Extremity trauma and bites/stings

Question 0

Patient with combined injury of artery, nerves, and bone – order of surgical repair? Also do?

Answer 0

1. Bone, then delicate vascular repair then nerves

2. Add fasciotony to prevent compartment syndrome

Question 1

management of extremity injury when no major vessels are in the vicinity of injury?

If penetration is near major vessels but patient is asymptomatic?

If obvious vascular injury?

Answer 1

Tetanus prophylaxis and wound cleaning

Doppler or CT angio to assess major vessels

Surgical exploration and repair

Question 2

Hazards of crushing injury? Management?

Answer 2

Hyperkalemia, myoglobinuria, myoglobinemia, renal failure

Vigorous fluid administration, osmotic diuresis, alkalinization of the urine

Question 3

Required for all bites?

Answer 3

Tetanus prophylaxis and wound care

Question 4

Management:

1. Provoked Dog bite
2. Unprovoked dog bite
3. Wild animal bite

Answer 4

1. Observation of dog for developing signs and reviews; no rabies immunization for pt unless bite to face
2. Kill animal and examine brain for rabies OR rabies prophylaxis (immunoglobulin plus vaccination)
3. Same as unprovoked dog bites

Question 5

Snakebite – signs of venom? Anti-venom dose based on? Only first aid measure that is valid for snake bites?

Answer 5

Severe pain, swelling, discoloration within 30 minutes of bite

Size of envenomation, not size of patient

Splint during transportation (Don’t suck out venom, don’t wrap with ice, don’t tourniquet)

Question 6

Antidote for black widow spider bite?

Answer 6

Calcium gluconate

Question 7

Signs and Management of brown recluse spider bite?

Answer 7

Skin ulcer with necrotic center and surrounding halo of erythema

1. dapsone
2. Delay surgical excision until full extent of damage is evident (wait as long as one week)

Question 8

Dirtiest bite? Management?

Answer 8

Human bite; extensive irrigation and debridement in OR