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

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

Toxins
- Ciguatera
- Neurotoxic shellfish poisoning
- Paralytic shellfish poisoning
- Scombroid
- Tetrodotoxin (e.g. pufferfish)
Stingers
- Stingray injury
Venomous fish (catfish, zebrafish, scorpion fish, stonefish)
- Cone shells
- Lionfish
- Sea urchins
Nematocysts
- Coral reef
- Fire coral
- Jellyfish (Cnidaria)
  - Box jellyfish
  - Sea wasp
- Portuguese man-of-war
- Sea anemones
Phylum porifera (sponges)
Bites

Plain radiographs of all injured areas to identify fractures, periosteal stripping, retained foreign bodies (e.g. teeth)
Wound cultures

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

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