Animal Bites in Emergency Medicine Follow-up

  • Author: Alisha Perkins Garth, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Dec 23, 2010
 

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.

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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.

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Transfer

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

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Complications

Complications of bite wounds may include the following:

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

The prognosis of animal bite wounds is generally excellent.

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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.

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Contributor Information and Disclosures
Author

Alisha Perkins Garth, MD  Staff Physician, Exempla St Joseph Hospital, Denver, Colorado

Alisha Perkins Garth, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, and American College of Emergency Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

N Stuart Harris, MD, MFA, FACEP  Chief, Division of Wilderness Medicine, Massachusetts General Hospital (MGH) Fellowship Director, MGH Wilderness Medicine Fellowship. Attending Physician, MGH Assistant Professor in Surgery, Harvard Medical School

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.

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

James Steven Walker, DO, MS  Clinical Professor of Surgery, Department of Surgery, University of Oklahoma College of Medicine

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.

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

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

References

  1. Centers for Disease Control and Prevention. Nonfatal dog bite-related injuries treated in hospital emergency departments--United States, 2001. MMWR Morb Mortal Wkly Rep. Jul 4 2003;52(26):605-10. [Medline].

  2. Chambers GH, Payne JF. Treatment of dog bite wounds. Minn Med. 1969;52:427-430. [Medline].

  3. Freer L. Bites and injuries inflicted by wild and domestic animals. In: Auerbach PS, ed. Wilderness Medicine. 5th ed. Mosby; 2007:1133-55.

  4. Dire DJ. Cat bite wounds: risk factors for infection. Ann Emerg Med. Sep 1991;20(9):973-9. [Medline].

  5. Talan DA, Citron DM, Abrahamian FM, et al. Bacteriologic analysis of infected dog and cat bites. N Engl J Med. Jan 14 1999;340(2):85-92. [Medline].

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  7. Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft-tissue infections. Clin Infect Dis. Nov 15 2005;41(10):1373-406. [Medline].

  8. Gilchrist J, Sacks JJ, White D, Kresnow MJ. Dog bites: still a problem?. Inj Prev. Oct 2008;14(5):296-301. [Medline].

  9. Weiss HB, Friedman DI, Coben JH. Incidence of dog bite injuries treated in emergency departments. JAMA. Jan 7 1998;279(1):51-3. [Medline]. [Full Text].

  10. Sacks JJ, Lockwood R, Hornreich J, Sattin RW. Fatal dog attacks, 1989-1994. Pediatrics. Jun 1996;97(6 Pt 1):891-895. [Medline].

  11. Palacio J, Leon-Artozqui M, Pastor-Villalba E, Carrera-Martin F, Garcia-Belenguer S. Incidence of and risk factors for cat bites: a first step in prevention and treatment of feline aggression. J Feline Med Surg. Jun 2007;9(3):188-95. [Medline].

  12. Moscati RM, Mayrose J, Reardon RF, Janicke DM, Jehle DV. A multicenter comparison of tap water versus sterile saline for wound irrigation. Academic Emergency Medicine. May 2007;14 (5):404-9. [Medline].

  13. Oehler RL, Velez AP, Mizrachi M, Lamarche J, Gompf S. Bite-related and septic syndromes caused by cats and dogs. Lancet Infect Dis. Jul 2009;9(7):439-47.

  14. Cummings P. Antibiotics to prevent infection in patients with dog bite wounds: a meta-analysis of randomized trials. Ann Emerg Med. Mar 1994;23(3):535-40. [Medline].

  15. Gilbert DN, Moellering RC, Eliopoulos FM, Sande MA, eds. Bites. In: The Sanford Guide to Antimicrobial Therapy. 37th ed. 2007:46,47,140.

  16. Guy RJ, Zook EG. Successful treatment of acute head and neck dog bite wounds without antibiotics. Ann Plast Surg. Jul 1986;17(1):45-8. [Medline].

  17. Trott A. Bite wounds. In: Wounds and Lacerations Emergency Care and Closure. 2nd ed. St Louis, Mo: Mosby-Year Book Inc; 1997:265-84.

  18. Weber EJ. Mammalian bites. In: Marx JA, Hockberger RS, Walls RM, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed. Mosby; 2006:906-21.

 
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Animal bites. The devastating damage sustained by a preadolescent male during a pit bull attack. Almost lost in this photograph is the soft tissue damage to this victim's thigh. This patient required 2 units of O- blood and several liters of isotonic crystalloid. Repair of these wounds required a pediatric surgeon, an experienced orthopedic surgeon, and a plastic surgeon. Attacks such as these have caused a movement in some areas of the country to ban pit bulls.
Animal bites. Massive soft tissue damage of the right leg caused by a pit bull attack. This patient was transferred to a level one pediatric trauma center for care. At times, staff members may need counseling after caring for savagely mauled patients.
Animal bites. Massive soft tissue damage of the lower left leg caused by a pit bull attack. Most of the fatalities from dog bites are children. Rottweilers and pit bulls are responsible for about 60% of fatalities.
Animal bites. A different angle of the patient in Image 3 showing the massive soft tissue damage to this child's left lower leg. Pit bull attacks are not rare.
Animal bites. Wounds to the left arm inflicted during a pit bull attack. This young patient was also bitten once on the left side of his face.
 
 
 
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