Shark bite: Difference between revisions
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*Extremely high incidence of contamination with atypical microorganisms leading to wound infections | *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 | *Death is usually due to lack of prehospital resuscitation, hemorrhagic shock, or drowning | ||
==Differential Diagnosis== | |||
{{Marine envenomation DDX}} | |||
==Evaluation== | ==Evaluation== | ||
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**Coverage against ''Vibrio'', ''Staph'', ''Strep'' species | **Coverage against ''Vibrio'', ''Staph'', ''Strep'' species | ||
**Patients with abdominal injuries should be covered against enteric and anaerobic organisms | **Patients with abdominal injuries should be covered against enteric and anaerobic organisms | ||
==Disposition== | |||
==See also== | |||
*[[Marine toxins and envenomations]] | |||
==External Links== | |||
==References== | |||
Tintinalli, J. E., & Stapczynski, J. S. (2011). ''Tintinalli's emergency medicine: A comprehensive study guide.'' New York: McGraw-Hill. pp. 1359. | |||
[[Category: Environmental]] | |||
Revision as of 19:16, 5 September 2017
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
Differential Diagnosis
Marine toxins, envenomations, and bites
- Toxins
- Ciguatera
- Scombroid
- Tetrodotoxin (e.g. pufferfish)
- Shellfish poisoning
- Amnesic shellfish poisoning
- Diarrheal shellfish poisoning
- Neurotoxic shellfish poisoning
- Paralytic shellfish poisoning
- Stingers
- Venomous fish
- Cone shell
- Lionfish
- Sea urchins
- Crown-of-Thorns Starfish
- Stonefish
- Other: Catfish, zebrafish, scorpion fish
- Nematocysts
- Coral reef
- Fire coral
- Jellyfish (Cnidaria)
- Portuguese man-of-war
- Sea anemones
- Seabather's eruption
- Phylum porifera (sponges)
- Bites
- Infections
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
Disposition
See also
External Links
References
Tintinalli, J. E., & Stapczynski, J. S. (2011). Tintinalli's emergency medicine: A comprehensive study guide. New York: McGraw-Hill. pp. 1359.