36 - animal bites Flashcards
parts of clinical assessment of bite
Hx - circumstances - Sx - allergies - tetanus Phs - damage - type of wound Xrays - of possble bony - skull film in children with head bites cutures - only if signs of infection
wound mgmt
most important part
- irrigate with saline syringe
- high risk for infection wounds should not be closed
5 risk risk wound factors
- puntures
- crush
- over 12hours
- hand or foot
- near joints
3 patient factors
- immunocompromised
- > 50
- prosthetic joints or valves
what is penetrating injury in vicinity of MCP
human bite clenched fist until proven otherwise
- high potential for complications
Tx of clenched fist bite
- copious irrigation and debridement
- avoid sutures
- soak qid and keep elevated as often as possible
- if signs of infection, IV Abx
typical bite micro
poly
- staph and strep common
3 special bact. in bites
- pasturella multocida
- gram neg rod
- 80% of cat and 50% of dog
- metastatic infections
- penicillin - capnocytophaga canimorsus
- gram neg rod
- normal in cats and dogs
- can cause overwhelming sepsis
- sens. to pen - eikenella corrodens
- common in human bites
- pen, cipro, clav
when to use prophylaxis
high risk btes
- full doses for 3-5 days
3 lines of Abx chouhce
- amox-clav
- 2nd gen ceph
- cefuroxime, cefaclor, cefoitin - combo
- clindamycin + flouro or doxy or septra
admission crit
- severe injury
- severe infection
- not responding to oral therapy
- ## immunocompromised
when to give tetanus
- all bites tetanus prone, so should give unless have had booster in last 5 years
main cause of rabies
bat bites
how is rabies transmitted
in saliva, and then travels up the senurons to brain
** what must be done in cases of possible rabies bite
report to public health
what is rabies postexposure prophylaxis
- passive with rabies Ig 20IU/Kg
- active in series of 4 on days 0,3,7,14
- if immunocompromized, should get a day 28 as well
- vaccine to deltoid
- RIG into and around wound
if previously immunized, should het 2 doses on day 0 and 3
Tx for low risk domestic
- observe animal 10 days
- Tx at first sign of rabies
T for wild animal
Tx as rabies unless can see animal
Tx for livsetock or small animals
- consult public health
- err on side of caution
when to def. give rabies
- head or neck bites
- steroid or immunocompromised
- high risk region by dog or cat
when to give for bats
- bite or scratch
- direct contact with bat
