ABCs
Analgesia and/or regional anesthesia
Hemostasis
Aggressive debridement and irrigation
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 compartments, 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.
First line: fluoroquinolone or third-generation cephalosporin
Second line: 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.
Alligator and crocodile attacks
Toxins
Deterioration after intubation
Ciguatera
Heat syncope
Scombroid
Heat tetany
Tetrodotoxin 