Bite Wounds, Burns and Bullets Flashcards
Most common pathogen cultured from bite wounds in dogs and cats?
Pasteurella multocida
(NAVLE Q)
What communicable diseases can be transmitted in cat-to-cat bites?
FeLV and FIV
must do FeLV/FIV testing on arrival, and again 2 months later due to latency of infection
The canine jaw can generate a force of _______ psi
150 to 450 psi
Puncture wounds on the surface look innocent but extensive damage to underlying tissue is common in bite wounds. This is known as the ___________
Iceberg Effect
Where are large dog breeds more likely to have bite wounds compared to small dogs?
Large dogs = wounds on neck and face
Small dogs = wounds on dorsum, esp caudal to last rib
Do dog or cat bites have a greater risk of infection, and why?
Cat bites - usually a puncture wound inoculating bacteria deep into underlying tissue = greater risk of infection
What is BDLD?
Big dog little dog
- combines lifting and shaking of the skin in addition to crushing and tearing
Avulsion injuries are common in dog bite wounds. What does this mean?
Damage to major direct cutaneous artery and vein with compromise to collateral vascular supply
Bite wounds “declare themselves” 3-7 days following initial bite wound. What does this mean?
Surrounding tissue and skin becomes necrotic following initial wound
(gets worse before getting better)
What is a further complication of cervical bite wounds?
Pneumomediastinum from damage to trachea
- Give O2, pain meds, and stabilize prior to exploring
What is the initial management of a bite wound if the patient is stable for sedation/ anesthesia?
- Aseptically probe (for assessment of dead space)
- Debride wound edges until they bleed
- Wound reconstruction using a penrose drain
Drains are usually NOT necessary for bite wounds located _________
On the head or extremities
What is the initial management of a bite wound located on the head or extremities?
- Aseptically probe (for assessment of dead space)
- Debride wound edges until they bleed
- Use anatomic passive drain by making a stab incision ventral to the wound
- Lavage and close, but keep stab incision open for draining
- Bandage limb (not face)
Why are radiographs taken in patients with bite wounds?
Looking for penetration of thorax or ABD (Pneumomediastinum, pneumothorax, pneumoperitoneum, ascites, herniation, rib fractures)
What is the treatment protocol for a patient presenting with a clear ABD hernia due to a penetrating abdominal wound?
- EMERGENCY
- Perform immediate exploratory laparotomy
(Emergency due to inoculation of bacteria into normally bacteria free abdominal cavity)
What is the treatment protocol for a patient presenting with penetrating thoracic bite wounds?
- Generally not a surgical emergency (unlike with penetrating ABD wounds)
- Clip, clean, debride, and explore but be careful with lavage
- Do rads
- Loss of integrity to chest wall (Ex: multiple rib fractures) requires surgical reconstruction
What is required for penetrating thoracic bite wounds resulting in extensive rib fractures?
Prosthetic mesh reconstruction (Prolene mesh implant) with thoracostomy tube placed (to restore neg thoracic pressure) and closed suction drain
List the risk factors of penetrating thoracic wounds suggesting higher level of care will be needed
- Pneumothorax (25x risk of requiring thoracotomy than if no pneumo)
- Rib fracture(s)
- Flail chest
ALL CASES REFER TO SPECIALIST!!
(Risk of MORTALITY if pleural effusion or positive bacterial culture)
List the risk factors associated with mortality in patients with penetrating thoracic wounds
- Pleural effusion (penetrated lungs)
- Positive bacterial culture (20x risk of dying)
True or False: Multiple/severe bite wounds can initiate SIRS
TRUE
Why is fresh frozen plasma sometimes indicated for patients with multiple/severe bite wounds?
Bite wounds can initiate SIRS → coagulopathy → MODS → ARDS
**FFP contains all coag factors + proteins
(check coag panel on BDLD cases)
How is BD/BD different from BDLD wounds?
Less shearing/avulsion injury with BDBD bite wounds, iceberg effect is minimal
What is the treatment protocol for bite wound abscesses?
- FNA/cytology if needed
- Surgical drainage mandatory → Lance with #15 blade → Lavage → OWM using non selective debridement then switch to MRD to allow for 2nd intention healing OR enbloc debridement and primary closure → tie over bandage
Most common cause of thermal burns in pets?
Iatrogenic from stupid vets that use electrical heating pads, hot water bottles, etc
Use HotDog warming sytem or Bair Hugger!!!
What is a superficial burn?
1st degree, involves outermost epidermis
- Moist, painful, heals spontaneously within days
What is a partial thickness burn?
2nd degree, involves epidermis and portion of the dermis
- Painful w inflammation, can heal spontaneously but takes weeks to months
What is a full thickness burn?
3rd degree, involves full thickness of epidermis and dermis
- Dark brown, non painful, ESCHAR/ “Eschar Split”
What type of burn is extension beyond the dermis?
4th degree
(Needs Sx/And intention
What is “Eschar Split”?
- When you gently lift scab and only see SQ and not dermis or epidermis
Burn areas approaching ____% of TBSA may warrant euthanasia due to poor prognosis for recovery
50%
When is chilled saline used for conservative therapy of burns?
If burn wound is assessed within 2 hours from injury
Most common cause and location of shearing injuries?
- Limb caught beneath car and dragged, ass with severe abrasion of soft tissue and malleoli
- Involves tarsocrural joint (ankle)
What topicals are commonly used for burn wounds?
- Silver sulfadiazine!!
- Manuka honey!!
- Aloe vera
- Chilled saline if fresh burn < 2hrs
Treatment plan for degloving/shearing injuries?
- If large flap of tissue has been avulsed = unlikely viable, primary closure will fail
- Use OWM
- Immobilize the tarsus with LATERALLY placed splint + modified Robert Jones bandage
