-crushing, tearing
Human bites (or clenched fist injuries)
-Tenosynovitis, septic arthritis, osteomyelitis, cellulitis, lymphangitis, abscess
-cause or of tissue
-complications: (6)
-Staph, strep
-MC organisms: (2)
-can also transmit (3) -Herpes, herpetic whitlow, Hep B
(HIV risk is negligible)
Clenched fist injury (CFI) -MCP (metacarpophalangeal)
-occurs in the region as the first strikes the mouth/teeth of another person
-Dx: examine joint ROM to assess for injury; assess for space involvement, get xrays
-extensor tendon; joint; fractures, foreign bodies
for or bodies
-copious irrigation (NS) and debridement
-Hand: leave open;
Other: primary closure unless infx suspected
Human bites treatment
-initial tx: -Augmentin
-Hand wounds vs other body locations:
-Leave open
-Prophylactic abx:
Dress wound
-Uncomplicated hand wound: leave , wound, (mobilization), elevate for hrs,
Immobilize
prophylactic ; re-eval in 2 days
Elevate 24 hours
-Tendon/Joint injury: consult
Prophylactic antibiotics
-Infected wound at presentation: obtain , start
-Local mild cellulitis: tx with abx, immobilization, close FU
-consult hand surgeon (may need exploration +/- abx)
-Mod/severe infections: admit for surg consult + IV abx ( - , , PCN allergy: + )
+ tetanus prophylaxis -obtain cultures, start systemic abx
-outpatient
-(Ampicillin-sulbactam, Cefoxitin, PCN allergy: Clindamycin+Cipro)
-xrays
-irrigation + debridement; closure of wounds (not hands/feet)
Dog bites initial ER eval + management
-initial evaluation: obtain if infx, FB suspicion, bony involvement, or intracranial bites to -leave open
heads of children
-ED care: + ; 1º of wounds (unless hands/feet) -Augmentin;
-Puncture wounds, hands, face, high-risk pts (first-line, PCN allergy, children): PCN allergy: Clinda + Cipro;
-High-risk pts (asplenia, alcoholism, chronic lung dz): for coverage children: Clinda + Bactrim
alternatives: Cefuroxime, Doxy
-Penicillin for Capnocytophaga canimorsus coverage
Cat bites -Pastuerella multocida
-major pathogen:
-can cause: (2) -septic arthritis (esp with steroids/alcoholism), bone infx
-initial eval: obtain if evidence of FB, infx, or bony involvement
-xrays
-ED care: + ; primary vs secondary closure as indicated
-Prophylactic abx in high risk pts (arthritis/prosthetic joints, hand punctures, immunocomp): -irrigation + debridement
(3)
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Human bites (or clenched fist injuries)
-Tenosynovitis, septic arthritis, osteomyelitis, cellulitis, lymphangitis, abscess
-cause or of tissue
-complications: (6)
-Staph, strep
-MC organisms: (2)
-can also transmit (3) -Herpes, herpetic whitlow, Hep B
(HIV risk is negligible)
Clenched fist injury (CFI) -MCP (metacarpophalangeal)
-occurs in the region as the first strikes the mouth/teeth of another person
-Dx: examine joint ROM to assess for injury; assess for space involvement, get xrays
-extensor tendon; joint; fractures, foreign bodies
for or bodies
-copious irrigation (NS) and debridement
-Hand: leave open;
Other: primary closure unless infx suspected
Human bites treatment
-initial tx: -Augmentin
-Hand wounds vs other body locations:
-Leave open
-Prophylactic abx:
Dress wound
-Uncomplicated hand wound: leave , wound, (mobilization), elevate for hrs,
Immobilize
prophylactic ; re-eval in 2 days
Elevate 24 hours
-Tendon/Joint injury: consult
Prophylactic antibiotics
-Infected wound at presentation: obtain , start
-Local mild cellulitis: tx with abx, immobilization, close FU
-consult hand surgeon (may need exploration +/- abx)
-Mod/severe infections: admit for surg consult + IV abx ( - , , PCN allergy: + )
+ tetanus prophylaxis -obtain cultures, start systemic abx
-outpatient
-(Ampicillin-sulbactam, Cefoxitin, PCN allergy: Clindamycin+Cipro)
-xrays
-irrigation + debridement; closure of wounds (not hands/feet)
Dog bites initial ER eval + management
-initial evaluation: obtain if infx, FB suspicion, bony involvement, or intracranial bites to -leave open
heads of children
-ED care: + ; 1º of wounds (unless hands/feet) -Augmentin;
-Puncture wounds, hands, face, high-risk pts (first-line, PCN allergy, children): PCN allergy: Clinda + Cipro;
-High-risk pts (asplenia, alcoholism, chronic lung dz): for coverage children: Clinda + Bactrim
alternatives: Cefuroxime, Doxy
-Penicillin for Capnocytophaga canimorsus coverage
Cat bites -Pastuerella multocida
-major pathogen:
-can cause: (2) -septic arthritis (esp with steroids/alcoholism), bone infx
-initial eval: obtain if evidence of FB, infx, or bony involvement
-xrays
-ED care: + ; primary vs secondary closure as indicated
-Prophylactic abx in high risk pts (arthritis/prosthetic joints, hand punctures, immunocomp): -irrigation + debridement
(3)
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