Snake, Dog, Cat and other Bites

Bite Me
By:Howard J. McGowan, Maj, USAF, MC

Objectives
* Discuss general wound care principles
* Determine high risk vs low risk bites as related to antibiotic prophylaxis
* Determine need for tetanus prophylaxis
* Determine need for rabies prophylaxis
* Review common biting animals to include dogs, cats, humans, snakes, spiders, and ticks

General Wound Care
* Cleanse and debride wound
* Liberal application of ice or other cold packs
* Pressure to control bleeding
* Sterile dressing
* Hand and foot wounds require immobilization
* If wound high risk antibiotics should be started
* Consider need for tetanus/rabies

High Risk Wounds
o Location
+ Hand, wrist, foot
+ Scalp or face in infants (risk of cranial perforation)
+ Over a major joint (risk of perforation)
+ Through and through bite of cheek

o Biting species
+ Human (hand wound)
+ Cat (hand and lower extremity wounds)
+ Pig
o Type of wound
+ Puncture (impossible to irrigate)
+ Tissue crushing that cannot be debrided (typical of herbivore)
+ Carnivore bite over vital structure (artery, nerve, joint)
o Patient factors
+ Older than 50 years of age
+ Asplenia
+ Chronic alcoholic
+ Altered immune status (chemotherapy, AIDS, immune defects)
+ Diabetes
+ Peripheral vascular insufficiency
+ Chronic corticosteroid therapy
+ Prosthetic or diseased cardiac valve
+ Prosthetic or seriously diseased joint

Low Risk Wounds
* Face, scalp, ears, mouth
* Self-bite of buccal mucosa (not through and through)
* Large clean lacerations that can be thoroughly cleansed
* Partial thickness lacerations and abrasions

Antibiotics
To Close or Not
* Wound closure
o Puncture wounds, wounds that appear clinically infected, and wounds more than 24 hours old may have a better outcome with delayed primary closure
o May consider early primary closure if less than 8 hours old or located on face

Tetanus Prophylaxis
Rabies
Dog Bites
Cat Bites
Human Bites
Snake Bites
* Hemotoxic symptoms
* Intense pain
* Edema
* Weakness
* Swelling
* Numbness/Tingling
* Rapid pulse
* Ecchymoses
* Muscle fasciculation
* Unusual metallic taste
* Vomiting
* Confusion
* Bleeding disorders
* Neurotoxic symptoms
* Minimal pain
* Ptosis
* Weakness
* Paresthesia/Numbness at bite
* Diplopia
* Dysphagia
* Sweating
* Salivation
* Diaphoresis
* Hyporeflexia
* Respiratory depression
* Paralysis
* Evaluation/Treatment
Antivenoms
Spider Bites
Tick Bites
Summary
* Discussed general wound care principles
* Reviewed high risk vs low risk bites as related to antibiotic prophylaxis
* Reviewed need for tetanus prophylaxis
* Reviewed need for rabies prophylaxis
* Reviewed common biting animals to include dogs, cats, humans, snakes, spiders, and ticks

Bite Me.ppt