NSG 6665 Exam #2
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1. Animal & Human -Every year there are approximately 4.5 million dog bites, 400,000 cat bites, and
Bites 250,000 human bites
-Bites can produce local inflammation, systemic symptoms, and can transmit
systemic diseases
-Most common complication- infection of skin and surrounding soft tissue
-Most contaminated bites (in order)
-Human, cat, dog
2. Etiology of Hu- -Animal bites: 90% dogs, 10% cats, <1% rodent
man & Animal -Human bites: majority from another child; adult-consider abuse
Bites -What was source of bite: animal or human?
-If animal, what kind and is animal known to family
-What is the health status of the animal?
-Was the attack provoked?
-Can the animal be observed over the next 10-14 days?
-How old is the wound?
-What home treatment, if any, was initiated?
-When was the last tetanus shot?
-If human bite, was it from a child or adult?
-If from adult, was the bite part of an abusive cycle or the result of a physical
altercation?
-X-ray if suspicious of a joint being penetrated, a fracture or a foreign body
3. Treatment of An- -Culture wound if infection is present
imal & Human -Common pathogens:
Bites -Dog/cat: Pasteurella multocida, Pasteurella canis, Staphylococcus aureus
-Human: staphylococcus aureus, streptococcus viridans, Eikenella corrodes
-Administer analgesia or anesthesia as indicated
-Irrigate the wound with normal saline
-Exception is cat bites- soak in diluted solution of tap water and iodine for 15
minutes
-Assess for possible foreign body
, NSG 6665 Exam #2
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-Debridement of area if needed
-Determine need for primary closure vs secondary intention
-Administer tetanus toxoid if:
-Incomplete immunization
-No booster dose within 5 years
-Immunization status is unknown
-PO antibiotic:
-1st line: Augmentin 10 mg/kg x 3 doses daily for 3-5 days (max 500 mg/125mg
per dose)
-PCN allergy consider extended spectrum cephalosporin or Bactrim plus Clin-
damycin or metronidazole
-Cefuroxime 10-15 mg/kg/day, Doxycycline 1-2 mg/kg BID, TMP-SMX 4-6 mg/kg
BID
-Clindamycin 10 mg/kg TID, metronidazole 10 mg/kg TID
-Post exposure Rabies Prophylaxis:
-Determine rabies status of animal
-Report bites to animal control if appropriate and the animal needs to be ob-
served
-HRIG (Human rabies immunoglobulin) Imogram 20 units/kg total dose
-10 units/kg infiltrated around wound
-10 units/kg given IM
-HDCV (Human diploid cell vaccine) Imovax 1 mL IM on days 0,3,7,14,28
4. Insect & Arthro- -Etiology: bees, wasps, ants, spiders, scorpions, ticks, centipedes, millipeds
pod Bites -Reactions may be immediate or delayed
-Immediate:
-Normal: localized swelling, erythema, transient pain
-Toxic: produced by exogenous vasoactive amines in venom; usually occur with
multiple stings
-Large toxic: swelling expanding from the area of the bite, lasting more than 24
hours
-Systemic: generalized symptoms remote from sting site
, NSG 6665 Exam #2
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-Delayed:
-Systemic with varied manifestations
-Serum sickness-like reaction
-Myocarditis
-Transverse myelitis
-Nephrosis
5. Bees, Wasps, & -History: ask about past history of local or systemic reaction
Ant Stings -Physical exam:
-Mild reactions: local redness, pruritis, pain, edema, and possibly generalized
urticaria
-Severe reactions: anaphylaxis- local signs and urticaria, plus any of the following:
watery eyes, difficulty breathing, swallowing, or wheezing hoarseness, thickened
speech, GI disturbances, abdominal pain, dizziness, weakness, confusion, col-
lapse, unconsciousness, even death
-Fire ant bites can cause vesicles that develop into pustules
-For mild local reactions:
-Remove visible stingers with the edge of a sharp object gently scraped over the
bite
-Apply cool compresses or use cool baths
-Administer an antihistamine
-Topical glucocorticoid creams or ointments may help reduce itching
-For moderate to severe reactions:
-Moderate reactions may need to be treated with oral antihistamines, corticos-
teroids, and inhaled bronchodilators (if wheezing)
-Institute emergency measures for treatment of anaphylactic reactions and trans-
port to the ED via ambulance
-Epinephrine- 0.01 mg/kg IM; not to exceed 0.3 mg to 0.5 mg, every 5-15
minutes. Usually, the patient will respond after one or two doses
-Give antihistamines immediately following epinephrine (and repeated every 6
hours for up to 3 days)
, NSG 6665 Exam #2
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-Nebulized albuterol
-Administer high-flow oxygen (warm humidified) by nonrebreather mask
6. Mosquitos, Fleas, -History
& Chiggers Bites -Mosquito and flea bites: known bite or presence of cat, dog, or furry animal;
complaints of a brief stinging sensation following by itching
-Chigger bites: complaints of itching followed by dermatitis; history of playing or
walking in grassy areas, parks, or other mite habitat near woods and water
-Physical Exam
-Mosquito bites: local irritation with potential pruritic/urticarial wheal
-Flea bites: urticarial wheal or papule surrounded by redness, central hemor-
rhagic puncta, grouping of multiple lesions in linear configuration commonly on
arms, ankles, legs, waists, thighs, buttocks, and lower abdomen
-Chigger bites: discrete, bright-red papules with hemorrhagic puncta; more
commonly seen on legs and belt line; intense pruritic that peaks on day 2 and
can persist for months
-Control pruritic
-Cool compresses
-Topical corticosteroids
-Topical antipruritic agents
-Oral antihistamines of topical corticosteroids do not provide relief
-Removal of embedded chiggers
-Colloidal oatmeal baths
-Prevent/treat secondary infections
-Prevention of further bites
-Elimination of fleas by treating animals and cleaning carpets, bedding, uphol-
stered furniture
-Avoid areas that are potentially infested with mosquitos, fleas, or chiggers.
7. Black Widow Spi- -History: known history of bite or exposure to environment where they live;
der Bites description of spider
-Physical exam:
Study online at https://quizlet.com/_gopuet
1. Animal & Human -Every year there are approximately 4.5 million dog bites, 400,000 cat bites, and
Bites 250,000 human bites
-Bites can produce local inflammation, systemic symptoms, and can transmit
systemic diseases
-Most common complication- infection of skin and surrounding soft tissue
-Most contaminated bites (in order)
-Human, cat, dog
2. Etiology of Hu- -Animal bites: 90% dogs, 10% cats, <1% rodent
man & Animal -Human bites: majority from another child; adult-consider abuse
Bites -What was source of bite: animal or human?
-If animal, what kind and is animal known to family
-What is the health status of the animal?
-Was the attack provoked?
-Can the animal be observed over the next 10-14 days?
-How old is the wound?
-What home treatment, if any, was initiated?
-When was the last tetanus shot?
-If human bite, was it from a child or adult?
-If from adult, was the bite part of an abusive cycle or the result of a physical
altercation?
-X-ray if suspicious of a joint being penetrated, a fracture or a foreign body
3. Treatment of An- -Culture wound if infection is present
imal & Human -Common pathogens:
Bites -Dog/cat: Pasteurella multocida, Pasteurella canis, Staphylococcus aureus
-Human: staphylococcus aureus, streptococcus viridans, Eikenella corrodes
-Administer analgesia or anesthesia as indicated
-Irrigate the wound with normal saline
-Exception is cat bites- soak in diluted solution of tap water and iodine for 15
minutes
-Assess for possible foreign body
, NSG 6665 Exam #2
Study online at https://quizlet.com/_gopuet
-Debridement of area if needed
-Determine need for primary closure vs secondary intention
-Administer tetanus toxoid if:
-Incomplete immunization
-No booster dose within 5 years
-Immunization status is unknown
-PO antibiotic:
-1st line: Augmentin 10 mg/kg x 3 doses daily for 3-5 days (max 500 mg/125mg
per dose)
-PCN allergy consider extended spectrum cephalosporin or Bactrim plus Clin-
damycin or metronidazole
-Cefuroxime 10-15 mg/kg/day, Doxycycline 1-2 mg/kg BID, TMP-SMX 4-6 mg/kg
BID
-Clindamycin 10 mg/kg TID, metronidazole 10 mg/kg TID
-Post exposure Rabies Prophylaxis:
-Determine rabies status of animal
-Report bites to animal control if appropriate and the animal needs to be ob-
served
-HRIG (Human rabies immunoglobulin) Imogram 20 units/kg total dose
-10 units/kg infiltrated around wound
-10 units/kg given IM
-HDCV (Human diploid cell vaccine) Imovax 1 mL IM on days 0,3,7,14,28
4. Insect & Arthro- -Etiology: bees, wasps, ants, spiders, scorpions, ticks, centipedes, millipeds
pod Bites -Reactions may be immediate or delayed
-Immediate:
-Normal: localized swelling, erythema, transient pain
-Toxic: produced by exogenous vasoactive amines in venom; usually occur with
multiple stings
-Large toxic: swelling expanding from the area of the bite, lasting more than 24
hours
-Systemic: generalized symptoms remote from sting site
, NSG 6665 Exam #2
Study online at https://quizlet.com/_gopuet
-Delayed:
-Systemic with varied manifestations
-Serum sickness-like reaction
-Myocarditis
-Transverse myelitis
-Nephrosis
5. Bees, Wasps, & -History: ask about past history of local or systemic reaction
Ant Stings -Physical exam:
-Mild reactions: local redness, pruritis, pain, edema, and possibly generalized
urticaria
-Severe reactions: anaphylaxis- local signs and urticaria, plus any of the following:
watery eyes, difficulty breathing, swallowing, or wheezing hoarseness, thickened
speech, GI disturbances, abdominal pain, dizziness, weakness, confusion, col-
lapse, unconsciousness, even death
-Fire ant bites can cause vesicles that develop into pustules
-For mild local reactions:
-Remove visible stingers with the edge of a sharp object gently scraped over the
bite
-Apply cool compresses or use cool baths
-Administer an antihistamine
-Topical glucocorticoid creams or ointments may help reduce itching
-For moderate to severe reactions:
-Moderate reactions may need to be treated with oral antihistamines, corticos-
teroids, and inhaled bronchodilators (if wheezing)
-Institute emergency measures for treatment of anaphylactic reactions and trans-
port to the ED via ambulance
-Epinephrine- 0.01 mg/kg IM; not to exceed 0.3 mg to 0.5 mg, every 5-15
minutes. Usually, the patient will respond after one or two doses
-Give antihistamines immediately following epinephrine (and repeated every 6
hours for up to 3 days)
, NSG 6665 Exam #2
Study online at https://quizlet.com/_gopuet
-Nebulized albuterol
-Administer high-flow oxygen (warm humidified) by nonrebreather mask
6. Mosquitos, Fleas, -History
& Chiggers Bites -Mosquito and flea bites: known bite or presence of cat, dog, or furry animal;
complaints of a brief stinging sensation following by itching
-Chigger bites: complaints of itching followed by dermatitis; history of playing or
walking in grassy areas, parks, or other mite habitat near woods and water
-Physical Exam
-Mosquito bites: local irritation with potential pruritic/urticarial wheal
-Flea bites: urticarial wheal or papule surrounded by redness, central hemor-
rhagic puncta, grouping of multiple lesions in linear configuration commonly on
arms, ankles, legs, waists, thighs, buttocks, and lower abdomen
-Chigger bites: discrete, bright-red papules with hemorrhagic puncta; more
commonly seen on legs and belt line; intense pruritic that peaks on day 2 and
can persist for months
-Control pruritic
-Cool compresses
-Topical corticosteroids
-Topical antipruritic agents
-Oral antihistamines of topical corticosteroids do not provide relief
-Removal of embedded chiggers
-Colloidal oatmeal baths
-Prevent/treat secondary infections
-Prevention of further bites
-Elimination of fleas by treating animals and cleaning carpets, bedding, uphol-
stered furniture
-Avoid areas that are potentially infested with mosquitos, fleas, or chiggers.
7. Black Widow Spi- -History: known history of bite or exposure to environment where they live;
der Bites description of spider
-Physical exam:
