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Burns, Bites and Stings of Animals and Insects Patrick C. Obasi.

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Presentation on theme: "Burns, Bites and Stings of Animals and Insects Patrick C. Obasi."— Presentation transcript:

1 Burns, Bites and Stings of Animals and Insects Patrick C. Obasi

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3 Rabies  Wild animals constitute the most potential source of infection for both humans and domestic animals in US  About 10,000 pts receive post exposure prophylaxis for rabies annually  Most domestic animal bites are provoked by attack.  Post exposure prophylaxis combining local wound treatment, passive immunization, and vaccination is very effective  Any wild animal that bites or scratches a person should be killed at once

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5 Table of Rabies Prophylaxis Guide Animal Type Evaluation and Disposition of Animal Postexposure Prophylaxis Recommendations Dogs and cats Healthy and available Should not begin prophylaxis for 10 days observation unless animal develops symptoms of rabies Rabid or suspected rabid Immediate vaccination Unknown (escaped) Consult public health officials Skunks, raccoons, bats, foxes, and most other carnivores; woodchucks Regarded as rabid unless geographic area is known to be free of rabies or until animal proven negative by laboratory tests Immediate vaccination Livestock, rodents, and lagomorphs (rabbits and hares) Consider individually Consult public health officials; bites of squirrels, hamsters, guinea pigs, gerbils, chipmunks, rats, mice, other rodents, rabbits, and hares almost never require antirabies treatment

6 Rabies: Local Care of Animal Bites  Thorough irrigation  Cleansing with soap solution  Debridement  Administration of tetanus toxoid  Abx

7 Rabies Vaccination  2 rabies vaccines currently available in US Rabies vaccine adsorbed (RVA) (Imovax) Human diploid cell rabies vaccine (HDCV)  Either administered with HRIG (Imogan rabies)  Vaccine administered intramuscularly in deltoid area for adult and anterolateral aspect of thigh for children

8 SFX of Vaccines  Muscle aches  Headache  Nausea  Abdominal pain  Pain, erythema, swelling, itching at injection site  Neurologic illness  Note: Steroids can interfere with the development of active immunity

9 Manifestations of Rabies  Paresthesia  Headache  Stiff neck  Lethargy  Pulmonary sxs  Maniacal behavior  Muscle spasm of throat with dysphasia  Convulsion → coma → paralysis → death

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11 Snakebites  Poisonous snakes of medical importance are of members of the family crotalidae or pit vipers  Coral snakes of the elapidae family also important  Poisonous snakes identified by their elliptical pupil  Non poisonous snakes do not have pits and fangs  Poisonous snakes have single row of sub caudal plates

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14 Clinical Manifestation of Envenomation  Hypotension  Weakness  Nausea/vomiting  Pain, swelling, tenderness and ecchymosis at site of bite  Paresthesia and muscle fasciculations  Defect in blood coagulation  Pulmonary edema

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16 Grading of Envenomation GradeSigns and Sxs 0 – No envenomation Fang marks, min pain, small edema and erythema I – Minimal envenomation Fang marks, mod to severe pain, surrounding edema and erythema II – Moderate envenomation Fang marks, severe pain, edema, erythema, possible systemic involvement (nausea, vomiting, shock) III – Severe envenomation Fang marks, large surrounding edema and erythema with generalized petechiae and ecchymosis IV – Very severe envenomation Systemic effect present. Sx may include renal failure, coma, death

17 Management of Snakebites  Application of a tourniquet, incision and suction are appropriate if done within one hour from time of bite  The most important treatment for snakebite is antivenin (crotalidae polyvalent immune fab)  IVF required to replace the decreased extra cellular fluid volume resulting from edema formation  Fascial planes may become tense with obstruction of venoms and later arterial flow, requiring fasciotomy  Vit K may be required to correct bleeding and clotting abnormalities  Tetanus toxoid administered and abx recommended to prevent secondary infection

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19 Insect Stings  Group includes the honey bee, bumblebee, wasp, hornets and fire ants  Venom is just as potent a that of snakes  Sxs consist of * Localized pain *Petechial hemorrhages *Swelling of skin and mucus membrane *Generalized erythema *Abdominal cramps *H/A *Pulmonary and cerebral edema *Blurred vision *Vascular collapse

20 Insect Stings  Death results from combination of shock, respiratory failure and CNS changes  Most death from insect sting occur within 15 to 30 minutes  Early application of a tourniquet may prevent rapid spread of venom  Emergency kit containing epinephrine commercially available

21 Black Widow Spider

22 Spider Bites: Black Widow Spider  The most biting spider in US is the black widow (latrodetus mataus)  Its venom is neurotoxic  Generalized muscle spasm is the most prominent physical finding  Other sxs are nausea/vomiting, headache  Priapism and ejaculation (have been reported)  Tx: Narcotics for pain Muscle relaxant for spasm Calcium gluconate relieves most sxs  Most pts recover within 24 hrs

23 Brown Recluse Spider

24 Spider Bites: Brown Recluse Spider  Severe bite results in necrosis and sloughing of skin with residual ulcer formation  Pathophysiology of bite: intravascular coagulation → formation of micro thrombi → capillary occlusion → hemorrhage → necrosis  Sxs include fever, nausea, vomiting, weakness, arthralgia, malaise, petechiae  Hemolysis and thrombocytopenia responsible for death

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27 Brown Recluse Spider  Tx: Early excision Corticosteroids Heparin Dapsone (reduces inflammation at site of venom injection)

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29 Scorpion Stings  Only the bark scorpion (centraroides exilicanda) medically important  Found mainly in the desert of Southwest  Venom is neurotoxic  Diagnosis reinforced by the “tap test”  Sxs include anxiety, blurred vision, or temporary blindness, dyspnea, wheezing, involuntary urination and defecation, SVT, SZ

30 Scorpion Stings  Tx: Airway management Treat arrhythmias and HTN if indicated Calcium gluconate for muscle spasms No narcotics (aggravate neurotoxic effects) Goat-derived antivenin available only in Arizona

31 Burns-Classification

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33 Rule of Nines

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35 Topical Treatment of Burns  Silver Nitrate Causes electrolyte imbalances (Na +, Ca +, Po4 -, Cl - ) No Pseudomonas sp. coverage Limited eschar penetration  Silvadene (Silver Sulfadiazine) Can cause neutropenia and thrombocytopenia Limited eschar penetration and ineffective against Pseudomonas sp Sulfa allergy  Sulfamylon (Mafenide Sodium) Carbonic anhydrase inhibitor Coverage against Pseudomonas sp Painful For burns over cartilage

36  Parkland Formula  Measure of adequate resuscitation  Escharotomy –(indication, timings)  Indications for Intubation  Complications after Burns (ulcer types)

37 Parkland Formula  For burns > 20%  4cc/kg x % body burn x 24 hrs  Give half in 8 hrs Parkland Formula

38  Measure of adequate resuscitation Urine Output  1cc/kg in adult and 2-4 cc/kg in peds  Escharotomy –(indication, timings) Circumferential burns Problem with ventilation with chest burns  Indications for Intubation Upper airway stridor or obstruction, hypoxemia,  Complications after Burns (ulcer types) Curling’s Marjolin’s


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