eMedicine Specialties > Emergency Medicine > Environmental

Bites, Animal: Follow-up

Author: Alisha Perkins Garth, MD, Staff Physician, Harvard Affiliated Emergency Medicine Residency, Brigham and Women's Hospital, Massachusetts General Hospital
Coauthor(s): N Stuart Harris, MD, MFA, FACEP, Assistant Professor in Surgery, Harvard Medical School, Massachusetts General Hospital; Attending Physician, Massachusetts General Hospital; Clifford S Spanierman, MD, Consulting Staff, Departments of Emergency Medicine and Pediatrics, Lutheran General Hospital of Oak Brook, Advocate Health System
Contributor Information and Disclosures

Updated: Jun 25, 2009

Follow-up

Further Inpatient Care

  • Patients with infected animal bites may need inpatient care. This depends on the general health of the patient, the extent and nature of the infection, and the patient's compliance.
  • Consider admitting patients with hand bites that become infected (generally involving deep structures). Consider consultation with hand surgery service if deep infection, such as involving the tendon sheath or other structures, is suspected as surgical irrigation may be indicated.

Further Outpatient Care

  • Close follow-up care is essential in animal bite wounds. Reevaluate a low-risk bite for signs of infection within 48 hours and a high-risk bite within 24 hours.
  • In some centers that have an observation unit, admission to that area for direct clinical observation and repeat doses of parenteral antibiotics can be considered on a case-by-case basis.

Transfer

  • Patients who require extensive repair or prolonged inpatient care may need transfer to a tertiary care facility.

Complications

Complications of animal bite wounds may include the following:

  • Wound infection
  • Sepsis
  • Cosmetic deformity
  • Loss of limb
  • Loss of function

Prognosis

  • The prognosis of animal bite wounds is generally excellent.

Patient Education

  • Educating patients about the risk of infection despite proper wound care, antibiotics (if indicated), and close follow-up care is very important. Even bite wounds that have received the best care may become infected. Teach patients the signs of infection and the need for prompt attention if the wound should become infected.
  • For excellent patient education resources, visit eMedicine's Bites and Stings Center and Bacterial and Viral Infections Center. Also, see eMedicine's patient education articles Animal Bites and Rabies.

Miscellaneous

Medicolegal Pitfalls

  • Meticulous documentation of both the history of the bite and of treatment is important to prevent questions about the appropriateness of care. Documentation should include a thorough assessment of neurovascular and functional status, evidence that retained foreign bodies were carefully ruled out, decisions about antibiotic use, decisions of primary versus delayed closure, rabies risk assessment, and other aspects of care.
  • In many locations, animal bites must be reported to local authorities.

Special Concerns

  • Pediatric patients
    • Previously bitten patients remain at risk if the dog, cat, or other animal that bit them continues to be aggressive or is located where another bite could occur.
    • Move the animal to another location.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Jack L Stump, MD, to the development and writing of this article.



More on Bites, Animal

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Multimedia: Bites, Animal
References
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References

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Further Reading

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Keywords

animal bites, animal bite management, wound management, animal bite treatment, animal bite infection, bite wound, animal bite wound, dog bite, cat bite, pet bite, wild animal bite, bite wound infection, bite-related infection, mammal bites, rodent bites, ferret bites, rabbit bites, pit bull bite, cellulitis, rabies, septic arthritis, Staphylococcus, Streptococcus, Pasteurella, Bacteroides, Capnocytophaga canimorsus, Eikenella, Enterobacter, Proteus, Haemophilus, Klebsiella, Actinomyces, Fusobacterium, Peptostreptococcus, Clostridium, Wolinella, Propionibacterium, osteomyelitis

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Contributor Information and Disclosures

Author

Alisha Perkins Garth, MD, Staff Physician, Harvard Affiliated Emergency Medicine Residency, Brigham and Women's Hospital, Massachusetts General Hospital
Alisha Perkins Garth, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Emergency Medicine Residents Association, Phi Beta Kappa, Sigma Xi, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

N Stuart Harris, MD, MFA, FACEP, Assistant Professor in Surgery, Harvard Medical School, Massachusetts General Hospital; Attending Physician, Massachusetts General Hospital
N Stuart Harris, MD, MFA, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, International Society for Mountain Medicine, and Massachusetts Medical Society
Disclosure: Nothing to disclose.

Clifford S Spanierman, MD, Consulting Staff, Departments of Emergency Medicine and Pediatrics, Lutheran General Hospital of Oak Brook, Advocate Health System
Disclosure: Nothing to disclose.

Medical Editor

Robert M McNamara, MD, FAAEM, Chair and Professor, Department of Emergency Medicine, Temple University School of Medicine
Robert M McNamara, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Medical Association, Pennsylvania Medical Society, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

James Steven Walker, DO, MS, Clinical Professor of Surgery, Department of Surgery, University of Oklahoma Health Sciences Center
James Steven Walker, DO, MS is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, and American Osteopathic Association
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Jonathan Adler, MD, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital; Division of Emergency Medicine, Harvard Medical School
Jonathan Adler, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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