Chapter 13: Environmental Emergencies

BITES AND STINGS

Mammalian Bites

The vast majority of mammalian bite wounds seen in the ED are due to domesticated animals. Infecting organisms vary based on the oral flora from the biting animal (Table 13.1).

Wounds With Increased Risk of Infection (High-Risk Wounds)

• Puncture wounds

• Intraoral, hand, below knee, or over joints

• Cat bites > human bites > dog bites

• Immunocompromised (eg, asplenic, alcoholic, diabetic) or elderly patient

• Presence of peripheral vascular disease or prosthetic valve

• Delayed presentations

DIAGNOSIS

• X-ray to rule out foreign body (particularly tooth fragments) or fracture.

• Check blood sugar to see if diabetic.

GENERAL TREATMENT

• Anesthetize, clean and irrigate, and debride devitalized tissue.

• Explore in full flexion and extension for ligamentous or tendon injury.

  • If present, surgical consultation and admission are warranted.

• Tetanus prophylaxis.

• Consider rabies prophylaxis (animal bites).

• No evidence for infection:

  • Okay to close wound unless high-risk wound.

  • Give antibiotic prophylaxis if high-risk wound (Table 13.2).

• Evidence of infection:

  • Admit for intravenous (IV) antibiotics if high-risk wound or patient, otherwise treat with oral antibiotics.

• Arrange follow-up in 48 hours for discharged patients.

Human Bites

Infections are commonly polymicrobial.

• Streptococcus viridans.

• Staphylococcus aureus.

• Bacteroides sp.

• Corynebacterium sp.

• Eikenella corrodens (a gram-negative rod found in dental plaque).

• Fusobacterium sp.

• Other transmitted infections include syphilis and herpes.

• HIV and hepatitis transmission should be considered if exposure to blood occurred.