History
The history in patients with animal bites should include the following:
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Time and location of event
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Type of animal and its status (ie, health, rabies vaccination history, behavior, whereabouts)
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Circumstances surrounding the bite (ie, provoked or defensive bite versus unprovoked bite)
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Location of bites (most commonly on the upper extremities and face)
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Prehospital treatment
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Patient’s medical history (immunocompromise, peripheral vascular disease, diabetes, tetanus and rabies vaccination history)
Physical Examination
Major resuscitation rarely is required. With children, reassurance and parental presence may facilitate examination. Where applicable, consider the following:
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Distal neurovascular status
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Tendon or tendon sheath involvement
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Bone injury, particularly of the skull in infants and young children
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Joint space violation
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Visceral injury
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Foreign bodies (eg, teeth) in the wound
Significant damage due to bites is shown in the images below.
Animal bites. The devastating damage sustained by a preadolescent male during a dog 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 certain dog breeds.
Animal bites. Massive soft tissue damage of the right leg caused by a dog attack. This patient was transferred to a level one pediatric trauma center for care. At times, staff members may need counseling after caring for mauled patients.
Complications
Complications of bite wounds may include the following:
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Wound infection
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Sepsis
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Cosmetic deformity
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Loss of limb
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Loss of function
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Animal bites. The devastating damage sustained by a preadolescent male during a dog 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 certain dog breeds.
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Animal bites. Massive soft tissue damage of the right leg caused by a dog attack. This patient was transferred to a level one pediatric trauma center for care. At times, staff members may need counseling after caring for mauled patients.
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Animal bites. Massive soft tissue damage of the lower left leg caused from a dog attack. Most of the fatalities from dog bites are children.
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Animal bites. A different angle of the patient in Image 3 showing the massive soft tissue damage to this child's left lower leg.
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Animal bites. Wounds to the left arm and hip inflicted during a dog attack.
