NBME Shelf Review (Part 4) – Environmental

Summary: <br> General Bite Wound Management<br> <br> <br> <br> * Irrigate thoroughly* Update tetanus* LOW RISK bites get sutured* High risk bites to cosmetic areas (face) get sutured AND antibiotics* High risk bites to non-cosmetic areas are left open AND get antibiotics<br> <br> <br> <br> Rabies<br> <br> <br> <br> * Give vaccine if… * ANY suspicion for bat bite (bat in room, cave, etc)* Bite by wild animal that can’t be monitored* Bite by domestic animal that develops symptoms during observation<br> <br> <br> <br> Black widow spider<br> <br> <br> <br> * Painful bite* Symptoms* Abdominal pain* Diaphoresis* Myalgias* Muscle spasms/cramping* Supportive care<br> <br> <br> <br> Pit Viper Bite<br> <br> <br> <br> * Causes Coagulopathy/DIC* Swelling around bite site* Treat with CroFab antivenin<br> <br> <br> <br> Brown Recluse Bite<br> <br> <br> <br> * Painless bite* Ulceration/necrosis around bite site<br> <br> <br> <br> Altitude Illnesses<br> <br> <br> <br> * Acute Mountain Sickness (AMS)* Headache* Nausea and vomiting* Treat with acetazolamide or decent* High Altitude Pulmonary Edema (HAPE)* Shortness of breath* Treat with supplemental oxygen and immediate decent* Consider nifedipine or sildefenil* High Altitude Cerebral Edema* Ataxia* Confusion* Cushings reflex* Bradycardia* Hypertension* Cheyne-Stokes respirations* Treat with supplemental oxygen and immediate decent* Consider dexamethasone<br> <br> <br> <br> Digit Amputation<br> <br> <br> <br> * Wrap in saline soaked gauze* Put in plastic bag* Place on ice* Send to surgeon<br> <br> <br> <br> Tooth avulsion<br> <br> <br> <br> * Reimplant tooth in socket* Place in glass of milk<br> <br> <br> <br> Frostbite<br> <br> <br> <br> * Remove wet clothing* Rewarm at body temperature<br> <br> <br> <br> Additional Reading<br> <br> <br> <br> * Rabies Prophylaxis <a href="http://www.emclerkship.com/rabies/">(EM Clerkship)</a><br>