Bites

Question 1

peak incidence for bites age wise..

Answer 1

5-9 yo

Question 2

dog bites worry about __ injury

Answer 2

curshing / tearing due to high PSI and rounded teeth

Question 3

if under 5 dog bite most likely on their

Answer 3

head / neck

Question 4

cat bites have high…

Answer 4

infection rates
puncture wounds / deep lacerations
typically hands / upper extrememity

Question 5

most common pathogens animal bites

Answer 5

Pasteurella
Staphylococci
Streptococci
Anaerobic bacteria

Capnocytophage canimorusus - sepsis!!

Question 6

cat bites worry about ___ which causes cat scratch fever

Answer 6

bartonella henselae

Question 7

Capnocytophage canimorusus can cause fatal sepsis / bacteremia quickly in pts such as…

Answer 7

asplenic pts
chronic alcohol abusers
underlying hepatic disease

Question 8

lymphangitis

Answer 8

red streaky tracts - inflammation no the vessels of the system

Question 9

make sure you get a _____ more definitive than wound culture!

Answer 9

blood culture

Question 10

t/f if doesn’t look infected you don’t have to order a wound culutre

Answer 10

TRUE!! document!

Question 11

why bad if there is bone disruption in a bite?

Answer 11

considered an open fracture - put on abx

Question 12

if you feel bubbles / rice crispy bubble under the skin think of…

Answer 12

gas from necrotizing fasciitis or because of bite air got trapped under skn

Question 13

never treat a bite by ___

Answer 13

using glue! cyanoacrylate tissue adhesive! trap in bacteria

Question 14

4 criteria for when can close a bite with sutures

Answer 14

its a dog bite - just a laceration
clinically uninfected
less than 12 hrs old or 24 if on face
not located on the hand or foot

Question 15

6 contraindications to closing a bite

Answer 15

1. crush injury
2. puncture wounds
3. bites on the hands or feet
4. wounds more than 12 hours old or 24 on face
5. cat or human bites unless on face
6. if host is compromised

Question 16

how to treat a bite if you cant close it?

Answer 16

irrigate, dressed, left open to drain, examine each day to look for signs of infection

Question 17

4 criteria for surgical consultation

Answer 17

1. deep wounds that penetrate major structures
2. facial lacerations
3. any neurovascular compromise
4. wounds with complex infections: abcess, hand, jt, infxn etc

Question 18

t/f do you put lidocaine in the finger?

Answer 18

no do a digital blck

lidocaine alone can lead to increased bleeding and/or digital ischemia
- reversal agent is phentoalamine if digital ischemia appears

Question 19

fluoroquinolones ..why not best option for bites?

Answer 19

worry about the tendon rupture ..so not first option

Question 20

first option for bite abx

Answer 20

augmentin but watch for upset stomach and yeast infections

Question 21

kanavel sign of..

Answer 21

infectious tenosynovitis aka flexor tenosynovitis

Question 22

Kanavel sign:

Answer 22

finger in slight flexion
fusiform swelling
tenderness along flexor tendon sheath
pain with passive extension of digit

Question 23

how to treat infectious tenosynovitis

Answer 23

surgical drainage call hand surgeon

Question 24

rabies is only contagious once virus is in … except

Answer 24

salivary glands, exception - bats

Question 25

animals infected die within

Answer 25

10 days after first acting sick

animal that bites.. watch for 10 days

Question 26

when do you start your rabies prophylaxis?

Answer 26

if there is any suspicion or if bite is on head or neck since incubation is shorter for those areas

Question 27

post exposure prophylaxis is recommended for all persons with

Answer 27

bites, scratches or mucous membrane exposure to bats

Question 28

in addition to RIG what else is give for rabies tx

Answer 28

vaccine on days 0, 3, 7 and 14

Question 29

human bites are more common in ..

Answer 29

adult males .. usually on hand

Question 30

“fight bite” is where?

Answer 30

over dorsal aspects of 3rd and 4th MCP jts

Question 31

how treat fight bite?

Answer 31

empirically - abx!!

Question 32

bacteria in human saliva

Answer 32

streptococci 
staphylococcus aureus 
eikenella 
fusobacterium 
peptostreptococcus 
prevotella 
porphyromonas species

Question 33

eikenella human bites are ristant to..

Answer 33

clindamycin, erythromycin, aminoglycosides, antistaphylo penicillins and cephalosporins

Question 34

what is first choice abx for human bites?

Answer 34

amoxicillin clavulantae (augmentin)

Question 35

how long tx for tenoxynovitis

Answer 35

3 wks

Question 36

how long tx for cellulitis

Answer 36

10-14 days

Question 37

how long tx for septic arthritis

Answer 37

4 wks

Question 38

how long tx for osteomyelitis

Answer 38

6 wks

Question 39

what is always a risk with clindamycin risk?

Answer 39

risk of cdiff

Question 40

how does epinephrine impact alpha and beta receptors?

Answer 40

alpha: increase peripheral resistance, reverses systemic hypotension / vascular permability
beta: bronchodilation, chronotoropic HR, + inotropic effects

Question 41

3 main meds for insect bites – anaphylaxis

Answer 41

epinephrine
H1 and H2 blockers - antihistamine effects
corticosteroids: methylprednisolone IV

Question 42

why does bp drop with insect bites?

Answer 42

histamine etc.. = vascular permeability = third spacing = decrease intravascular fluid

Question 43

what if insect sting leads to refractory htn? what is tx

Answer 43

consider vasopressors like dopamine