What is the most common bacteria associated with a cat bite?
Pasterurella Multocida
What is the treatment for a cat bite?
augmentin; additional therapies if hx of MRSA
what will a dog bite leave a patient with?
disfigurment
what does a black widow spider bite cause?
neurtoxic venom that causes depletion of acetylcholine, causing muscle spasm
what is a characteristic of the black widow spider?
red hour glass figure on the body
what is a grade 1 spider bite classified as?
normal VS; no problems
what is a grade 2 spider bite classified as?
stable VS, localized muscle pain, local diaphoresis
what is a grade 3 spider bite classified as?
generalized muscle spasm, HTN, and tachycardia
what does a brown recluse spider bite look like?
central red blister/belb that grows in size until it erupts and forms an ulcer
what can develop as a result of a brown recluse spider bite?
hemorrhage, intravascular hemolysis, DIC, and renal failure
how are brown recluse spider bites treated?
steroids and wound management
what must happen for a spider bite to be the diagnosis?
patient must physically see the spider bite them
what is an alternative cause of a spider bite (looks like a spider bite)?
MRSA
what are the bacterial isolates that are seen with a human bite?
aerobic and anaerobic bacteria; viral pathogens such as hepatitis, HIV, and herpes
what is essential for wound closure?
always irrigate thoroughly
what should be done for a dog bite?
abx and closure
what should be done for a cat bite?
abx and if large enough can close
what should be done for a human bite?
abx and leave open; if closure is preferred do it loosely
what are the three routs for infection from anthrax?
cutaneous, inhalation, and gastrointestinal
what are the bacterial causes of anthrax?
bacillus anthracis
what are portals of entry for anthrax?
GI track (invades lymph-travel via B cells), Skin (invades lymph), and lung
what is fatal when anthrax is entered through the lungs?
hemorrhagic mediastinitis
what is the most common portal of entry for anthrax?
cutaneous; abrasions and cuts, large area of skin, starts as painless, pruritic papule then enlarges and develops central vesicle/bulla which erodes and leaves an ulcer; low mortality rate
how would anthrax enter the GI tract?
ingestion of undercooked infected meat, can affect mouth to ascending colon; similar ulcers in GI tract that cause bleeding; mortality rate is 4-60%
what is the prodromal phase of anthrax inhalation?
flu like symptoms, possible nausea, hemoptysis, dyspnes, odynophagia, or chest pain
what is the fulminant phase of anthrax inhalation?
uniformly leads to death within days
what imaging can help to dx anthrax inhalation?
widening of the mediastinum or other cxr findings
how do you treat cutaneous anthrax?
cipro/doxy 7-14 days; exposure to anthrax with no dx need tx for 60 days
how do you treat GI and inhalation anthrax?
cipro, rifampin and vancy/clindamycin
what is tularemia?
zoonotic disease caused by francisella tularensis
what is francisella tularensis?
aerobic fastidious gram negative bacteria, common in rabbits, muskrats, squirrels and voles; transmission occurs via contact with infected animal or biting insect; biting flies in west, ticks in east
where does bacteria spread to in tularemia?
spreads from site of inoculation to regional lymph nodes, replicates in macrophages then spread further
what is the most common form of tularemia?
ulceroglandular; recent exposure to animal/tick is common
what is ulceroglandular?
erythematous papulo-ulcerative lesion with central eschar, then develop tender regional lymphadenopathy
how is ulceroglandular diagnosed?
clinically
what is the drug of choice for tularemia?
streptomycin, gentamicin; meningitic tularemia is treated with aminoglycoside and chloramphenical or doxycycline
what is a 1st degree burn?
only epidermis, painful, no blisters
what is a 2nd degree burn?
dermis, painful and blisters
what is a 3rd degree burn?
epidermis, dermis, and subcutaneous fat, burns are not painful
what is the rule of 9's percentages?
head 4.5%trunk (anterior) 18%trunk (posterior) 18%genitals 1%arm 4.5%leg 9%
how long does a second partial thickness burn take to heal?
10-21 days
how long does a full thickness burn take to heal?
skin graph is needed
what is escharotomy?
cutting burnt skin so that there can be movement
what is the treatment for a 1st degree burn?
no treatment necessary
what is the treatment for a 2nd degree burn?
<15% TBSA and healthy can be d/c home; may need sulfadiazine dressings, over 15-20% need admitted
what is the fluid restriction for burns?
LR at 2-4mL/kg/TBSA percentage with the first half given in 8 hours and the second half gien over the next 16 hours
what is a smoke inhalation injury?
pt wearing oxygen and smoking; combinatio nof heat related airway injury, particulate matter/chemical airway irritation and or carbon monoxide poisoning; early intubation
how are smoke inhalation injuries treated?
early intubation and high flow oxygen
what do electrical injuries depend on?
type, current, duration of exposure and path of energy transfer
which electrical injury is the worst?
AC; alternating current
what does a AC or DC electrical injury cause?
AC= ventricular fibrillationDC= asystole
when does tetany occur in an electrical injury?
40-110Hz
what is the treatment for electrical injuries?
treat burns per ABLS protocol, 4mL/kg/TSBA % with LR; get to burn center if warranted
what is a side flash lightning strike?
near miss but some voltage strikes
what is a contact voltage lightning strike?
touching object that is struck
what is a ground voltage lightning strike?
walking near ground strike
what is a thermal burning lightning strike?
clothing or object burns pt
what is a blunt injury lightning strike?
pt is thrown
how many volts are absorbed with a lightning strike in how long?
10-30million volts in 1.1millisecond
what happens when a pt is struck by lightning?
immediate death due to cardiopulmonary arrest; must do CPR
what occurs immediately in pts that are struck by lightning?
asystole but healthy patients will regain a perfusing rhythm naturally
what lasts long when a patient is struck by lightning?
respiratory arrest and patient suffers hypoxia
what does a lightning injury look like?
superficial burns have pathognomonic feather like/branch like pattern called Lichtenberg figures
what are other injuries associated with lightning injuries?
ruptured TMs, transient lower extremity paralysis, confusion, unequal pupils
what is the treatment for a lightning injury?
fasciotomies are not common; transfer to burn center
what is a chemical weapon?
nerve agents, cholinesterase inhibitors such as sarin, VX tabun; present with excess cholinergic activity, inhibits nerve transmission in skeletal muscle
what is toxic asphyxiants?
cyanide or arsine; inhibit cellular respiration so patients present with hypoxia and lactic acidosis
what are pulmonary irritants?
phosgene is a common industrial chemical, also chlorine and ammonia; direct injury to lung tissue with pulmonary edema
what are blister agents?
sulfur mustard and lewisite; toxic to eyes, skin, and lungs
where are anthrax infections common?
most infections occur through the skin; lung infections are much more lethal
what is the bubonic plague and what is is caused by?
high fever, chills, buboes (painful swollen lymph nodes), exposure to fleas; Uersinia pestis
what is important to do with the snake for a snake bite?
identify it
how many snake bites may be dry?
about 20%
what are signs of infection with a snake bite?
fang marks ooze non clotted blood, severe pain, local swelling/blistering indicative of envenomation
how are pit vipers identified?
vertical slit pupils, small pit between nostril and eye, arrow shaped head, single row of scales
what are the four types of venomous snakes?
copperhead, cottonmouth, coral snake, and the rattlesnake
what is the treatment for a snake bite?
hydrate, fasciotomies,CROFAB
what is important to remember when identifying the coral snake?
red and yellow kill a fellow; red and black friend of jack
what are scorpion stings similar to?
bee stings
what scorpion has neurotoxic venom that can cause respiratory compromise?
Bark scorpion
what is scorpion venom?
strongly cholinergic
what should be avoided with a scorpion sting?
opiates and barbiturates
what should be given for anticholinergic effects of scorpion sting?
atropine
what are hymenoptera stings?
honeybees, wasps, hornets, yellow jackets, fire ants and harvester ants
what is the treatment for a bee sting?
remove the stinger; oral antihistamines
what is the treatment for anaphylaxis from a bee sting?
epinephrine, albuterol, and dopamine for hypotension
what is anaphylaxis?
acute life threating syndrome
what is true anaphylaxis?
IgE mediated, patient has prior exposure to antigen
what is an anaphylactoid reaction?
occurs via other mechanisms not involving IgE (blood products, contrast material)
how fast can anaphylaxis occur?
minutes after exposure; longer time of onset less severe reaction
what is a result of respiratory causes and cardiovascular causes of anaphylaxis?
death respiratory (70%); death cardio (25%)
what is criterion 1 for anaphylaxis?
acute onset (minutes to hours) involving skin and ucose with one of the following: respiratory compromise or decreased blood pressure
what is criterion 2 for anaphylaxis?
two or more of the following that occur rapidly after exposure to likely antigen: inbolbement of skin/mucosal tissue, respiratory compromise, decreased blood pressure, presistent gastrointestinal symptoms
what is criterion 3 for anaphylaxis?
reduced BP after exposure: in adults systolic BP less than 90mmHg or greater than 30% decrease from baselinein infants/children: greater than 30% decrease in systolic baseline
how is low systolic BP defined in children?
less than 70mmHg from 1 month up to 1 yearless than 70mmHg +(2*age) from 1 to 10 yearsless than 90mmHg from 11 to 17 years
what is the treatment for anaphylaxis?
remove offending antigen; monitor vitals; gie epinephrine IM (lateral thigh); treat additional respiratory issues with beta-agonists; histamine blockade with diphenhydramine and cimetidine/ranitidine, corticosteroids to prevent late reaction
what is urticaria?
pruritic erythematous cutaneous elevations of skin which are blanchable, will migrate; acute lasts 2-3 weeks; chronic more than 6 weeks
what are common causes of urticaria?
food, drugs and infections
what is the treatment of choice for urticaria?
antihistamines
what is angioedema?
larger swellings of subcutaneous tissue or submucosally; last longer and are less pruritic than urticaria; caused by ACE inhibitors