Bites

Posted by & filed under Company News, Medical Director Notes.

Initial Treatment

The first steps to take after getting away from the animal (or person) is to cleanse the wound thoroughly.  This can be done with soap and water and large volumes of tap water directly to the open wound in just a few minutes.  Then hold direct pressure until the bleeding stops and apply as close to a clean dressing as you have available.  Most of these wounds are appropriate for evaluation and treatment at a quality Urgent Care center.  Unless you have lost enough blood that you need an ambulance, or the wounds are extensive enough that they require a repair in the operating room by a plastic surgeon, then the Urgent Care is the place for you.

 

Suturing / Closing Wounds

A transplant surgeon told me in medical school that anyone can learn to suture and do surgery (actually he said a monkey could do it, but that may have been an exaggeration), but what requires an experienced clinician is deciding if / when (and how) to repair a wound.

The biggest risk with most bite wounds is infection, so closing a bite wound tightly may not be the right choice in many cases and can trap more bacteria and increase the risk of infection.  So some bite wounds may be appropriately closed only loosely with sutures for best healing.  Some may even be best treated by no sutures at all.

The timing of wound closure is important as well and most wounds are best closed as soon as possible.  Some wounds that are more than 6-12 hours old will heal best without suturing.

Facial wounds are more likely to be appropriate for close suturing since the face has an excellent blood supply (which is why it bleeds so well when lacerated), and is thus low risk for infection.

 

Antibiotics and infections

Antibiotics don’t prevent all infections and aren’t nearly as important as wound cleansing and proper wound care.  But many bite wounds are higher risk for infection and do benefit from antibiotics.

Each wound needs to be addressed for infection risk and need for antibiotics based on multiple factors including the animal, the extent of the wound, the location of the wound (face, hand, foot…) and the immune system of the patient.

 

Specific Bite Considerations

 

Cat bites and even scratches are the highest risk of infection of common animal bites that we see and get infected about ½ the time.  Many of these infections appear in the first 12 hours which is not common with most skin infections.  So cat bites are the most important for aggressive wound care and early antibiotics.  The earlier the better for cat bite treatment.  Once we see any element of a cat bite skin infection it is often appropriate to treat with either IV or injected antibiotics to get a jump-start on the recovery.

 

Dog bite wounds are not nearly as likely to become infected as cat bites and develop infections about 10% of the time.  The rate of these infections is more dependent on the location of the wound, the host, and the tissue damage.  A smaller dog-bite wound to the face of a child is probably only about a 1% risk of infection, while an extensive dog bite to the the lower leg of a diabetic adult may be closer to a 40% risk of infection.  Dog bites also need to be reported to the police, to assess the risk of rabies and risk of the dog to other people.  If the dog has no history of biting (no record), is not ill and is up to date on rabies immunizations, there should be no problems for the dog

 

Snake bites are typically not venomous in this area so should usually be treated as other bite wounds with cleansing and local wound care.  If possibly venomous, then the patient needs emergency treatment ASAP.  Prior to arriving in the ER where antivenom should be available, you should isolate and immobilize the wound.  Some advocate wrapping the wounded area snugly such as with an ACE wrap to decrease blood flow, not to the point of stopping arterial flow, such as with a tourniquet.  Splinting the wounded area should decrease blood flow and the spread of venom through the body as well.

 

Human bites may not seem as common to the general public, but are seen frequently in the emergency / Urgent Care fields.  They are similar in risk of infection as dogs and should be treated similarly.  A common injury that is treated as a “human bite” is when a fist strikes the teeth and causes a hand wound.  Those “fight bites” carry a higher risk of infection and need early and appropriate medical care.

 

Spider and other insect bites

Many people think that any raised red spot on their skin is caused by a spider bite. Studies have shown that these skin infections are not likely caused by spiders.

It seems that what people imagine to be spider bites are typically infections of the skin and often abscesses.

The best treatment for abscesses is to be seen at a quality urgent care, surgeon, or your doctor if he or she is comfortable with this procedure. Most abscesses need to be drained in order to resolve appropriately.

 

Rabies considerations

Rabies is extremely rare in domestic animals in the US and is only usually found in bats, raccoons, foxes and skunks.  See this Rabies map for the US from the CDC.

If the animal can be observed (and is not ill) then rabies vaccination is not necessary.

Speak to your clinician about the particular risk of rabies associated with each bite.

 

 

The Bottom Line

Most bite wounds can be treated appropriately at a quality Urgent Care center.  Treatment is typically wound care with cleansing, tissue repair and other efforts at infection prevention such as antibiotics and rabies vaccination when needed.  Rabies prophylaxis is not typically carried at Urgent Cares, but is probably safe to be started the next day unless a high risk exposure exists.

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