Shark Related Injuries: A Case Series of Emergency Department Patients

Tomberg, Ryan J.; Cachaper, Girlyn A.; Weingart, Gregory S.

doi:10.1016/j.ajem.2018.06.059

Cited by 7 publications

(9 citation statements)

References 8 publications

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“… 107 Commonly affected populations include males, Whites, and those of middle age. 108 Presentation often involves the legs (41.8%) and arms (18.4%), with limb loss documented in 7% of attacks. 107 However, most patients sustain only minor injuries that can be primarily repaired.…”

Section: Methodsmentioning

confidence: 99%

Practical Review of the Management of Animal Bites

Savu

Schoenbrunner

Politi

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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Background: Animal bites are common worldwide. Due to the plethora of animals, there are diverse pathogens with specific associated risks and treatment algorithms. It is crucial to understand these to develop and execute appropriate management plans. This practical review was designed to amalgamate the most common bites worldwide and synthesize data to help guide treatment plans. Methods: A PubMed literature search was performed focusing on the major animal bites. High-level studies were preferred and analyzed but lower-level studies were also used if high-level studies did not exist. Results: The tables presented in this article cover the pertinent information regarding the incidence, common presentation, initial treatment, and potential complications associated with bites from dogs, cats, horses, rodents, snakes, marine life, and spiders. Many of the pathogens associated with the bites are treatable with various and somewhat common antimicrobials, though some are less easy to access. Basic irrigation, debridement, and wound culture are common to almost every animal and should be the first step in treatment. Conclusions: Based on the current studies, the most important factor in treating animal bites is timely presentation to a medical facility and/or physician. It is critical that the offending animal be accurately identified to help guide medical and surgical algorithms, including specific antimicrobial treatment guided by the most commonly presenting pathogens specific to certain animals.

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Section: Methodsmentioning

confidence: 99%

Practical Review of the Management of Animal Bites

Savu

Schoenbrunner

Politi

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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“…Prior studies on SRIs have either used three large independent databases (the Global Shark Attack File (GSAF), the International Shark Attack File (ISAF), or the South African Shark Attack File), 3–5 compared shark attack databases with local medical records (Virginia, USA, 6 and La Réunion Island, France 7 ), or presented individual case reports in South Africa 8 and Mexico/Canada. 9 In the few studies that have identified the shark species implicated in SRIs, the majority were caused by the great white shark ( Carcharodon carcharias ) in South Africa 5 and by the bull shark ( Carcharhinus leucas ) in La Réunion Island, France.…”

Section: Introductionmentioning

confidence: 99%

Shark-related injuries in Hawai’i treated at a level 1 trauma center

Scala

Hayashi

Kaneshige

et al. 2020

Trauma Surg Acute Care Open

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BackgroundAlthough rare, human–shark interactions can result in a wide spectrum of injuries. This is the first study to characterize shark-related injuries (SRIs) in Hawai’i.MethodsThis is a retrospective review of the State of Hawai’i Division of Aquatic Resources Shark Incidents List between January 1, 2009 and December 31, 2019. Trauma registry data and medical records of patients treated for SRIs at the only level 1 trauma center in Hawai’i were reviewed.ResultsSixty-one patients sustained SRIs in the Hawaiian Islands: 25 in Maui, 16 in O’ahu, 12 in Hawai’i, and 8 in Kaua’i. In cases where the shark species could be identified, tiger sharks were the most frequent (25, 41%). Four cases were fatal—all died on scene in Maui with the shark species unknown. Forty-five survivors (79%) received definitive care at regional facilities. Twelve (21%) were treated at the level 1 trauma center, of which two were transferred in for higher level of care. Of the 12 patients, 11 (92%) had extremity injuries, with 3 lower extremity amputations (25%), 2 with vascular injuries (17%), and 5 with nerve injuries (42%). One had an injury to the abdomen. All patients had local bleeding control in the prehospital setting, with 9 (75%) tourniquets and 3 (25%) hemostatic/pressure dressings applied for truncal or proximal extremity injuries. The mean time from injury to emergency department arrival was 63 minutes.DiscussionMost SRIs are managed at regional facilities, rather than at a level 1 trauma center. Prehospital hemorrhage control is an important survival skill as time to definitive care may be prolonged. For cases treated at the level 1 trauma center, nerve injuries were common and should be suspected even in the absence of major vascular injury. Correlating shark behavior with observed injury patterns may help improve public awareness and ocean safety.Level of evidenceLevel V, epidemiological.

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“…[1][2][3][4] Therefore, victims of shark-related injuries involving shark bites require treatment for the prevention of infections caused by the transfer of pathogenic bacteria. 5,6 A review of 11 recent shark-related injuries in the USA indicated that only three of the reviewed patients received an appropriate selection of antibiotics for treatment of infection (using ciprofloxacin), and none of the reviewed patients received dual antibiotic therapy. 5 An earlier review of 83 shark-related injuries in South African waters could only confirm that 18 of the reviewed patients received any antibiotic treatment (using a variety of different antibiotics), and three of these patients continued to develop septic complications that required further surgical intervention.…”

Section: Introductionmentioning

confidence: 99%

“…5,6 A review of 11 recent shark-related injuries in the USA indicated that only three of the reviewed patients received an appropriate selection of antibiotics for treatment of infection (using ciprofloxacin), and none of the reviewed patients received dual antibiotic therapy. 5 An earlier review of 83 shark-related injuries in South African waters could only confirm that 18 of the reviewed patients received any antibiotic treatment (using a variety of different antibiotics), and three of these patients continued to develop septic complications that required further surgical intervention. 6 Currently, there is no consensus on the most appropriate antibiotics to be used in treating bacterial infections resulting from shark-related injuries due to large differences in the composition of bacterial microbiota present among different shark species and their geographical locations.…”

Section: Introductionmentioning

confidence: 99%

“…6 Currently, there is no consensus on the most appropriate antibiotics to be used in treating bacterial infections resulting from shark-related injuries due to large differences in the composition of bacterial microbiota present among different shark species and their geographical locations. 4,5 Therefore, further information is needed on the antibiotic resistance of bacteria present in the oral cavities of different shark species from different regions of the world that might be responsible for shark-related injuries in humans.…”

Section: Introductionmentioning

confidence: 99%

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Antibiotic sensitivity of bacteria isolated from the oral cavities of live white sharks (Carcharodon carcharias) in South African waters

Gennari¹,

Kock²,

Smale³

et al. 2019

S. Afr. J. Sci.

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The white shark (Carcharodon carcharias) is responsible for 49% of shark-related injuries in South Africa, yet no information currently exists on the composition or antibiotic resistance of bacteria hosted by these apex predators in South African waters. This study aimed to address this gap by sampling the bacteria present in the oral cavities of 28 live C. carcharias along South Africa’s southern coastline. The antibiotic resistance of the range of microbiota was also assessed using antibiotic disc diffusion tests. A total of 51 strains from at least 20 species of bacteria were isolated from the oral cavities of C. carcharias. Of these strains, the most common bacteria present were Serratia spp., Proteus vulgaris and Vibrio alginolyticus. The overall antibiotic resistance was relatively higher in this study than that reported for bacterial microbiota sampled from other shark species. Results indicate that the combination therapy of imipenem (carbapenem antibiotic) and vancomycin (glycopeptide antibiotic) might be the most parsimonious option to effectively treat infections resulting from white shark bites, particularly in South Africa. It is hoped that, in addition to assisting medical professionals to treat shark bite victims, these findings enhance the understanding of the microbial communities present in large coastal predators and their surrounding environments.

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Shark Related Injuries: A Case Series of Emergency Department Patients

Cited by 7 publications

References 8 publications

Practical Review of the Management of Animal Bites

Practical Review of the Management of Animal Bites

Shark-related injuries in Hawai’i treated at a level 1 trauma center

Antibiotic sensitivity of bacteria isolated from the oral cavities of live white sharks (Carcharodon carcharias) in South African waters

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