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B ites

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.

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B ites

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  1. Bites Dr. Stella Yiu Staff Emergency Physician

  2. Insect bites: LMCC Objectives Determine what complications they caused List critical investigations Construct management plan

  3. Complications

  4. 3 complications in insect bites Local reaction/ Allergic reaction Toxins Infection

  5. Complications -1. Local reaction

  6. Complications - 1. Allergic reaction

  7. CDMQ: Treat anaphylaxis to bee sting (7)

  8. CDMQ: Treat anaphylaxis to bee sting (7) Airway: imEpi, intubate if needed Breathing: Ventolin Circulation: iv fluids, iv epi Antihistamines (H1, H2) Steroids Remove stinger

  9. Complications - 2. Toxins

  10. Brown recluse spider: in SE Ont and S Quebec

  11. Brown recluse spider: Necrosis + Systemic collapse • Venom digests tissues • Systemic: • Fever • DIC • Renal failure • Seizures, Coma

  12. Black widow spider: Neuro + Autonomic • Muscle cramping/rigid (large muscle) • N/v, headache • HR, BP

  13. Treatment: Supportive & Specific Iv fluids, pressors, Benzo (GABA) Surgical debridement (Brown recluse) Specific: Antivenom (Black widow spider)

  14. Complications - 3. Infections

  15. Ticks

  16. Lyme disease Early (weeks) Rash, bell’s palsy, joint pain Late (months) Joint pain, Neuro symptoms Treatment?

  17. Mosquito • Malaria • West Nile

  18. Malaria = Flu like illness form endemic area Cough Fatigue, malaise Arthalgia/Myalgia

  19. Severe malaria = Systemic involvment Brain: 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? Plasmodium Ovale Plasmodium Vivax Salmonella Typhi Dengue Fever Plasmodium Falciparum

  21. CDMQ: Order bloodwork (5)

  22. CDMQ: List bloodwork to be ordered Hb, platelet Liver function, Creatinine, Lytes (Na) Hemolysis screen (LDH, haptoglobin) Malaria screen Thick 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 Objectives Determine what complications they caused - Allergy, toxins, infections List critical investigations Construct management plan

  26. Animal bites: LMCC objectives Risk of transmissible infection from bites Manage animal bites including reporting

  27. MCQ 7: Who does not need antibiotic? 35 yohx of splenectomy with dog bite to face 7 yo with dog bite to face 15 yo with cat bite to foot 25 yo asthmatic with fight bite to hand 40 yo DM with cat bite to face

  28. Dog Cat Human Needlestick

  29. Dog bites – Wound management Do we treat with antibiotics? Do we close?

  30. Dog bites - Infections Bacteria: Anaerobes, Strep, Staph (5% infected)

  31. Dog bite = No antibiotics except

  32. Dog bite – What wound to close?

  33. Dog bites – Deciding rabies risk Rabies vaccine status (stray, unknown) Behavior

  34. Dog bites – Deciding rabies risk Observe animal x 10 days If treat: Rabies Immunoglobulin + Rabies vaccine

  35. Cat bite What infections do we worry about? What is the risk of infection?

  36. Cat bite: Pasturella, 80%infection rate

  37. Cat bite= Abx + immobilize Prophylaxis: Clavulin, cefuroxime Treat: iv Ceftriaxone Splint Frequent reassessments, r/o osteomyelitis

  38. What other animals do we worry about rabies? Fox Raccoon Skunk Bat Needs bites, contact with open wound or mucous membrane

  39. Patient presents with this. List your mgt steps (7).

  40. Rule out foreign body (teeth) Irrigation ++ Abx Rule out fracture or tendon injury Tetanus Discuss HIV prophylaxis + Hep B imm Do not close, repeated assessments (Splint)

  41. Rule out Tendon Injury

  42. Human bites: Dirty! 50% infection rate: Bacteria: Staph, Strep, Eikenella

  43. Human bites: Dirty! 50% infection rate: Bacteria: Staph, Strep, Eikenella Prophylaxis: Clavulin, Cefuroxime, Cellulitis: iv Ceftriaxone+ flagyl Close wound?

  44. Viruses from human bites: Hep B, Hep C, HIV

  45. Hep B If primary series done: Check immunity (anti-HBsAgAb): give HBIg + booster if low If no primary series: HBIg + HBV vaccines

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