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