Pediatric emergency medicine trisk 2032 2032
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incubation period with chills, fever, malaise, headache, and a maculopapular or
petechial rash. There are two forms: Haverhill fever (Streptobacillus moniliformis
) and Sodoku (Spirillum minus ), both of which are responsive to IV penicillin.
Another uncommon bacterium for which lagomorphs, particularly rabbits, are
hosts is Francisella tularensis. Tularemia is usually spread to humans by rabbit
bites, although contact with or ingestion of contaminated animals or insect
vectors is sufficient for transmission. Ulceroglandular tularemia is the most
common form of the disease. Tularemiais typically treated with gentamicin,
ciprofloxacin, or doxycycline. Streptomycin may be used but is no longer readily
available in the United States.
Serious infections from multiple bacteria, including osteomyelitis, sepsis,
endocarditis, and meningitis, have been reported as complications of mammalian
bite wounds. The risk of rabies or tetanus always must be considered in animal
bites.
Management
Meticulous and prompt local care of the bite wound is the most important factor
in satisfactory healing and prevention of infection. The wound should be
forcefully irrigated with a minimum of 200-mL normal saline. A 19-gauge needle
or catheter attached to a 30-mL syringe will supply sufficient pressure for wound
decontamination and will decrease the infection rate by 20-fold. Stronger irrigant
antiseptics—povidone-iodine, 20% hexachlorophene, alcohols, or hydrogen
peroxide—may damage wound surfaces and delay healing. Soaking in various
preparations has not proved helpful in reducing infections.
Most open lacerations from mammalian bites can be sutured if local care is
provided within several hours of the injury and good surgical technique is used.
Facial wounds often mandate primary closure for cosmetic reasons and, overall,
are low infection risks because of the good vascular supply. If there is a high risk
of infection such as in hand bites, the emergency provider may elect to allow the
wound to close by secondary intention or by delayed primary closure. In large
hand wounds, hemorrhage should be carefully controlled. We suggest closing the
subcutaneous dead space in these wounds with a minimal amount of absorbable
suture material. Cutaneous sutures can then be placed after 3 to 5 days if there is
no evidence of infection.
Extremities with extensive wounds should be immobilized in a position of
function and kept elevated as much as possible. This is especially true of hand
wounds, which should have bulky mitten dressings and be supported by an arm
sling. All significant wounds should be rechecked in follow-up within 24 to 48
hours.
