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RRPA Clinical Decision Making I > Bites, Stings, and Creepy Things > Flashcards

Bites, Stings, and Creepy Things Flashcards

1
Q

What is worse, dog or cat bites?

A

Cat bites

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2
Q

What is more common, dog or cat bites?

A

Dog bites

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3
Q

How often should a tetanus be updated?

A

10 years without incident, 5 years with incident.

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4
Q

What percentage of dog bites get infected?

A

5%

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5
Q

What percentage of cat bites get infected?

A

50%

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6
Q

The most important part of initial wound care for a bite is?

A

Irrigation

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7
Q

List some risks for infection with bites.

A

Immunocompromised, DM, hand or foot bite, poor vascular supply, bite near hardware, crush injury, multiple puncture wounds, cat bite, delayed presentation.

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8
Q

What is considered delayed presentation for a bite?

A

> 12 hours if bite is to extremity

>24 for face

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9
Q

What is the most common bacteria found in cat and dog bites?

A

Pasteurella (although most are polymicrobial)

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10
Q

What rare bacteria from dog bites has a very high mortality rate?

A

Capnocytophaga

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11
Q

What criteria is used to assess for flexor tenosynovitis?

A

Kanavel’s criteria.

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12
Q

List the 4 components of Kanavel’s criteria.

A

Tenderness along course of flexor tendon
Fusiform or symmetrical swelling of the finger
Pain with passive ROM
A flexed posture of the finger.

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13
Q

Cat bites are concerning due to their sharp teeth penetrating deep structures. What complications can this cause?

A

Tenosynovitis
Osteomyelitis
Septic arthritis

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14
Q

The pressure exerted during a dog bite can cause deep injury. What complications should we not forget to evaluate for?

A

Fracture, vascular injury

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15
Q

How quickly does infection typically take to set in for cat bites? Dog bites?

A

Cat - 12 hours

Dog - 24 hours

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16
Q

What technique should you consider for better irrigation of cat bites?

A

“staring”

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17
Q

What should you examine for on a XR of a bite injury?

A

Fracture, free air, foreign body

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18
Q

What does free air indicate on an XR of a bite?

A

Can be gas forming bacteria or can be caused from the trauma(free air from trauma increases risk of infxn).

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19
Q

T/F? Cat bites should be closed by primary closure.

A

False

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20
Q

Can lacs to the face from a dog bite be closed?

A

Yes - face can be closed due to extensive blood supply reducing infxn risk

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21
Q

What two areas should not be closed following bites?

A

Hands and feet

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22
Q

Prophylactic antibiotics should be prescribed in what bite situations?

A

Bites to hands, feet, face
Immunosuppressed
Puncture wounds
Wounds that are sutured

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23
Q

What medication should be used for prophylaxis of all bites?

A

Augmentin

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24
Q

For wound infections after bites, what antibiotic should be used?

A

Augmentin or IV usasyn 3gm

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25
Q

What bacteria do we worry about in human bites?

A

Eikenella corrodens (gram neg anaerobe)

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26
Q

T/F? HIV can be transmitted through human bites.

A

False

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27
Q

What diseases can be transmitted through human bites?

A

Hep B and herpes

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28
Q

T/F? All human bites need antibiotics.

A

True

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29
Q

What antibiotic is used for human bites?

A

Augmentin

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30
Q

When should human bites be closed?

A

Only if on the face

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31
Q

What is the herpes infection called when obtained for infected saliva?

A

Herpetic whitlow

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32
Q

What bacteria is responsible for cat scratch disease?

A

Bartonella henselae

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33
Q

What signs/symptoms are indicative of cat scratch disease?

A

Swollen lymph nodes 1-3 weeks after cat scratch or bite

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34
Q

Does cat scratch disease require antibiotics?

A

Most cases resolve without, treat with azithro or doxy if ill.

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35
Q

What is the vector for rabies in the US?

A

Bats and cats

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36
Q

Worldwide, what is the most common vector for rabies?

A

Dogs

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37
Q

Do patients bit by dogs and cats ever require rabies PEP?

A

If the animal that bit them was sick.

If animal status unknown, joint decision making guide pt to office of public health

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38
Q

Outside of domestic pets, what bites need rabies PEP?

A

Racoon, fox, skunk, and bat bites/scratches.

39
Q

What medication is given for rabies PEP?

A

Human rabies immune globulin (HRIg) at bite site.

Vaccine on days 0, 3, 7, and 14

40
Q

Hanta virus infects what system?

A

Pulomonary

41
Q

How is Hanta virus transmitted?

A

Mice and rats urine and feces

42
Q

Incubation period for Hanta virus?

A

2 weeks

43
Q

T/F? Brown recluse initial bites are painless.

A

True

44
Q

Brown recluse venom is _____ toxic

A

Necro

45
Q

Cutaneous loxoscelism caused by brown recluse bites have what characteristic sign?

A

Red white and blue sign

46
Q

T/F? Brown recluse bites can be treated with anti-venom.

A

False - no anti venom exists

47
Q

Black widow bites are ____ toxic.

A

neuro

48
Q

Black widow venom causes massive ______ release.

A

Acetylcholine

49
Q

Symptoms of black widow bite?

A

Intense pain, diaphoresis, hypertension, fever, agitation, can mimic an acute abdomen

50
Q

Tx for black widow bites?

A

Pain control, 12-24 hours observation, anti venom if they’re unstable.

51
Q

Rattlesnake bites are ___ toxic and _____ toxic

A

necro and hemotoxic

52
Q

Tx for rattlesnake bite in the field?

A

Remove restrictive items.
Immobilize if possible
Go to hospital.

53
Q

Tx for rattlesnake bite in hospital?

A

Contact poison control
Monitor VS
Labs - CBC, BMP, PT/INR, CPK
Update TDAP

54
Q

Major envenomation is marked by unstable VS, hematologic abnls and spreading edema. It should be treated with?

A

Anti-venom - Crotalidae Polyvalent Immune Fab (CroFab)

55
Q

A patient was bit by a red, white, and black snake. Is it venomous?

A

No

Red on yellow kill a fellow, red on black venom is lack

56
Q

Coral snake venom is ___ toxic

A

Neurotoxic

57
Q

T/F? Coral snake envenomation’s should be treated with early anti-venom and ICU admission.

A

true

58
Q

Lyme disease is caused by what bacteria?

A

Borrelia burgdorferi

59
Q

Name the rash associated with lyme disease.

A

Erythema migrans (bullseye pattern)

60
Q

Tx for lyme disease?

A

Doxycycline 100mg BID x 14 days

61
Q

Lyme disease is spread by what type of tick?

A

Deer tick

62
Q

Rocky mountain spotted fever is spread by what types of ticks?

A

Wood tick and dog tick

63
Q

Rocky mountain spotted fever is caused by what bacteria?

A

Rickettsia rickettsii

64
Q

What rash is characteristic of rocky mountain spotted fever?

A

Erythematous macules, then petechiae that start on the distal extremities.

65
Q

How long after a tick bite does the RMSF rash occur?

A

1 week after bite

66
Q

What symptoms accompany the rash in RMSF?

A

Fever, HA, myalgias, malaise, abd pain, NV

67
Q

Treatment for RMSF?

A

Doxy 100mg BID x at least 7 days or continued 3 days after fever subsides

68
Q

Second line tx for RMSF?

A

Chloramphenicol 12.5mg/kg PO QID x 7 days

69
Q

Ehrilchiosis is a tick borne disease that causes what symptoms?

A

Flu like

70
Q

Babesia is a tick borne illness that causes what symptoms?

A

Hemolytic anemia

71
Q

Colorado tick fever causes what symptoms?

A

Fever

72
Q

Tularemia is carried by ticks and ______.

A

Rabbits

73
Q

Tularemia infects what body system?

A

Pulmonary

74
Q

What is the typical response to a Hymenoptera sting?

A

PEST response
Puritis
Erythema
Soft Tissue swelling

75
Q

Treatment for a non infected sting?

A

Remove stinger
Antihistamines +/- steroids
Ice
TDAP

76
Q

What reaction is concerning when a patient has 50+ stings?

A

Toxic systemic reaction

77
Q

About what percentage of have anaphylactic reactions to Hymenoptera stings?

A

3%

78
Q

Treatment for anaphylaxis?

A

Epi

Watch airway

79
Q

What rash is caused by blocked sweat glands creating small vesicles, and is more common is children?

A

Miliaria ruba - “heat rash”

80
Q

List the 5 heat disorders from least to most severe.

A 
Heat edema
Heat syncope
Heat cramps
Heat exhaustion
Heat stroke
81
Q

Treatment for heat edema?

A

Extremity elevation, rest, cooling, and oral fluids

82
Q

What is the physiologic cause of heat syncope?

A

Vasodilation leads to redistribution of intravascular volume leading to hypo perfusion.

83
Q

Symptoms of heat syncope?

A

Cool, clammy skin, weak pulse, hypotension.

84
Q

Is core body temp increased in heat syncope?

A

No - core body temp normal

85
Q

Tx for heat syncope?

A

Oral or IV hydration

86
Q

Physiologic cause for heat cramps?

A

Sweating leads to sodium and potassium loss. Electrolyte disturbances leads to muscle spasms.

87
Q

Tx for heat cramps?

A

Fluid and salt replacement (gatorade)

88
Q

Is core temperature normal or elevated in heat cramps?

A

Can be normal or mildly elevated.

89
Q

Physiologic cause of heat exhaustion?

A

Dehydration and sodium loss causes systemic reaction.

90
Q

Is core temp elevated in heat exhaustion?

A

Yes, but less than 104f.

91
Q

Tx for heat exhaustion?

A

Cooling, rehydration (oral and IV), electrolyte replacement (replace Na slowly!), admission

92
Q

Heat stroke is differentiated from heat exhaustion by what symptoms?

A

CNS symptoms - AMS, coma, visual disturbance

93
Q

Are fever reducers helpful to bring down core temp in heat stroke?

A

No

94
Q

Tx for heat stroke?

A

Cooling by water immersion

RRPA Clinical Decision Making I (17 decks)

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