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BLISS > Bites, Stings And Infestations > Flashcards

Bites, Stings And Infestations Flashcards

1
Q

Nerovascular exam

A

1st step in management of a sting/bite/infection

  • make sure to check parenthesis, alertness and ability to move
  • make sure to also look for bone and joint involvement as this indicates a worsening condition*
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2
Q

Tetanus toxoid vs tetanus immunoglobulin

A
  • during the management of a bite/sting or infestation, make sure to check last tetanus injection*

toxoid must be given if:

  • last vaccine was > 10 yrs (clean wound)
  • last vaccine was > 5 yrs (dirty wound)

Immunoglobulin must be given if less than 3 full doses of a tetanus vaccine in patient history

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3
Q

Rabies prevention and antibiotic use

A

Rabies:
- must give immunoglobulin and vaccine if no prior vaccine has ever been given.

  • only have to give vaccine if previous vaccine series has been given

Antibiotics:

  • specific for certain bacteria and typically oral medications
  • most common prescribed is amoxicillin-clavulonic acid orally*
  • IV is indicated with bone/joint/ serious tissue damage
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4
Q

When to close bite/sting wounds

A

Facial wounds must always be closed

  • NEVER CLOSE HAND/FEET WOUNDS*
  • poor circulation so would just result in pus filled hypoxia

Try to not close cat or human bites and only close superficial dog bites

Broad criteria for closure:

  • uninflected at time
  • < 24 hrs old
  • not on hand/foot
  • not immunocompromised
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5
Q

Human bites overview

A

Breast bites are to be assumed sexual assault until proven otherwise

Arm bites > 2.5 cm in diameter on children are assumed to be child abuse until proven otherwise

2 categories of human bites:
clenched fist injuries
- typically result from fights and usually at 3-4th fingers
- need antibiotics and might need to operative treatment if fever and extreme swelling are present

occlusive bites (closing mouth around the skin)  
- need antibiotics and most commonly caused by children
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6
Q

Elkinella corrodens

A

Unique pathogen to human bites only

Causes blood culture-negative endocarditis

  • infection rate is 30%
  • resistant to most antibiotics and has to be treated with amoxicillin-clavuloinic acid

staph and step are also possible human bite pathogens

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7
Q

Cat bites overview

A

Most common in women and typically hand or feet

80% of cat bites lead to infection and usually within 24 hrs of bite
- narrow penetrating wounds increases chances of infection

  • marked by really small bite marks, but extreme swelling of the bite area*

Usually require xrays to evaluate for teeth, joint or bone involvement

Most common symptom outside of swelling is cellulitis

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8
Q

Pasteurella multocida

A

Unique pathogen to cat bites and has a 30% mortality rate

Results in osteomyelitis and joint abscess if left untreated
- can also result in tenosynovits which requires 100% surgery

Treatment:
- amoxicillin-clavulonic acid

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9
Q

Cat scratch fever

A

Caused by Bartonella henselae infections
- caused by flea feeces under cat nails/ around their teeth

  • cardinal sign is fever with gigantic sentinel lymph nodes to site of infection

DO NOT CUT OPEN OR DRAIN LYMPH NODE
- prescribe antibiotics (which don’t actually help, just prevents other possible opportunistic pathogens) and let the body heal itself

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10
Q

Dog bite overview

A

Most common in males 5-9 years

  • children - face/neck
  • adults = arm/ leg

Much more dangerous since dogs apply more pressure and tear rather than puncture

  • causes of death include carotid avulsion (throat bite), skull injuries/Brian injuries and mengitits
  • can also cause compartment syndrome due to increase pressure and accompanying rhabdomyolysis

Infection rate is 30%

Dog bites almost always are indicated for xrays

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11
Q

Capnocytophaga canimorsus

A

Pathogen unique to dogs

- 30% mortality rate and much higher chance in immunocompromised

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12
Q

Fight bite injuries specifics

A

Should include imaging and labs to R/O tenosynovits/osteomyelitis and septic arthritis

Most common infectious agents are Elkinella corrodens and staph aureus

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13
Q

Viper snake bites

A

Toxic snake bites that produce cytotoxic effects

Include rattlers copperheads and pit vipers

Pit viper bites can be dry bites (25%)

Symptoms:

  • oozing pus at bite site
  • cell injury signs (swelling ecchymoses, blackening necrosis)
  • systemic signs: fatigue, headache, DIC, fasciculations
  • can develop IgE mediated anaphylaxis due to type 1 sensitivity

Almost all infections are gram-negative infections

TREATMENT:

  • antivenin ASAP ( especially if progression of injury, coagulpathy or systemic effects kick in)
  • DO NOT USE TOURNIQUETS OR SUCK VENOM OUT
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14
Q

Elapid snake bites

A

Include coral snakes, spitting cobra and black mamba

Presents with neurotoxic effects
- most common is ACh receptors bind irreversibly.

Most common in fingers

Symptoms:

  • parasthesia, double-vision, dysphasia, aphasia, muscle weakness/CNS dysfunction
  • Death almost always occurs via respiratory failure*

Treatment:

  • antivenin if neurological symptoms present
  • if not severe neurological symptoms, supportive care is indicated
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15
Q

Characteristics of venomous vs non-venomous snakes

A

Non venomous:

  • red on black: venom lack
  • rounded head w/ rounded pupil
  • NO FANGS
  • double row of subcaudal plates

Venomous:

  • red on yellow: kill a fellow
  • triangle-shaped head w/ elliptical pupil
  • FANGS
  • single row of subcaudal plates and/or rattle
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16
Q

Brown recluse/ hobo spider

A

Common spider bite that live in woodpiles/cellars (reclusive areas)

Asymptomatic initially but will develop “volcanic “ lesions if untreated.
this leads to ischemic necrosis, hemolysis and thrombocytopenia w/ renal failure within days

Treatment:

  • NO ICE
  • treat with hyperbaric chamber and surgical debridement
  • can use dapsone, unless patient has G6PD (will cause hemolysis)
17
Q

Black widow

A

Common spider bite that mostly occurs within woodpiles/ dumps
- can occur anywhere though since black widows are far more aggressive than brown recluses

Effects are caused by latrotxin
- destabilizes neuronal membranes and forcibly permanently opens sodium channels, which causes chronic depletion of ACh into synapse

Symptoms:

  • immediate pain at lesion site
  • abdominal cramps that mimic appendicitis
  • vomiting
  • nausea
  • cardiac arrthymias

Treatment:

  • ice and pain medications w/ calcium gluconate if mild symptoms/ healthy
  • benzodiazepines Intravenously with antivenin if extreme symptoms are present/ old or child
18
Q

Scorpions

A

Only species that is dangerous is bark scorpion
- usually found under rocks/ logs or floors

C. Sculpturatus venom stings
- neurotoxin that causes repetitive firing of axons by chronic unregulated sodium channel activation

Symptoms:

  • immediate pain at site
  • local = edema, erythema and “jump sign” when touched
  • systemic = very large erythema are, anxiety, spasms, nausea, strange eye movements

Treatment:

  • Ice and pain medication via opiate usually if mild/healthy
  • antivenin with IV benzodiazepines if extreme symptoms/old or young
  • in both cases can prescribe nitroprusside for control of HTN*
19
Q

Bees/ wasps/ fire ants (Hymenoptera)

A

Toxicity is not caused by venom, but rather by bodies systemic reaction to the venom

Symptoms:
- local = Irritation, itching, redness, swelling, immediate pain
- systemic (allergic) =
IgE mediated (most common cause of death)
Cardiovascular collapse, ischemia and shock

Can result in serum sickness after treatment

Can result in delayed systemic toxicity after 24 hrs from exposure.
- causes multi-organ failure

Treatment:
Ice and pain meds
- IV corticosteroids, NSAIDs
- IV antihistamines if allergic reaction

20
Q

Marine animals

A

Includes jellyfish, stingrays and sea urchins

  • MOST dangerous = box jellyfish*
  • causes respiratory arrest

Treatment:

  • MUST remove stinger
  • DO NOT PEE ON OR SCRUB THE WOUND
  • immerse in hot water w/ vinger if pain is extreme
  • can use topical lidocaine as well
  • if stingray stinger causes lacerations, must repair and treat antibiotics*
  • not doing so results in necrotizing facilities and sepsis, which would be treated with tetracycline and ciprofloxacin
21
Q

Scabies

A

Caused by mites that burrow in skin and lay eggs
- identified via magnifying glass

Results in pus filled lesions that can be confused with impetigo or atopic dermatitis

Treatment:

  • permethrin cream
  • lindane (EXCEPT in young since its neurotoxic)
  • require fumigation of house to prevent recurrence
22
Q

Bed bugs

A

Feed off blood and cause red itch non-pus filled papules
- often confused with mosquito bites, hives or eczema

Treatment:

  • wash self and fumigate house
  • toss all bedding and clothes infected
23
Q

Mites

A

Transmitted via ticks and results in rickettsialpox reactions

  • rash occurs at site of bites and often resembles chicken pox
  • rash looks firm, red/black papular lesions

Symptoms

  • fever, chills, headache
  • swollen lymph nodes (not anywhere close to cat scratch size though)
  • rash, myalgia, sweating

Treatment:
- remove mites and fumigate house

24
Q

Carpet beatles

A

Everything is similar to bed bugs except they caused rash via movement on you, NOT BITING

Rash is much more systemic and is intensely pruitic and can become bulbous

Treatment:

  • fumigate house and clean self
  • same as bed pugs
25
Q

Fleas

A

Bites them selves do not do anything.
- symptoms arise from hypersensitivity to them and complications to scratching them

  • scratching bites causes secondary infections usually via staph aureus*

Rash is similar to lice mites and scabies except can be hemorrhagic

  • most common sites are ankles and waist line*

Treatment:
- prevent by treating pets and fumigating house
-

26
Q

Head lice

A

Most common sites are scalp, body and gentialia hair

  • most common infestation and almost exclusively in children 3-12 yrs*

Symptoms:

  • intense purity’s of area, red Macules
  • looks lie dermatitis and eczema/ scabies

Diagnosis: must ID lice on hair shafts (look like grains of rise)

Treatment:

  • permethrin shampoo (initially and then 1 week after 1st treatment)
  • MUST REMOVE ALL AND NO NEED TO FUMIGATE
  • Not suppose to recommend missing school
27
Q

Is pregnancy a contraindication of antivenin?

A

No

BLISS (42 decks)

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