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)