Bites 8.9 Flashcards
common pathogens of animal bites
Pasteurella species, staphylococci, streptococci, anaerobic bacteria, Capnocytophaga canimorsus, Bartonella henselae (cat scratch disease)
Presentation
fever, erythema, swelling, tenderness, purulent drainage and lymphangitis
Diagnostic labs
WBC, CRP, ESR may be elevated
Blood cultures for antibiotic therapy in infected bites
Would culture if the bite appears infected
Human bite pathogens
Eikenella corrodens, streptococci, Staphylococcus, Fusobacterium, peptostreptococcus, prevotella, and porphyromonas species
dog and cate bite pathogens
pasteurella multocida
Diagnostic imaging
plain radiographs, ultrasound (for abscess formation), Head CT
guidelines for management
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
Wounds that should not be closed
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
Surgical consultation for
deep wounds that penetrate bone, tendon, joints or major structures, complex facial lacerations, neurovascular compromise, complex infections
Go to drug for dog bites
Augmentin then fluoroquinolones then Doxy and metronidazole
bite complication
infectious flexor tenosynivitis, rabies, tetanus
Eikenella resistance
clindamycin, erythromycin, aminoglycosides, and anti-staphylococcal penicillins and first gen cephalosporins
Treatment time frame cellulitis
10-14 days
TX time tenosynovitis
3 wks
TX time septic arthritis
4 wks
TX time osteomyelitis
6 wks
Other diseases from human bites
Hep B and C, syphillis, and herpes
insect sting initial assessment
assess airway obstruction form angioedema, assess breathing, assess circulation for signs of shock (BP, cap refill, altered mental status)
insect sting anaphylaxis management
intubate rapidly, two large bore IV lines, continuous pulse ox, cardiac monitor. Airway must be obtained! (cricothyrotomy if completely obstructed)
Anaphylaxis meds
Epinephrine first (IV 3-5 mL slowly over 1-2 mins), Alpha agonist, beta agonists, anithistamines, corticosteroids
Insect string w/o obstruction
albuterol 0.5 mL, perenteral glucocorticoids. Epinephrine in moderate distress but not in mild distress
Urticaria TX
anithistamines, oral steroids, consider subq epinephrine??
Snake bite presentation
ecchymosis, swelling, NVD, weakness, light-headedness, diaphoresis, chills, coagulopathy, rhabdomyolysis, tachycardia, tachypnea, neurotoxicity (rattlesnakes only)
pre-hospital snake bite care
immobilize injury at the level of the heart, remove any clothing or jewelry
ED snake bite Diagnostic tests
CBC, electrolytes and BUN/Cr, CK, PT/PTT, INR, D-dimer, fibrinogen, urine, ECG
Mild envenomation
local pain, edema, no signs of systemic toxicity, normal labs
Moderate envenomation
severe pain, edema larger than 12 inches, NV and altered lab values
Severe envenomation
petechiae, ecchymosis, blood-tinged sputum, hypoTN, renal dysfunction, abnormal labs
Snake bite TX
tetanus, abx if infection suspected, Polyvalent Crotalinae antivenom (CroFav/FabAV)
contraindications to CroFab
hypersensitivity to papaya or pineapple enzyme
