin (HRIG150; KEDRAB 150 IU/mL) as part of PEP in patients (aged <17) with suspected or confirmed rabies exposure, where PEP was indicated. Thirty participants received 20 IU/kg HRIG150 infiltrated into the detectable wound site(s), with any remainder injected intramuscularly, concomitantly with the first of a 4-dose series (days 0, 3, 7, and 14) of rabies vaccine. Rabies virus neutralizing antibody (RVNA) titers and tolerability were assessed on day 14 following administration. Participant safety was monitored for 84 days. No serious adverse events, rabies infections, or deaths were recorded. Twenty-one participants (70.0%) experienced a total of 57 treatment-emergent adverse events (TEAEs) within 14 days following administration. Twelve participants (40.0%) experienced a total of 13 adverse events deemed treatment related. All TEAEs were mild in severity. On day 14, 28 participants (93.3%) had RVNA levels of ≥0.5 IU/mL (mean±standard deviation: 18.89 ± 31.61). These results demonstrate that HRIG150 is well tolerated and effective in pediatric patients as a component of PEP. To the authors' knowledge, this study is the first to establish pediatric safety and efficacy of HRIG in the US.

End-tidal CO2 (etCO2) monitoring is not a new modality in the pediatric emergency department (PED) and emergency department. It is the standard of care during certain procedures such as intubations and sedations and can be used in variety of clinical situations. However, etCO2 may be underused in the PED setting. The implementation of etCO2 monitoring may be accomplished many ways, but a foundation of capnography principles specifically in ventilation, cardiac output, and current literature regarding its application is essential to successful implementation. It is the intention of this article to briefly review the principles of etCO2 monitoring and its clinical applications in the PED setting.

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randomized and quasi-randomized controlled trials comparing glucocorticoids with any control (either placebo, adrenaline (epinephrine), an antihistamine, or any combination of these).Results: A total of 204 patients with biphasic anaphylaxis were identified with follow-up. All patients either experienced confirmed biphasic or protracted reactivity. Average time to onset of the second phase was 10.2 hours (CI: 2-38). Time to resolution of initial symptoms was significantly longer for biphasic reactors (112 vs 133 minutes; P ¼ .03). All biphasic and protracted anaphylactoid reactions received corticosteroids. Most importantly, patients who received steroid administration vs those who did not were equally as likely to experience protracted and biphasic reactions (P¼.04).Conclusions: Biphasic and protracted anaphlyaxis is a potential outcome for those experiencing anaphylactoid reactions. Prevention of this outcome is primarily unproven and based on observed data; there is no beneficence of steroid administration in the prevention of biphasic/protracted anaphlaxis. This neccessitates the need for further investigation into their efficacy.