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EMERGENCY MED > BITES > Flashcards

BITES Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Common pathogens in order of prevalence (found in animal bites)

A

Pasteurella spp, staph , streph, anaerobic spp

Capnocytophaga canimorsus* (virulent!)

Bartonella (Cat bites)

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2
Q

Bacteria spa that is particularly virulent, can lead to sepsis - especially in a splenic / alcoholic / hepatitis pts

A

Capnocytophaga canimorsus

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3
Q

Bacteria found in “cat scratch fever”

A

Bartonella

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4
Q

Lymphadenopathy vs lymphangitis

A

swollen node vs red streaky tracks

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5
Q

Complications from animal bites include

A

Subcutaneous abscesses,

osteomyelitis,

septic arthritis,

tendonitis,

bacteremia and sepsis

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6
Q

Labs for animal bites

A

CBC (for WBC count)
CRP / ESR

Blood cultures PRIOR to antibiotic therapy (in pts with fever / infected bite)

Wound culture (if bite appears to be infected)

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7
Q

What might an elevated CRP / ESR might indicate in animal bite

A

Cellulitis, joint infection, osteomyelitis, sepsis

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8
Q

Bacteria - other than staph / streph - found in human bites, often misidentified

A

Eikenella corrodens

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9
Q

Wound cultures indicated in a clinically uninfected bite wounds?

A

NO

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10
Q

Indication for x-ray in animal bite

A

Deep bite wounds near joints (AP / lateral film)

Markedly infected wounds to detect

  • bony/soft tissue injury
  • subcutaneous gas (infection or trapped air)
  • osteomyelitis
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11
Q

If bite is deep enough to disrupt bone, how does classification of injury change?

A

Changes to include “open fracture”

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12
Q

Use of ultrasound in animal bite?

A

Can help identify abscess formation

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13
Q

Use of head CT in animal bites?

A

Dog bites to the head - esp children - can penetrate skull

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14
Q

Criteria for primary closure of animal bites

A
  • Clinically uninfected
  • Less than 12 hours old
  • Less than 24 hours old if wound is on the face
  • NOT located on the hand or foot
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15
Q

Steps to take when choosing primary closure

A
  • Extensive irrigation
  • Debridement
  • Avoidance of deep sutures
  • Use prophylactic antibiotics
  • Close follow up

DO NOT use cyanoacrylate tissue adhesive

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16
Q

Ok to use glue closure for animal bite?

A

NO

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17
Q

Types of wound NOT TO CLOSE due to high risk of infection

A

Crush injuries

Puncture wounds

Bites on hands or feet

Wounds more than 12 hrs old (24 hrs on face)

Cats or human bites, except those on face*

Bite wounds in compromised hosts (asplenic, immuno) or papery skin

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18
Q

Recommended to close cat or human bites?

A

NO! Unless it’s on the face

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19
Q

Surgical consult recommended for the following wounds:

A

Deep wounds that penetrate bone, tendons, joints, etc

Complex facial lacerations

Neurovascular compromise

Complex infections (abscess, osteomyelitis, hand or joint infections)

20
Q

Two important questions to ask right away when patient presents with dog bite

A

Dog’s rabies shot up to date?

Did patient have tetanus booster within less than 5 years?

21
Q

Common/relatively safe Antibiotic which is good for animal bites

A

Augmentin

22
Q

Complication of cat bite to the hand

A

Flexor Tenosynovitis

23
Q

Physical exam finding of cat bite to the hand which indicates flexor tenosynovitis

A

Kanavel sign - flexor tendon sheath infection, which are as follows:
Finger held in slight flexion
Fusiform swelling
Tenderness along the flexor tendon sheath
Pain with passive extension of the digit

24
Q

On physical exam of patient with cat bite to the hand includes :
Finger held in slight flexion
Fusiform swelling
Tenderness along the flexor tendon sheath
Pain with passive extension of the digit

A

Kanavel sign

25
Q

Treatment for flexor tenosynovitis

A

Surgical drainage

26
Q

Non-immunized treatment regiment for Rabies Prophylaxis

A
  1. Wound cleansing
    - immediate soap and water
    - virucidal agent, povidine-iodine solution if available
  2. Rabies Immunoglobulin
    - Full Dose infiltrated around any wounds
    - Remaining volume administered IM, at site distant from wound
  3. Vaccine
    - HDCV or PCECV 1.0 mL, IM (deltoid area ), one each on days 0 , 3, 7, and 14
27
Q

Virucidal cleaning agent?

A

Povidine-iodine solution

28
Q

Rabies vaccine administration details

A

HDCV or PCECV 1.0 mL, IM (deltoid area ), one each on days 0 , 3, 7, and 14

29
Q

Where should rabies immunoglobulin be administered

A
  • Full dose infiltrated around wounds

- Remaining volume administered IM at anatomical site distant to wound

30
Q

Clenched fist injuries (human bites via fist fight) can lead to

A

Septic arthritis of the MCP joint - rapidly destructive

31
Q

If a patient presents with a human bite, and wound does not appear to be infected, do they get prophylactic antibiotics?

A

YES - all human bites get prophylactics. Very prone to infection

32
Q

Groups of common bacteria found in human bites

A

Streptococci, Staphylococcus aureus

Eikenella
Fusobacterium 
Peptostreptococcus 
Prevotella 
Porphyromonas
33
Q

Eikenella spp (from human bites) are resistant to

A

Clindamycin, Erythromycin, Aminoglycosides, anti-staph penicillins, first gen cephalosporin

34
Q

Recommended antibiotics for human bites

A

Augmentin, Moxifloxicin

35
Q

Treatment protocols for human bites

A

cellulitis 10-14 days
3 weeks for tenosynovitis,
4 weeks for septic arthritis
6 weeks for osteomyelitis

36
Q

Prophylaxis treatment period for human bites

A

3-5 days

37
Q

Order of insects that cause more venom deaths in US than any other

A

Hymenoptera

Apis species (bees–European, African), vespids (wasps, yellow jackets [a type of wasp], hornets), and ants

38
Q

Initial assessment for insect bites/stings

A

Assess for airway obstruction from angioedema: stridor, hoarseness, difficulty swallowing/pooling saliva

Assess breathing: rate, pulse ox, auscultation for adequate air movement/absence of wheezing

Assess circulation for signs of shock: blood pressure, nail bed capillary refill, mental status

39
Q

Anaphylaxis with signs of impending airway obstruction from angioedema and/or respiratory collapse:

A

Intubate the patient with rapid sequence technique

Two large-bore IV lines to provide a route for meds/fluid bolus

Continuous pulse ox, cardiac monitor

40
Q

Anaphylaxis with obstructive angioedema, protocols

A

Obtain a surgical airway through cricothyrotomy

Cricothyrotomy contraindicated < 8 years

41
Q

If patient is < 8 years, has anaphylaxis with obstructive angioedema

A
  • temporarily obtain needle cricothyrotomy with largest-bore needle practical
  • give parenteral beta agonists, antihistamines, and glucocorticoids
  • consult anesthesia/ENT for definitive airway management in the OR
42
Q

Drug of choice for anaphylaxis

A

Epinephrine

IM/SC: 0.2-0.5 mg q5-15min (1:1,000 solution; 1 mg/mL) if cardiovascularly stable

IV: 3-5 mL (0.3-0.5 mg) of the 1:10,000 solution (0.1 mg/mL) diluted in 10 mL of normal saline or distilled water flush slowly over 1-2 minutes

ET tube: 3-5 mL of 1:10,000 solution and flush

43
Q

Antihistamines for anaphylaxis

A

parenteral H1 blocker diphenhydramine (Benadryl) 50mg IV

parenteral H2 blocker (eg, Ranitidine [Zantac] 50mg IV or Pepcid 20mg IV)

44
Q

Corticosteroids for anaphylaxis

A

methylprednisolone 125 mg IV (delayed onset)

45
Q

Tx for hypotension from insect bites/stings

A

IV crystalloid fluid boluses

Epinephrine via continuous infusion (1 mg in 250 mL of normal saline at a rate of 0.5-1 mL/min)

EMERGENCY MED (10 decks)

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