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Chapter 1 Index
A. General Information
about the well child examination B. Nutrition Issues
C. Sleep Issues
D. Dental Issues
E. Anticipatory Guidance
--Discipline: Normal
Toddlers
--Discipline: To Spank
or Not to Spank
--Toilet Training: or Once Upon a Potty
--Reach Out and Read
--Anticipatory Guidance: Other Items to Ask
Birth – 6 years of age
--Smoking: Adverse
Effects on Children
--What’s New in Car Seats in 2002
--Water Safety: Prevention and Treatment of
Drowning
--Common Accidents
--The Problems Associated with Walkers
--Toys: Choosing Safe Toys - Playing is Learning
--Cats and Dogs: Medical Issues |
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Management of
Bites (NEJM 99;340:85-93)
(1997
Redbook)
I.
Introduction: One problem
that is often difficult to solve in practice is how bites should be
handled. Each year in the US there are 4.7 million dog bites; 400,000 cat
bites; 250,000 human bites. Infections after bites: 50% after cat; 10-15%
after human and dog bites. The following approach updates the approach we
should be using:
II. Management of
wounds: In general wounds
should be left open if they are:
- punctures rather than lacerations,
- are not
potentially disfiguring,
- are
inflicted by humans,
- involve
the legs and arms (particularly the hands) as opposed to the face, or
- occurred
more than 6-12 hours earlier in the case of bites to arms and legs, and
12-24 hours earlier in the case of bites to the face. Facial lacerations
are usually closed.
| 1. Local care to the wound |
copious irrigation; |
| |
debridement: be cautious
near the face |
| 2. Suturing |
do not use subcutaneous
sutures on the face |
| 3. Use of antibiotics |
|
|
|
|
| A. Prophylactic antibiotics |
controversial- not given
routinely, but for high risk wounds |
| B. Which antibiotic? |
depends on microbiology: |
| Organisms responsible |
| A. Aerobes (36% ) |
pasteurella |
Strep |
Staph |
moraxella |
| B. Anaerobes (1%): |
fusobacterium |
Bacteroides |
Prevotella |
|
| C. Mixed (56%): |
|
|
|
|
| D. No growth (7%) |
|
|
|
|
| Treatment: aim at
pasteurella, strep staph and anaerobes |
| Pasteurella sensitivity |
ampicillin |
Penicillin |
Ceph-2/3rd doxycycl |
(not first generation
cephalosporins, erythromycin or clindamycin)
use: augmentin |
|
|
|
|
| 4. Use of tetanus |
give tet immune globulin
and toxoid to all children who have not had more than 2 shots |
| |
give toxoid to all
children who have not had tetanus in last 5 yrs |
| 5. Use of rabies vaccine |
see red book |
| |
If no previous
vaccination: 5 doses rabies vaccine deltoid, and rabies immune globulin
(20 IU per kg) |
| |
Use rabies vaccine if bat in the room |
| Human Bites: must also
worry about HIV, Hep B and syphilis |
| Cat Scratch: look for papule; Indirect Fluorescent Ab, EIA to Bart.
Henselae |
III. Conclusion: You will be asked to see many minor
injuries in your practice including dog, cat and human bites. If you suture
in your office, be aware that these children need close follow-up in order
to make sure that they don’t develop deep infections.
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