Bites, Poisonings, Heat Injuries

Children

What group of people are most at risk for animal bites?

True

True or false: Dogs and cats are the most common animal bite injury

Infection

With human/animal bites what is the largest complication besides tissue, bone, and/or joint destruction?

Tx bite injury

Tx:

*Initial treatment includes copious irrigation, debridement, analgesics, and tetanus prophylaxis

*Prophylactic antibiotics for areas at risk of infection including joint wounds, wounds >6-12 hours old, and wounds on hands/feet

*Loose suturing of lacerations

*Puncture wounds left open

*joint wound splinting

*Rabies prophylaxis

False

True or false: Bite puncture wounds should be closed up

0, 3, 7, 14

Rabies prophylaxis is very important regarding animals bites and is delivered in a two-step manner. Step one includes an initial injection of the rabies immunoglobulin. Step two includes vaccine injections on what four subsequent days of treatment?

Poisoning

What type of injury has goals that revolve around three basic efforts: Decreasing absorption, enhancing elimination, and implementing substance control?

Decreasing absorption

The first basic effort of caring for a poisoning. Includes gastric lavage and usage of activated charcoal

Intubate

If a patient needs a gastric lavage but has an altered LOC or diminished gag reflex, what should be done before administering the lavage?

1 hour

Within how soon of a poisoning should a patient receive a gastric lavage or activated charcoal?

Caustic agents, co-ingested sharp objects, nontoxic substances

What are three contraindications for a gastric lavage?

Diminished bowel sounds, paralytic ileus, ingestion of substance poorly controlled by charoal

What are three contraindications for activated charcoal?

True (absorbs antidote)

True or false: Activated charcoal should not be given immediately before, during, or after the usage of an antidote?

Enhance elimination

The second basic effort of caring for a poisoning. Includes The dispensing of cathartics such as Sorbitol, whole bowel irrigation, or hemodialysis/hemoperfusion

Cathartics

What should be given with the first dose of activated charcoal to stimulate intestinal motility and elimination in a poisoning?

Toxin control

The third basic effort of caring for a poisoning

Heat exhaustion

The prolonged exposure to heat over hours or days

S/S Heat exhaustion

S/S:

*Fatigue

*extreme thirst

*N/V

*anxiety

*tachypnea

*tachycardia

*dilated pupils

*mild confusion

*ashen color

*profuse diaphoresis

*Hypotension

*Temperature of 99.6-105.8 d/t dehydration

Tx heat exhaustion

Tx:

*Place pt in cool area and remove restrictive clothing

*Place moist sheet over pt to reduce core temperature

*Oral fluids

*Replace electrolytes

*NS if oral solutions aren't tolerated

Heat Stroke

The failure of hypothalmic thermoregulatory processes that results in vasodilation, increased sweating, increased RR, depleted F&E - specifically sodium.

S/S heat stroke

S/S:

*Altered mentation

*Absence of perspiration

*Possible circulatory collapse

*Possible cerebral edema/hemorrhage from thermal injury to brain

Tx heat stroke

Tx:

*Stabilize ABCs and rapidly reduce temperature

*100% O2, intubated

*Removal of clothing

*Cover with wet sheets

*Place patient in front of large fan (most effective d/t skin being largest organ)

*immerse in ice water bath

*Administer cool fluids if alert or lavage with cool fluids

*Aggressive Tx until core temp reaches ~102F

Chlorpromazine (Thorazine)

Shivering increases core temperature. In treating heat stroke, what medication can be administered to help prevent shivering?