Jaynstein - Bites, Stings, Creepy Things Flashcards
1
Q
which is worse: cat bites or dog bites
A
cat
2
Q
which is more common: dog bites or cat bites
A
dog
80-90%
3
Q
which dog breeds have the most potential for injury
A
police dogs
4
Q
t/f: tx is different dog bites if the dog is known and UTD on vaccinations
A
F!
tx is the same
5
Q
important hx for bites (5)
A
animal known?
breed
time of bite
pt comorbidities
tetanus hx
6
Q
tetanus vaccine schedule
A
q 10 years w.o incident
q 5 years w. incident
7
Q
goal of bite wound management
A
prevention of infxn
8
Q
__% of dog bites get infected
__% of cat bites get infected
A
dogs: 5%
cats: 50%
* but tx is basically the same*
9
Q
most critical aspect of bite care
A
irrigation
also evaluate for FB
10
Q
bites at high risk for infxn (7)
A
immunocompromised
etoh
hand or foot/extremity
crush injury
multiple puncture wounds
cat bite
delayed presentation
11
Q
delayed presentation for extremity bite is > __ hr
A
12
12
Q
delayed presentation for face bite is > __ hr
A
24
13
Q
mc bacterial infxn from both dog and cat bites
A
pasteurella
14
Q
most bites are polymicrobial, so also worry about __ (2)
A
staph
strep
15
Q
bacteria of concern in dog bites that is rare but has high mortality
A
capnocytophaga
16
Q
3 major complications w. cat bites dt sharp teeth that penetrate joints
A
septic arthritis
osteomyelitis
tenosynovitis
17
Q
bacteria associated w. joint infxns in cats
A
pasteurella multocida
18
Q
management of cat puncture wound
A
anesthetize
open up
irrigate
always, no matter what
19
Q
besides irrigation, how else would you manage this cat puncture bite
A
document:
document # of punctures
drainage
surrounding erythema
complete NV exam w. CMS
date and time stamp line
20
Q
Kanavel’s criteria for tenosynovitis (4)
A
tenderness along course of flexor tendon
fusiform or symmetrical swelling of finger
pain w. passive ROM
flexed posture of the finger
21
Q
which is more concerning, flexor or extensor injuries
A
flexor
22
Q
cat bites are more concerning for infxn, but dog bites are more concerning for
A
structural damage →
soft tissue injury, crush injury, avulsion/tears
23
Q
tx considerations for bites
A
document nerve, vascular, bone assessment
consider imaging
24
Q
for dog bites, always check and document that you evaluated __
A
distal CNS
25
infxn timeline for cat vs dog bites
cats: 12 hr
dogs: 24 hr
26
t/f you need labs/cultures before starting abx for bites
F!
27
all cat/dog bite pt's should be given what abx
Augmentin
28
imaging to consider for boney injury, free air, or FB
xray
29
imaging for vascular injury
CT w. contrast
CTA extremity
30
tx for cat bites should NEVER include
closing the wound
*star them, clean out*
31
dog bites on the __ may be closed
dog bites on the __ should not be closed
face
hand/foot
32
if you do suture a dog bite laceration use __ sutures
and never \_\_
simple interrupted
double closure
33
what are PEP abx
post exposure prophylaxis
34
PEP is recommended for what bites (6)
hand
feet
face
immuno comp
puncture
sutured wounds
35
first choice abx w. dosing for bites
Augmentin 875 mg bid x 5 days
36
first choice abx w. dosing for bite wounds if PCN allergy
doxycycline 100 mg bid x 7 days
37
abx for infected bite
Augmentin 875 mg PO x 5 days
Unasyn 3 gm IV
38
minimum f.u for bites
12-24 hr
39
t/f: animal bites are considered tetanus prone
T!
40
always do vascular study for __ dog bites
police
41
t/f: all dog/cat bites need to be reported in CO
T!
42
t/f: human bites are more serious than dog/cat bites
T!
43
2 viruses that can be transmitted via human bites
hep B
HSV
44
can HIV be transmitted via human bite
no!
45
major bacteria to consider in human bite
eikenella corrodens
46
besides eikenella, also consider __ (2) in human bites
staph
strep
47
bacteria to consider/cover for bite on the foot
pseudomonas
48
what is this called
fight bite
*2nd MTP*
49
abx for human bites
augmentin 875 mg PO bid x 7 days
repetition, repetition, repetition :)
50
do not close human bites unless they are located on the \_\_
face
51
tx for human bites
open
irrigate
+/- hep B vaccination
52
what is this called
herpetic whitlow
HSV infxn from infected saliva
53
what should you ask about if you see unexplained LAD on a kiddo
cat bite → cat scratch dz
54
bacteria responsible for cat scratch dz
bartonella henselae
55
3 sx of cat scratch dz (3)
low-grade fever
fatigue
regional **tender** LAD
56
cat scratch dz occurs __ weeks after injury
1-3
57
tx for cat scratch dz (3)
don't drain or I&D
most self resolve
abx if ill
58
abx for cat scratch fever
azithro
or
doxy
59
who gets pre-exposure for rabies
vets
60
major vector for rabies in the US
bats
61
mc vector for rabies worldwide
dogs
62
in the US, are cats or dogs more commonly rabid
cats
63
tx for animal that is not ill at the time of bite
quarantine for 10 days
no PEP
64
tx for animal that is sick at the time of bite
held by city
PEP given immediately
65
4 animal bites that need PEP immediately
raccoons
foxes
skunks
bats
66
5 animal bites that are +/- PEP on individual basis
livestock
horses
rodents
rabbits
hares
67
rabies PEP schedule
days 0, 3, 7, 14
68
when should you give PEP for bat bites
when not 100% sure that a bat didn't scratch or bite pt
69
zoonotic systemic infxn from mice/rats
hanta virus
70
hanta virus has a __ week intubation
and manifests as __ infxn
2
pulmonary
71
initial presentation of brown recluse bite
painless
72
brown recluse bites are \_\_toxic
necro (skin)
73
brown recluse rxn involving localized skin erythema and edema that resolves spontaneously over 1 week
minor loxoscelism
74
brown recluse rxn involving severe skin erythema w. cutaneous blisters and/or irregular ecchymosis; red, white, blue sign
cutaneous loxoscelism
75
what is this showing
**brown recluse bite**
red, white, and blue sign
76
red, white, blue sign:
red:
white:
blue:
red: vasodilation
white: ischemia
blue: necrosis
77
brown recluse bite tx (3)
no anti-venom
often extensive wound care w. debridement
heals in 6-8 weeks
78
what is latrodectus hesperus
black widow
79
black widow bites are \_\_toxic
neuro
80
black widow bite sx
intense, sudden, local or regional pain
diaphoresis
**htn**
agitation
fever
**abdominal spasms**
81
black widow bite can mimic __ sx
acute abdomen
82
tx for black widow bite (2)
pain control for abd spasms → benzos
obs x 12-24 hr
+/- anti venom
83
t/f: there is an anti venom for brown recluse bites
F
84
t/f: there is an anti venom for black widow bites
T
85
what are these showing
black widow bites
86
geographic location of black widow bites
all over US
87
classifications of snake bites in terms of toxicity
hemotoxic
neurotoxic
necrotoxic
cardiotoxic
nephrotoxic
88
2 families of venomous snakes in US
viperidaes
elapidae
89
venomous viperidaes snakes include (3)
pit vipers
rattlesnakes
copperheads
90
viperidaes snakes are \_\_toxic (2)
hemo
necro
91
venomous elapidae snakes include (3)
cobras
mambas
coral snakes
92
elapidae snakes are \_\_toxic
neuro
93
largest snake threat in CO
rattlesnakes
94
sx of rattlesnake bite
edema
pain
ecchymosis at site
RBC destruction, thrombocytopenia, coagulopathy → unstable vitals
95
tx for rattlesnake bite (8)
remove rings/restrictive material
immobilize
rest extremity at level of heart
call poison control
monitor VS min 8 hr
labs
measure and mark
update tetanus
96
tx to AVOID in rattlesnake bites (6)
compression
incision
mouth suction
excision
tourniquet
ice/heat
97
labs for rattlesnake bite
CBC
BMP
PT/INR
CPK
98
classification of rattlesnake bite
minor vs major envenomation
99
tx consideration for all pt's who receive rattle snake anti venom
ICU admit
100
name of rattlesnake anti venom
crotilidae polyvalent immune Fab (CroFab)
101
dosing for CroFab
initial: 4-6 vials
life threatening: 8-12 vials
*each vial is several thousand $$*
102
how often to mark/document erythema/edema for rattlesnake bite
q 1-2 hr
103
how to remember venomous vs non venomous coral snake
red on yellow kill a fellow
red on black venom it lacks
104
coral snakes are \_\_toxic
neuro
105
sx of coral snake bite
n/v
HA
CN sx → ptosis, dysarthria, dysphagia, muscle weakness, resp failure
106
sx of coral snake bite occur w.in
12-24 hr → keep pt
107
tx for coral snake bite
admit
anti venom early
update tetanus
+/- constriction bandage
108
tx consideration for ticks that stay on skin \> 6 hr
scalpel
109
sx of tick borne illness mimic
flu → FUO (fever of unknown origin)
110
tick season
late spring - early fall
111
important hx in FUO (3)
travel
pet
livestock exposure
112
what is this showing
bulls-eye → lyme dz
113
what tick carries lyme dz
borrelia burgdorferi
114
rash of lyme dz
erythema migrans
115
describe erythema migrans (5)
1-3 days after bite
target lesion
erythematous
increases in size
fades 3-4 weeks
116
sx of lyme dz (7)
fever
malaise
HA
monoarthritis (knee/hip) → polyarthritis
CN dysfxn
meningitis
hearing loss
117
CN affected by lyme dz
CN VII → BP
118
dx for lyme dz (6)
ELISA
western blot
serology
synovial fluid PCR
urine antigen
IgG/IgM
119
tx for lyme dz
adults vs kids
doxycycline 100 mg bid x 14 days
kids: amoxicillin 50 mg/kg/day TID x 21 days
120
tick borne illness carried by wood tick/dog tick
rocky mtn spotted fever
121
mc rickettsial dz in the world
RMSF
122
describe the rash in RMSF (3)
1 week after bite
erythematous macules → then petechiae
starts on distal extremities
123
besides rash, 6 other sx of RMSF
fever
HA
myalgias
malaise
abd pain
n/v
124
dx for RMSF
clinical
125
hematology finding of RMSF
thrombocytopenia
*only used for confirmatory testing*
126
what is this showing
RMSF rash
127
tx for RMSF
doxy 100 mg x 7 days min
continue x 3 days post fever
128
abx for RMSF if doxy contraindication
chloramphenicol 12.5 mg/kg PO 4 times daily x 7 days
129
5 other tick borne diseases (besides lyme and RMSF)
ehrlichiosis
babesiosis
colorado tick fever
tularemia
tick borne relapsing fever
130
tick borne illness that causes hemolytic anemia
babesiosis
131
tick borne illness found in rabbits \_\_
causes __ sx
tularemia
pulmonary
132
3 tick borne illnesses in CO
colorado tick fever
tularemia
tick born relapsing fever
133
most stings come from \_\_,
which include __ (3)
vespids
wasps, hornets, yellow jackets
134
what does PEST stand for
rxn to stings:
pruritis
erythema
soft tissue swelling
135
tx for a sting that is inflamed but not infected
antihistamines
+/- steroids
136
tx for sting that is showing signs of cellulitis
abx
137
what is hymenoptera
bee
138
tx for bee sting
remove stinger
pain control
tetanus (really??)
139
be aware of bee stings in the (2)
mouth
eye
140
toxic systemic rxns are seen with \> __ bee stings
50
141
tx for anaphylaxis
intubate early
142
epi dosing for kids vs adults
kids: 0.01 mg/kg IM 1:1000 (epipen JR 0.15 mg)
adults: 0.3-0.5 mg IM 1:1000 (epipen 0.3 mg)
143
temp hemostasis occurs via what 4 mechanisms
conduction
convection
radiation
evaporation
144
what is miliaria rubra
heat rash
145
what is this showing
miliaria rubra
146
tx for miliaria rubra is mc in
kids
147
tx for miliaria rubra
none necessary
148
heat disorders mild → extreme (5)
edema
syncope
cramps
exhaustion
stroke
149
what is this showing
what is the tx
heat edema
elevation, rest, cooling, oral fluids
150
simple, transient LOC or collapse after exertion in heat
heat syncope
151
sx of heat syncope (3)
cool, clammy skin
weak pulse
hypotn
152
core body temp in heat syncope
normal
153
tx for heat syncope
oral/IV hydration
154
spasm of voluntary abd muscles and extremities 2/2 to electrolyte disturbance
heat cramps
155
2 mc lytes involved w. heat cramps
1. sodium
2. potassium
156
core temp in heat cramps
nl or mildly elevated
157
tx for heat cramps
oral hydration
Na replacement (sports drink)
158
systemic rxn to prolonged heat exposure dt dehydration or sweating
heat exhaustion
159
first part of spectrum of heat stroke
heat exhaustion
160
parameters for heat exhaustion
elevated but \< 40C
161
sx of heat exhaustion (5)
ha
n/v
malaise
muscle cramps
dizziness
162
sx that is NOT component of heat exhaustion
CNS
163
tx for heat exhaustion (4)
cooling
rehydration (oral and IV)
lyte replacement
admit
164
severe systemic dysfxn of heat regulation - multiorgan failure
heat stroke
165
almost all heat stroke pt's have __ dysfxn
liver
166
sx of heat stroke (4)
**CNS:**
AMS
confusion
coma
visual disturbance
167
core temp in heat stroke
\>40C (104F)
168
complications of heat stroke (3)
rhabdo
DIC
ARF
169
minimum labs for heat stroke (4)
CMP
CPK
UA
coag panel
170
tx for heat stroke
cooling → water immersion until temp \<102F
admit
171
are fever reducers helpful in heat stroke
no
172
indications for poor prognosis in heat stroke (4)
persistent hyperprexia (temp \>107)
coma
elevated LFTs
hyperK
173
3 locations where ice packs are most effective
neck
groin
axilla
174
3 advanced cooling techniques
water immersion
ECMO
peritoneal lavage
