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Department of Pediatrics : Academic Divisions : Emergency Medicine : Resident Manual : Wound Care : Animal Bites

Anesthesia

Anesthetize the wound as for other wounds.

Irrigation

The skin around the wound can be cleaned with a soft sponge and 1% Betadine solution to remove obvious contaminants. The wound should be thoroughly cleansed with 200-1000 cc of Sterile saline using a 30 cc syringe with a splash guard attached. Minimum amount of saline to be used is 200cc's/bite.

Debridement

Debride wound margins to viable tissue with a #15 scalpel blade.

Closure

Do not suture hand or foot bites, puncture wounds, or wounds in immunosuppressed patients.

DOG bites less than 6 hours old may be sutured without increasing risk of infection if adequately irrigated and debrided.

CAT and HUMAN bites should not be sutured, except on the face.

Antibiotics

Local care ultimately prevents infection more effectively than any prophylactic antibiotics.

Prophylactic antibiotics are recommended in DOG or RAT bite wounds to the hands, feet and face. Recent dog bite wounds that can be completely cleansed and debrided and that are in well-vascularized areas may not require antibiotics.

Prophylactic antibiotics indicated in:

  • Cat bits
  • Human bites
  • Puncture wounds
  • Hand and foot wounds
  • Wounds with care delayed beyond 12 hours
AnimalsOrganismsAntibioticsConsider Rabies Vaccine?
Bat, Skunk, RaccoonUnknownAugmentin or DoxycylineYES
CatPasturella Multicida/ StaphAugmentin or TMP/SMX PLUS ClindaNO
DogP. canis and multicida, Staph, Bacteroides, Fusobacterium, EF-4, CapnocytophagiaAugmentin or TMP/SMX PLUS ClindaYES
HumanViridans Strep, Staph, Corynebacterium, Eikenella, bacteroides, PeptostrepAugmentin (Unasyn) or Clindamycin AND TMP/SMXNO


See Red Book for alternatives because of allergies, etc.

Tetanus

Toxoid should be given, if indicated. Also, consider giving dTaP per Red Book recommendations.

Rabies

Prophylaxis guidelines can be found in the Harriet Lane Handbook or the Red Book. Call the Health Department for advice on obtaining the vaccine/immunoglobulin.

Follow-up

The wound should be checked 24-48 hours after initial treatment.

Hospitalization

Consider admission in infected bites covering an extensive area, bites with large tissue loss requiring grafting, in hand bites where patient's compliance with wound management is poor, bites that violate facial cartilage, joint space, bone, tendon, and bites with neurovascular injury.

Report

Nurse will complete the animal incident/rabies investigation report.

Patient/Family Education

Review signs/symptoms of wound infection and advise them to promptly seek medical attention with any concerns. Inform family of risk of infection despite proper wound care and antibiotics.

References

Hodge D, and Tecklenburg F, Bites and Stings in Fleisher & Ludwig. Pediatric Emergency Medicine, Baltimore, MD, 2000

Rabies Control Act of South Carolina with 1990 and 1992 amendments. South Carolina DHEC

Knapp JF. Updates in Wound Management for the Pediatrician. Pediatric Clinics of North America 46(6):1201-13, 1999.

Chen E, Horing S, Sheperd SM, et al. Primary Closure of Mammalian Bites. Academic Emergency Medicine 7(2):157-61, 2000.


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