Posted by nidhi from IP 69.142.119.10 on February 01, 2006 at 05:44:35:
In Reply to: To nidhi posted by Crush it on January 31, 2006 at 19:40:10:
I. A neighbor is bitten by house-dog who received rabies immunization within last year.
Necessary points to remember in case of animal bites:
a. Rabies prophylaxis
b. Tetanus prophylaxis
c. Wound prophylaxis for infection
d. Keep in mind osteomyelitis: animal teeth are sharp and can dig down to the bone
Hence:
a. Ask about tetanus immunization status and proceed as follows
If w/in last 5 yrs nothing needed
If w/in last 5-10 yrs tetanus toxoid booster, 1 shot
More than 10 yrs/immunization status not known: tetanus immunoglobulin and full series of toxoid: one now, two others 6wks & 6mths apart.
b. Wound cleaning/irrigation with NS no closure/suturing
(i) If multiple/on face/hands/feet/joint then amox.-clavulanate oral for 10-14days
(ii) Otherwise schedule follow-up in 2-3 days time to check for wound infection / development of s/s of osteomyelitis if near bone/joint.
Osteomyelitis suspected (swelling, oozing, ulcer track- probe to see): do bone scan (x-ray will not be + at this point), then anti-staph antibiotic for 6-8wks.
c. Watch & report if dog has erratic behavior / unprovoked biting: chances slim because q-vignette says house-dog & vaccinated but better off on the other side.
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II Woman in ED with breast-bite occurring during sexual activity
1. Clean & irrigate wound with NS, cover w/ soft pad if irritation from clothing occurs.
2. Amox.-clavulanate : orally for 10-14days
(Even w/o s/s of infection because human saliva has bacteria: staph, strep, anaerobes)
3. Counsel for antibiotic adherence
4. Schedule office follow-up in 10 -14 days time to check wound healing
PLEASE POINT OUT ALL/ANY MISTAKES VISIBLE.
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Also, THANKS A LOT crush it for helping by posting cases.
IF time is not a constraint, I would REALLY appreciate if you could keep posting 1-2 cases everyday. This helps me practice which I have thought of doing every morning practice like real exam. Otherwise I am backlogged with MCQs itself considering my situation. I take my exam in Feb. end whatever the outcome but will definitely not fail from trying my best from my end.