I grew up in Australia, home to some of the most poisonous
animals; we have poisonous snakes, spiders, jellyfish, octopi, and even the
cute looking platypus! Not all bites from venomous animals need anti-venom, and
not all bites from nonvenomous animals are innocent. Below are some general
guidelines:
·
Take a detailed history
o Time
and circumstances of bite
o What
animal? Some patients keep specimen or photos
o Symptoms
relating to bite
o Allergies
o Tetanus
immunization status
o Rabies
risk?
o HIV/hepatitis
risk (human bite)
·
Do a thorough physical examination
o Type
of wound: abrasion, laceration, puncture, crush injury
o Assess
for direct tissue damage: skin, bone, tendon, neurovascular status
·
Investigations
o Bloods:
CBC, electrolytes, creatine kinase, coagulation studies, renal function tests,
ABG
o Urine:
myoglobin or blood
o ECG
o X-rays—check
for bony injury or gas in tissue (infection)
o CT
Skull in children with scalp bite wounds to rule out cranial perforation
·
Management
o DRABC
o Address
anaphylactic shock if applicable
§
Epinephrine (IV over 5 min)
§
Beta-agonist bronchodilator
§
Antihistamines
§
Cimetidine IV/IM/PO
§
Steroids
o Wound
cleansing and copious irrigation
o Debridement
if necessary
o Swab
and culture if there are signs of infection
o Prophylactic
antibiotics (amoxicillin + clavulinic acid 3~5 days) is recommended to all bite
wounds to the hand
o Vascular
structures (face/scalp) are less likely to become infected and can be sutured;
avascular structures (pretibial regions/hands/feet) are not to be sutured—allow
healing by secondary intention
o Tetanus
shot
o Immunoglobulin
therapy for rabies if applicable
For snakebites, consult Provincial Poison Information
Center. If envenomation present, administer anti-venom as directed. For
Massasauga Rattle Snake ONLY: if not serious tissue damage AND INR is normal
six hours after bite, the patient can be discharged.
As usual, your contribution is welcomed in the comments section. This blog post is available in podcast form. Look for "Med On The Go" in iTunes, Googleplay, or Podbean. www.medonthego.podbean.com
As usual, your contribution is welcomed in the comments section. This blog post is available in podcast form. Look for "Med On The Go" in iTunes, Googleplay, or Podbean. www.medonthego.podbean.com
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