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Emergency Medicine > Animal/Human Bites > Flashcards

Animal/Human Bites Flashcards

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1
Q

What is the peak age of incidence in regards to animal bites, specifically from dogs?

A

5-9 y/o

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2
Q

Are more animal bites from dogs or cats?

A

Dogs (85% vs 10% cats)

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3
Q

In patients under 5 years old 60-70% of dog bites are where?

A

Head/neck (think height of the child vs mouth of dog)

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4
Q

Dog or Cat?

  1. Crushing/tearing wound due to rounded teeth/strong jaws
  2. Puncture wounds/deep lacerations with high infection rates
A
  1. Dog

2. Cat

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5
Q

> 60% of cat bites are located where?

A

The hands and upper extremities

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6
Q

The organisms Pasteurella multocida and Caphocytophaga canimorsus are commonly responsible for infected bites from (humans/animals).

A

Animals

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7
Q

What condition is caused by Bartonella henselae?

A

Cat scratch fever

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8
Q

What should always be obtained prior to administering abx therapy to pts with an infected wound and fever?

A

A blood culture

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9
Q

What organism is commonly associated with a bite from a human?

A

Eikenella corrodens

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10
Q

What should you do for a pt who has a wound bite near a joint or with disruption of bone?

A

Rx abx

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11
Q

Should you close animal bite wounds with deep sutures, etc? Why/why not?

A

No, will close in any infxn present and thus will not heal

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12
Q

T/F Wound glue (cyanoacrylate tissue adhesive) is the recommended alternative to sutures in regards to bite wounds

A

FALSE, glue is even worse! Will even more greatly trap in any infxn

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13
Q

If a pt’s bite wound is clinically uninfected and <12 hours old, can you close the wound?

A

Yes

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14
Q

You can close a pt’s bite wound if it is NOT located on the ___ or ___

A

hand or face

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15
Q

If a bite wound is < or = ____ hours old on the face, you can close it

A

24

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16
Q

What abx is the best for animal bites? What additional abx is also good for human bites?

A

Animal: Augmentin (Amoxicillin clavulanate)
Human: Moxifloxacin and Augmentin (Amoxicillin clavulanate)

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17
Q

What are Kanavel signs? What do they indicate if present?

A

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

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18
Q

In rabies fatal if left untreated?

A

Yes, usually within 10 days

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19
Q

Rabies is only contagious if what is true?

A

The virus is active in the salivary glands

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20
Q

What is the exception for rabies existing only in the salivary glands?

A

BATS, ick

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21
Q

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?

A

4 days, begin IMMEDIATELY

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22
Q

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

A

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

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23
Q

If a pt presents with fever, erythema, swelling, tenderness, purulent drainage and lymphangitis following a bite, what do we suspect?

A

infection!

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24
Q

What is lymphangitis?

A

Red, streaking tracts seen on the surface of the skin, tracking along lymph system from the wound as infxn spreads

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25
Q

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?

A

Sepsis

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26
Q

If a pt presents with osteomyelitis or septic arthritis following a bite wounds, who should they be referred to?

A

Ortho

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27
Q

Where is tendonitis most common?

A

Hands

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28
Q

Wound cultures (are/are not) indicated in clinically uninfected bite wounds

A

Not indicated

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29
Q

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

A

AP and lateral plain radiographs

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30
Q

Plain radiographs are also indicated in markedly infected wounds to detect ______, ______, and ______

A

Bony and soft tissue injury, subcutaneous gas, and changes associated with osteomyelitis

31
Q

If a pt presents with “rice krispy-feeling” skin, what might they have?

A

SubQ gas

32
Q

What imaging study is useful in detecting abscess formation?

A

US

33
Q

Dog bites to the head occasionally penetrate the skull, especially at what age? Why? What imaging study should be ordered?

A

Babies, due to soft cranium

CT head

34
Q

In what type of wound is it considered malpractice to close?

A

puncture wounds

35
Q

T/F Deep wounds that penetrate bone, tendons, joints, or other major structures should be referred for a surgical consulation

A

True

36
Q

What vaccination should always be inquired about following a bite wound?

A

Tetanus

37
Q

Since 2004, how many documented survivors are there of rabies?

A

3

38
Q

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

A

69, hehe

39
Q

The predominant reservoir of rabies in the United States is now _____, with most cases occurring in what types of animals?

A

Wildlife, i.e. raccoons, skunks, foxes, coyotes and bats

40
Q

A healthy unvaccinated domestic dog, cat, or other mammal that bites a person should be confined and observed for ____ days. Why?

A

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

41
Q

At what point in time can a pt’s post-exposure prophylaxis be discontinued? (hint: has to do with what happens to the animal?)

A

If the animal remains well for 10 days, the regimen can be discontinued at that time

42
Q

Bat rabies is found in how many of the continental united states?

A

all 49

43
Q

T/F Any human exposure to bats is a possible rabies exposure

A

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

44
Q

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 ____.

A

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

45
Q

Human bite wounds are more common in (children/adults) (male/female)

A

Adult males

46
Q

T/F Patients with human bite wounds typically present on the day of injury

A

False, they come in the next day, typically after infection has already set in

47
Q

A majority of human bites are located where?

A

On the hands

48
Q

Patients with closed fist hand human bite injuries typically presents with small cuts on the dorsal aspect of which two joints?

A

3rd and 4th metacarpophalangeal (MCP)

49
Q

Human saliva is known to contain as many as _____ species of bacteria

A

50

50
Q

T/F Human bite wound pathogens consist of aerobic but not anaerobic bacteria

A

False, human bite wound pathogens consist of both aerobic and anaerobic bacteria
(most commonly streptococci, Staphylococcus aureus, Eikenella, Fusobacterium, Peptostreptococcus, Prevotella, and Porphyromonas species)

51
Q

________ isolates from human bites are relatively resistant to clindamycin, erythromycin, aminoglycosides and anti-Staphylococcal PCNs and 1st-generation cephalosporins

A

Eikenella

52
Q

Do all human bite wounds require antibiotic prophylaxis ?

A

yes, for 3-5 days

53
Q

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?

A

10-14 days

54
Q

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?

A

3 weeks

55
Q

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?

A

6 weeks

56
Q

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?

A

4 weeks

57
Q

Any patient negative for anti-HBs antibodies who is bitten by an individual positive for HBsAg should receive what tx/vaccine(s)?

A

Hepatitis B immune globulin (HBIG) and hepatitis B vaccine

58
Q

The risk for transmitting HIV through saliva is extremely low, except when…

A

…there is infected blood in the saliva

59
Q

Human bites can transmit numerous other infections, including _____ and ____, ______ (rare), and ______

A

hepatitis viruses B (HBV) and C (HCV)
primary syphilis (rare)
HSV

60
Q

Are insect bite allergies and death are of (rapid/slow) onset?

A

Rapid–> 50% of deaths within 30 minutes of the sting

75% occur within 4 hours

61
Q

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)

A

Hymenoptera

62
Q

If a pt presents with airway obstruction from angioedema following an insect bite or sting, what signs/sx may they present with?

A

Stridor, hoarseness, difficulty swallowing/pooling saliva

63
Q

If a pt presents with anaphylaxis with obstructive angioedema following an insect bite/sting, what surgical procedure should be performed right away?

A

cricothyrotomy

64
Q

In what age group is a cricothyrotomy contraindicated? What should be done instead of a chrichothyrotomy?

A

<8 y/o

Parenteral beta agonists, antihistamines, and glucocorticoids

65
Q

________ is the drug of choice for insect bit/sting anaphylaxis

A

Epinephrine

66
Q

How long do IV steroids take to work? What does this mean for timing of their administration?

A

~4 hours, so administer ASAP

67
Q

What are the alpha agonist effects of epinephrine?

What are the beta agonist effects?

A

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

68
Q

Why might a pt present with hypotension following an insect bite/sting?

A

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

69
Q

If a pt presents with hypotension following an insect bite/sting, how would you tx this?

A

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

70
Q

If a pt presents with mild-moderate bronchospasm following an insect bite/sting, how would you tx this?

A

Nebulized beta agonist and parenteral glucocorticoids

71
Q

If a pt presents with moderate-severe bronchospasm following an insect bite/sting, how would you tx this?

A

Parenteral beta agonist

consider intubation

72
Q

If a pt presents with urticaria (hives) following an insect bite/sting, how would you tx this?

A

Antihistamine, oral steroids, consider epinephrine

73
Q

T/F If a pt presents with a local reaction to an insect bite/sting, it would be appropriate to elevate it

A

True, also ice

Emergency Medicine (20 decks)

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