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Clinical Decision Making Exam 1 > Jaynstein - Bites, Stings, Creepy Things > Flashcards

Jaynstein - Bites, Stings, Creepy Things Flashcards

1
Q

which is worse: cat bites or dog bites

A

cat

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2
Q

which is more common: dog bites or cat bites

A

dog

80-90%

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3
Q

which dog breeds have the most potential for injury

A

police dogs

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4
Q

t/f: tx is different dog bites if the dog is known and UTD on vaccinations

A

F!

tx is the same

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5
Q

important hx for bites (5)

A

animal known?

breed

time of bite

pt comorbidities

tetanus hx

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6
Q

tetanus vaccine schedule

A

q 10 years w.o incident

q 5 years w. incident

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7
Q

goal of bite wound management

A

prevention of infxn

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8
Q

__% of dog bites get infected

__% of cat bites get infected

A

dogs: 5%
cats: 50%
* but tx is basically the same*

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9
Q

most critical aspect of bite care

A

irrigation

also evaluate for FB

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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

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11
Q

delayed presentation for extremity bite is > __ hr

A

12

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12
Q

delayed presentation for face bite is > __ hr

A

24

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13
Q

mc bacterial infxn from both dog and cat bites

A

pasteurella

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14
Q

most bites are polymicrobial, so also worry about __ (2)

A

staph

strep

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15
Q

bacteria of concern in dog bites that is rare but has high mortality

A

capnocytophaga

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16
Q

3 major complications w. cat bites dt sharp teeth that penetrate joints

A

septic arthritis

osteomyelitis

tenosynovitis

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17
Q

bacteria associated w. joint infxns in cats

A

pasteurella multocida

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18
Q

management of cat puncture wound

A

anesthetize

open up

irrigate

always, no matter what

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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

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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

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21
Q

which is more concerning, flexor or extensor injuries

A

flexor

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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

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23
Q

tx considerations for bites

A

document nerve, vascular, bone assessment

consider imaging

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24
Q

for dog bites, always check and document that you evaluated __

A

distal CNS

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25
Q

infxn timeline for cat vs dog bites

A

cats: 12 hr
dogs: 24 hr

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26
Q

t/f you need labs/cultures before starting abx for bites

A

F!

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27
Q

all cat/dog bite pt’s should be given what abx

A

Augmentin

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28
Q

imaging to consider for boney injury, free air, or FB

A

xray

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29
Q

imaging for vascular injury

A

CT w. contrast

CTA extremity

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30
Q

tx for cat bites should NEVER include

A

closing the wound

star them, clean out

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31
Q

dog bites on the __ may be closed

dog bites on the __ should not be closed

A

face

hand/foot

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32
Q

if you do suture a dog bite laceration use __ sutures

and never __

A

simple interrupted

double closure

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33
Q

what are PEP abx

A

post exposure prophylaxis

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34
Q

PEP is recommended for what bites (6)

A

hand

feet

face

immuno comp

puncture

sutured wounds

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35
Q

first choice abx w. dosing for bites

A

Augmentin 875 mg bid x 5 days

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36
Q

first choice abx w. dosing for bite wounds if PCN allergy

A

doxycycline 100 mg bid x 7 days

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37
Q

abx for infected bite

A

Augmentin 875 mg PO x 5 days

Unasyn 3 gm IV

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38
Q

minimum f.u for bites

A

12-24 hr

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39
Q

t/f: animal bites are considered tetanus prone

A

T!

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40
Q

always do vascular study for __ dog bites

A

police

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41
Q

t/f: all dog/cat bites need to be reported in CO

A

T!

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42
Q

t/f: human bites are more serious than dog/cat bites

A

T!

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43
Q

2 viruses that can be transmitted via human bites

A

hep B

HSV

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44
Q

can HIV be transmitted via human bite

A

no!

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45
Q

major bacteria to consider in human bite

A

eikenella corrodens

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46
Q

besides eikenella, also consider __ (2) in human bites

A

staph

strep

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47
Q

bacteria to consider/cover for bite on the foot

A

pseudomonas

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48
Q

what is this called

A

fight bite

2nd MTP

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49
Q

abx for human bites

A

augmentin 875 mg PO bid x 7 days

repetition, repetition, repetition :)

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50
Q

do not close human bites unless they are located on the __

A

face

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51
Q

tx for human bites

A

open

irrigate

+/- hep B vaccination

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52
Q

what is this called

A

herpetic whitlow

HSV infxn from infected saliva

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53
Q

what should you ask about if you see unexplained LAD on a kiddo

A

cat bite → cat scratch dz

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54
Q

bacteria responsible for cat scratch dz

A

bartonella henselae

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55
Q

3 sx of cat scratch dz (3)

A

low-grade fever

fatigue

regional tender LAD

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56
Q

cat scratch dz occurs __ weeks after injury

A

1-3

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57
Q

tx for cat scratch dz (3)

A

don’t drain or I&D

most self resolve

abx if ill

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58
Q

abx for cat scratch fever

A

azithro

or

doxy

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59
Q

who gets pre-exposure for rabies

A

vets

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60
Q

major vector for rabies in the US

A

bats

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61
Q

mc vector for rabies worldwide

A

dogs

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62
Q

in the US, are cats or dogs more commonly rabid

A

cats

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63
Q

tx for animal that is not ill at the time of bite

A

quarantine for 10 days

no PEP

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64
Q

tx for animal that is sick at the time of bite

A

held by city

PEP given immediately

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65
Q

4 animal bites that need PEP immediately

A

raccoons

foxes

skunks

bats

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66
Q

5 animal bites that are +/- PEP on individual basis

A

livestock

horses

rodents

rabbits

hares

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67
Q

rabies PEP schedule

A

days 0, 3, 7, 14

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68
Q

when should you give PEP for bat bites

A

when not 100% sure that a bat didn’t scratch or bite pt

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69
Q

zoonotic systemic infxn from mice/rats

A

hanta virus

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70
Q

hanta virus has a __ week intubation

and manifests as __ infxn

A

2

pulmonary

71
Q

initial presentation of brown recluse bite

A

painless

72
Q

brown recluse bites are __toxic

A

necro (skin)

73
Q

brown recluse rxn involving localized skin erythema and edema that resolves spontaneously over 1 week

A

minor loxoscelism

74
Q

brown recluse rxn involving severe skin erythema w. cutaneous blisters and/or irregular ecchymosis; red, white, blue sign

A

cutaneous loxoscelism

75
Q

what is this showing

A

brown recluse bite

red, white, and blue sign

76
Q

red, white, blue sign:

red:

white:

blue:

A

red: vasodilation
white: ischemia
blue: necrosis

77
Q

brown recluse bite tx (3)

A

no anti-venom

often extensive wound care w. debridement

heals in 6-8 weeks

78
Q

what is latrodectus hesperus

A

black widow

79
Q

black widow bites are __toxic

A

neuro

80
Q

black widow bite sx

A

intense, sudden, local or regional pain

diaphoresis

htn

agitation

fever

abdominal spasms

81
Q

black widow bite can mimic __ sx

A

acute abdomen

82
Q

tx for black widow bite (2)

A

pain control for abd spasms → benzos

obs x 12-24 hr

+/- anti venom

83
Q

t/f: there is an anti venom for brown recluse bites

A

F

84
Q

t/f: there is an anti venom for black widow bites

A

T

85
Q

what are these showing

A

black widow bites

86
Q

geographic location of black widow bites

A

all over US

87
Q

classifications of snake bites in terms of toxicity

A

hemotoxic

neurotoxic

necrotoxic

cardiotoxic

nephrotoxic

88
Q

2 families of venomous snakes in US

A

viperidaes

elapidae

89
Q

venomous viperidaes snakes include (3)

A

pit vipers

rattlesnakes

copperheads

90
Q

viperidaes snakes are __toxic (2)

A

hemo

necro

91
Q

venomous elapidae snakes include (3)

A

cobras

mambas

coral snakes

92
Q

elapidae snakes are __toxic

A

neuro

93
Q

largest snake threat in CO

A

rattlesnakes

94
Q

sx of rattlesnake bite

A

edema

pain

ecchymosis at site

RBC destruction, thrombocytopenia, coagulopathy → unstable vitals

95
Q

tx for rattlesnake bite (8)

A

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
Q

tx to AVOID in rattlesnake bites (6)

A

compression

incision

mouth suction

excision

tourniquet

ice/heat

97
Q

labs for rattlesnake bite

A

CBC

BMP

PT/INR

CPK

98
Q

classification of rattlesnake bite

A

minor vs major envenomation

99
Q

tx consideration for all pt’s who receive rattle snake anti venom

A

ICU admit

100
Q

name of rattlesnake anti venom

A

crotilidae polyvalent immune Fab (CroFab)

101
Q

dosing for CroFab

A

initial: 4-6 vials

life threatening: 8-12 vials

each vial is several thousand $$

102
Q

how often to mark/document erythema/edema for rattlesnake bite

A

q 1-2 hr

103
Q

how to remember venomous vs non venomous coral snake

A

red on yellow kill a fellow

red on black venom it lacks

104
Q

coral snakes are __toxic

A

neuro

105
Q

sx of coral snake bite

A

n/v

HA

CN sx → ptosis, dysarthria, dysphagia, muscle weakness, resp failure

106
Q

sx of coral snake bite occur w.in

A

12-24 hr → keep pt

107
Q

tx for coral snake bite

A

admit

anti venom early

update tetanus

+/- constriction bandage

108
Q

tx consideration for ticks that stay on skin > 6 hr

A

scalpel

109
Q

sx of tick borne illness mimic

A

flu → FUO (fever of unknown origin)

110
Q

tick season

A

late spring - early fall

111
Q

important hx in FUO (3)

A

travel

pet

livestock exposure

112
Q

what is this showing

A

bulls-eye → lyme dz

113
Q

what tick carries lyme dz

A

borrelia burgdorferi

114
Q

rash of lyme dz

A

erythema migrans

115
Q

describe erythema migrans (5)

A

1-3 days after bite

target lesion

erythematous

increases in size

fades 3-4 weeks

116
Q

sx of lyme dz (7)

A

fever

malaise

HA

monoarthritis (knee/hip) → polyarthritis

CN dysfxn

meningitis

hearing loss

117
Q

CN affected by lyme dz

A

CN VII → BP

118
Q

dx for lyme dz (6)

A

ELISA

western blot

serology

synovial fluid PCR

urine antigen

IgG/IgM

119
Q

tx for lyme dz

adults vs kids

A

doxycycline 100 mg bid x 14 days

kids: amoxicillin 50 mg/kg/day TID x 21 days

120
Q

tick borne illness carried by wood tick/dog tick

A

rocky mtn spotted fever

121
Q

mc rickettsial dz in the world

A

RMSF

122
Q

describe the rash in RMSF (3)

A

1 week after bite

erythematous macules → then petechiae

starts on distal extremities

123
Q

besides rash, 6 other sx of RMSF

A

fever

HA

myalgias

malaise

abd pain

n/v

124
Q

dx for RMSF

A

clinical

125
Q

hematology finding of RMSF

A

thrombocytopenia

only used for confirmatory testing

126
Q

what is this showing

A

RMSF rash

127
Q

tx for RMSF

A

doxy 100 mg x 7 days min

continue x 3 days post fever

128
Q

abx for RMSF if doxy contraindication

A

chloramphenicol 12.5 mg/kg PO 4 times daily x 7 days

129
Q

5 other tick borne diseases (besides lyme and RMSF)

A

ehrlichiosis

babesiosis

colorado tick fever

tularemia

tick borne relapsing fever

130
Q

tick borne illness that causes hemolytic anemia

A

babesiosis

131
Q

tick borne illness found in rabbits __

causes __ sx

A

tularemia

pulmonary

132
Q

3 tick borne illnesses in CO

A

colorado tick fever

tularemia

tick born relapsing fever

133
Q

most stings come from __,

which include __ (3)

A

vespids

wasps, hornets, yellow jackets

134
Q

what does PEST stand for

A

rxn to stings:

pruritis

erythema

soft tissue swelling

135
Q

tx for a sting that is inflamed but not infected

A

antihistamines

+/- steroids

136
Q

tx for sting that is showing signs of cellulitis

A

abx

137
Q

what is hymenoptera

A

bee

138
Q

tx for bee sting

A

remove stinger

pain control

tetanus (really??)

139
Q

be aware of bee stings in the (2)

A

mouth

eye

140
Q

toxic systemic rxns are seen with > __ bee stings

A

50

141
Q

tx for anaphylaxis

A

intubate early

142
Q

epi dosing for kids vs adults

A

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
Q

temp hemostasis occurs via what 4 mechanisms

A

conduction

convection

radiation

evaporation

144
Q

what is miliaria rubra

A

heat rash

145
Q

what is this showing

A

miliaria rubra

146
Q

tx for miliaria rubra is mc in

A

kids

147
Q

tx for miliaria rubra

A

none necessary

148
Q

heat disorders mild → extreme (5)

A

edema

syncope

cramps

exhaustion

stroke

149
Q

what is this showing

what is the tx

A

heat edema

elevation, rest, cooling, oral fluids

150
Q

simple, transient LOC or collapse after exertion in heat

A

heat syncope

151
Q

sx of heat syncope (3)

A

cool, clammy skin

weak pulse

hypotn

152
Q

core body temp in heat syncope

A

normal

153
Q

tx for heat syncope

A

oral/IV hydration

154
Q

spasm of voluntary abd muscles and extremities 2/2 to electrolyte disturbance

A

heat cramps

155
Q

2 mc lytes involved w. heat cramps

A
  1. sodium
  2. potassium
156
Q

core temp in heat cramps

A

nl or mildly elevated

157
Q

tx for heat cramps

A

oral hydration

Na replacement (sports drink)

158
Q

systemic rxn to prolonged heat exposure dt dehydration or sweating

A

heat exhaustion

159
Q

first part of spectrum of heat stroke

A

heat exhaustion

160
Q

parameters for heat exhaustion

A

elevated but < 40C

161
Q

sx of heat exhaustion (5)

A

ha

n/v

malaise

muscle cramps

dizziness

162
Q

sx that is NOT component of heat exhaustion

A

CNS

163
Q

tx for heat exhaustion (4)

A

cooling

rehydration (oral and IV)

lyte replacement

admit

164
Q

severe systemic dysfxn of heat regulation - multiorgan failure

A

heat stroke

165
Q

almost all heat stroke pt’s have __ dysfxn

A

liver

166
Q

sx of heat stroke (4)

A

CNS:

AMS

confusion

coma

visual disturbance

167
Q

core temp in heat stroke

A

>40C (104F)

168
Q

complications of heat stroke (3)

A

rhabdo

DIC

ARF

169
Q

minimum labs for heat stroke (4)

A

CMP

CPK

UA

coag panel

170
Q

tx for heat stroke

A

cooling → water immersion until temp <102F

admit

171
Q

are fever reducers helpful in heat stroke

A

no

172
Q

indications for poor prognosis in heat stroke (4)

A

persistent hyperprexia (temp >107)

coma

elevated LFTs

hyperK

173
Q

3 locations where ice packs are most effective

A

neck

groin

axilla

174
Q

3 advanced cooling techniques

A

water immersion

ECMO

peritoneal lavage

Clinical Decision Making Exam 1 (22 decks)

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