II. Indications

III. Epidemiology

  1. Dog Bites account for 80-90% of Animal Bites in U.S.
  2. Cat Bites account for 5-10% of Animal Bites in U.S.

IV. Risk Factors: Bite site infection

  1. Vascular compromise in affected wound
    1. Peripheral Arterial Disease
    2. Venous Insufficiency
    3. Lymphedema
    4. Longstanding Tobacco Abuse
  2. Distal extremity wounds have diminished vascular supply (Hand bite, Foot Bite)
  3. Bite site near a prosthetic joint
  4. Crush injury or Puncture Wound
  5. Cat Bite (long slender fangs risk deep space infection)
  6. Delayed presentation
    1. Arm or leg bite site >6-12 hours
    2. Facial bite site >12-24 hours
  7. Diabetes Mellitus or other immunosuppressed state

V. Exam

  1. See Hand Exam
  2. Neurovascular injury
    1. Extremity pulses and Capillary Refill
    2. Motor and senory exam
    3. Compartment Syndrome
  3. Structural injury
    1. Tendon Injury
    2. Open Fracture
    3. Joint penetration
  4. Retained Foreign Body

VI. Imaging

  1. XRay affected bite site
    1. Evaluate for Retained Foreign Body (esp. Avulsed Teeth)
  2. Head Imaging (e.g. Head CT)
    1. May be indicated in severe bites to the head
    2. Penetrating skull bites can generate enough force for Skull Fracture (risk of CNS Infection, abscess)

VII. Management: General

  1. Control bleeding first
  2. Inject 1% Lidocaine through intact skin
  3. Copious wound irrigation with Normal Saline
    1. Set up 500 ml saline bag with 20 gauge angiocatheter (or 20 ml or larger syringe)
    2. Place bag into BP cuff and pump up to 300 mmHg
    3. Irrigate wound with 500 cc of Normal Saline
      1. Consider irrigation with dilute povidone-Iodine solution if the animal is suspected to be rabid
  4. Wound closure
    1. Indications for closure by Secondary Intention
      1. Cat Bite
      2. Human Bite
      3. Puncture Wounds
      4. Infected wounds
      5. Wounds older than 24 hours
      6. Crush wounds with structural injury (urgent Consultation)
      7. Distal extremity wounds with poor perfusion
    2. Indications for Sutured closure
      1. Wound less than 12 hours old
      2. Wounds located on face less than 24 hours old
  5. Wounds near joint or bone
    1. Obtain baseline XRay of puncture
    2. Obtain Orthopedic Consultation
  6. Wound exploration
    1. Explore wound for tendon, joint or bone injury
    2. Explore wound for foreign bodies (e.g. teeth fragments, which may break off in older animals)
      1. XRay wound if suspected Radiopaque Foreign Body
  7. Referral Indications
    1. Wounds near bone or joint
    2. Crush wounds with structural injury
    3. Infected wounds
    4. Wounds with significant edema
    5. Neurovascular compromise (emergent Consultation)
  8. Immunization
    1. Tetanus Vaccine
    2. Rabies Prophylaxis
      1. See Rabies Postexposure Prophylaxis for full list of indications
      2. Indicated if dog or cat with Unknown Vaccination status
        1. Unprovoked attack
        2. Animal cannot be quarantined for 10 days
          1. Do not euthanize animal prior to completion of 10 day observation
      3. Immediate wound management (see Rabies Prophylaxis)
      4. Start Vaccine within 48 hours
  9. Antibiotic
    1. See Dog Bite Infection

VIII. References

  1. Cowling and House (2017) Crit Dec Emerg Med 31(5): 15-20
  2. Ellis (2014) Am Fam Physician 90(4):239-43 [PubMed]

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Related Studies

Ontology: Animal bite (C0003044)

Definition (MEDLINEPLUS)

Wild animals usually avoid people. They might attack, however, if they feel threatened, are sick, or are protecting their young or territory. Attacks by pets are more common. Animal bites rarely are life-threatening, but if they become infected, you can develop serious medical problems.

To prevent animal bites and complications from bites

  • Never pet, handle, or feed unknown animals
  • Leave snakes alone
  • Watch your children closely around animals
  • Vaccinate your cats, ferrets, and dogs against rabies
  • Spay or neuter your dog to make it less aggressive
  • Get a tetanus booster if you have not had one recently
  • Wear boots and long pants when you are in areas with venomous snakes

If an animal bites you, clean the wound with soap and water as soon as possible. Get medical attention if necessary.

Centers for Disease Control and Prevention

Concepts Injury or Poisoning (T037)
ICD9 E906.5
SnomedCT 157939001, 217696009, 287171004, 31986002, 418975000
LNC LA17118-3
Spanish mordedura de un animal, mordedura de un animal (evento), Mordedura de animal NEOM, mordeduras de animales, SAI (hallazgo), mordeduras de animales, SAI (evento), Animal bites NOS, mordeduras de animales, SAI (trastorno), mordeduras de animales, SAI, mordedura de animal (anomalía morfológica), mordedura de animal, Mordedura de animal
Italian Morso di animale, Morso di animale NAS
Dutch dierlijke beet NAO, beet; dier, dier; beet, dierenbeet
French Morsure d'animal SAI, Morsure d'animal
German Tierbiss NNB, Tierbiss
Portuguese Mordedura de animal NE, Mordedura de animal
Japanese 動物咬傷NOS, 動物咬傷, ドウブツコウショウNOS, ドウブツコウショウ
English Animal bites NOS, Animal bite NOS, Animal bite, Bite;animal, animals bites, animal bites, Animal Bites, Animal bites NOS (disorder), Animal bites, Animal bites NOS (event), Animal bite (morphologic abnormality), bite; animal, animal; bite, Bite by unspecified animal, animal bite, Animal bites NOS (finding), Bite of animal (event), Bite of animal
Czech Kousnutí zvířetem, Kousnutí zvířetem NOS
Hungarian Állatharapás, Állatharapás k.m.n.

Ontology: Mammal bite wound (C0561547)

Concepts Injury or Poisoning (T037)
SnomedCT 283683002, 242606001
Spanish mordedura de un mamífero (evento), mordedura de un mamífero (hallazgo), mordedura de mamífero, herida por mordedura de mamífero (trastorno), herida por mordedura de mamífero, mordedura de mamífero (trastorno), mordedura de un mamífero
English Mammal bite, Bite of mammal, Mammal bite wound (disorder), Mammal bite wound, Mammal bite (disorder), Bite of mammal (finding), Bite of mammal (event)