34 HOW TO TREAT : MAMMALIAN BITE INJURIES
34 HOW TO TREAT : MAMMALIAN BITE INJURIES
8 MARCH 2024 ausdoc . com . au
Figure 10 . De-tipping amputation of the thumb from breaking up a fight between two dogs .
Figure 11 . Delayed flexor sheath infection after a dog bite .
How to Treat Quiz .
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1 . Which ONE lists the correct order of the frequency of bite injuries assessed in Australian EDs ? a Dog , cat , other and human bites . b Human , dog , cat and other bites . c Dog , cat , human and other bites . d Dog , other , cat and human bites .
2 . Which THREE bites require antimicrobial prophylaxis ? a Non-penetrating injury . b Puncture wounds unable to be debrided adequately . c Cat bites . d Wounds on the hands , feet or face or genitals .
3 . Which THREE injuries require emergent surgical assessment ? a Any requiring a tourniquet for haemorrhage control . b Neurovascular injuries . c Minor toddler bite . d Facial or neck injuries .
4 . Which ONE is not a barrier to wound healing ? a Peripheral vascular disease and smoking . b Puberty . c Diabetes . d Alcohol consumption .
5 . Which THREE are wounds that may require surgical / specialist referral ? a Wounds at high risk of infection requiring washout and debridement . b Complex or large wounds . c Tissue loss or avulsion injuries . d Minor bites in children .
6 . Which TWO statements regarding infection risk are correct ? a Dog bites have a higher rate of infection than cat bites . b Infections can relate to oral flora from the biter or skin flora from the patient . c Oral flora are by nature polymicrobial . d Standard practice is to treat for either aerobes or anaerobes when providing antimicrobial prophylaxis and treatment .
7 . Which THREE are appropriate in the management of most minor bite injuries ? a Exploration , debridement and irrigation . b Antibiotics . c Up-to-date tetanus vaccination . d Ensuring the patient is returning to a safe environment .
8 . Which ONE is generally recommended as the first-line antimicrobial prophylaxis for mammalian bite injuries ( with no known allergies )? a Metronidazole . b Amoxycillin – clavulanate for three days . c Metronidazole plus trimethoprim – sulfamethoxazole . d Benzathine benzylpenicillin .
EARN CPD OR PDP POINTS
• Read this article and take the quiz via ausdoc . com . au / how-to-treat
• Each article has been allocated one hour by the RACGP and ACRRM .
• RACGP points are uploaded every six weeks and ACRRM points quarterly .
MAMMALIAN BITE INJURIES
9 . Which TWO statements regarding the surgical management of mammalian bites are correct ? a Expedite surgical management when this is required . b Primary suturing is performed at the time of debridement . c Surgical management is indicated for soft tissue injury penetrating fascia with a significant skin breach . d Facial wounds are left to drain because of the high risk of infection .
10 . In which THREE situations are vaccination or prophylaxis required ? a PEP for HIV in high-risk situations ( biter is HIV positive and blood exchange occurs ). b Tetanus vaccination for all wounds other than a clean minor cut . c Rabies vaccination in returned travellers with bite injuries acquired in a rabies endemic country . d Hepatitis B in macaque monkey bites . collections in delayed presentations : this in addition to checking inflammatory markers and taking swabs for culture .
CONCLUSION
BITE injuries are a common presentation in both primary care and ED . They require consideration of several factors including wound care , antibiotic prophylaxis , vaccination , and whether the patient needs referral to ED or specialist services for surgical and other specialist management . Knowledge of infections related to specific animal species helps to guide diagnosis and management .
RESOURCES
• Department of Health and Aged Care — The Australian Immunisation Handbook immunisationhandbook . health . gov . au
• The Australasian Society for HIV , Viral Hepatitis and Sexual Health Medicine — PEP Guidelines pep . guidelines . org . au
• US Centers for Disease Control and Prevention — Rabies Status : Assessment by Country bit . ly / 3LM5SuG
• Therapeutic Guidelines — Antibiotic bit . ly / 45dxQGl
References Available on request from howtotreat @ adg . com . au