Shark bite

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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
  • Death is usually due to lack of prehospital resuscitation, hemorrhagic shock, or drowning

Differential Diagnosis

Marine toxins and envenomations

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, Staph, Strep species
    • Patients with abdominal injuries should be covered against enteric and anaerobic organisms

Disposition

See also

External Links

References