4 - Bites and Burns Flashcards
Mammalian bites
- Less than 1% of all ER visits
- Usually children
- Nondomestic mammal bites less common
- Human bites represent 60/100,000 people
Human bites microbiology
o Eikenella corrodens: Found in 20% of infected wounds
o Staph. And Strep. Species
o Treponema pallidum
Dog and cat bites microbiology
o Pasteurella multocida: Most common pathogen
o Susceptible to penicillin
o S. aureus, Strep. viridans, Bacteriodes sp. also common
o Rabies (Domestic: Healthy and observe for 10 days-no vaccine, Wild: Regard as rabid unless confirmed-RIG and Human Diploid Cell Vaccine)
Management of bite wounds
- Manage as puncture wounds
- Debridement and irrigation
- Tetanus and Rabies prophylaxis
Antibiotic prophylaxis for bit wounds
o Some say you are setting yourself up for a superinfection
o If you debride and irrigate it adequately, you shouldn’t need an antibiotic
o The drug of choice for pasturella and eikenella is Augmentin
Pathophysiology of a burn
o Zone of coagulation (center)
o Zone of stasis (2nd circle)
o Zone of hyperemia (3rd circle)
Evaluation of depth of burn
Partial thickness
- First degree
- Second degree (superficial or deep)
Full thickness
- Third degree
NOTE: we are getting away from saying “first degree” and “second degree” burns, we mostly just call them a partial thickness (superficial or deep dermis involvement) or full thickness - First degree burns (i.e. sunburn) are not really classified or talked about
Evaluation of size of burn
- Total body surface area (TBSA)
- Rule of nines or number of palms (the size of your palm is approx. 1%)
- Entire foot is approximately 3.5% of the TBSA
Second degree burn – superficial
- Injury to the epidermis and a portion of the dermis. Does not totally destroy the basal cell layer
- PAINFUL with blister formation and erythema
Second degree burn – deep
- Injury to much of the dermis and basal cell layer.
- Skin appendages intact
- May have blister formation
- Dry, anesthetic and mottled
- NO PAIN
Third degree burn
- Injury is full thickness and includes skin appendages
- Leathery, whitish to dark in color, thrombosed vessels and anesthetic
- NO PAIN
Case Study 1
45 year old police officer presents to ED while you are doing a 4th year rotation in ED. He was bitten by a police German Shepard during a training exercise on his left hand. Complains of pain in the left hand that he rates at 4/10. He cleaned the wound by flushing it out with water and covering with a clean towel and came directly to ED. Accident occurred 30 minutes ago.
Additional exams or tests
- Tetanus shot?
- X-ray? Look for a fracture in the bone
Treatment
- Suture it up – faster healing, but could have infection
- Leave parts open – contamination can get out, drainage
- Antibiotic if signs of infection or prophylaxis
Case Study 2
o 40 year old female presents to clinic with a burn on the top of her right foot. She was grilling with charcoal and someone knocked over the grill and a piece of charcoal landed on the top of her foot. She was wearing flip flops at the time of the accident. She ran burn under water then covered it with antibiotic ointment and a band-aid. The accident occurred yesterday and she presents today because of pain and development of a large blister that has since popped this morning. She rates her pain as 10/10. Denies any fever or chills
Dermatology: Circumferential burn 1 cm in diameter dorsal right 2nd metatarsal neck. Blister present, but open. No drainage. Pain on palpation around area of burn - Need to palpate even though it is painful – apologize and do it.
