Environmental Medicine Flashcards
What is a common pathogen found in wound infections from dog bites
Pasteurella multocida
What are the indications of using antibiotics for dog bites
Signs of infection
Bite on face present for >24 hours OR bite on extremity >8 hours without irrigation
Immunocompromised state for the victim
Crush injury or significant contamination of wound
Bite wounds of the hands or feet
What antibiotics would be given to personnel that meet the criteria for Abx treatment of a dog bite
1st - Amoxicillin/Clavulanate (Augmentin) 875/125 mg BID or 500/125 mg TID OR
2nd - Clindamycin 300 mg PO q 6 hours for 7 days OR
3rd - Ciprofloxacin 750 mg PO BID for 4-8 weeks
What has a higher infection rate in comparison to other domestic animals
Cat bites
Greater than 60% of cat bites are located where
The hand or finger; these wounds may be deep puncture wounds, which are difficult to clean
70% of cat bite infections are due to what
Pasteurella
What is the antibiotic treatment for cat bites
Augmentin
Clindamycin + fluoroquinolone if penicillin allergic
In general, larger animals should raise more suspicion of blunt and penetrating trauma, including what
Deep arterial damage, nerve damage and internal organ damage
When dealing with wild animal bites, antibiotics should be directed against what
Aeromonas hydrophilia
What antibiotics should be used for a wild animal bite
Trimethoprim-sulfamethoxazole (Bactria DS) 800 mg/160mg PO q 12 hours for 7 days
OR
Doxycycline 100mg BID for 7 days
In salt (ocean) water, where antibiotics should also be directed against what? Using what?
Vibrio species
Using doxycycline + Ceftriaxone 1g IV daily OR
Ceftriaxone (Rocephin) 2 gIV every 12 hours
According to the World Health Organization in 2015 about 3.2 billion people, nearly half of the world’s population are at risk of what
Malaria
What are the other mosquito-borne illnesses
Encephalitis
Yellow fever
Dengue
Chikungunya
Zika
Lymphatic filariasis
What are the mosquito-borne illnesses found in the U.S.
Eastern equine encephalitis
Western equine encephalitis
St. Louis encephalitis
La crosse encephalitis
West Nile virus
For the most current Force Protection recommendations when deploying or conducting field operations, who should always be consulted
Centers for Disease Control and Prevention (CDC), and the local COCOM and TYCOM
Incubation period for mosquito borne diseases range from what to what
48 hours to one year or more
What is the order of insects that includes ants, bees, and wasps
Hymenoptera
What are the clinical signs of Hymenoptera stings
A local reaction is the most common reaction which consists of a small red patch that burns and itches
The generalized reaction consists of diffuse red skin, hives, swelling of lips and tongue, wheezing, abdominal cramps and diarrhea
Stings to the mouth and throat are more serious, as they may cause airway swelling
Victims of multiple stings often experience what
Vomiting
Diarrhea
Dyspnea
Hypotension
Tachycardia
Syncope
Skin infections
In advanced stages of toxicity, the victim of a Hymenoptera sting often experiences what
Increased muscle activity with hyperkalemia
Acute tubular necrosis
Renal failure
Pancreatitis
Coagulopathy
Heart attack
Stroke
What is the treatment of Hymenoptera stings
Remove the stinger: scrape away the stinger in a horizontal fashion (try not to grasp the stinger sac)
Wash the site with soap and water
Place a cold compress or ice on the site to reduce inflammation
Give oral analgesics as needed for pain relief
Topical steroid cream can be helpful for swelling, as are oral antihistamines
What antihistamines can be used for Hymenoptera stings
Antihistamines (immediate, but temporary) :
Loratadine - Claritin - 10 mg orally once daily
Desloratidine - clarinex - 5mg once daily
Fexofenadine - Allegra - 60mg twice daily or 120mg once daily
Cetirizine - Zyrtec - 10mg orally once daily
What should be used for treatment of a Hymenoptera sting if there is wheezing and respiratory difficulty
Epinephrine should be given immediately
What diseases do ticks transmit
Lyme disease
RMSF
Relapsing fever
Colorado tick fever
Ehrlichiosis
Babesiosis
Tularemia
Southern tick-associated rash illness (STARI)
What is a non-infectious ascending paralysis similar to Gillian-Barre syndrome that may occur within five days after the tick attaches
Tick paralysis - removal of the tick is curative
What areas are ticks found in
With weeds, shrubs, and trails - often found at forest boundaries where deer and other mammals reside (they sit on low-hanging shrubs with legs outstretched until an animal passes)
Which tick-borne diseases are treated with a tetracycline such as doxycycline while an evacuation is being planned
Lyme disease
RMSF
Tularemia
Ehrlichiosis
What is the treatment for tick paralysis
Removal of the tick
How do you remove a tick
Use thin-tipped tweezers or forceps to grasp the tick as close to the skin surface as possible and pull the tick straight upward with steady even pressure
Wash the bite with soap and water, then wash hands after the tick has been removed
Watch for local infection and symptoms of tick-borne illness (incubation period 3-30 days), especially headache, fever, and rash
What is Colorado tick fever caused by and how do you treat
It is caused by a virus and treatment is supportive
Which snake bite is neurotoxic and what does it cause
Coral snake - neurotoxins cause respiratory paralysis (signs and symptoms:ptosis, dysphasia, diplopia, and respiratory arrest via diaphragmatic paralysis
Which snake bite is cytolytic and what does it cause
Rattlesnakes, other pit vipers - cytolytic venoms cause tissue destruction by digestion and hemorrhage due to hemolysis and destruction of the endothelial lining of the blood vessels
What is the ditty for coral snakes
Red touches black, you’re ok jack - red touches yellow, you’re a dead fellow
What are the identifications of a venomous snake
Triangular head
Keeled scales
Elliptical pupils
Nostrils plus IR pit
Single row of sub causal scales
What are the identifications of a non venomous snake
Oval shaped head
Round pupil
No IR pit
Double row of subcaudal scales
What are neurotoxic signs and symptoms
Ptosis
Dysphagia
Diplopia
Respiratory arrest via diaphragmatic paralysis
What are cytolytic signs and symptoms
Local pain
Redness
Swelling
Extravasation of blood
Perioral tingling
Metallic taste
Nausea and vomiting
Hypotension
Coagulopathy
What is the treatment of snake bites
Remove from threat, try to ID snake
Immobilize the patient and maintain the bitten part in a neutral position
Remove jewelry
DO NOT apply a tourniquet or attempt to extract venom
Irrigate and clean bite
Loose dressing if he too is bite, expect swelling
Do not let patient walk, limit exertion
MEDEVAC
What should be avoided while treating a snake bite
Incision and oral suction
Mechanical suction devices
Cryotherapy
Surgery
Electric shock therapy
Tourniquets
What should be taken into consideration when treating a snake bite
Emergency management of respiratory depression and shock, followed by timely anti-venom administration whenever possible to patients with appropriate indications comprise the key initial interventions in patients with snakebites
What are the signs and symptoms of a black widow spider bite
Generalized muscular pain
Muscle spasms
Rigidity
Abdominal pain
What is the treatment of a black widow spider bite
Pain may be relieved with pain control and muscle relaxants (benzos and supportive care)
What are the signs and symptoms of a brown recluse spider bite
Causes progressive local necrosis as well as hemolytic reactions (rare). Bite is usually painless
What is the treatment for a brown recluse spider bite
Pain management for secondary local necrosis and close monitoring initially
Consider antibiotic prophylaxis in field setting
Bites occasionally progress to extensive local necrosis and may require excision of the bite site and oral corticosteroid
What are signs and symptoms of a scorpion sting
Muscle cramps
Twitching and jerking
Occasionally hypertension
Convulsions
Pulmonary edema
What is the treatment for a scorpion sting
Supportive care is appropriate for North American species
Always review the threat of local species when operating OCONUS
If severe neurologic or neuromuscular dysfunction, consult poison control and discuss further management and anti-venom
Suction oral secretions, airway management, cardiac monitoring, IV opioids preferably fentanyl due to no histamine release, benzodiazepines for spasms unless getting anti-venom
What are the signs and symptoms of a jellyfish sting
Pain
Erythema
Edema
Pruritus
Vesiculations
Anaphylaxis
What is the treatment for a jellyfish sting
Rinse the area with seawater. Do not rinse with fresh water - freshwater promotes nemocyst activation
Remove tentacles with a gloved hand and scrape off any remaining nemocytsts by covering with sand/shaving cream/baking soda and scrape off with straight edge - sticky tape may also remove nemocysts
Vinegar x30 seconds deactivates nemocysts
What are signs and symptoms of coneshell stings
Mild to severe pain
Stinging or numbness
Local to total paralysis
What is the treatment for coneshell stings
Pressure immobilization dressing and supportive care to include close monitoring of respiratory status
MEDEVAC for advanced supportive care, possible need for ventilation if symptoms worsen. Usually resolves in 24-72 hours
What are signs and symptoms of a stingray or stinging fish
Barbed spines that are a penetrating injury and envenomation
Spine commonly remains lodged in wound
What is the treatment of a stingray/stinging fish injury
Remove and irrigate to remove fragments
Toxin is heat labile and immediate relief of pain can be obtained by placing the wound in water heated to 40-45 Celsius (104-113 Fahrenheit) for 30min intervals
Poison control useful for all envenomations
Extremely painful and typically does not respond well to pain relievers
Local anesthetic can be used to help with pain if hot water immersion is ineffective (NOT in combination)