Clin. Med: Bites, Stings, Marine things

Why do patients with animal bites seek medical attention?

infection, tetanus, rabies, wound care

What is the most frequent complication of animal bites?

wound infection

All animal bites should be considered ______ prone.

tetanus

How long can tetanus take to manifest after an animal bite?

24 hours to 30 days

What two organisms are fastidious and often misidentified from cultures from animal bites?

Eikenella, Pasteurella

True or false: any mammal can get rabies.

true

What is the only rodent implicated in rabies?

woodchucks

What is the most common US domestic animal to get rabies?

cats

What are some common animals that spread rabies?

bats, foxes, cats, skunks, dogs

Rabies is a ______ that leads to encephalitis.

rhabdovirus

Describe the rabies vaccine series post-exposure or working w/ ID.

0, 3, 7, 14 days

_______ account for 80-90% of reported animal bites in the US.

dogs

What is the most common site of a dog bite in adults?

dominant hand

What is the most common site of a dog bite in children?

face or neck

Most dog bites are polymicrobial, including what species?

alpha hemolytic strep, s. aureus, pasturella multocida, staph intermedius

What breed is the "godfather" of dog bites?

pit bulls

Name some dog breeds known to frequently bite humans.

pit bulls, Rottweilers, chow chows, german shepherds, dobermans

What two breeds accounted for 76% of all fatal dog attacks from 2005-2014?

pit bull, rottweiler

What age group makes up the greatest proportion of dog bite fatality victims?

0-2

What kind of irrigation should you use on a dog bite wound?

superficial

What is first line antibiotic prophylaxis following a dog bite?

augmentin 500mg TID

What is the antibiotic prophylaxis of choice following a dog bite in a patient who is penicillin allergic?

clindamycin + fluoroquinolone

When should a patient with a dog bite follow up after initial treatment?

24-48 hours

Most cat bites result in what kind of wound?

puncture wound

What is the major pathogen found within infected cat bites?

pasteurella multocida

What is the antibiotic of choice following a cat bite?

augmentin

What are some alternative antibiotics for cat bites?

ceftin, doxycycline

What antibiotics should NOT be used in a patient with a cat bite because of resistance?

cephalexin, dicloxacillin, clindamycin

Human bites most often occur from either ______ or _______.

passion, aggression

Where do "fight bites" typically occur?

dorsal aspect of fingers or MCP joint

Which tendons are typically affected by fight bites, extensors or flexors?

extensors

When the fist is opened after a fight bite, the bacterial inoculation is dragged with the tendon in what direction?

proximally

Fight bites commonly present as _______ or suspected _______.

cellulitis, boxer's fracture

What are the most common organisms from human bites?

s. aureus, streptococcus, eikenella corodens

What are some elements of treatment for uncomplicated fight bite cases?

tetanus, x-rays, wound culture and care, antibiotics, f/u with hand specialist

What should you do for a complicated fight bite case?

consult hand surgery

What is the first line oral antibiotic therapy for fight bites?

augmentin BID x 5 days

What is the first line IV antibiotic therapy for fight bites?

unasyn

What is unasyn?

ampicillin-sulbactam

What can be used for PO antibiotics for a fight bite in a patient who is allergic to PCN?

clindamycin + cipro or bactrim

What time line from a fight bite can be closed primarily (except on the face)?

< 12 hours

What location of fight bite should NOT be closed primarily?

hands, feet

Name 5 scenarios when you would not use primary wound closure.

Crush injury

Puncture wound,

Hand/foot bites

Wounds >12 hours old (or 24 on the face)

Bites in immunocompromised patients

Name some conditions of compromised patients when you would NOT consider primary wound closure.

immunocompromised, absent spleen, DM, venous stasis

What are the 4 most important tick-related illnesses?

Borrelia infections

Rickettsia diseases

Babesiosis

Ehrlichiosis

Name some tick-borne borrelia infections.

lyme disease, relapsing fever

Name a tick-borne rickettsial disease.

RMSF

Name a tick-borne viral disease.

Colorado Tick Fever

What is the leading suspect in both Lyme disease and babesiosis?

deer tick

What kind of tick is responsible for RMSF and colorado tick fever?

wood tick (dog tick)

What kind of tick is responsible for lyme disease and ehrlichiosis?

lone star tick

Describe the pattern of tick paralysis.

ascending, symmetric, flaccid paralysis

Tick paralysis is caused by a venom that results in failure of _______ release at the neuromuscular junction.

acetylcholine

What can confirm the diagnosis of tick paralysis?

resolution of paralysis after tick removal

Name some differential diagnoses for tick paralysis.

Guillain-barre, eaton-lambert, myasthenia gravis, poliomyelitis, botulism

How quickly after a tick attaches does tick paralysis occur?

5-6 days

What organism causes RMSF?

rickettsia rickettsii

When do most cases of RMSF occur?

April to October

Where do most cases of RMSF occur?

SE US

Describe the prodrome of RMSF.

fever, rigors, headache, myalgia

Describe the EARLY rash with RMSF.

blanching macular eruption on distal extremities, including palms and soles

Describe the LATE rash with RMSF.

purpura spreading to trunk and abdomen

What are the drugs of choice for RMSF?

tetracycline, chloramphenicol

Palmar and plantar petechiae in a severely ill patient should be treated as ______ until proven otherwise.

RMSF

What causes lyme disease?

borrelia burgdorferi (spirochete)

Describe stage I Lyme disease.

constitutional sx, erythema chronicum migrans

Describe stage II Lyme disease.

neuro or cardiac complications

Name some conditions associated with stage II Lyme disease.

aseptic meningitis, encephalitis, bell's palsy, myocarditis, conduction blocks

Describe stage III Lyme disease.

asymmetric, episodic, oligoarticular arthritis

What are the drugs of choice for treating Lyme disease?

tetracycline or doxycycline

Where are brown recluse spiders endemic?

Texas to California

What is the distinguishing shape of the brown recluse spider?

fiddle shaped

What classic sign is associated with a brown recluse spider bite?

red, white, blue sign

________ bite is associated with significant localized tissue destruction.

brown recluse

Name some systemic signs/symptoms of brown recluse bite.

fever, nausea, vomiting, arthralgia, weakness, leukopenia, hemolytic anemia

Use of ______ is controversial for a brown recluse spider bite.

dapsone

What do you want to check before putting a patient on dapsone for a brown recluse bite?

LFTs, G6PD deficiency

Where do black widow spider bites usually occur?

hand or arm

When are black widow bites common?

April to October

_______ presents clinically with severe and sustained muscle spasm produced by a neurotoxic protein, which causes the release of acetylcholine and norepinephrine at the presynaptic junction.

black widow spider bite

What are some signs/sx associated with black widow bite?

weakness, fever, salivation, vomiting, diaphoresis

What is the treatment for black widow bites?

wound care, tetanus, benzos, antivenin

Name some pit vipers.

rattlesnakes, cottonmouths, copper heads

Pit viper venom is complex and produces what kinds of effects?

hematologic, cardiovascular, neuromuscular

Describe the shape of the head of a pit viper.

triangle

Describe the pupils of a pit viper.

slit pupil

What is included in the initial management following pit viper envenomation?

immobilization, rapid transport

True or false: a tourniquet can assist in preventing spread of pit viper envenomation.

false

Patients who do not develop evidence of pit viper envenomation after_________ of observation can be discharged home with close follow up.

6-8 hours

______ have small mouths and the bites are usually limited to the fingers, toes, and folds of the skin.

coral snakes

What are some systemic symptoms of a coral snake bite?

tremors, drowsiness, euphoria, marked salivation

What are some signs of cranial nerve involvement with a coral snake bite?

slurred speech, diplopia, dysphagia, dyspnea

What causes death in patients sustaining coral snake bites?

respiratory and cardiac arrest

How do you treat coral snake envenomation?

4-6 vials of antivenin

How do you identify a venomous coral snake?

red on yellow, kill a fellow; red on black, venom lack

_______ include wasps, bees, and ants.

hymenoptera

What are some treatments for localized involvement of hymenoptera stings?

ice, steroid cream, oral antihistamines

What are some options for patients experiencing anaphylactic reaction to hymenoptera stings?

benadryl, steroids, H2 blockers, epinephrine

The order _______ contains several families of caterpillars that are poisonous to humans.

lepidoptera

What is the most poisonous caterpillar in the US?

wooly slug (puss caterpillar)