NBME Shelf Review (Part 4) – Environmental

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)