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Bites - human and animal - Management
When should I refer someone with an animal bite?
- Refer to secondary care:
- Penetrating wounds involving arteries, joints, nerves, muscles, tendons, bones, or the central nervous system. Note: penetrating bites to the hands or feet are at particular risk of infection and serious complications.
- Facial wounds (excluding very minor wounds).
- Bites where there is a possibility of a foreign body (e.g. a tooth) in the wound.
- Wounds which might benefit from closure.
- Devitalized wounds where debridement is required.
- Bites where the severity of the injury is difficult to assess.
- People with severe cellulitis, or with infected bite wounds that are not responding to treatment, or who are systemically unwell.
- People with an increased risk of infection — including those with diabetes or cirrhosis, those who are immunocompromised, and asplenic individuals (especially if they are not taking prophylactic penicillin).
- Bites that might need reconstructive surgery.
- Children with scalp wounds (for X-ray).
- Bites to poorly vascularized areas eg ear cartilage/nose cartilage.
- If an animal has bitten a child, consider the possibility of poor parenting and supervision. Follow local policies for referral of children considered at risk.
- If there is a possibility that the person has been exposed to rabies, seek immediate advice from the Virus Reference Department of the Health Protection Agency. For more information see Managing someone at risk of rabies.
Basis for recommendation
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