text
stringlengths 0
99
|
|---|
(A from Classen DC, Evans RS, Pestotnik SL, et al. |
N Engl J Med. |
1992;326:281- |
286. |
B from Steinberg JP, Braun BI, Hellinger WC, et al. |
Ann |
Surg. |
• The primary insult from a burn is the wound itself. |
The total burn size is typi- |
cally less than 10% of total body surface area (TBSA) in 72% of cases. |
Department of the Army, the U.S. |
Department of Defense, or |
the federal government. |
The author is an employee of the U.S. |
government, and this work was performed |
as part of official duties. |
487 |
238 Bites |
Ellie J. |
C. |
Goldstein and Fredrick M. |
DIAGNOSIS |
• The diagnosis is made by the patient’s reported history of events. |
• Plain radiographs should be obtained if there is a high likelihood of bony injury. |
THERAPY |
• Irrigate wounds with copious amounts of normal saline. |
• Cautiously débride devitalized or necrotic tissue. |
Follow rabies guidelines for details on management of bites that |
carry a risk of rabies. |
Culture |
Aerobic and anaerobic cultures should be taken from infected wounds. |
Irrigation |
Copious amounts of normal saline should be used for irrigation. |
Débridement |
Devitalized or necrotic tissue should be cautiously débrided. |
Wound Closure |
Primary wound closure is not usually advocated. |
For larger wounds, edges may be approximated with |
adhesive strips in selected cases. |
Immunizations |
Provide tetanus and rabies immunization, if indicated. |
Elevation |
Elevation may be required if any edema is present. |
Lack of elevation is a common cause of therapeutic |
failure. |
Reporting |
Reporting the incident to a local health department may be required. |
bid, two times a day; PO, orally; qid, four times a day; tid, three times a day. |
• Provide t etanus and rabies immunization, as indicated. |
TABLE 238-1 Management of Bite Wounds—cont’d |
490 |
D Zoonoses |
239 Zoonoses |
W. |
Ian Lipkin |
DEFINITION |
• A zo onosis is an infectious disease of humans that originates in animals. |
DIAGNOSIS |
• The m ajority of zoonotic diseases are diagnosed using molecular methods. |
Thus, treatment is primarily supportive. |
In contrast, many |
bacterial zo onoses can be treated with antibiotics. |
PREVENTION |
• Vaccines are established for only a minority of zoonotic diseases. |
491 |
E Protection of Travelers |
240 Protection of Travelers |
David O. |
Ascertain which is best suited to the individual patient and |
itinerary. |
• E ducate on personal protection against arthropods. |
TRAVELER’S DIARRHEA |
• R ecommend food and water precautions. |
493 |
241 Infections in Returning Travelers |
David O. |
• Is malaria possible? |
If there is end-organ damage, initiate empirical therapy. |
• Are there localizing findings? |
Go to syndromic approach and differential diagnosis. |
• Are there no localizing findings? |
see Antiretroviral therapy (ART). |
aeruginosa, 34t-36t |
for pertussis, 339 |
for SFG rickettsioses, 258 |
for trachoma, 250 |
without P. |
see Bronchoalveolar lavage (BAL). |
see Banna virus (BAV). |
Benzathine penicillin |
for S. |
see Catheter-associated urinary tract infection |
(CA-UTI). |
see Chronic fatigue syndrome (CFS). |
see Cardiovascular implantable |
electronic device (CIED) infections. |
characteristics of, 362, 363t |
other diseases associated with, 362 |
Clostridium tetani, 360 |
CMV. |