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21 Cards in this Set
- Front
- Back
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Bite Prevention
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Don’t take away food before dog is finished
Don’t tease; be aware of intention Beware of tied dogs (more territorial) Don’t run or stare—stand ground Don’t separate fighting dogs with hands Don’t feed famished street dogs with hands Always supervise children around animals Avoid any contact with “tame” wild animals or bats No ferrets with infants—prone to attack |
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Wound Management
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Irrigate
Debride Clip Hair Scrub |
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Wound Irrigation Procedure
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Irrigate wound w/ 100-200 ml normal saline or 1-5% (not 10%) povidone iodine solution per inch
12 ml syringe w/ 19 gauge needle = 20 PSI (ideal) 35 ml syringe w/ 19 gauge needle = 8 PSI Dramatic reduction in infection rate! |
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Wound Debridement
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nonviable or crushed tissue w/ scalpel
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Wound Hair
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Clip rather than shave
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Wound Scrubbing
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Scrubbing with cotton gauze or fine mesh sponge if wound is heavily contaminated or old or if rabies exposure is suspected
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Tetanus Bacteriology
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Clostridium tetani is present in animal saliva as well as soil
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Tetanus Prophylaxis
Fully Immunized Patient |
Clean wound
need Td booster w/in 10 y Dirty wound in fully immunized pt—need Td booster w/in 5 y Tetanus immune globulin (TIG) may be considered esp. in high risk bites if > 10 years since last tetanus booster |
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Tetanus Prophylaxis
Unimmunized Patient |
TIG 250-500 units in one arm and Td in other arm then Td boosters at 30 and 60 days
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Suturing: To Close or Not to Close?
Considerations |
Consider risk of infection (bite location, condition, and age, type of animal, health of patient), cosmetics, and function
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Suturing: To Close or Not to Close?
Location: Face/scalp wounds |
low risk—close
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Suturing: To Close or Not to Close?
Location: hand, foot, over major joints, bite through cheek |
high risk—leave open if possible
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Suturing: To Close or Not to Close?
High Risk animals |
cats, monkeys, humans
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Suturing: Placement
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try to keep loose to allow drainage and remove sooner than usual (3d with steristrips)
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High Risk Wounds
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Animal type: cat, pig, monkey, and human bites are much more likely to be infected than dog or rodent bites
High risk locations: hand, foot, over major joints, bite through cheek Puncture wounds Older than 8-12 hours Dirty or neglected |
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High Risk Patients
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Immune deficiency states (AIDS, chemotherapy, chronic corticosteroids)
Asplenic Alcoholic Elderly (over 50 y) Diabetic Peripheral Vascular Disease Prosthetic valve or joint |
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Mammalian Bacterial Flora
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Bite infections are polymicrobial w/ mixed aerobic and anaerobic flora. Initial wound cultures are never helpful.
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Mammalian Bacterial Flora
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Common culprits: Staph aureus, Strep pyogenes, Pasteurella multocida, Eikinella corrodens, Proteus, Pseudomonas, Klebsiella, Enterobacter
Anaerobes: Bacteroides, Peptococcus, Peptostreptococcus, Veillonella, Proprionobacterium Occasional: Capnocytophaga canimorsus (DF-2), atypical mycobacteria, non-oxidizer group (NO-1) |
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Prophylactic Antibiotics
Most Useful in? |
Most useful in
high risk bites (cat), high risk sites (hand/foot), and high risk people |
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Prophylactic Antibiotics
Time Course? |
To be most effective should be given w/in 3 h before wound coagulum encapsulates bacteria
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Prophylactic Antibiotics
Time Course |
3-5 day course is maximum needed
Better to give IM or samples rather than script since time is critical |
