MAMMALIAN BITES Flashcards
MANAGEMENT
INITIAL MANAGEMENT
Hemorrhage Control
Copious Irrigation
Debrided
Dressed with non adherent dressing
Re-evaluation in 24-48 hrs
Prophylactic Antibiotics if indicated
Tetanus prophylaxis.
0.5 mL IM.
Rabies prophylaxis if indicated
PRIMARY CLOSURE
Face or scalp
Simple and appropriate for single-layer closure
No devitalized tissue
No underlying fracture
No diabetes / immunocompromise
INDICATIONS FOR PROPHYLACTIC ANTIBIOTIC
All cat bites
All human bites
Dog bite to hand
wounds
Immunocompromized:
asplenia
chronic alcohol
Diabetes
at risk for capnocytophagia
Heavily contaminated wounds / older wounds with devitalized tissue
PPx: 3-5 days
Infection: 7-14 days
Amoxicillin-Clavulanate
875 mg PO bid
OR
metronidazole 500 mg PO q 12 hours
PLUS
doxycycline 100 mg by mouth q 12 hours
OR
Trimethoprim-sulfamethoxazole (160 mg/800 mg)
PLUS
metronidazole 500 mg PO q 12 hours
OR
Ciprofloxacin 500 mg PO q12 hours
PLUS
clindamycin 300 mg PO q 12 hours
OR
metronidazole 500 mg by mouth q 12 hours.
CDC Post-Exposure Rabies Prophylaxis:
DOG, CAT, FERRET
RACCOON, SKUNK, FOX, OTHER CARNIVORE, BAT
LIVESTOCK, HORSES
LAGOMORPH, SMALL RODENT
DOG, CAT, FERRET:
Healthy - observe animal for 10 days. Vaccination if animal develops signs of rabies
Rabid (or suspected) - Vaccination
Unknown - consult public health, consider vaccine
RACCOON, SKUNK, FOX, OTHER CARNIVORE, BAT
Immediate vaccine
If animal is being tested delay vaccine until results
LIVESTOCK, HORSES
Consult public health
LAGOMORPH, SMALL RODENT
Consider individually
These small mammals are not reported to transmit rabies
Consult public health
SEVERE INFECTIONS
Piperacillin-tazobactam 3.375 g intravenously every 6 hours 7-10 days
Ceftriaxone 1 g intravenously q 24 hrs for 7-14 days
PLUS
Metronidazole 500 mg intravenously q 8 hrfor 7-10 days for anaerobic coverage
DOCUMENTATION
HISTORY
Type of Animal
Domestic vs. Wild
Animal Behaviour
Rabies Status
Animal Status (captured vs. free)
Signs of infection: 12-24 hrs onset risk of pasturella, onset > 24 hrs strep or staph
RED FLAG
Violation of Joint Space
Cat Bite to Hand
Open Fracture
Infection
PHYSICAL
Ensure thorough wound eval
NV status
full ROM / strength
