Treating a Double Trouble Shark Attack

Welcome to Culture Clinic, MedPage Today's collaboration with Northwell Health to offer a healthcare professional's take on the latest viral medical topics.

Until this past weekend, Nadia Baranchuk, MD, an emergency medicine physician at Northwell Health on Long Island, had never treated a shark bite victim -- or even seen one -- in her 10-year career.

But this July 4, she treated two shark bite victims in a single afternoon. Luckily, both patients could walk and didn't need an ambulance to bring them to the emergency room.

While shark attacks remain exceedingly rare, Long Island makes up a significant portion of East Coast cases. Last year, there were five bites in a 2-week period, and this weekend, there were at least two other bites aside from the ones Baranchuk treated, according to The Washington Post.

"I'm no expert at this, obviously. We train for multiple medical emergencies, but a shark attack is not something I've seen," Baranchuk told MedPage Today. "I've seen worse dog bites."

Both swimmers Baranchuk treated were on Fire Island, a thin 32-mile island off Long Island's south shore that's a popular vacation destination. She wonders whether it was the same shark, since the first patient estimated his shark was 3 feet long, and the second patient said her shark was about 4 feet.

Baranchuk said that while both patients were definitely in a lot of pain, surprisingly "they were very calm."

"Sharks can cause different kinds of wounds. It could be an abrasion, laceration, a puncture wound, and the worst-case scenario: amputation," Baranchuk explained.

The first patient was bitten on his hand, and overall, the damage was minor. Hands are delicate, and full of small bones and ligaments, but the patient could still move his hand and didn't lose sensation. He had punctures about an inch deep on all sides, as well as superficial abrasions.

"He did not have any injury to the ligaments in terms of flexion extension, but the puncture wounds were pretty extensive," Baranchuk noted.

An x-ray to check for foreign bodies showed a lingering shark tooth in his hand, which required surgery to have the tooth removed.

An hour later, Baranchuk heard she would be treating a second shark bite victim. She said she thought, "Okay, I got this now! Let's go figure this out."

This time, the patient described standing in the water and suddenly feeling pain in her thigh. She saw the shark and punched it until it detached, but it left abrasions on her outer thigh and deeper punctures on her inner thigh.

Baranchuk didn't suture the bite wounds because the deepest punctures, about 2 inches, stopped bleeding on their own. The wounds were flushed out thoroughly with water, and an x-ray confirmed no foreign bodies in the wounds, so the patient went home with antibiotics.

Because sharks live in saltwater, different bacteria in an aquatic environment could be in a shark's mouth, Baranchuk said.

"We do dual-coverage antibiotics, where for dog and cat bites we do one type of antibiotic. They're getting both because you're still treating regular staph and strep infections ... and then, for specifically shark bites, you've got to cover for Vibrio," she said.

Both patients will take dual-coverage antibiotics for 10 to 14 days and will come in if they develop symptoms that make sticking to the antibiotic regimen difficult. Otherwise, it's a matter of waiting for the wounds to heal.

"You might hear about [shark attacks] on the news. But then, when you see them as your patients, it's a completely different ballgame," Baranchuk said.

Comment