How To Treat Bite Injuries

By Tamara D. Fishman, DPM

As the warmer months emerge, people are more likely to tackle spring cleaning of cluttered areas, go outside without shoes and socks, and head to the beach for fun in the sun. Unfortunately, there is also an increased risk of lower-extremity bite injuries with these scenarios, whether the injuries are from dogs, insects, spiders or stingrays. Let’s start out by taking a closer look at dog bite injuries. Every 40 seconds, someone in the United States seeks medical attention for a dog bite-related injury, according to the Centers for Disease Control and Prevention (CDC). From 1979 to 1998, dog attacks killed more than 300 Americans. There is a dog bite epidemic in the United States. In a 10-year period, the number of dogs rose by 2 percent while the number of bites increased by 37 percent. There are almost 5 million victims annually and 800,000 of these people need medical attention. Children are at greater risk of injury and death from dog bites. In 1994, approximately 2.5 percent of U.S. children under 14 years old were bitten compared with 1.6 percent of adults over the age of 18. In 1997 and 1998, 27 people died from dog bites and 19 of them were children under 12. Children, especially boys ages 5 to 9, have the highest incidence rate for emergency department visits resulting from dog bites. When it comes to breeds that pose a high risk for dog bite injuries, the CDC says to be wary of pitbulls, rotweilers, German shepherds, huskies, Alaskan malamutes, Doberman pinschers, chows, Great Danes, St. Bernards and akitas. Dog bites can cause puncture wounds, lacerations and crush injuries. Dog bites may contain Pasteurella multocida, mixed anaerobes and staphylococcus. Cat bites are often puncture wounds that may contain Pasteurella multocida. Other aerobes and anaerobes include S. aureus. Bite wound treatment consists of: • obtaining a complete medical history (including any first aid that was performed); • administering appropriate tetanus prophylaxis; • performing appropriate wound care; • splinting lacerated legs; • elevating the extremity; and • administering prophylactic antibiotics if the animal’s teeth penetrated to bone or tendon sheath or if the wound is more than eight hours old. Amoxicillin/clavulanate covers most of the organisms found in dog and cat bite wounds. You may administer tetracycline as an alternative to augmentin. Overall, it’s important to clean wounds well, administer antibiotics if necessary and follow these patients closely. Essential Tips On Detecting And Treating Insect Bites Many patients are aware of an insect bite when it occurs. Patients may report localized reactions such as discomfort and moderate or severe pain. When treating these patients, you may note erythema, warmth and edema surrounding the bite site. These local reactions are rarely serious or life-threatening and can usually be treated with cold compresses after cleaning of the wound. Ice packs may be helpful for a large local reaction. For most insect bites, lab studies, biopsies and microscopic exams of scrapings from the wound are not necessary. While diagnosing an insect bite is difficult, keep an eye out for wheals or urticaria as these initial signs commonly appear within minutes of the insect bite. Trying to determine the insect responsible can be challenging. In your examination of the patient, you should pinpoint the bite location and identify any patterns as well as the number of bites. Be aware that some patients may have a systemic response to an insect bite. Patients who have such a response will complain of the aforementioned localized symptoms in addition to a rash, pruritis, uticaria and angioedema. If these symptoms progress, the patient may develop weakness, disorientation, syncope, hypotension, dyspnea and anxiety. Anaphylactic shock is the most notable immediate risk associated with insect exposures. Severe anaphylaxis can be fatal in as little as 10 minutes. Mortality associated with insect bites can be caused by either anaphylactic reaction or complications from infection. Reliable figures are not currently available. Estimates of mortality from insect-provoked anaphylaxis in the U.S. range from 50 to 150 people annually. Epinephrine is treatment for a known systemic reaction. The method of administration (subcutaneous, intramuscular and intravenous) will depend on the patient’s condition and your expertise or that of a referring doctor.

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