A three year old Amerindian girl presented without warning to emergency department (ED) in the country’s only tertiary care hospital, after being attacked by a jaguar in the remote Isseneru Village, Cuyuni-Mazaruni (Region 7), Guyana.
Her mother says that she turned away from the child to tend to the clothes when she heard “screams and then saw the jaguar ripping away at her”.
The second attack, which caused grievous injuries, occurred at about 10:30am, and relatives rushed the child to the local health center by speedboat, about 10 minutes away. Thinking that the child was already dead, the family left her at the river bank and ran to get the health center nurse.
The ED staff performed a rapid physical exam, quickly placed the child in a cervical collar, cleaned and dressed her wounds, and started two peripheral IV lines.
Physical examination showed an awake, alert and cooperative child with multiple deep lacerations over her scalp, face, and torso. A puncture of the skull was observed within a scalp laceration. A portable chest radiograph and an eFAST exam demonstrated no abnormalities. At that point, general, orthopedic, and neurosurgery consults were obtained. Ophthalmology became involved near the end of the patient’s hospital stay.
About four hours post-arrival and nine hours post-injury, her vital signs were blood pressure 100/62mmHg, pulse 100/minute, temperature 99.8°F axillary, and respiratory rate 32/minute.
They found an open fracture to the left fronto-temporal region, a depressed fracture to the left middle parietal bone, and boney defects in the left frontal zygomatic arch and left frontal bone. A depressed fracture of the left posterior parietal bone with a 5cm dural tear was flushed with normal saline and the edges debrided and skin closed. An open fracture to left angle of mandible was washed and closed, and a laceration to the left nostril extending onto the left side of the face was repaired.
Post-operatively, the child was sent to the intensive care unit on a ventilator. The child self-extubated on the third day and was discharged the next day to the pediatric surgical ward. She was discharged from the hospital 22 days after arrival
The child returned home to normal activities. Her only deficits are healing wounds with some scarring across her face and a left ptosis, most probably from local nerve injury.
Credits: Kenneth V. Iserson, MD, MBA, The University of Arizona, http://creativecommons.org/licenses/by/4.0/