Shark bite: Difference between revisions
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==Background== | ==Background== | ||
[[File:Great white.png|thumb|Great white shark]] | |||
[[File:Tiger shark.jpeg|thumb|Tiger shark]] | |||
*White shark (''Carcharodon carcharias''), tiger shark (''Galeocerdo curvier'') appear to be disposed to human attacks than other species | *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 | *Approximately 70-100 shark attacks worldwide per year and 5-15 deaths | ||
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*Massive tissue injury | *Massive tissue injury | ||
**Substantial tissue loss from stripping mechanism and extremity amputation are common | **Substantial tissue loss from stripping mechanism and extremity amputation are common | ||
*Hemorrhagic shock | *[[Hemorrhagic shock]] | ||
*Extremely high incidence of contamination with atypical microorganisms leading to soft tissue infections and necrosis | *Extremely high incidence of contamination with atypical microorganisms leading to [[Skin and soft tissue infections|soft tissue infections]] and necrosis | ||
**Most common organisms include ''[[Vibrio]]'' spp. | **Most common organisms include ''[[Vibrio]]'' spp. | ||
**Other potential organisms include ''[[Pseudomonas]]'', ''[[Staph]]'', ''[[Citrobacter]]'', '' | **Other potential organisms include ''[[Pseudomonas]]'', ''[[Staph]]'', ''[[Citrobacter]]'', ''Micrococcus'' | ||
*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 | ||
Revision as of 15:35, 8 September 2019
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 soft tissue infections and necrosis
- Most common organisms include Vibrio spp.
- Other potential organisms include Pseudomonas, Staph, Citrobacter, Micrococcus
- 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 indicated for all shark bites, even when minor