Animal/Human Bites Flashcards
What is the peak age of incidence in regards to animal bites, specifically from dogs?
5-9 y/o
Are more animal bites from dogs or cats?
Dogs (85% vs 10% cats)
In patients under 5 years old 60-70% of dog bites are where?
Head/neck (think height of the child vs mouth of dog)
Dog or Cat?
- Crushing/tearing wound due to rounded teeth/strong jaws
- Puncture wounds/deep lacerations with high infection rates
- Dog
2. Cat
> 60% of cat bites are located where?
The hands and upper extremities
The organisms Pasteurella multocida and Caphocytophaga canimorsus are commonly responsible for infected bites from (humans/animals).
Animals
What condition is caused by Bartonella henselae?
Cat scratch fever
What should always be obtained prior to administering abx therapy to pts with an infected wound and fever?
A blood culture
What organism is commonly associated with a bite from a human?
Eikenella corrodens
What should you do for a pt who has a wound bite near a joint or with disruption of bone?
Rx abx
Should you close animal bite wounds with deep sutures, etc? Why/why not?
No, will close in any infxn present and thus will not heal
T/F Wound glue (cyanoacrylate tissue adhesive) is the recommended alternative to sutures in regards to bite wounds
FALSE, glue is even worse! Will even more greatly trap in any infxn
If a pt’s bite wound is clinically uninfected and <12 hours old, can you close the wound?
Yes
You can close a pt’s bite wound if it is NOT located on the ___ or ___
hand or face
If a bite wound is < or = ____ hours old on the face, you can close it
24
What abx is the best for animal bites? What additional abx is also good for human bites?
Animal: Augmentin (Amoxicillin clavulanate)
Human: Moxifloxacin and Augmentin (Amoxicillin clavulanate)
What are Kanavel signs? What do they indicate if present?
Signs: Finger held in slight flexion, fusiform swelling, TTP along flexor tendon sheath, pain with passive extension of the digit
Indicate: Flexor tendon sheath infection
In rabies fatal if left untreated?
Yes, usually within 10 days
Rabies is only contagious if what is true?
The virus is active in the salivary glands
What is the exception for rabies existing only in the salivary glands?
BATS, ick
If a pt is bitten on their head or neck by an animal suspected to have rabies, what is the incubation period and when should prophylaxis begin?
4 days, begin IMMEDIATELY
Capnocytophaga canimorsus, is a fastidious gram-(positive/negative) rod, that can cause ____ and ____ ____ after animal bites, especially in patients who do not have a ___(organ)___, chronic alcohol abusers, or those with underlying _____ disease
Capnocytophaga canimorsus, a fastidious gram-negative rod, can cause bacteremia and fatal sepsis after animal bites, especially in patients who do not have a spleen, chronic alcohol abusers, or those with underlying hepatic disease
If a pt presents with fever, erythema, swelling, tenderness, purulent drainage and lymphangitis following a bite, what do we suspect?
infection!
What is lymphangitis?
Red, streaking tracts seen on the surface of the skin, tracking along lymph system from the wound as infxn spreads
If a pt with h/o bacteremia presents with a systemic infection w/ associated tachycardia, low BP, fever, shaking chills, and multi system organ failure, what does the pt have?
Sepsis
If a pt presents with osteomyelitis or septic arthritis following a bite wounds, who should they be referred to?
Ortho
Where is tendonitis most common?
Hands
Wound cultures (are/are not) indicated in clinically uninfected bite wounds
Not indicated
Deep bite wounds near joints warrant _____ and _____ radiographs to evaluate for disruption of bone or joints and evidence of foreign bodies, such as embedded teeth
AP and lateral plain radiographs
Plain radiographs are also indicated in markedly infected wounds to detect ______, ______, and ______
Bony and soft tissue injury, subcutaneous gas, and changes associated with osteomyelitis
If a pt presents with “rice krispy-feeling” skin, what might they have?
SubQ gas
What imaging study is useful in detecting abscess formation?
US
Dog bites to the head occasionally penetrate the skull, especially at what age? Why? What imaging study should be ordered?
Babies, due to soft cranium
CT head
In what type of wound is it considered malpractice to close?
puncture wounds
T/F Deep wounds that penetrate bone, tendons, joints, or other major structures should be referred for a surgical consulation
True
What vaccination should always be inquired about following a bite wound?
Tetanus
Since 2004, how many documented survivors are there of rabies?
3
Though ~50,000 people worldwide die of rabies every year, only ____ cases of human rabies were diagnosed in the United States from 1980 through 2010 due to domestic animal control and vaccination programs
69, hehe
The predominant reservoir of rabies in the United States is now _____, with most cases occurring in what types of animals?
Wildlife, i.e. raccoons, skunks, foxes, coyotes and bats
A healthy unvaccinated domestic dog, cat, or other mammal that bites a person should be confined and observed for ____ days. Why?
10
Rabid animals uniformly show sickness and then die within 10 days (usually five to seven days) after the spread of rabies virus from the CNS to the salivary glands
At what point in time can a pt’s post-exposure prophylaxis be discontinued? (hint: has to do with what happens to the animal?)
If the animal remains well for 10 days, the regimen can be discontinued at that time
Bat rabies is found in how many of the continental united states?
all 49
T/F Any human exposure to bats is a possible rabies exposure
True, PEP is recommended for ALL persons with bites, scratches, or mucous membrane exposures to bats; even if the bat is in the room with someone who was asleep, should have PEP
As part of rabies PEP, the first step is to _______.
Then, the full dose of ______ should be administered ____(location)____, with any remaining injected ___(how and where)___.
The vaccine should then be injected into the _____ on days ____, ____, ____, and ____.
wash the wound with soap and water (best if soap is virucidal)
RIG (rabies immune globulin)
around the site of the wound
IM at a site distant to the wound
Vaccine HDCV or PCECV 1.0 mL, IM (deltoid area), one each on days 0, 3, 7, and 14
Human bite wounds are more common in (children/adults) (male/female)
Adult males
T/F Patients with human bite wounds typically present on the day of injury
False, they come in the next day, typically after infection has already set in
A majority of human bites are located where?
On the hands
Patients with closed fist hand human bite injuries typically presents with small cuts on the dorsal aspect of which two joints?
3rd and 4th metacarpophalangeal (MCP)
Human saliva is known to contain as many as _____ species of bacteria
50
T/F Human bite wound pathogens consist of aerobic but not anaerobic bacteria
False, human bite wound pathogens consist of both aerobic and anaerobic bacteria
(most commonly streptococci, Staphylococcus aureus, Eikenella, Fusobacterium, Peptostreptococcus, Prevotella, and Porphyromonas species)
________ isolates from human bites are relatively resistant to clindamycin, erythromycin, aminoglycosides and anti-Staphylococcal PCNs and 1st-generation cephalosporins
Eikenella
Do all human bite wounds require antibiotic prophylaxis ?
yes, for 3-5 days
A pt with a human bite wound is dx’d with associated cellulitis. How long should the patient be tx’d with the appropriate abx?
10-14 days
A pt with a human bite wound is dx’d with associated tenosynovitis. How long should the patient be tx’d with the appropriate abx?
3 weeks
A pt with a human bite wound is dx’d with associated osteomyelitis. How long should the patient be tx’d with the appropriate abx?
6 weeks
A pt with a human bite wound is dx’d with associated septic arthritis. How long should the patient be tx’d with the appropriate abx?
4 weeks
Any patient negative for anti-HBs antibodies who is bitten by an individual positive for HBsAg should receive what tx/vaccine(s)?
Hepatitis B immune globulin (HBIG) and hepatitis B vaccine
The risk for transmitting HIV through saliva is extremely low, except when…
…there is infected blood in the saliva
Human bites can transmit numerous other infections, including _____ and ____, ______ (rare), and ______
hepatitis viruses B (HBV) and C (HCV)
primary syphilis (rare)
HSV
Are insect bite allergies and death are of (rapid/slow) onset?
Rapid–> 50% of deaths within 30 minutes of the sting
75% occur within 4 hours
The order________ includes:Apisspecies (bees: European, African),vespids(wasps, yellow jackets [a type of wasp], hornets), and ants.
__________ cause more deaths in the U.S. than any other envenomation.
(hint: same answer both blanks)
Hymenoptera
If a pt presents with airway obstruction from angioedema following an insect bite or sting, what signs/sx may they present with?
Stridor, hoarseness, difficulty swallowing/pooling saliva
If a pt presents with anaphylaxis with obstructive angioedema following an insect bite/sting, what surgical procedure should be performed right away?
cricothyrotomy
In what age group is a cricothyrotomy contraindicated? What should be done instead of a chrichothyrotomy?
<8 y/o
Parenteral beta agonists, antihistamines, and glucocorticoids
________ is the drug of choice for insect bit/sting anaphylaxis
Epinephrine
How long do IV steroids take to work? What does this mean for timing of their administration?
~4 hours, so administer ASAP
What are the alpha agonist effects of epinephrine?
What are the beta agonist effects?
Alpha-agonist effects: increases peripheral vascular resistance, reverses peripheral vasodilatation/systemic hypotension/vascular permeability
Beta-agonist effects: bronchodilation, chronotropic cardiac activity, and positive inotropic effects
Why might a pt present with hypotension following an insect bite/sting?
Histamine, prostaglandins, and leukotrienes vasodilate peripheral vessels, increase capillary permeability, and allow fluid into the third space, which reduces systemic vascular resistance, increases the vascular bed, and decreases intravascular fluid
If a pt presents with hypotension following an insect bite/sting, how would you tx this?
IV crystalloid fluid boluses
Epinephrine via continuous infusion
Alternatively give norepinephrine (Levophed): advantage more alpha effect/less beta effect than epinephrine
Consider vasopressors (usually dopamine) for refractory hypotension
If a pt presents with mild-moderate bronchospasm following an insect bite/sting, how would you tx this?
Nebulized beta agonist and parenteral glucocorticoids
If a pt presents with moderate-severe bronchospasm following an insect bite/sting, how would you tx this?
Parenteral beta agonist
consider intubation
If a pt presents with urticaria (hives) following an insect bite/sting, how would you tx this?
Antihistamine, oral steroids, consider epinephrine
T/F If a pt presents with a local reaction to an insect bite/sting, it would be appropriate to elevate it
True, also ice
