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Environmental Emergencies > Bites > Flashcards

Bites Flashcards

1
Q

6 factors that make bite wounds higher risk

A

Location: Intra oral, hands, joints, below knee
Type: puncture wounds
Cat bites > human > dogs
Delayed presentation
Patient factors: immune suppressed or elderly
Presence of peripheral vascular disease or prosthetic valve

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2
Q

General approach to management of bites

A

Anesthetize, irrigate, debride devitalized tissue
Explore in full flexion and extension for ligamentous injury
X-ray to rule out fracture or foreign body
Tetanus
Check blood sugar for diabetes
Consider rabies as appropriate (public health)
Close if not high risk and no signs infection
Antibiotics (iv if signs infection) if high risk
Arrange for follow up in 48 hours

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3
Q

7 indications for prophylactic antibiotics in bites

A 
Cat or human
Deep puncture or extensive crush injury
Delayed presentation 
Prosthetic valve
Immunesuppression 
Presence of peripheral vascular disease
Intraoral, below knee, hand or joint wounds
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4
Q

What are the potential complications of a fight bite

A

Tenosynovitis, joint infection, osteomyelitis

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5
Q

Management of fight bite

A

Copious irrigation
Exploration for deeper infection, exploration for ligamentous injury
Antibiotic coverage (clavulin, or cipro/flagyl or clinda/Septra for pcn allergy)
Consider if need HIV and hep b prophylaxis if blood borne exposure

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6
Q

What is the bug in a cat bite

A

Pasteurella multocida

Presents as rapidly progressing cellulitis usually within 24 hours

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7
Q

Antibiotic prophylaxis for cat bites

A

Amox clav prophylaxis x 5 days

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8
Q

5 bugs associated with dog bites

A 
P multocida 
S aureus
Fusobacterium
Bacteroides
Capnocytophaga carnimorsus
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9
Q

Antibiotic choice if pcn allergic in dog bites

A

Clinda cipro/Septra

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10
Q

What is the feared complication of captycytophaga canimorsus bite

A

Sepsis, overwhelming DIC, cutaneous gangrene at the bite site

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11
Q

6 diseases that can be transmitted by rodents

A 
Rat bite fever (assoc w brain, myocardial and soft tissue abscesses ) -- streptobacillus
Plague
Hantavirus pulmonary syndrome 
Leptospirosis
Tularaemia
Sporotrichosis
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12
Q

Appearance and toxicity of black widow spider

A

Yellow-red hourglass on belly

Venom is neurotoxin, release of acetylcholine and norepi at nerve terminals

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13
Q

Clinical presentation and treatment of black widow spider bite

A

Muscle cramping (back, abdomen, legs), target lesion at bite site, tachycardia hypertension, n/v, in peds can cause cardiac failure and respiratory collapse

Management: local wound care, tetanus, symptomatic treatment (benzos for cramping, opioids for pain), nitroprusside for htn
Antivenom for high risk or severe symptoms

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14
Q

5 Indications for antivenom in black widow bites

A

Children and elderly
Pregnancy
Comorbidities (HTN, atherosclerotic disease)
Severe pain despite symptomatic treatment
Severe envenomation (seizures, uncontrolled Htn, respiratory failure)

Administer test dose of antivenom first as has horse serum (anaphylaxis will occur immediately)

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15
Q

Identifying feature of brown recluse spider

A

Brown violin shape on cephalothorax

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16
Q

Mechanism of toxicity of brown recluse

A

Venom has cytotoxic enzymes, leads to necrotic wound +- systemic toxicity

17
Q

Presentation of brown recluse bites

A

Initial painless bite site
Then: target lesion w pustule
3-4 d later Bullae and necrotic tissue formation w Eschar
Systemic effects: fevers, chills, n/v, hemolysis, seizures, renal failure, DIC, pulm edema

18
Q

Management of brown recluse bite

A

Local wound care, tetanus
Supportive therapy as needed for systemic effects
Possibly dapsone (but assoc w hemolysis in g6pd and methemoglobinemia)
Delayed excision, debridement +-skin grafting

19
Q

Three types of reactions to Hymenoptera stings

A

Local toxic reaction
Allergic reaction
Serum sickness (7-10 days post sting)

20
Q

Mechanism of toxicity in Hymenoptera stings

A

Local reaction to venom, in sensitized individual causes mast cell degranulation and allergic reaction
Can cause delayed type III immune response with systemic symptoms and rash (usually angioedema and urticaria)

21
Q

Management of Hymenoptera stings

A

Local wound care, tetanus prophylaxis
Remove stingers without squeezing venom sac
Oral antihistamine
Treat anaphylaxis
Rx epi pen (60% recurrence with future exposure)

22
Q

Clinical presentation of bark scorpion

A

Roving eye movements, muscle spasm and excessive secretions (reap distress) are hallmark,
Also causes numbness, tingling, hyperthermia,can cause cardiopulmonary arrest (mortality highest in children under 5)
Anxiety, n/v

23
Q

Treatment of bark scorpion bite

A

Local wound care and tetanus prophylaxis
Atropine for excessive secretions
Scorpion antivenom (only available in Arizona)
Opioids and benzos for supportive treatment

24
Q

Three types of Venomous marine animals

A

Stingers
Nematocysts
Bites

25
Q

How to inactivate venom in stingers and nematocysts

A

Stingers immerse in hot water x 90 mins or until pain is relieved
Nematocysts immerse in acetic acid (vinegar) or isopropyl alcohol or cover in baking soda – no fresh or tap water rinsing

26
Q

Mechanism of toxicity for octopus bites

A

Tetrodotoxin– causes flaccid paralysis and respiratory failure

27
Q

Two major families of venomous snake bites

A

Viperidae (includes rattlesnakes) and elapidae

28
Q

Mechanism of toxicity of viperidae bites

A

Venom has digestive enzymes and proteins
Local edema and toxicity (compartment syndrome, bullae, local petechia or ecchymosis)
Systemic toxicity: oral paresthesias and metallic taste, fasciculatjons, tachycardia and hypotension, anaphylaxis

29
Q

Indications for antivenom or Crofab in snake bites

A 
Severe localized pain 
Moderate local edema or erythema 
Spreading erythema proximally
Coagulopathy (thrombocytopenia, decreased fibrinogen, elevated PT)
Systemic symptoms
Concern for compartment syndrome
30
Q

Management of verapidae bites

A 
Immobilize in neutral, no tourniquet
Wound care, tetanus prophylaxis 
Correct coagulopathy 
Antivenom as indicated 
Avoid fasciotomy for compartment syndrome
31
Q

Presentation of elapidae envenomation

A

Minimal local reaction. Neurotoxin causes weakness, numbness, fasciculations, tremor, diplopia and bulbar palsies, respiratory paralysis

Antivenom in all cases

32
Q

Difference between fever and hyperthermia

A

Fever: increased hypothalamic set point from cytokines
Hyperthermia: hypothalamus overwhelmed by heat production

33
Q

Three groups of risk factors for heat illness

A

Increased heat production (hyperthyroid, NMS, seizure, MH)
Decreased heat loss (drugs, volume depletion, peds)
Impaired mobility (elderly, peds, alcoholic, disabled)

34
Q

What is malignant hyperthermia

A

Genetic instability of skeletal muscles leading to excessive calcium release with exposure to anesthetic (including sux) leading to muscle rigidity and profound hyperthermia

35
Q

What are heat cramps secondary to

A

Post exertion all secondary to relative hyponatremia with individuals repleting only with free water– usually self limited and lab values are often normal

Environmental Emergencies (5 decks)

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