CHAPTER 46: Puncture Wounds and Bites Flashcards

1
Q

A wound whose depth is greater than its width

A

Puncture wound

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2
Q

TRUE or FALSE?

Puncture wounds are associated with lower incidence of infections and complications.

A

FALSE
Puncture wounds are problematic regardless of location and are independently associated with higher incidence of infections and complications compared to other wounds.

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3
Q

The rate of infection from puncture wounds associated with dog bites is about —?—%

A

10% to 11%

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4
Q

Organisms causing most of soft tissue infections from puncture wound

A

Gram-positive organisms

Staphylococcus aureus predominates

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5
Q

Most frequent pathogen isolated from plantar puncture wound-related osteomyelitis particularly when the injury occurs through the rubber sole of an athletic shoe

A

Pseudomonas aeruginosa

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6
Q
  • Elderly
  • Diabetes +/- microvascular complications
  • Immunocompromised
  • Peripheral vascular disease
A

Patient characteristics as Risk Factors for Puncture Wound Complications (Table 46-1 page 318)

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7
Q

TRUE or FALSE?

Wounds >4 hours old with increasing pain and redness are likely infected.

A

FALSE

Wounds >6 HOURS old with increasing pain and redness are likely infected.

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8
Q

TRUE or FALSE?

Probing the wound with a blunt instrument to assess depth and the presence of a foreign body is of unproven utility.

A

TRUE
Practice of probing the wound with a blunt instrument to assess depth and the presence of a foreign body is of unproven utility, but may improve the ability to cleanse wounds.

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9
Q

Plain radiographs will detect >90% of radiopaque foreign bodies —?— mm in diameter

A

> 1 mm in diameter

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10
Q

Foreign object that is difficult to visualize with any imaging modality

A

Rubber from athletic shoes

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11
Q

TRUE or FALSE?

Traditional wound-cleaning techniques are largely ineffective in puncture wounds.

A

TRUE
Traditional wound-cleaning techniques are largely ineffective as a result of the small entrance wound that has often spontaneously sealed by the time of presentation.

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12
Q

The hallmark of all infectious complications of puncture wound

A

Persistent pain

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13
Q

Cellulitis usually presents within —?— days after injury

A

within 4 days after injury

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14
Q

Complication of puncture wounds is usually associated with a retained foreign body

A

Localized abscess

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15
Q

Complication of puncture wounds with key physical examination finding is tenderness, redness, or swelling remote from the puncture site

A

Deep soft tissue infection

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16
Q

Is the most disastrous consequence of puncture wounds

A

Osteomyelitis

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17
Q

Patients with osteomyelitis present often —?— days after injury

A

often >7 days after injury

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18
Q

The imaging modality most helpful in the diagnosis of osteomyelitis

A

MRI

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19
Q
Risk of infection in a nonimmune recipient after an inadvertent needlestick contaminated from an infectious source
Hep A: —?—
Hep B: —?—
Hep C: —?—
HIV: —?—
A

Hep A: negligible
Hep B: 37 to 62%
Hep C: 2%
HIV: 0.3%

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20
Q

Risk of subsequent amputation in high-pressure injection injuries is reduced if surgical debridement is performed within —?— hours of the injury

A

within 6 hours of the injury

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21
Q

The natural history of epinephrine autoinjector injury is spontaneous resolution from -?— hours

A

from 6 to 13 hours

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22
Q

Is the one treatment consistently described that rapidly reverses digital ischemia from accidental epinephrine injection but is rarely indicated

A

Phentolamine
Dose: 1.5 to 3.0mg
0.5 mL phentolamine solution (5 mg/mL) + 0.5mL of 1% lidocaine
(1-mL total volume containing 2.5 milligrams of phentolamine that can be subcutaneously injected)

23
Q

Primarily closure of the bite wound with percutaneous sutures has a risk of postrepair wound infection of —?—

24
Q

Dog bites in immunocompromised individuals most often due to this organism

A

Capnocytophaga canimorsus

25
TRUE or FALSE? Wound closure of bite wound is associated with a small increased risk of local wound infection and unlikely enhance the risk of serious systemic infection from Capnocytophaga.
TRUE Wound closure of bite wound is associated with a small increased risk of local wound infection, but is unlikely to enhance the risk of serious systemic infection from Capnocytophaga, unless the patient is immunodeficient or the wound is at high risk of infection.
26
TRUE or FALSE? | Primary wound closure should be avoided in patients with systemic immunodeficiencies
TRUE The current practice is to avoid primary wound closure in patients with systemic immunodeficiencies and higherrisk wounds.
27
Only approximately —?—% of dog bites will become infected
approximately 5%
28
Up to —?—% of cat bites that present for care will become infected if untreated
Up to 50%
29
Common organisms obtained from this animal bite: Pasteurella multocida Bartonella henselae
Cat Tx: Amoxicillin-clavulanate; Azithromycin Common Bites and First-Line Treatment (Table 46-4 page 322)
30
``` Common organisms obtained from this animal bite: Pasteurella Streptococci Staphylococci Capnocytophaga canimorsus ```
Dog Tx: Amoxicillin-clavulanate Common Bites and First-Line Treatment (Table 46-4 page 322)
31
``` Common organisms obtained from this animal bite: Eikenella Staphylococci Streptococci Herpes simplex (herpetic whitlow) ```
Human Tx: Amoxicillin-clavulanate; Cephalexin; Acyclovir or valacyclovir Common Bites and First-Line Treatment (Table 46-4 page 322)
32
``` Common organisms obtained from this animal bite: Streptobacillus moniliformis (North America) or Spirillum minus/minor (Asia) ```
Rats, mice, squirrels, gerbils Tx: Amoxicillin-clavulanate Common Bites and First-Line Treatment (Table 46-4 page 322)
33
``` Common organisms obtained from this animal bite: Multiple organisms Brucella Leptospira Francisella tularensis ```
Livestock, large game animals Tx: Amoxicillin-clavulanate or specific agent for disease Common Bites and First-Line Treatment (Table 46-4 page 322)
34
Common organisms obtained from this animal bite: | Rabies
Bats, monkeys, dogs, skunks, raccoons, foxes (all carnivores and omnivores) Tx: Rabies immune globulin, rabies vaccine Common Bites and First-Line Treatment (Table 46-4 page 322)
35
Common organisms obtained from this animal bite: | Herpes B virus (Cercopithecine herpesvirus)
Monkeys Tx: Acyclovir or valacyclovir Common Bites and First-Line Treatment (Table 46-4 page 322)
36
Common organisms obtained from this animal bite: Aeromonas spp. Staphylococci Streptococci
Freshwater Tx: Fluoroquinolone or TMP-SMX Common Bites and First-Line Treatment (Table 46-4 page 322)
37
Common organisms obtained from this animal bite: Vibrio Staphylococci Streptococci
Saltwater Tx: Fluoroquinolone; Doxycycline Common Bites and First-Line Treatment (Table 46-4 page 322)
38
Is the antibiotic most commonly recommended for prophylaxis of uninfected wounds and for treatment of local infections following dog, cat, or human bites.
Amoxicillin-clavulanate
39
Antibiotic adequate for Pasteurella multocida
Penicillin V OR Ampicillin
40
Alternative antibiotic for patients with CAT bites who has penicillin allergy
Doxycycline OR Cefuroxime
41
Alternative antibiotic for patients with DOG bites who has penicillin allergy
Clindamycin PLUS Fluoroquinolone
42
Antibiotics that should not be used alone for dog or cat bites
Cephalexin Dicloxacillin Erythromycin Clindamycin
43
Capnocytophaga canimorsus produces a rare but fulminant bacteremic illness after a dog bite, with fatal multiorgan failure, particularly in patients with these conditions with:
Splenectomy Alcoholism Immunosuppressive disorders
44
Is a clinical syndrome of regional lymphadenopathy developing 7 to 12 days after a cat bite or scratch
Cat-scratch disease | caused by Bartonella henselae
45
Most cases of Cat-scratch Disease with only lymph node involvement resolve in —?— months
2 to 5 months
46
TRUE or FALSE? | Human bites are treated as non-contaminated wounds.
FALSE | All human bites should be treated as contaminated wounds.
47
Is a common human bite injury incurred when a flexed knuckle strikes a human tooth in the course of an altercation
Closed-fist injury
48
Primary closure of human bite wounds to the face is associated with a postrepair wound infection rate of approximately —?—%
approximately 10%
49
Is cost effective and adequate as an initial agent in human bite injuries
Cephalexin
50
Is a local infection caused by HSV after a human bite or contact with infected saliva
Herpetic whitlow | Tx: oral acyclovir (7 to 10 days) OR topical acyclovir ointment (7 to 14 days)
51
Consists of two similar febrile illnesses occurring after a small percentage of bites from rats, mice, squirrels, or gerbils
Rat-bite fever (caused either by either Streptobacillus moniliformis (North America) or Spirillum minus/minor (Asia)) Tx: IV penicillin (5 to 7 days) followed by oral penicillin (addt'l 7 days)
52
Disseminated viral illnesses resulting from mammalian bites
Rabies Hepatitis Herpes B virus HIV
53
Human infection with B virus (Herpes B/Macacine herpesvirus 1) these complications
Myelitis & Hemorrhagic encephalitis | case fatality rate of 70%
54
TRUE or FALSE? | Viral hepatitis and HIV can both be transmitted by a human bite.
TRUE Viral hepatitis and HIV can both be transmitted by a human bite, although HIV viral concentration in nonbloody saliva is thought to be relatively low.