Evidence-Based Management Of Mammalian Bite Wounds

Rempe, Brian MD
Aloi, Mara MD
Iskyan, Kara M.D.
Godwin, Steven A. MD, FACEP
Turner, Troy MD, FRCPC

¹Authors
²Associate Program Director, Emergency Medicine Residency Allegheny General Hospital, Pittsburgh, PA
³Program Director, Emergency Medicine Residency Allegheny General Hospital, Pittsburgh, PA
⁴Resident Physician, Emergency Medicine/Internal Medicine Combined Residency Allegheny General Hospital, Pittsburgh, PA
⁵Peer Reviewers
⁶Associate Professor And Program Director, Department Of Emergency Medicine, University Of Florida College Of Medicine - Jacksonville, Jacksonville, FL
⁷Assistant Professor, Department Of Pediatrics, University Of Alberta, Edmonton, AB, Canada

Date of original release: September 1, 2009

Date of most recent review: August 10, 2009

Termination date: September 1, 2012

Medium: Print and Online

Method of participation: Print or online answer form and evaluation

Prior to beginning this activity, see “Physician CME Information” on the back page.

Pediatric Emergency Medicine Practice 6(9):p 1-17, September 2009.

The emergency department is in chaos, and your chart rack is full. You pick up the next chart and are relieved to see the chief complaint: “Scratches on hand and leg.” However, your relief turns to dismay when you see a 15-year-old boy in the room with his very concerned mother and you hear the following history: The patient was carrying the family cat into the house when the pet became frightened by an unleashed dog. The cat bit the patient on the left hand before running into the bushes. The dog ran after the cat, with the patient in hot pursuit. As the patient retrieved his cat, the dog bit him on the right calf. The patient quickly sought out the dog's owner, a local homeless man. When approached by the patient, the man rudely denied responsibility for the dog's actions. Still a novice at conflict resolution skills, the patient argued with the dog's owner, eventually punching him in the face and sustaining a wound to his third MCP joint.

The cat is healthy and has received all of its shots. The histories of the dog and the dog's owner, however, are unknown. The patient's mother just wants “some antibiotics and a tetanus shot.” How should each of the bites be treated? Is there concern for transmission of HIV from a potential human bite wound? Should the patient receive antibiotic prophylaxis, viral prophylaxis, or both?

Your next patient is a healthy but upset 22-month-old child accompanied by his mother, who is clearly worried. The patient was playing with the family's new kitten, which became agitated and bit the toddler on the left forearm. The patient started running to his mother in the next room but tripped on the carpet and fell. As he landed, he accidentally bit himself on his right arm. How should each of these bites be treated?