Bites - Animal or human
Disclaimer
These guidelines have been produced to guide clinical decision making for the medical, nursing and allied health staff of Perth Children’s Hospital. They are not strict protocols, and they do not replace the judgement of a senior clinician. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline.
Read the full PCH Emergency Department disclaimer.
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Aim
To guide staff with the assessment and management of patients who present to the Emergency Department with animal or human bites.
Human Bites
Common pathogens:
- Staphylococci
- Streptococci
- Bacteroides
- Anaerobic cocci
- Eikenella corrodens.
Animal Bites
- Most common cause of bites are dog bites followed by cat bites.
- Increased risk of infection:
- Staphylococci
- Streptococci
- Bacteroides
- Anaerobic cocci
- Pasturella multocida (more common in cat bites).
- Rabies prophylaxis is not routinely required for bites in Australia but beware of patients presenting from rabies-endemic regions (Asia, Africa, Central and South America).
Assessment
Investigations
- The majority of children require no investigations.
- Investigations are indicated only if systemic symptoms, suspicion of underlying infection or in an immunocompromised patient.
- FBC, CRP and Blood cultures are indicated in the unwell child who appears septic.
Management
Animal and human bites are common injuries prone to infection. Antibiotics are recommended for all animal and human bites.
- All bites require through cleaning, irrigation, inspection and potentially debridement or foreign body removal.
- Cleaning and irrigation should be attempted early in the presentation within the ED.
- More complex wounds or younger, less co-operative patients may need this completed under sedation or in the operating theatre.
- The wound should not be closed unless thoroughly irrigated and debrided.
- Review the patient's tetanus immunisation history. Consider the need for Tetanus Prophylaxis. See Tetanus Prone Wounds.
Antibiotics
- Most wounds require presumptive antibiotic treatment.
- Prophylaxis or mild to moderate infection: Oral Amoxicillin / clavulanic acid.
- Severe infection or injury - IV amoxicillin / clavulanic acid
Nursing
- Apply EMLA if patient condition is is likely to require significant wound management or intravenous antibiotics.
Observations
- Baseline observations include heart rate, blood pressure, respiratory rate, oxygen saturations, temperature and neurovascular observations (if circumferential or significant swelling).
- Minimum of hourly observations should be recorded whilst in the emergency department.
- Any significant changes should be reported immediately to the medical team.
Bibliography
- WA Health Child and Adolescent Health Service. Skin, Soft Tissue and Orthopaedic Infections ChAMP Empiric Guidelines Version 2, August 2014
- Nelson Textbook of Pediatrics, 20th edition by Robert Kliegman
- Textbook of Paediatric Emergency Medicine, 2nd edition, Cameron Elesevier, 2012
| Endorsed by: |
Head of Department, Emergency Department |
Date: |
Aug 2021 |
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