Trauma Surgery [BITES AND STINGS]

1) Rabies
Rabies must be considered when any animal bite has occurred. Animal Bite
What’s done with the animal and the person depends on risk Domesticated Animal and Provoked à Observe
associated with the animal. If a domesticated animal is Wild Animal à Kill + Biopsy
provoked (a little girl pulls a dog’s tail), just observe the animal. Unavailable or Bx à IgG +Vaccine
If it’s an unprovoked attack (signs of rabies) or is a wild animal Bx à Observe
the index of suspicion goes up. Wild animals usually run. The
animal needs to be captured and killed so we can look for signs
of rabies in the brain biopsy. If Rabies or the animal is
unavailable (nutty squirrel attacks and flees) give rabies ppx
(vaccine + IgG). If no signs, then you just do nothing.

2) Bee Stings
In any regular person bee stings hurt and the pincer may need to
be removed. End of story. Allergic people go into anaphylaxis Bee Stings
(warm, flushed, wheezing, stridor) and require vasopressor Normal: remove pincer, treat pain
support with 1:1000 IM Epinephrine. This is a form of Anaphylaxis: IM 1:1000
vasomotor shock. Adjunct treatment involves histamine
antagonists (H1 and H2) and systemic steroids.

3) Snakebite
Snakes may be venomous or not. A venomous snake can
envenomate or not. Those that are venomous will have danger Snakebite
features: slit-like eyes, rattlers, cobra cowl. They should prompt Danger: Slit-Like Eyes, Cobra Cowl, Rattlers
anti-venom treatment. Young snakes can’t control their venom Pt: Erythema, Skin Changes, Pain at site
and are more dangerous. If the snake can’t be identified, look for Tx: Anti-venom IV, Ø Tourniquet/Cut/Suck
signs of toxin (erythema, skin changes, and pain). Movies show
cutting, sucking, and tourniquetting - those are delay measures
that are NOT done in the hospital. We’re providing treatment and
operating if necessary.

4) Black Widow Bites

If the patient sees a black spider with an hourglass on the belly Black Widow
(highly unlikely to see it and get bit) and then has abdominal Danger: Black Spider with Hourglass Belly
pain or pancreatitis it was a black widow. Give IV Calcium Pt: Abdominal Pain, Pancreatitis
Gluconate to stabilize muscles. Tx: IV Calcium Gluconate

5) Brown Recluse
If a patient is going through an attic or old boxes (especially in
the south) and gets bit by “something” think brown recluse. The Brown Recluse
patient will be asymptomatic for the first day. The next day there Danger: Attic, Boxes and Ulcer at Bite site
is a small ulcer. This is the time to act. Necrotic ulcers with a Pt: Necrotic Ulcer with Ring of Erythema
ring of erythema at the bite site is brown recluse. A wide Tx: Wide debridement, grafts
debridement will need to be done. Continue to monitor as the
toxin goes to work over about a week. Skin grafts will be placed
after the fact.

6) Human Bites
Human bites that break skin are some of the dirtiest wounds Human Bites
possible. Be it sexual endeavors or a fist fight (knuckle on Danger: Sexual Endeavor, Fist Fight, Zombies
tooth), there’s likely a cover story. The patient needs surgical Pt: Laceration only, cover story
exploration and massive irrigation. Antibiotics are used if there’s Tx: Wash, abx and drain if abscess
an ugly wound. Use Amoxicillin-Clavulanate. Give a Tetanus
shot if it’s been >5 years since the booster.

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