Bitten But not Bored. Review

23 year old dude was walking in his neighborhood, listening to the latest Pitbull jam, when a domesticated unleashed dog attacks him. Vitals are normal. Musical taste is questionable. He has a few abrasions and small lacerations on his lower leg, ambulating normally, no other signs of trauma.

What do you do for this patient?

1. Clean and irrigate extensively.

2. XR if you are worried about any retained dog teeth or other foreign bodies, or any bony involvement. Look out for crush injuries with dog bites.

3. To suture or not?? General practice is to AVOID primary closure with sutures unless all of the following are met: on the face/scalp, within < 6 hours, with simple lacerations, and in an immuno-competent host.

Do you give antibiotics?

Dog bites generally do not need antibiotics – approximately 5% will become infected without treatment, which is the same as any other nonbite laceration.

When do you give antibiotics for dog bites? What will you prescribe?

1. Bites on the hands or involing joint space. 2. Bites in immunocompromised patients. 3. Very deep bites or those requiring any surgery.

Dog bites can be infected with Pastuerella, staph and strep species, and Capnocytophaga canimorsus. Treat with amoxicillin-clauvulanate for 5-7 days

What about the poor dog?

You must report all dog bites in NYC. Follow this link to report it.

Worried about rabies if this were a stray dog? See here for management.

What if this were a 48 year-old cat lady bitten on her leg by one of her 13 cats?

All cat bites warrant antibiotics. Cats are filthy creatures. (Just kidding, they are pretty clean but their teeth cause deep puncture wounds that are much easier to become infected.) Again, treat with amox-clauvulanate.

By Dr. Kylie Birnbaum

References

Tintinalli’s 7th Ed.

Special thanks to Dr. Willis