5 What Basic Functions Must Animals Do To Stay Alive Dog Bite Treatment

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Dog Bite Treatment

Dog bites can be traumatic and painful experiences that can leave physical and emotional scars. However, as long as adequate, timely and appropriate treatment is given in most cases, the prognosis is excellent. Although there are no exact figures, about 60-90% of bites are caused by dogs, and a third and a half of bites occur in children. In 70% of these cases, the victims are bitten by their dog or a dog they know. According to a report, in the UK, you are more likely to be killed by a lightning strike than a dog attack!

First aid for bites:

Before you start treating the victim, make sure the situation is safe for you and the victim. Make sure the dog is not nearby by picking up the victim or having the dog’s owner move the dog away and either chain or lock it away from you. You should try to find the name and address of the owner, breed and immunization status of the dog if possible, as this may be useful if further treatment or action is required.

Try to stop the bleeding, but only use tourniquets as a last resort for severe bleeding that cannot be controlled in any other way. If possible, keep the injured part elevated above the heart to control bleeding.

The mouth carries many bacteria which can cause infection in a wound, so it is vital that the wound is thoroughly cleaned with boiled and cooled water for 5-10 minutes. Running water is preferable otherwise wet the area with water that is changed frequently (you should wear gloves while doing this to protect yourself).

Do not apply antibacterial creams to animal bites, as some bacteria in the saliva can multiply, or reproduce quickly in a short interval, in certain creams. Some can also damage skin tissue and healing.

Apply direct pressure to the wound with a clean cloth. Dress the wound with a non-adhesive, sterile gauze and bandage. Watch out for signs of infection, if they develop up to 48 hours after the bite, you should see your doctor. Bites, by definition, break the skin, which allows bacteria from saliva in the animal’s mouth to enter the open wound and can result in infection. Antibiotic prophylaxis is usually given. Prophylaxis is a Greek word meaning advance guard; in medical terms it means that a measure is taken to maintain health and prevent the spread of a disease or condition.

If any part is detached during an attack (such as an ear), then you should wrap the part in clean paper, store it in a plastic bag surrounded by ice, and take it with you to the hospital.

Signs and symptoms of infection:

  • Pain around the wound
  • Redness
  • lightness
  • Swelling
  • Pus or discharge
  • fever
  • Swollen glands

First aid for infections:

The wound should be covered with a sterile bandage leaving the area around it visible so you can monitor for signs of spread. Try to keep the wound elevated and supported. See your doctor as soon as possible to prevent further complications.

The risk of infection is particularly high in punctures, hand injuries, full-thickness wounds, those requiring surgical debridement, and wounds involving joints, tendons, ligaments, and fractures. Infections are also more likely if the wound is deep or dirty, or if there is a lot of blood under the wound.

Certain factors make some people more vulnerable to infection:

  • Diabetes mellitus. (Increases the risk of Pasteurella infection)
  • Alcoholics. (Increases the risk of Pasteurella infection)
  • Cirrhosis or scarring of the liver.
  • People on steroid therapy. (Increases the risk of Pasteurella infection)
  • Rheumatoid arthritis. (Increases the risk of Pasteurella infection)
  • Lymphoedema after radiotherapy. (Increases the risk of Pasteurella infection)
  • Asplenia which is the absence of normal spleen function.
  • Wound more than six hours old.
  • devitalized tissue.
  • Previously stitched wounds.
  • Full-thickness wounds involving tendons, joints, or ligaments.
  • Bites on limbs especially hands.
  • Those with compromised immune systems due to medication or illness.

Pasteurella is a bacteria found in most animals. If a wound becomes infected by these bacteria, then the wound becomes red and inflamed, this happens quickly: within 24 hours and there is considerable pain and swelling. Occasionally it can cause pneumonia or other respiratory infections; very rarely causes kidney infections or meningitis. If treated immediately with antibiotics, then the prognosis is good. However, if an infection is left untreated, it can spread to the bloodstream causing blood poisoning, or cause swelling, joint stiffness and tissue damage.

Complications:

Scars. In children, dog bites often involve the face, potentially resulting in lacerations (cuts) and severe scarring.

Infections:

  • Such as tetanus, rabies, septicemia, septic arthritis, tendonitis, peritonitis, meningitis and osteomyelitis which is a bone infection.
  • Wound infection occurs in 2-30% of dog bites.
  • Infections from bites are polymicrobial, (involve more than one species) often including anaerobes that can survive without oxygen. Common bacteria include Staphylococcus, Streptococcus, Eikenella, Pasteurella, Proteus, Klebsiella, Haemophilus, Entrobacter, Capnocytophaga, Canimorsus and Bacteroides.

Fractures.

Distortion.

If you have kept the bite out of place, then you may be at risk of rabies. At present, the UK is largely free of rabies (although some bats carry the disease in the UK), but it is common in Africa, Asia, Central and South America, and a few cases have been reported in Eastern Europe. Rabies is a serious disease that can be fatal to humans, so if you’ve been bitten or scratched outside, you should seek immediate medical attention even if you don’t think you’ve been infected – rabies is virtually undetectable in its early stages . You should contact the Health Protection Agency, the Center for Infection or Health Protection Scotland. Staff should know:

  • Your previous vaccination status
  • The place where you were bitten
  • Place and date of bite
  • Whether the attack was provoked or not
  • Be it a domestic or wild dog
  • Current health of the animal if known.

Treatment to prevent the development of rabies is called post-exposure prophylaxis and includes 1 dose of anti-rabies immunoglobulin (this is a blood product that contains anti-rabies antibodies) and 5 doses of the anti-rabies vaccine. If prophylaxis is required, it can usually be obtained from these centres, such as rabies vaccine (which is injected into the muscle) and human rabies immunoglobulin.

Hospital treatment:

About one in five people bitten by a dog seek medical attention, of those only 1% require hospitalization.

Some bites can be particularly serious and require more attention than just first aid. Also injuries can be more extensive than they appear, especially puncture wounds as they are small but deep and can damage tendons or joints. Wounds can be quite complex as bites can involve sharp forces: the dog sinks its teeth into your skin, you react by pulling back and the skin tears. You should see your doctor if:

the bite is in:

  • hand,
  • leg,
  • a knot,
  • a tendon,
  • a ligament
  • scalp,
  • face,
  • ears,
  • nose,
  • You need antibiotics; you will usually need to be hospitalized.
  • You think an infection has developed or is likely to develop.
  • You have bleeding that does not stop after 15 minutes of direct pressure
  • You think you have a broken bone or nerve damage
  • You are not up to date with your tetanus vaccine
  • You have been bitten by a dog with unknown immunization status

When you go to a doctor, they may ask for the following information:

– Dog breed. This is especially important as a bite from a larger dog is more likely to damage deeper structures such as tendons or bones.

– The health condition of the animal

– Time and place of the event

– Circumstances (ie a provoked or unprovoked attack.)

– The animal’s current location

– Any pre-hospital treatment

– Any factor likely to compromise immunity such as HIV or steroid therapy

– Any recent antibiotics (if the infection is present in a patient taking antibiotics, then this may suggest that the infection is caused by a resistant organism)

Your wound should be washed with normal saline or drinking water to remove dirt and bacteria. If the wound is contaminated then a 1% providone solution is used as it is better than saline. Providone is diluted so that it is germicidal but not toxic to the tissues. If you have not been immunized against tetanus within the last 5-8 years, then a booster shot is usually given. However, contracting tetanus from a dog bite is rare.

Sometimes debridement is required, which involves the medical removal of dead, damaged, or infected tissue, either by surgical, mechanical, chemical, or autolytic (self-digesting) means. Dead or damaged skin must be removed because it is an ideal place for infection to develop. Debridement also helps remove any blood clots or foreign bodies that may have lodged in the wound. Wound cleaning and debridement are more important than medication in many cases.

Once the wound has been properly cleaned, then the primary suture(s) can be performed. This is especially good for facial wounds as it has an excellent blood supply to speed up healing. Open wounds may need to be sutured, taped, or held together with steri tape. Suturing can help prevent tooth decay and improve the cosmetic result. However, some wounds may be left open for a few days to ensure they do not become infected before they are closed. Delayed closure for 3-5 days is usually done in cases where the bite is on the hand, those with major crush injuries, wounds that need significant debridement, and wounds that are more than six hours old. During this time they should be covered with a sterile, non-stick dressing to prevent other bacteria from entering the wound and causing infection.

Antibiotics may be prescribed to prevent infection and should provide protection against Pasteurella, anaerobes and staphylococcus bacteria. At first this may be given intravenously through a drip into a vein. Antibiotics are useful for:

  • All wounds after primary closure
  • Puncture wound
  • Big wounds
  • Bites hand and wrist. Prophylaxis with antibiotics significantly reduces the risk of infection in bites on the hand, but they may not be as effective for bites elsewhere.
  • Bites on the face
  • Crush wounds with devitalized tissue
  • Wounds that required surgical debridement
  • Injuries involving joints, tendons, ligaments or fractures
  • Dog bite injuries to the genitals
  • High-risk patients such as those with diabetes, those with compromised immune systems, splenectomy, those on chemotherapy, splenectomy, artificial heart valves, rheumatoid arthritis, and those with prosthetic joints.

In mild infections, co-amoxiclav is usually prescribed as the first line of treatment. However, antibiotics are usually not needed for bites that are 2 days old and show no signs of infection: the infection has normally developed by this time if bacteria are present.

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