CC Jan 2016 Human bite wounds

echoecho's version from 2016-03-20 15:51


Question Answer
Which part of the body do most human bite wounds occur on?the hands
When does the "fight bite" occur?a clenched fist injury that happens after the patient strikes another person in the mouth
These injuries have a high likelihood of what?infection (up to 50%)
Which gender are more likely to have clenched first bite wounds?men
One study found an association of clenched fight bite wounds associated with what use and on what part of the week and part of the year?1) alcohol use 2) weekends 3) holidays
Why are fight bites difficult to assess?1) with the hand in full flexion (fist), puncture injuries over the metacaralphalangeal (MCP) joints with penetration into the joint may occur 2) with extension of the MCP joint, however, the tendon and visible puncture site may retract and LESSEN the clinician's concer for joint injury and the risk of associated septic arthritis
Fight bits should prompt a higher level of ______ and require greater _____?suspicion; investigation
Define occlusional bites?bites in which the assailant's teeth close on the victim's skin.
Infection risks are much ______ (lower vs. higher) but vary based on locationlower
Occlusional bites in young children are commonly occur on what part of the body?on exposed surfaces (face, upper extremities) and are inflicted by other children
If there is an intercanine distance of > 3 cm, this suggests what?child abuse
When are radiographs indicated?1) when there is a concern about injury to bones, joints and presence of foreign body (example = tooth)
What tests may be elevated in the presence of infection, but normal values do NOT rule out infection and the studies are not required?CBC, CRP, ESR
Should recent, uninfected bite wounds be cultured?no
Should infected bite wounds be cultured? Why?1) yes 2) because aerobic and anaerobic cultures are common contaminants
True or false? Wound cultures rarely influence antibiotic selection or affect outcomes?true
List the aerobe pathogens from human bite wounds?1) Streptococcus species 2) Staphylococcus species 3) Eikenella corrodens 4) Haemophilus species
List the anaerobe pathogens from human bite wounds?1) Prevotella species 2) Fusobacterium species 3) Veillonella species 4) Peptostreptococcus species
List the other pathogens from human bite wounds?1) hepatitis B virus 2) HIV 3) Candida 4) hepatitis C virus
One study showed the median number of pathogens per injury is what?4 (one anaerobic and three aerobic)
What pathogens are rarely isolated from cultured bite wounds?1) mycobacterium 2) fungi
Although far less frequent, what pathogens also pose a threat?viral pathogens
What pathogens may occur through blood present in the saliva?hepatitis B and C, HIV
Serologic testing for hep B and hep C and HIV is recommended with what follow-up testing?in 6 weeks, 3 months and 6 months
***Only if the wound was the result of contact with a person known to be hepatitis B or HIV positive is post-exposure _________ recommended?prophylaxis
When assessing the risk of infection, why is the anatomic location of bite wounds taken into consideration?because those on the hands or close to bones or joints are at a GREATER risk for infection and disability (including cellulitis, abscesses, tenosynovitis, septic arthritis, osteomyelitis and disseminted infection)
Why are bite wounds inflicted by children considered lower risk of causing an infection?because they have lower bacterial load in their mouths and their weaker mucles of mastication
What is the cornerstone of initial treatment?general wound care (exploration, cleansing, irrigation, debridement of devitalized tissue)
What treatment is particularly critical?high-pressure irrigation with saline
Associated deep tissue (neurovascular and/or musculoskeletal) injury should be managed how?accordingly
*** Patients who have not had a tetanus immunization in the last ___ years should receive a booster immunization?5
Those who have not completed a primary series should be placed in a recall system, why?to ensure full immunization is achieved
Why is safety wound closure controversial?the concern that suturing thse wounds may facilitate microbial growth
When is primary closure of UNINFECTED bite wounds considered?1) simple wounds of the extremities and trunk (excluding hands and feet) that are < 6 hours old 2) simple wounds of the head and neck < 12 hours old 3) simple facial wounds < 24 houts old
Why is infection less likely on the face?because of the excellent blood supply of the face
Closure with what type of suture material is preferred?nonabsorbable percutaneous sutures
Should skin adhesives be used for closure?no
Wounds older than 24 hours or those on the hands and feet are treated how?1) debridement 2) wet to dry dressing 3) observation
*** Prophylactive antibiotics for 5-7 days are indicated for any human bite < _____ hours old that penetrates the epidermis? 72
List the recommended antibiotic prophylaxis for human bite wounds?1) PREFERRED REGIMEN = Amoxicillin-clavulanate (Augmentin ) = Adult dose is 875/125 mg BID and Pediatric dose is 20 mg/kd of the Amoxicillin component BID 2) ALTERNATIVE REGIMENS = Clindamycin = Adult dose 450 mg TID and Pediatric dose is 10 mg/kg/dose TID OR Metronidazole = Adult dose 500 mg TID and 10 mg/kg/dose TID PLUS Trimethoprim-sulfamethoxasole (Bactrim DS) = Adult dose 1 double strength tablet BID and Pediatric dose 4-5 mg/kg of trimethoprim component BID OR Moxifloxacin (Avelox) = Adult dose 400 mg daily and Pediatric dose not recommended < 18 years OR Cefuroxim (Ceftin) = Adult dose 500 mg BID and Pediatric dose 15 mg/kg/dose BID OR Doxycycline (Vibramycin) = Adult dose 100 mg BID and Peditric dose not recommended < 8 years OR Ciprofloxacin (Cipro) = Adult 500-750 mg BID and Pediatric dose not recommended < 18 years
What medication is the preferred medication for human bite wounds?Amoxicillin-clavulanate
True or false? Prophylactic antibiotics result in a statistically significant reduction in the rate of infection in hand bites (odds ratio 0.10, 95% confidence interval 0.01 to 0.86 and number needed to treat = 4, 95% CI 2-50)?true
Why is hospitalization helpful for patients with systemic signs and symptoms, frank local infection or deep tissue damage (auricular cartilage, tendon, bone or joint injury)?1) provide parenteral antibiotics 2) immobilization / elevation of the affected body part 3) frequent application of moist heat
List the IV antibiotic choices?1) ampicillin / sulbactam (Unasyn) 2) Cefoxitin (Mefoxin) 3) ticarcillin / clavulanate (Timentin) 4) piperacillin / tazobactam (Zosyn)
Consultation with whom is helpful in managing complicated injuries and aesthetics?Ortho or plastic surgery
If a patient with minimal signs of infection is treated on an outpatient basis (using the same medications used for prophylaxis until an organism is identified), close monitoring for at least _____ days is required?five
*** SUMMARY = True or false? Human bite injuries to the hands have a high risk of infection ( > 50%)?true
*** SUMMARY = Bacterial infections are complex with what multiple organisms?aerobic and anaerobic
*** SUMMARY = Prophylactic antibiotic coverage with what medication is recommended for bits that penetrate the epidermis?amoxicillin-clavulanate (Augmentin)
*** SUMMARY = Bite injuries over the metacarpal-phalangeal (MCP) joints carry a high risk of what?septic arthritis