Bites 8.9

Question 1

common pathogens of animal bites

Answer 1

Pasteurella species, staphylococci, streptococci, anaerobic bacteria, Capnocytophaga canimorsus, Bartonella henselae (cat scratch disease)

Question 2

Presentation

Answer 2

fever, erythema, swelling, tenderness, purulent drainage and lymphangitis

Question 3

Diagnostic labs

Answer 3

WBC, CRP, ESR may be elevated
Blood cultures for antibiotic therapy in infected bites
Would culture if the bite appears infected

Question 4

Human bite pathogens

Answer 4

Eikenella corrodens, streptococci, Staphylococcus, Fusobacterium, peptostreptococcus, prevotella, and porphyromonas species

Question 5

dog and cate bite pathogens

Answer 5

pasteurella multocida

Question 6

Diagnostic imaging

Answer 6

plain radiographs, ultrasound (for abscess formation), Head CT

Question 7

guidelines for management

Answer 7

primary closure if clinically uninfected, less then 12 hrs old and NOT located on the hand or foot. Extensive irrigation, debridement, avoid deep sutures, prophylactic antibiotic. DO NOT GLUE

Question 8

Wounds that should not be closed

Answer 8

crush injuries, puncture, bites on hands or feets, older than 12 hrs or 24 hrs on the face, cat or human bites except those on the face, bites in compromised hosts

Question 9

Surgical consultation for

Answer 9

deep wounds that penetrate bone, tendon, joints or major structures, complex facial lacerations, neurovascular compromise, complex infections

Question 10

Go to drug for dog bites

Answer 10

Augmentin then fluoroquinolones then Doxy and metronidazole

Question 11

bite complication

Answer 11

infectious flexor tenosynivitis, rabies, tetanus

Question 12

Eikenella resistance

Answer 12

clindamycin, erythromycin, aminoglycosides, and anti-staphylococcal penicillins and first gen cephalosporins

Question 13

Treatment time frame cellulitis

Answer 13

10-14 days

Question 14

TX time tenosynovitis

Answer 14

3 wks

Question 15

TX time septic arthritis

Answer 15

4 wks

Question 16

TX time osteomyelitis

Answer 16

6 wks

Question 17

Other diseases from human bites

Answer 17

Hep B and C, syphillis, and herpes

Question 18

insect sting initial assessment

Answer 18

assess airway obstruction form angioedema, assess breathing, assess circulation for signs of shock (BP, cap refill, altered mental status)

Question 19

insect sting anaphylaxis management

Answer 19

intubate rapidly, two large bore IV lines, continuous pulse ox, cardiac monitor. Airway must be obtained! (cricothyrotomy if completely obstructed)

Question 20

Anaphylaxis meds

Answer 20

Epinephrine first (IV 3-5 mL slowly over 1-2 mins), Alpha agonist, beta agonists, anithistamines, corticosteroids

Question 21

Insect string w/o obstruction

Answer 21

albuterol 0.5 mL, perenteral glucocorticoids. Epinephrine in moderate distress but not in mild distress

Question 22

Urticaria TX

Answer 22

anithistamines, oral steroids, consider subq epinephrine??

Question 23

Snake bite presentation

Answer 23

ecchymosis, swelling, NVD, weakness, light-headedness, diaphoresis, chills, coagulopathy, rhabdomyolysis, tachycardia, tachypnea, neurotoxicity (rattlesnakes only)

Question 24

pre-hospital snake bite care

Answer 24

immobilize injury at the level of the heart, remove any clothing or jewelry

Question 25

ED snake bite Diagnostic tests

Answer 25

CBC, electrolytes and BUN/Cr, CK, PT/PTT, INR, D-dimer, fibrinogen, urine, ECG

Question 26

Mild envenomation

Answer 26

local pain, edema, no signs of systemic toxicity, normal labs

Question 27

Moderate envenomation

Answer 27

severe pain, edema larger than 12 inches, NV and altered lab values

Question 28

Severe envenomation

Answer 28

petechiae, ecchymosis, blood-tinged sputum, hypoTN, renal dysfunction, abnormal labs

Question 29

Snake bite TX

Answer 29

tetanus, abx if infection suspected, Polyvalent Crotalinae antivenom (CroFav/FabAV)

Question 30

contraindications to CroFab

Answer 30

hypersensitivity to papaya or pineapple enzyme