Shark bite: Difference between revisions

 
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==Background==
==Background==
* White shark (''Carcharodon carcharias''), tiger shark (''Galeocerdo curvier'') appear to be disposed to human attacks than other species
[[File:Great white.png|thumb|Great white shark (#1 most fatal unprovoked attacks).]]
[[File:Tiger shark.jpeg|thumb|Tiger shark (#2 most fatal unprovoked attacks).]]
[[File:Bullshark Beqa Fiji 2007.jpg|thumb|Bull shark (#3 most fatal unprovoked attacks).]]
*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


==Clinical presentation==
==Clinical Features==
[[File:PMC2211397 pone.0001495.g002.png|thumb|Healed thigh many years after a shark attack.]]
*Direct traumatic effects depend on size and species of shark
*Direct traumatic effects depend on size and species of shark
*Typically, attack appendages of victims  
*Typically, attack appendages of victims  
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**Upper limb may be injured when the victim attempts to fight off the attack
**Upper limb may be injured when the victim attempts to fight off the attack
*Massive tissue injury
*Massive tissue injury
*Substantial tissue loss and extremity amputation 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 wound infections
*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.
**Other potential organisms include ''[[Pseudomonas]]'', ''[[Staph]]'', ''[[Citrobacter]]'', ''Micrococcus''
*Death is usually due to lack of prehospital resuscitation, hemorrhagic shock, or drowning
 
==Differential Diagnosis==
{{Marine envenomation DDX}}
 
==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
**Coverage against ''[[Vibrio]]'' ([[doxycycline]]), ''[[Staph]]'', ''[[Strep]]'' species
**Patients with abdominal injuries should be covered against enteric and anaerobic organisms
 
==Disposition==
 
 
==See also==
*[[Marine toxins and envenomations]]
 
==External Links==
 
 
==References==
<references/>
 
[[Category: Environmental]]
[[Category:Trauma]]

Latest revision as of 20:31, 11 March 2021

Background

Great white shark (#1 most fatal unprovoked attacks).
Tiger shark (#2 most fatal unprovoked attacks).
Bull shark (#3 most fatal unprovoked attacks).
  • 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

Healed thigh many years after a shark attack.
  • 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
  • Death is usually due to lack of prehospital resuscitation, hemorrhagic shock, or drowning

Differential Diagnosis

Marine toxins, envenomations, and bites

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
    • Coverage against Vibrio (doxycycline), Staph, Strep species
    • Patients with abdominal injuries should be covered against enteric and anaerobic organisms

Disposition

See also

External Links

References