Bites and Stings

Question 1

Rabies

Answer 1

• Etiology: Animal bite
• If animal is wild, it will need to be captured and killed, analyzed to see if it had rabies. This is an infection control issue.
• Signs and symptoms of rabies?
  
  • Yes: Rabies Ig passive immunization.
  • No: Stop.

Question 2

Bee/Wasp sting

Answer 2

• Path: Hypotension, closing airway if anaphylactic
• Tx:
  
  • True anaphylaxis: IM epinephrine, also H1 and H2 blockers, systemic corticosteroids in addition
  • No anaphylaxis: Remove pincer

Question 3

Snake bites

Answer 3

• Features of poisonous snakes: Slit-like eyes, cobra cowl, rattler, water snake
• Pres: Skin changes, erythema, pain out of porportion to puncture site
• Dx: Clinical
• Tx:
  
  • If high-risk snake or high-risk patient, give anti-venom

Question 4

Black widow bite

Answer 4

• Features: Red hourglass belly
• Pres: Abdominal pain that presents like pancreatitis
• Dx: Clinical. Measure calcium.
• Tx: IV calcium, if calcium drops.

Question 5

Brown recluse spider

Answer 5

• Features: Southern states of US, attic or old boxes
• Bite -> Ulceration -> Necrosis of limb
• Dx: Clinical
• Tx: Repeated debridement, then follow-up with grafting. Supportive care.

Question 6

Dog/Cat bite

Answer 6

• Pathogens: Pasteurella, Bartonella (if cats), Tetanus
• Only concerning if skin is punctured.
• Dx: Clinical
• Tx: Irrugation. Leave wound open and allow to heal by secondary intention to avoid infection. Put on amoxicillin-clavulonate and manage according to tetanus wound protocol.

Question 7

Human bites

Answer 7

• Etiology: Sex acts or fist fights. . . which people do not want to share. So, they are probably going to lie, and you are going to have to see through it based on clinical and historical context. Also, sometimes dentists, but they will be forthcoming.
• Dx: Clinical
• Tx: Irrugation. Leave open to heal by secondary intention. Treat with amoxicillin-clavulonate and manage according to tetanus wound protocol.
  
  • Note: You treat human bites the same as dog or cat bites.

Question 8

If someone with a bite wound is really sick, you can use ___ instead of amoxicillin-clavulonate

Answer 8

If someone with a bite wound is really sick, you can use ampicillin-sulbactam instead of amoxicillin-clavulonate

Basically the difference between giving an oral med vs an IV med. Higher bioavailability.

Question 9

Most common cause of lymphangitis

Answer 9

Streptococcus pyogenes

May be associated with erysipelas