General Bite Wound Management

* 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

Rabies

* 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

Black widow spider

* Painful bite* Symptoms* Abdominal pain* Diaphoresis* Myalgias* Muscle spasms/cramping* Supportive care

Pit Viper Bite

* Causes Coagulopathy/DIC* Swelling around bite site* Treat with CroFab antivenin

Brown Recluse Bite

* Painless bite* Ulceration/necrosis around bite site

Altitude Illnesses

* 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

Digit Amputation

* Wrap in saline soaked gauze* Put in plastic bag* Place on ice* Send to surgeon

Tooth avulsion

* Reimplant tooth in socket* Place in glass of milk

Frostbite

* Remove wet clothing* Rewarm at body temperature

Additional Reading

* Rabies Prophylaxis (EM Clerkship)