B I T E W O U N D S Helena Ruotsalainen

F I R S T what animal ( human) ? when cleansing? wash immediately rabies possible? domestic / wild tetanus – booster ? 10 – 5 years surgery necessary? drugs (pain killers, antibiotics)

CAT ( DOG) BITES ( pets) pasteurella multocida ( canis) - pus forming cat bite more infections than dog bite hands, foot, face – deep/puncture wounds symptoms: swollen, red, lymphangitis, pus, deep to tendons, bone, abscesses, sepsis, big wounds or only superficial

C L E A N S I N G Clean/ tap water, soap water ( rabies) Sponge away visible dirt Irrigate with saline, syringe+needle to get under wound edges (but not deep/puncture wounds, penetrating injuries-dirt goes deeper- more complications)

T H E R A P Y Elevation ( hands, feet); reduces swelling Antibiotics: amoxicillin- clavulanic acid, sulfa-trimeth.+ gentamicin( clindamycin) Surgery? Remove devitalised tissue. No suture older than 8 hours. Wound clousure? Face- because cosmetical problem? Follow-up 48 hours for infection

C A T - S C R A T C H D I S E A S E (CDS) Bartonella Skin papule, lymphadenopathy begins after 1-2 weeks, may persist weeks. Overlying skin red, warm, tender Sometimes general infection ( endocarditis) If necessary: needle aspiration ( not incision) Antibiotics may help

R A T B I T E S (mice, gerbile) Streptobacillus ( gr negat.) Fever, rash, arthritis – no ulceration, no lympahadenopathy Complications: abscesses, heart, CNS Therapy: parenteral penicillin Wear gloves f.ex.at carbage work!

S N A K E B I T E S (bees, insect allergy) Poison: injury to capillaries, vasodilation, defects in blood coagulation) Swelling, pain, anaphylaxia, anuria Fluids leak from veins to tissues- hypovolemia, anuria Therapy: immobilisation, elevation, pain killers, antibiotics,methylprednisolon, tetanus Suspicion: follow-up 24 hours

A N A F Y L A X I A Adrenalin 1mg/ml 0.01ml/kg ad 0.5ml im Metylprednisolon 2mg/kg iv ad 120mg H Y P O V O L E M I A: fluids, oxygen Follow-up: weight, fluids in / out ( urine 2-3 ml/kg/h). After 2-3 days begins recovering: Fluids back to veins from issues ! Fluid volume – extra work to heart – possible lungoedema. Be careful with blood pressure/ weight/fluids / urine. Furesis may be needeed to get extra fluid out

R A B I E S ( v i r u s ) Rapidly progressive CNS manifestations Dogs:saliva, biting, licking, bats, via air in caves 5 steps: muscle cells-nerve cells-CNS-all over 1) incubation 5days-1 year (ca4-6weeks 2)prodromal symptoms 3) acute neurological 4) coma 5) death during 10 days Soap wash with brush, alcohol,vaccine, antiserum