Bites, Stings, and Creepy Things Flashcards
What is worse, dog or cat bites?
Cat bites
What is more common, dog or cat bites?
Dog bites
How often should a tetanus be updated?
10 years without incident, 5 years with incident.
What percentage of dog bites get infected?
5%
What percentage of cat bites get infected?
50%
The most important part of initial wound care for a bite is?
Irrigation
List some risks for infection with bites.
Immunocompromised, DM, hand or foot bite, poor vascular supply, bite near hardware, crush injury, multiple puncture wounds, cat bite, delayed presentation.
What is considered delayed presentation for a bite?
> 12 hours if bite is to extremity
>24 for face
What is the most common bacteria found in cat and dog bites?
Pasteurella (although most are polymicrobial)
What rare bacteria from dog bites has a very high mortality rate?
Capnocytophaga
What criteria is used to assess for flexor tenosynovitis?
Kanavel’s criteria.
List the 4 components of Kanavel’s criteria.
Tenderness along course of flexor tendon
Fusiform or symmetrical swelling of the finger
Pain with passive ROM
A flexed posture of the finger.
Cat bites are concerning due to their sharp teeth penetrating deep structures. What complications can this cause?
Tenosynovitis
Osteomyelitis
Septic arthritis
The pressure exerted during a dog bite can cause deep injury. What complications should we not forget to evaluate for?
Fracture, vascular injury
How quickly does infection typically take to set in for cat bites? Dog bites?
Cat - 12 hours
Dog - 24 hours
What technique should you consider for better irrigation of cat bites?
“staring”
What should you examine for on a XR of a bite injury?
Fracture, free air, foreign body
What does free air indicate on an XR of a bite?
Can be gas forming bacteria or can be caused from the trauma(free air from trauma increases risk of infxn).
T/F? Cat bites should be closed by primary closure.
False
Can lacs to the face from a dog bite be closed?
Yes - face can be closed due to extensive blood supply reducing infxn risk
What two areas should not be closed following bites?
Hands and feet
Prophylactic antibiotics should be prescribed in what bite situations?
Bites to hands, feet, face
Immunosuppressed
Puncture wounds
Wounds that are sutured
What medication should be used for prophylaxis of all bites?
Augmentin
For wound infections after bites, what antibiotic should be used?
Augmentin or IV usasyn 3gm
What bacteria do we worry about in human bites?
Eikenella corrodens (gram neg anaerobe)
T/F? HIV can be transmitted through human bites.
False
What diseases can be transmitted through human bites?
Hep B and herpes
T/F? All human bites need antibiotics.
True
What antibiotic is used for human bites?
Augmentin
When should human bites be closed?
Only if on the face
What is the herpes infection called when obtained for infected saliva?
Herpetic whitlow
What bacteria is responsible for cat scratch disease?
Bartonella henselae
What signs/symptoms are indicative of cat scratch disease?
Swollen lymph nodes 1-3 weeks after cat scratch or bite
Does cat scratch disease require antibiotics?
Most cases resolve without, treat with azithro or doxy if ill.
What is the vector for rabies in the US?
Bats and cats
Worldwide, what is the most common vector for rabies?
Dogs
Do patients bit by dogs and cats ever require rabies PEP?
If the animal that bit them was sick.
If animal status unknown, joint decision making guide pt to office of public health
Outside of domestic pets, what bites need rabies PEP?
Racoon, fox, skunk, and bat bites/scratches.
What medication is given for rabies PEP?
Human rabies immune globulin (HRIg) at bite site.
Vaccine on days 0, 3, 7, and 14
Hanta virus infects what system?
Pulomonary
How is Hanta virus transmitted?
Mice and rats urine and feces
Incubation period for Hanta virus?
2 weeks
T/F? Brown recluse initial bites are painless.
True
Brown recluse venom is _____ toxic
Necro
Cutaneous loxoscelism caused by brown recluse bites have what characteristic sign?
Red white and blue sign
T/F? Brown recluse bites can be treated with anti-venom.
False - no anti venom exists
Black widow bites are ____ toxic.
neuro
Black widow venom causes massive ______ release.
Acetylcholine
Symptoms of black widow bite?
Intense pain, diaphoresis, hypertension, fever, agitation, can mimic an acute abdomen
Tx for black widow bites?
Pain control, 12-24 hours observation, anti venom if they’re unstable.
Rattlesnake bites are ___ toxic and _____ toxic
necro and hemotoxic
Tx for rattlesnake bite in the field?
Remove restrictive items.
Immobilize if possible
Go to hospital.
Tx for rattlesnake bite in hospital?
Contact poison control
Monitor VS
Labs - CBC, BMP, PT/INR, CPK
Update TDAP
Major envenomation is marked by unstable VS, hematologic abnls and spreading edema. It should be treated with?
Anti-venom - Crotalidae Polyvalent Immune Fab (CroFab)
A patient was bit by a red, white, and black snake. Is it venomous?
No
Red on yellow kill a fellow, red on black venom is lack
Coral snake venom is ___ toxic
Neurotoxic
T/F? Coral snake envenomation’s should be treated with early anti-venom and ICU admission.
true
Lyme disease is caused by what bacteria?
Borrelia burgdorferi
Name the rash associated with lyme disease.
Erythema migrans (bullseye pattern)
Tx for lyme disease?
Doxycycline 100mg BID x 14 days
Lyme disease is spread by what type of tick?
Deer tick
Rocky mountain spotted fever is spread by what types of ticks?
Wood tick and dog tick
Rocky mountain spotted fever is caused by what bacteria?
Rickettsia rickettsii
What rash is characteristic of rocky mountain spotted fever?
Erythematous macules, then petechiae that start on the distal extremities.
How long after a tick bite does the RMSF rash occur?
1 week after bite
What symptoms accompany the rash in RMSF?
Fever, HA, myalgias, malaise, abd pain, NV
Treatment for RMSF?
Doxy 100mg BID x at least 7 days or continued 3 days after fever subsides
Second line tx for RMSF?
Chloramphenicol 12.5mg/kg PO QID x 7 days
Ehrilchiosis is a tick borne disease that causes what symptoms?
Flu like
Babesia is a tick borne illness that causes what symptoms?
Hemolytic anemia
Colorado tick fever causes what symptoms?
Fever
Tularemia is carried by ticks and ______.
Rabbits
Tularemia infects what body system?
Pulmonary
What is the typical response to a Hymenoptera sting?
PEST response
Puritis
Erythema
Soft Tissue swelling
Treatment for a non infected sting?
Remove stinger
Antihistamines +/- steroids
Ice
TDAP
What reaction is concerning when a patient has 50+ stings?
Toxic systemic reaction
About what percentage of have anaphylactic reactions to Hymenoptera stings?
3%
Treatment for anaphylaxis?
Epi
Watch airway
What rash is caused by blocked sweat glands creating small vesicles, and is more common is children?
Miliaria ruba - “heat rash”
List the 5 heat disorders from least to most severe.
Heat edema Heat syncope Heat cramps Heat exhaustion Heat stroke
Treatment for heat edema?
Extremity elevation, rest, cooling, and oral fluids
What is the physiologic cause of heat syncope?
Vasodilation leads to redistribution of intravascular volume leading to hypo perfusion.
Symptoms of heat syncope?
Cool, clammy skin, weak pulse, hypotension.
Is core body temp increased in heat syncope?
No - core body temp normal
Tx for heat syncope?
Oral or IV hydration
Physiologic cause for heat cramps?
Sweating leads to sodium and potassium loss. Electrolyte disturbances leads to muscle spasms.
Tx for heat cramps?
Fluid and salt replacement (gatorade)
Is core temperature normal or elevated in heat cramps?
Can be normal or mildly elevated.
Physiologic cause of heat exhaustion?
Dehydration and sodium loss causes systemic reaction.
Is core temp elevated in heat exhaustion?
Yes, but less than 104f.
Tx for heat exhaustion?
Cooling, rehydration (oral and IV), electrolyte replacement (replace Na slowly!), admission
Heat stroke is differentiated from heat exhaustion by what symptoms?
CNS symptoms - AMS, coma, visual disturbance
Are fever reducers helpful to bring down core temp in heat stroke?
No
Tx for heat stroke?
Cooling by water immersion
