Environmental Exposures Answers 487or pink and black configuration. Envenomation from these bites occurs from
the glands along the lower jaw and introduced into the victim through
grooved teeth, which the animal uses to continuously chew after it has bitten
down. These teeth may become embedded in the victim, thereby distributing
more venom.
Antivenin(b)is not available for these bites, as they are rarely fatal.
Broad-spectrum antibiotics (d)and tetanus prophylaxis (c)should be
administered at a later interval. Applying a suction device (e)as in snakebites
is not warranted. The patient should be observed for at least 6 hours for
systemic effects.
443.The answer is b.(Rosen, pp 1834-1841.)The patient should receive
full immunoprophylaxisfor the rabies virus.The Centre for Disease
Control (CDC) recommends postexposure prophylaxis when a bat is found
indoors in the same room as a person who might be unaware that a bite or
direct contact had occurred and rabies cannot be ruled out by testing the
bat. Full prophylaxis in the United States includes passive immunization
with human rabies immune globulin and active immunization with human
diploid cell vaccine. Immune globulin is administered in and around a bite
wound if visualized. Human diploid cell vaccine is administered at a distant
site from the immunoglobulin, usually in the deltoid, to avoid cross reactivity.
Human diploid cell vaccine is subsequently administered on days 3, 7, 14,
and 28.
(a)The patient should not be sent home without full immunoprophylaxis.
Ciprofloxacin (c)has no role in this patient or in rabies treatment. Rabies
is caused by a virus. Admitting the patient for observation (d)is incorrect
because rabies virus incubation ranges from 30 to 90 days with some
reporting up to 7 years. The patient should receive immunoprophylaxis
and be sent home. (e)The patient should receive both active and passive
immunoprophylaxis unless they already received it in the past. In that case,
they only receive the vaccine.