CHAPTER 46: Puncture Wounds and Bites Flashcards
A wound whose depth is greater than its width
Puncture wound
TRUE or FALSE?
Puncture wounds are associated with lower incidence of infections and complications.
FALSE
Puncture wounds are problematic regardless of location and are independently associated with higher incidence of infections and complications compared to other wounds.
The rate of infection from puncture wounds associated with dog bites is about —?—%
10% to 11%
Organisms causing most of soft tissue infections from puncture wound
Gram-positive organisms
Staphylococcus aureus predominates
Most frequent pathogen isolated from plantar puncture wound-related osteomyelitis particularly when the injury occurs through the rubber sole of an athletic shoe
Pseudomonas aeruginosa
- Elderly
- Diabetes +/- microvascular complications
- Immunocompromised
- Peripheral vascular disease
Patient characteristics as Risk Factors for Puncture Wound Complications (Table 46-1 page 318)
TRUE or FALSE?
Wounds >4 hours old with increasing pain and redness are likely infected.
FALSE
Wounds >6 HOURS old with increasing pain and redness are likely infected.
TRUE or FALSE?
Probing the wound with a blunt instrument to assess depth and the presence of a foreign body is of unproven utility.
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.
Plain radiographs will detect >90% of radiopaque foreign bodies —?— mm in diameter
> 1 mm in diameter
Foreign object that is difficult to visualize with any imaging modality
Rubber from athletic shoes
TRUE or FALSE?
Traditional wound-cleaning techniques are largely ineffective in puncture wounds.
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.
The hallmark of all infectious complications of puncture wound
Persistent pain
Cellulitis usually presents within —?— days after injury
within 4 days after injury
Complication of puncture wounds is usually associated with a retained foreign body
Localized abscess
Complication of puncture wounds with key physical examination finding is tenderness, redness, or swelling remote from the puncture site
Deep soft tissue infection
Is the most disastrous consequence of puncture wounds
Osteomyelitis
Patients with osteomyelitis present often —?— days after injury
often >7 days after injury
The imaging modality most helpful in the diagnosis of osteomyelitis
MRI
Risk of infection in a nonimmune recipient after an inadvertent needlestick contaminated from an infectious source Hep A: —?— Hep B: —?— Hep C: —?— HIV: —?—
Hep A: negligible
Hep B: 37 to 62%
Hep C: 2%
HIV: 0.3%
Risk of subsequent amputation in high-pressure injection injuries is reduced if surgical debridement is performed within —?— hours of the injury
within 6 hours of the injury
The natural history of epinephrine autoinjector injury is spontaneous resolution from -?— hours
from 6 to 13 hours
Is the one treatment consistently described that rapidly reverses digital ischemia from accidental epinephrine injection but is rarely indicated
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)
Primarily closure of the bite wound with percutaneous sutures has a risk of postrepair wound infection of —?—
5% to 15%
Dog bites in immunocompromised individuals most often due to this organism
Capnocytophaga canimorsus
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.
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.
Only approximately —?—% of dog bites will become infected
approximately 5%
Up to —?—% of cat bites that present for care will become infected if untreated
Up to 50%
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)
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)
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)
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)
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)
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)
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)
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)
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)
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
Antibiotic adequate for Pasteurella multocida
Penicillin V OR Ampicillin
Alternative antibiotic for patients with CAT bites who has penicillin allergy
Doxycycline OR Cefuroxime
Alternative antibiotic for patients with DOG bites who has penicillin allergy
Clindamycin PLUS Fluoroquinolone
Antibiotics that should not be used alone for dog or cat bites
Cephalexin
Dicloxacillin
Erythromycin
Clindamycin
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
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
Most cases of Cat-scratch Disease with only lymph node involvement resolve in —?— months
2 to 5 months
TRUE or FALSE?
Human bites are treated as non-contaminated wounds.
FALSE
All human bites should be treated as contaminated wounds.
Is a common human bite injury incurred when a flexed knuckle strikes a human tooth in the course of an altercation
Closed-fist injury
Primary closure of human bite wounds to the face is associated with a postrepair wound infection rate of approximately —?—%
approximately 10%
Is cost effective and adequate as an initial agent in human bite injuries
Cephalexin
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)
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)
Disseminated viral illnesses resulting from mammalian bites
Rabies
Hepatitis
Herpes B virus
HIV
Human infection with B virus (Herpes B/Macacine herpesvirus 1) these complications
Myelitis & Hemorrhagic encephalitis
case fatality rate of 70%
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.
