Alligator and crocodile attacks

Background

Crocodiles, alligators, and caimans all belong within the reptilian order Crocodylia, comprising a total of 23 species separated into three families: Alligatoridae (with eight species, including alligators and caimans), Crocodylidae (14 species, including the true crocodiles), and Gavialidae (the Indian gharial).

Crocodilian attacks are usually sudden and will catch the human subject by surprise. Worldwide there were 1237 attacks and 674 fatalities between January 2008 and July 2013. In the US there were 567 adverse encounters and 24 deaths between 1928 and 2009 although these events are suspected to be under reported. Most fatalities are reported in Florida, followed by Texas, Georgia, and South Carolina.

Clinical Features

Crocodilian bites can produce large crush injuries, punctures, and lacerations. Polymicrobial infections have been found frequently to cause serious deformity, sepsis, and even death.

Evaluation

• ABCs
• Examine patient head to toe for other injuries

Management

• Analgesia and/or regional anesthesia
• Hemostasis
• Aggressive debridement and irrigation
• Radiographs to assess for underlying fractures or tooth fragments
• Empirical antibiotic coverage with a fluoroquinolone or third-generation cephalosporin
• If patient is allergic to cephalosporin, also consider trimethoprim-sulfamethoxazole or

carbapenem.

• In wounds presenting with hemorrhagic bullae or necrosis,Vibrio species should be considered

and the wound treated with surgical drainage and doxycycline, fluoroquinolone, carbapenem, or other appropriate antibiotic.

• Injuries close to a joint should be considered open

until proved otherwise, with orthopedic consultation for possible exploration and cleansing. Areas of concern for compartment syndrome, with associated symptoms and signs of increased pain, tense com - partments, and decreased circulation or temperature, should be evaluated with tissue manometry.

• After exploration, irrigation, and debridement, bite wounds should preferably be left open because they are

typically crush wounds or deep lacerations with significant bacterial contamination and surrounding soft tissue trauma. Cosmetically sensitive areas should be copiously irrigated and referred for delayed closure after 5 days of antibiotic therapy.

Disposition

• Patients who develop cellulitis or signs of sepsis should be admitted to the hospital and treated

aggressively.

• Patients with severe trauma should be admitted for further evaluation and management. Only

minor wounds and patients with comprehensive plans for follow-up should be managed on an outpatient basis.

• Injuries causing significant trauma to the hands, face, and genitalia may require specialty surgical

consultation.

See Also

• Mammalian Bites
• Tetanus Prophylaxis

References

• Constance, Benjamin B and Read, Mark A. "Ch. 33 Alligator and Crocodile Attacks." In Auerbach, Paul S.; Cushing, Tracy A.; Harris, N. Stuart. Auerbach's Wilderness Medicine (7th ed.).Philadelphia: Elsevier, Inc. pp. 687-692.e1