Bites



Background

  • Bite injuries account for 1% of emergency department visits
  • Dog bites are the most common bite injury (account for 80-90% of presentations)
  • Cats bites become more frequently infected then dogs
  • Human bite wounds account for 2-3% of bite presentations
  • Beware reptile or "wild" animal (e.g. seal) bites - consult micro. with all.

Clenched fist injuries

  • Are the most severe of human bite injuries
  • Commonly present as a small wound over the MCPJ of the dominant hand (patient striking another person's teeth)
  • Human bite wounds to the hand more commonly develop bacterial infection than human bites at other sites, with clenched fist injuries conferring the highest risk, particularly because of the potential for breaching the MCP joint space to produce septic arthritis or osteomyelitis
  • Clinical examination should focus on the possibility of extensor tendon injury and joint penetration
  • Extensor tendon retracts when the hand is opened, so evaluation needs to be done with the hand in both the open and and the clenched positions

Management

  • Intact skin surrounding dirty wounds can be scrubbed with a sponge and 1% iodine solution or soap and water
  • Copious irrigation (warmed solution 33-37° [Evidence])of the wound with normal saline using a 19-G syringe is necessary.
  • Wounds that are dirty and contain devitalized tissue should be cleaned and debrided
  • Fresh head and neck wounds can generally be primarily closed
  • Bite wounds to the hand or feet should be left open for delayed primary closure or secondary intention. Non-puncture wounds elsewhere may be safely treated by primary closure after thorough cleaning. [BestBets].
  • Patients with significant hand wounds should be referred early to the soft tissue clinic (referral form) to evaluate the need for exploration
  • Complete management of bite injuries should include consideration of tetanus immunisation
  • For potential hepatitis exposure cases, please see needlestick page

Wounds of low risk (face, scalp, ears or mouth, large, clean lacerations) should be re-evaluated (GP or ANP) in 2 days time.

High risk (all other parts of the body, puncture wounds, immunocompromised patients) should be re-evaluated in 1 day time.


Content by Eanna Mac Suibhne eannamacs@gmail.com> Dr Íomhar O' Sullivan 27/07/2007. Last review Dr ÍOS 21/06/21.