Bites

Do you know him?

Steve Irwin

“The Crocodile Hunter”

Stingray Barb

Bites

Epidemiology

1% of ED visits80-90% are from dogs5-15% are from cats

Human Deaths from Animal Attacks

Humans – 200,000Snake – 60,000Crocodile– 1000Tiger – 800-1600Lion –60-200Leopard—30-125Hippopotamus 200-300

Any guesses about the animal?

It’s a Human Bite

Human Bites

Open Mouth

Microbiology80% S. aureusMouth AnaerobesGroup A β-hemolytic StrepEikenella

Dog/Cat Bites

Cat Bite

Pit Bull Bite

Dog Bite 4.7 million bits annually 750,000 visits 66% of bites are not reported 59 per 10,000 incidence 250 per 10,000 in India

96% percent of rabies cases

Chhabra M. Humna rabies in Delhi, Indian Journal of Peds, 2004; 71;217-220CDC, US, 2001. MMWR 2003;52:605-610

Cat Bites

400,000 bits annuallyMostly female catsMostly female victims

Smith Treating Mammalian bite wounds, J Clinical Pharm , 2000; 25:85-99

Microbiology

Pasteurella multocida –60%S. aureusCynocatophagiaAnaerobesThe average dog has 64 different bacterial

isolates in mouth

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Most poisonous snakes have the following characteristics:

Large fangs Vertical slits for pupils, much like those of a cat A heat-sensitive pit between the eye and the nostril

on each side of the head A variety of differently shaped blotches on a

background of pink, yellow, olive, tan, gray, or brown skin

The triangular head is larger than the neck

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Severity of Snakebite

The location of the bite (fatty tissue absorbs the venom more slowly than muscle tissue)

Whether disease-causing organisms are in the venom

The size and weight of the victim The general health and condition of the victim How much physical activity the victim engaged in

immediately following the bite (physical activity helps spread venom)

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Signs and Symptoms of Snakebite

Two distinct fang marks about half an inch apart at the bite site, which may or may not bleed (in some cases there may be only one fang mark)

Immediate and severe burning pain and swelling around the fang marks, usually within 5 minutes but sometimes taking as long as 4 hours to develop (swelling may affect the entire arm or leg)

Purplish discoloration and blood-filled blisters around the bite, usually within 2 to 10 hours

Numbness around the bite

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First Aid Care for Snakebite

Regardless of the type of snakebite, neverCut the skin, which can cause infectionUse suction of any kindUse a tourniquet, which can result in loss of

a limbApply ice, which causes more rapid

absorption of the venomUse electric shock, which can cause severe

injury

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First Aid Care for Snakebite

Instead, do the following:1. Treat a nonpoisonous snakebite as you would any minor wound; clean with soap and

water, cover with a dry sterile dressing, and seek medical advice.2. For pit viper bite, move the victim away from the snake (they will bite more than once,

and can strike half their body length). Keep the victim calm and quiet; if possible, the victim should not walk. Clean the bite with soap and water, then splint the affected extremity. Seek medical attention immediately; antivenim is available only in hospitals (partly because of its short shelf life) and must be administered within 4 hours.

3. For coral snake bite, gently wash the bite with soap and water and wrap the entire extremity with several elastic bandages, exerting moderate pressure to slow the spread of venom. Use overlapping turns to keep the pressure from the bandage firm, beginning at the end of the limb farthest from the heart; gently stretch the bandage as you wrap. Use figure-eight turns around the knee or elbow. When you have finished, the bandage should be firm, but you should be able to slip your finger under the bandage. Leave the toes or fingers exposed so you can check for any kind of discoloration, which would indicate that the bandage is wrapped too tightly; the victim should also stay alert for numbness or tingling in the fingers or toes, which also indicate that the bandage is too tight. Seek medical attention immediately: an effective antivenin is available.

Marine Bites

Shark, fish, eelVibrio(cirrhotics)Aeromonas(GNR)

Evaluation

Provoked or unprovoked?Penicillin allergyTetanus status Evaluate for injury below the skin

Treatment

Aggressive debridement and wound lavage

Closure of lacerations within 24 hoursMay avoid antibiotics in superficial dermis

non-extremity wounds(scalp)All hand bites get prophylactic antibioticsABX may be warranted in immuno-

compromised hosts

Antibiotic Selection

Amoxicillin/ClavulanateAzithromycinCipro

Rabies Prophylaxis

Live captured animal is bestNeed the headKeep it in the frig until it can be analyzedUnprovoked aggression Lack of fear of humansDaylight attacks

Bees/Wasps

Bumble beePaper wasp

Honey bee Yellow jacket

Bee Stings

Local edemaPrednisone—for local edemaH1 blockade –for urticariaEpinephrine-laryngeal edema

Flea Bites

Chiggers

Tick Line Up

Eyrthema Chronica Migrans

Prophylaxis

Routine use of antibiotics or serologic testing after tic bite

Remove attached tic ASAPTreatment with ticks attached longer than

48 hours (C-III)

Who to Treat

All Patients with ECM(A-I)All patients who develop a rash or high

fever (>100F) within 30 days of bite (A-II)Erlichiciosis or Babesiosis

All patients with positive ELISA(A-1)

Spiders

Spiders-Brown Recluse

Brown Recluse Bite

Harmless

Daddy Long Legs

House Spider

Black widow• Found in every state in

US

• Usually warmer climates

• Highly venomous

• Have them bring in the spider

Yellow Sac• Bites feel like bee sting• Serum Sickness• Eschar not always present

Scabies

Treatment

Permethrin (A)Launder clothing and sheetsLaunder the kids, spouseZoloft may be necessary

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Insect Bites and Stings

Signs and Symptoms include: A mark from the bite or sting Pain or tenderness at and surrounding the bite or sting Redness at and surrounding the bite or sting Swelling around the bite or sting A venom sac, stinger, tentacle, or other remnant of the insect at

the bite or sting

Medical help is necessary if: Itching lasts longer than 2 days. Signs of infection develop. Signs of an allergic reaction develop. The insect is poisonous, most often black widow or

brown recluse spiders (which can be fatal).

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First Aid for Bites and Stings

1. If the stinger is still present, remove it by gently scraping against it with the edge of your fingernail.

2. Wash the area around the bite or sting gently with a soap solution3. Remove any jewelry or other constricting objects as soon as possible—

ideally, before any swelling begins.4. Lower the site of the bite or sting slightly below the level of the victim’s

heart.5. Apply a cold compress to the site of an insect bite or scorpion sting to

relieve pain and swelling6. Apply a paste of baking soda and water to relieve the pain of bee sting7. Observe the victim carefully for at least 30 minutes to determine whether

he or she is developing the signs and symptoms of an allergic reaction 8. Keep the victim calm, limit physical activity, and keep the victim

warm; arrange for transport as soon as possible

Thank you