Embed Size (px)
DESCRIPTION
B ites. Dr. Stella Yiu Staff Emergency Physician. Insect bites: LMCC Objectives. Determine what complications they caused List critical investigations Construct management plan. Complications. 3 complications in insect bites. Local reaction/ Allergic reaction Toxins Infection. - PowerPoint PPT Presentation
Citation preview
Bites
Dr. Stella YiuStaff Emergency Physician
Insect bites: LMCC ObjectivesDetermine what complications they caused
List critical investigations
Construct management plan
2
Complications
3
3 complications in insect bites1. Local reaction/ Allergic reaction
2. Toxins
3. Infection
4
Complications -1. Local reaction
5
Complications - 1. Allergic reaction
6
CDMQ: Treat anaphylaxis to bee sting (7)
7
CDMQ: Treat anaphylaxis to bee sting (7)
Airway: im Epi, intubate if neededBreathing: VentolinCirculation: iv fluids, iv epi Antihistamines (H1, H2)SteroidsRemove stinger
8
Complications - 2. Toxins
9
Brown recluse spider: in SE Ont and S Quebec
10
Brown recluse spider: Necrosis + Systemic collapse
11
Venom digests tissues
Systemic: FeverDICRenal failureSeizures, Coma
Black widow spider: Neuro + AutonomicMuscle cramping/rigid (large muscle) N/v, headache
HR, BP
12
Treatment: Supportive & SpecificIv fluids, pressors, Benzo (GABA)Surgical debridement (Brown recluse)
Specific:Antivenom (Black widow spider)
13
Complications - 3. Infections
14
Ticks
15
16
Lyme disease
Early (weeks)Rash, bell’s palsy, joint pain
Late (months)Joint pain, Neuro symptoms
Treatment?
17
Mosquito
MalariaWest Nile
18
Malaria = Flu like illness form endemic area
CoughFatigue, malaiseArthalgia/Myalgia
19
Severe malaria = Systemic involvmentBrain: Coma
Hem: Severe anemia, thrombocytopenia
Resp: Pulmonary edema
20
MCQ 6: Pt returned from Congo with fever q48h. What is the most life-threatening infection that need to be ruled-out?A. Plasmodium OvaleB. Plasmodium VivaxC. Salmonella TyphiD. Dengue FeverE. Plasmodium Falciparum
21
CDMQ: Order bloodwork (5)
22
CDMQ: List bloodwork to be ordered
Hb, plateletLiver function, Creatinine, Lytes (Na)Hemolysis screen (LDH, haptoglobin)Malaria screenThick and thin smear
23
1 negative smear does not rule out malaria (repeat)
24
West Nile encephalitis
Similar investigations to other encephalitis
25
Insect bites: LMCC ObjectivesDetermine what complications they caused- Allergy, toxins, infectionsList critical investigations
Construct management plan
26
Animal bites: LMCC objectivesRisk of transmissible infection from bites
Manage animal bites including reporting
27
MCQ 7: Who does not need antibiotic?
A. 35 yo hx of splenectomy with dog bite to face
B. 7 yo with dog bite to faceC. 15 yo with cat bite to footD. 25 yo asthmatic with fight bite
to handE. 40 yo DM with cat bite to face
28
DogCatHumanNeedlestick
29
Dog bites – Wound managementDo we treat with antibiotics?
Do we close?
30
Dog bites - Infections
Bacteria: Anaerobes, Strep, Staph (5% infected)
31
32
Dog bite = No antibiotics except
33
34
Dog bite – What wound to close?
35
36
Dog bites – Deciding rabies riskRabies vaccine status (stray, unknown)Behavior
37
38
Dog bites – Deciding rabies riskObserve animal x 10 days
If treat: Rabies Immunoglobulin + Rabies vaccine
39
Cat bite
What infections do we worry about?
What is the risk of infection?
40
41
Cat bite: Pasturella, 80% infection rate
Cat bite = Abx + immobilize
Prophylaxis: Clavulin, cefuroximeTreat: iv CeftriaxoneSplint
Frequent reassessments, r/o osteomyelitis
42
What other animals do we worry about rabies?FoxRaccoonSkunkBat
Needs bites, contact with open wound or mucous membrane
43
44
Patient presents with this. List your mgt steps (7).
1. Rule out foreign body (teeth)2. Irrigation ++3. Abx4. Rule out fracture or tendon injury5. Tetanus6. Discuss HIV prophylaxis + Hep B
imm7. Do not close, repeated
assessments8. (Splint)
45
46
Rule out Tendon Injury
Human bites: Dirty!
50% infection rate: Bacteria: Staph, Strep, Eikenella
47
Human bites: Dirty!
50% infection rate: Bacteria: Staph, Strep, Eikenella
Prophylaxis: Clavulin, Cefuroxime, Cellulitis: iv Ceftriaxone + flagylClose wound?
48
Viruses from human bites: Hep B, Hep C, HIV
49
Hep B
If primary series done: Check immunity (anti-HBsAgAb): give HBIg + booster if low
If no primary series: HBIg + HBV vaccines
50
Hep C
No ProphylaxisFollow up with serology
51
PEP
Determine risk
52
Needlestick Injury: PEP
Baseline risk: 0.3%
53
Risk increases if:
54
Animal bites: LMCC objectivesRisk of transmissible infection from bites- Abx: Clavulin, Cefuroxime, Ceftriaxone
Manage animal bites including reporting
55
