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Emergency Medicine > Bites > Flashcards

Bites Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

peak incidence for bites age wise..

A

5-9 yo

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2
Q

dog bites worry about __ injury

A

curshing / tearing due to high PSI and rounded teeth

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3
Q

if under 5 dog bite most likely on their

A

head / neck

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4
Q

cat bites have high…

A

infection rates
puncture wounds / deep lacerations
typically hands / upper extrememity

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5
Q

most common pathogens animal bites

A

Pasteurella
Staphylococci
Streptococci
Anaerobic bacteria

Capnocytophage canimorusus - sepsis!!

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6
Q

cat bites worry about ___ which causes cat scratch fever

A

bartonella henselae

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7
Q

Capnocytophage canimorusus can cause fatal sepsis / bacteremia quickly in pts such as…

A

asplenic pts
chronic alcohol abusers
underlying hepatic disease

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8
Q

lymphangitis

A

red streaky tracts - inflammation no the vessels of the system

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9
Q

make sure you get a _____ more definitive than wound culture!

A

blood culture

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10
Q

t/f if doesn’t look infected you don’t have to order a wound culutre

A

TRUE!! document!

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11
Q

why bad if there is bone disruption in a bite?

A

considered an open fracture - put on abx

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12
Q

if you feel bubbles / rice crispy bubble under the skin think of…

A

gas from necrotizing fasciitis or because of bite air got trapped under skn

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13
Q

never treat a bite by ___

A

using glue! cyanoacrylate tissue adhesive! trap in bacteria

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14
Q

4 criteria for when can close a bite with sutures

A

its a dog bite - just a laceration
clinically uninfected
less than 12 hrs old or 24 if on face
not located on the hand or foot

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15
Q

6 contraindications to closing a bite

A
  1. crush injury
  2. puncture wounds
  3. bites on the hands or feet
  4. wounds more than 12 hours old or 24 on face
  5. cat or human bites unless on face
  6. if host is compromised
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16
Q

how to treat a bite if you cant close it?

A

irrigate, dressed, left open to drain, examine each day to look for signs of infection

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17
Q

4 criteria for surgical consultation

A
  1. deep wounds that penetrate major structures
  2. facial lacerations
  3. any neurovascular compromise
  4. wounds with complex infections: abcess, hand, jt, infxn etc
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18
Q

t/f do you put lidocaine in the finger?

A

no do a digital blck

lidocaine alone can lead to increased bleeding and/or digital ischemia
- reversal agent is phentoalamine if digital ischemia appears

19
Q

fluoroquinolones ..why not best option for bites?

A

worry about the tendon rupture ..so not first option

20
Q

first option for bite abx

A

augmentin but watch for upset stomach and yeast infections

21
Q

kanavel sign of..

A

infectious tenosynovitis aka flexor tenosynovitis

22
Q

Kanavel sign:

A

finger in slight flexion
fusiform swelling
tenderness along flexor tendon sheath
pain with passive extension of digit

23
Q

how to treat infectious tenosynovitis

A

surgical drainage call hand surgeon

24
Q

rabies is only contagious once virus is in … except

A

salivary glands, exception - bats

25
Q

animals infected die within

A

10 days after first acting sick

animal that bites.. watch for 10 days

26
Q

when do you start your rabies prophylaxis?

A

if there is any suspicion or if bite is on head or neck since incubation is shorter for those areas

27
Q

post exposure prophylaxis is recommended for all persons with

A

bites, scratches or mucous membrane exposure to bats

28
Q

in addition to RIG what else is give for rabies tx

A

vaccine on days 0, 3, 7 and 14

29
Q

human bites are more common in ..

A

adult males .. usually on hand

30
Q

“fight bite” is where?

A

over dorsal aspects of 3rd and 4th MCP jts

31
Q

how treat fight bite?

A

empirically - abx!!

32
Q

bacteria in human saliva

A 
streptococci 
staphylococcus aureus 
eikenella 
fusobacterium 
peptostreptococcus 
prevotella 
porphyromonas species
33
Q

eikenella human bites are ristant to..

A

clindamycin, erythromycin, aminoglycosides, antistaphylo penicillins and cephalosporins

34
Q

what is first choice abx for human bites?

A

amoxicillin clavulantae (augmentin)

35
Q

how long tx for tenoxynovitis

A

3 wks

36
Q

how long tx for cellulitis

A

10-14 days

37
Q

how long tx for septic arthritis

A

4 wks

38
Q

how long tx for osteomyelitis

A

6 wks

39
Q

what is always a risk with clindamycin risk?

A

risk of cdiff

40
Q

how does epinephrine impact alpha and beta receptors?

A

alpha: increase peripheral resistance, reverses systemic hypotension / vascular permability
beta: bronchodilation, chronotoropic HR, + inotropic effects

41
Q

3 main meds for insect bites – anaphylaxis

A

epinephrine
H1 and H2 blockers - antihistamine effects
corticosteroids: methylprednisolone IV

42
Q

why does bp drop with insect bites?

A

histamine etc.. = vascular permeability = third spacing = decrease intravascular fluid

43
Q

what if insect sting leads to refractory htn? what is tx

A

consider vasopressors like dopamine

Emergency Medicine (19 decks)

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