Shark bite
Background
Great white shark
Tiger shark
- 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
- Stingers
- Venomous fish (catfish, zebrafish, scorpion fish, stonefish)
- Nematocysts
- Coral reef
- Fire coral
- Jellyfish (Cnidaria)
- Portuguese man-of-war
- Sea anemones
- Seabather's eruption
- Phylum porifera (sponges)
- Bites
- Infections
- Vibrio species in saltwater
- Aeromonas species in freshwater
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
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