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Flashcards in BITES Deck (45)
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1

Common pathogens in order of prevalence (found in animal bites)

Pasteurella spp, staph , streph, anaerobic spp

Capnocytophaga canimorsus* (virulent!)

Bartonella (Cat bites)

2

Bacteria spa that is particularly virulent, can lead to sepsis - especially in a splenic / alcoholic / hepatitis pts

Capnocytophaga canimorsus

3

Bacteria found in "cat scratch fever"

Bartonella

4

Lymphadenopathy vs lymphangitis

swollen node vs red streaky tracks

5

Complications from animal bites include

Subcutaneous abscesses,

osteomyelitis,

septic arthritis,

tendonitis,

bacteremia and sepsis

6

Labs for animal bites

CBC (for WBC count)
CRP / ESR

Blood cultures PRIOR to antibiotic therapy (in pts with fever / infected bite)

Wound culture (if bite appears to be infected)

7

What might an elevated CRP / ESR might indicate in animal bite

Cellulitis, joint infection, osteomyelitis, sepsis

8

Bacteria - other than staph / streph - found in human bites, often misidentified

Eikenella corrodens

9

Wound cultures indicated in a clinically uninfected bite wounds?

NO

10

Indication for x-ray in animal bite

Deep bite wounds near joints (AP / lateral film)

Markedly infected wounds to detect
- bony/soft tissue injury
- subcutaneous gas (infection or trapped air)
- osteomyelitis

11

If bite is deep enough to disrupt bone, how does classification of injury change?

Changes to include "open fracture"

12

Use of ultrasound in animal bite?

Can help identify abscess formation

13

Use of head CT in animal bites?

Dog bites to the head - esp children - can penetrate skull

14

Criteria for primary closure of animal bites

- Clinically uninfected
- Less than 12 hours old
- Less than 24 hours old if wound is on the face
- NOT located on the hand or foot

15

Steps to take when choosing primary closure

- Extensive irrigation
- Debridement
- Avoidance of deep sutures
- Use prophylactic antibiotics
- Close follow up

**DO NOT use cyanoacrylate tissue adhesive**

16

Ok to use glue closure for animal bite?

NO

17

Types of wound NOT TO CLOSE due to high risk of infection

Crush injuries

Puncture wounds

Bites on hands or feet

Wounds more than 12 hrs old (24 hrs on face)

Cats or human bites, except those on face*

Bite wounds in compromised hosts (asplenic, immuno) or papery skin

18

Recommended to close cat or human bites?

NO! Unless it's on the face

19

Surgical consult recommended for the following wounds:

Deep wounds that penetrate bone, tendons, joints, etc

Complex facial lacerations

Neurovascular compromise

Complex infections (abscess, osteomyelitis, hand or joint infections)

20

Two important questions to ask right away when patient presents with dog bite

Dog's rabies shot up to date?

Did patient have tetanus booster within less than 5 years?

21

Common/relatively safe Antibiotic which is good for animal bites

Augmentin

22

Complication of cat bite to the hand

Flexor Tenosynovitis

23

Physical exam finding of cat bite to the hand which indicates flexor tenosynovitis

Kanavel sign - flexor tendon sheath infection, which are as follows:
Finger held in slight flexion
Fusiform swelling
Tenderness along the flexor tendon sheath
Pain with passive extension of the digit

24

On physical exam of patient with cat bite to the hand includes :
Finger held in slight flexion
Fusiform swelling
Tenderness along the flexor tendon sheath
Pain with passive extension of the digit

Kanavel sign

25

Treatment for flexor tenosynovitis

Surgical drainage

26

Non-immunized treatment regiment for Rabies Prophylaxis

1. Wound cleansing
- immediate soap and water
- virucidal agent, povidine-iodine solution if available

2. Rabies Immunoglobulin
- Full Dose infiltrated around any wounds
- Remaining volume administered IM, at site distant from wound

3. Vaccine
- HDCV or PCECV 1.0 mL, IM (deltoid area ), one each on days 0 , 3, 7, and 14

27

Virucidal cleaning agent?

Povidine-iodine solution

28

Rabies vaccine administration details

HDCV or PCECV 1.0 mL, IM (deltoid area ), one each on days 0 , 3, 7, and 14

29

Where should rabies immunoglobulin be administered

- Full dose infiltrated around wounds
- Remaining volume administered IM at anatomical site distant to wound

30

Clenched fist injuries (human bites via fist fight) can lead to

Septic arthritis of the MCP joint - rapidly destructive