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Emergency Medicine and Surgical Care > Bites 8.9 > Flashcards

Flashcards in Bites 8.9 Deck (30)
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1

common pathogens of animal bites

Pasteurella species, staphylococci, streptococci, anaerobic bacteria, Capnocytophaga canimorsus, Bartonella henselae (cat scratch disease)

2

Presentation

fever, erythema, swelling, tenderness, purulent drainage and lymphangitis

3

Diagnostic labs

WBC, CRP, ESR may be elevated
Blood cultures for antibiotic therapy in infected bites
Would culture if the bite appears infected

4

Human bite pathogens

Eikenella corrodens, streptococci, Staphylococcus, Fusobacterium, peptostreptococcus, prevotella, and porphyromonas species

5

dog and cate bite pathogens

pasteurella multocida

6

Diagnostic imaging

plain radiographs, ultrasound (for abscess formation), Head CT

7

guidelines for management

primary closure if clinically uninfected, less then 12 hrs old and NOT located on the hand or foot. Extensive irrigation, debridement, avoid deep sutures, prophylactic antibiotic. DO NOT GLUE

8

Wounds that should not be closed

crush injuries, puncture, bites on hands or feets, older than 12 hrs or 24 hrs on the face, cat or human bites except those on the face, bites in compromised hosts

9

Surgical consultation for

deep wounds that penetrate bone, tendon, joints or major structures, complex facial lacerations, neurovascular compromise, complex infections

10

Go to drug for dog bites

Augmentin then fluoroquinolones then Doxy and metronidazole

11

bite complication

infectious flexor tenosynivitis, rabies, tetanus

12

Eikenella resistance

clindamycin, erythromycin, aminoglycosides, and anti-staphylococcal penicillins and first gen cephalosporins

13

Treatment time frame cellulitis

10-14 days

14

TX time tenosynovitis

3 wks

15

TX time septic arthritis

4 wks

16

TX time osteomyelitis

6 wks

17

Other diseases from human bites

Hep B and C, syphillis, and herpes

18

insect sting initial assessment

assess airway obstruction form angioedema, assess breathing, assess circulation for signs of shock (BP, cap refill, altered mental status)

19

insect sting anaphylaxis management

intubate rapidly, two large bore IV lines, continuous pulse ox, cardiac monitor. Airway must be obtained! (cricothyrotomy if completely obstructed)

20

Anaphylaxis meds

Epinephrine first (IV 3-5 mL slowly over 1-2 mins), Alpha agonist, beta agonists, anithistamines, corticosteroids

21

Insect string w/o obstruction

albuterol 0.5 mL, perenteral glucocorticoids. Epinephrine in moderate distress but not in mild distress

22

Urticaria TX

anithistamines, oral steroids, consider subq epinephrine??

23

Snake bite presentation

ecchymosis, swelling, NVD, weakness, light-headedness, diaphoresis, chills, coagulopathy, rhabdomyolysis, tachycardia, tachypnea, neurotoxicity (rattlesnakes only)

24

pre-hospital snake bite care

immobilize injury at the level of the heart, remove any clothing or jewelry

25

ED snake bite Diagnostic tests

CBC, electrolytes and BUN/Cr, CK, PT/PTT, INR, D-dimer, fibrinogen, urine, ECG

26

Mild envenomation

local pain, edema, no signs of systemic toxicity, normal labs

27

Moderate envenomation

severe pain, edema larger than 12 inches, NV and altered lab values

28

Severe envenomation

petechiae, ecchymosis, blood-tinged sputum, hypoTN, renal dysfunction, abnormal labs

29

Snake bite TX

tetanus, abx if infection suspected, Polyvalent Crotalinae antivenom (CroFav/FabAV)

30

contraindications to CroFab

hypersensitivity to papaya or pineapple enzyme