Shark bite

Background

• White shark (Carcharodon carcharias), tiger shark (Galeocerdo curvier) appear to be disposed to human attacks than other species
• Approximately 70-100 shark attacks worldwide per year and 5-15 deaths

Clinical Features

• Direct traumatic effects depend on size and species of shark
• Typically, attack appendages of victims
  • In 70% on surface swimmers, only the lower limb is involved
  • Upper limb may be injured when the victim attempts to fight off the attack
• Massive tissue injury
  • Substantial tissue loss from stripping mechanism and extremity amputation are common
• Hemorrhagic shock
• Extremely high incidence of contamination with atypical microorganisms leading to wound infections
• Death is usually due to lack of prehospital resuscitation, hemorrhagic shock, or drowning

Evaluation

• Plain radiographs of all injured areas to identify fractures, periosteal stripping, retained foreign bodies (e.g. teeth)
• Wound cultures

Management

• Abrasions and small puncture wounds can be treated with thorough irrigation and topical antibiotics
• Devitalized tissue should undergo debridement and copious irrigation
  • Most injuries require debridement and repair in OR
• Prophylactic antibiotics
  • Coverage against Vibrio, Staph, Strep species
  • Patients with abdominal injuries should be covered against enteric and anaerobic organisms