Human Bites in Emergency Medicine Clinical Presentation

  • Author: Jeffrey Barrett, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Apr 8, 2010
 

History

  • Consider all injuries dorsal to the metacarpophalangeal (MCP) joint bite wounds until proven otherwise. Explanations offered for such wounds often are misleading, thus extreme caution is necessary. While a careful explanation of the need for an accurate history may elicit the truth from the patient, experienced emergency physicians often treat such injuries as bites regardless of the history.
  • Most bite wound infections are present at the initial ED visit. With closed-fist injuries, the initial injury often appears minor to the patient, thus no care is sought until infection develops. If a child receives a small laceration to the scalp or forehead during unwitnessed horseplay, carefully ascertain whether a tooth caused the wound to minimize complications.
  • Other aspects of a patient's history that may influence care include tetanus immunization status, time delay from injury to presentation, disability encountered, and the presence of underlying immunosuppressive disease.
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Physical

  • Physicians must be wary of any laceration overlying the MCP joint. Additionally, carefully assess bite wounds of the fingers for deeper penetration into the tendon apparatus. Extending the wound may be necessary to fully evaluate the underlying structures and the extent of injury.
  • The following points should be noted for specific bite wounds:
    • MCP wounds (closed-fist injury) - Integrity of the extensor tendons, signs of infection, crepitation, loss of knuckle height
    • Chomping injuries of the finger - Integrity of the extensor and flexor tendons, evidence of infection including flexor tenosynovitis
    • Ear bites - Loss of tissue, violation of cartilage
    • Other bites - Tissue loss, depth of penetration
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Causes

  • As with most intentional injuries, human bites often are the result of an incident involving alcohol.
  • Domestic violence may be a factor.
  • Child abuse may be associated with bite wounds from adults.
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Contributor Information and Disclosures
Author

Jeffrey Barrett, MD  Assistant Professor, Department of Emergency Medicine, Temple University School of Medicine

Jeffrey Barrett, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

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.

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

Samuel M Keim, MD  Associate Professor, Department of Emergency Medicine, University of Arizona College of Medicine

Samuel M Keim, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Public Health Association, 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

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