Dog bites can cause extensive tissue damage and infection with pasteurella, staph, strep, and Capnocytophaga species.
Typically have a ragged, torn appearance.
Infected bites may become erythematous, swollen, and tender
Clinical diagnosis based on history/physical exam
Wound irrigation with or without closure.
Rabies and tetanus prophylaxis. Consider antibiotics (ex. Augmentin) for high-risk wounds.
Most patients can be discharged with antibiotics and follow-up in 24-48 hours for wound check.
If concern for rabies, patient will need to return on days 3, 7, and 14 for repeat vaccinations.
In general, these wounds should be left open to heal via secondary intention if able.
Rabies is extremely rare in domesticated animals. If a domesticated, healthy appearing dog bit the patient and is able to be observed for 10 days for signs of rabies, then rabies post exposure prophylaxis is not immediately needed.
Heat stroke is an abnormal elevation in core body temperature leading to altered mental status and organ dysfunction. It can be either nonexertional (e.g. elderly, drug abuse, prescription medication) or exertional (heavy exercise often in the young, healthy patient).
CNS dysfunction (confusion, delirium, seizure) is a hallmark sign
Temperature > 40° C (104 ° F), tachycardia, tachypnea
Differentiated from heat exhaustion by presence of CNS dysfunction and temperature > 40° C
Aggressive cooling (cold water immersion, evaporative cooling).
Manage associated conditions, such as dehydration, rhabdomyolysis, and acute kidney injury
True heat stroke will require admission, possibly to the ICU if persistent hypotension or AMS.
Once the patient’s core temperature has been reduced down to 100.4 degrees F, reduce cooling efforts to prevent hypothermia.
If the cause of the heat stroke is not obvious, consider other etiologies (sepsis, thyroid storm, serotonin syndrome, neuroleptic malignant syndrome, etc.)
Snake envenomation (bite from a poisonous snake) can cause a wide range of symptoms from mild to life-threatening.
Crotalid (e.g. Pit Viper) bites cause hemotoxic symptoms, such as bleeding, local swelling and bruising, as well as systemic symptoms, including vomiting, confusion and shock.
Elapid (e.g. coral snake) envenomation can cause neurotoxic symptoms, such as cranial nerve weakness, paresthesias, difficulty swallowing or respiratory depression.
Clinical diagnosis; based on positive identification of snake and signs/symptoms of envenomation
Supportive care (remove jewelry, wrap wound loosely, immobilize at heart level). Antivenom is indicated for any moderate-severe symptoms
Manage hypotension, allergic reactions/anaphylaxis, and monitor for compartment syndrome
Admission required for patients requiring antivenom or those bit by elapids (needs 24 hour observation)
If “dry bite” or no signs of envenomation after 6-8 hours of observation, patients may be discharged with follow up in 24 hours.
Many prehospital treatments (ex. tourniquets, electricity, suction devices, cutting) are harmful and have not been shown to be effective.
Identification of the snake is key for proper treatment. Pit vipers tend to have a triangular head, elliptical pupils, and heat sensing plates between the eyes and nose. Elapids have narrow heads with round pupils.