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Bites - human and animal - Management
How do I assess someone with an animal bite?

  • Document how and when the bite occurred.
  • Examine the bite, and document its location, appearance, and any damage to underlying structures such as arteries, nerves, tendons, or joints.
  • Determine whether the person is at increased risk of the wound becoming infected, either due to the nature of the bite, or due to a medical condition (e.g. diabetes, immunosuppressed status).
  • Assess whether the wound is infected. The following may be present: redness, swelling, serosanguinous or purulent discharge, pain, localized cellulitis, lymphadenopathy, fever.
  • Assess tetanus status, drug history and any known allergies.
  • Assess the risk of acquiring rabies.
  • Send cultures for aerobic and anaerobic bacteria if the wound appears to be infected. Take samples from the deepest part of the wound, after topical decontamination, but before cleaning it thoroughly.
  • It is essential to obtain an X-ray in people with the following:
    • Penetrating scalp injuries in children. A small scalp puncture wound may indicate anchoring of teeth to the cranium during shaking, and it is important to identify underlying cranial injury or facial fractures.
    • Crush injuries, suspected fracture, foreign body.
  • Although rare, consider the possibility of child neglect if there is a report or appearance of an animal bite on a child who has been inadequately supervised.
Clarification / Additional information
  • Assess and document under what circumstances the bite occurred:
    • When and in what country did the bite occur?
    • What sort of animal bit the person?
    • Was the attack provoked?
    • Was the animal domestic or wild?
    • The nature of the bite — its site, number, depth, and amount of tissue destruction.
    • Any risk factors for infection.
    • Does the person have any other medical conditions?
    • What is the tetanus status of the person?
  • Record both positive and negative findings as there may be future litigation [Taplitz, 2004], including [Griego et al, 1995; Taplitz, 2004; Morgan and Palmer, 2007]:
    • The location of the wound. Photographs or diagrams may be useful.
    • The size and depth of the injury.
    • The type of wound (e.g. penetrating or crush injury).
    • The degree of crush injury, devitalized tissue, nerve or tendon damage, and involvement of bones, joints, or blood vessels.
    • The range and movement of any adjacent joints.
    • The presence or absence of signs of infection.
    • Any lymphadenopathy.
    • The presence of any foreign bodies (e.g. teeth) in the wound.
    • Any signs of infection.
    • Facial bites: perform an intraoral examination to exclude cheek lacerations with an intraoral communication [Morgan, 2005].
  • Assess the risk of rabies:
    • In which country was the person bitten?
      • If the person was bitten in the UK there is no risk of rabies unless the bite was from a bat.
      • If the person was bitten abroad use the Health Protection Agency country by country risk chart (pdf). Note that the origin of the animal is important. Was the animal non-indigenous or recently imported? Was it a terrestrial animal or a bat?
    • What was the type of exposure?
      • Use the Health Protection Agency Duty Doctor Rabies protocol (pdf), taking into account the site and severity of the exposure, whether the bite/scratch was provoked, the current state of health of the animal (if known), and its ownership. Determine the tetanus and rabies immunization status of the dog or cat, if known. People are at risk not only if they have sustained major bites, but also if they have had minor bites (e.g. bites through clothed areas of the arms, trunk, or legs), licks to the mucosa, or licks to non-intact skin (e.g. if there are scratches or abrasions).
    • What is the immune status of the person bitten?
      • Ask whether the person had a primary course of rabies vaccination or any boosters in the past, and if so when this was.
Basis for recommendation
  • The basis for this recommendation is advice from the Health Protection Agency Centre for Infections [HPA, 2008], and expert opinion on the management of bites [Griego et al, 1995; Taplitz, 2004; Morgan, 2005; Villani, 2006; Morgan and Palmer, 2007].
  • Consider the possibility of rabies in anyone who has been bitten by a bat in the UK [HPA, 2006e].
  • Consider the risk of rabies in anyone who has sustained a bite or scratch from a dog or cat whilst abroad [de Medeiros and Saconato, 2003; HPA, 2008]. The main host is usually a dog (in 99% of all human deaths from rabies) but other hosts include foxes, coyotes, wolves, jackals, cats, skunks, raccoons, mongooses, bats, and other biting animals [WHO, 1999].
  • The recommendation on when to consider child neglect is based on advice from the National Institute for Health and Clinical Excellence [NICE, 2009].

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