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.

Aim

To guide staff with the assessment and management of patients who present to the Emergency Department with animal or human bites.

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. All bites require prophylactic antibiotics.
  • The bite site requires meticulous wound preparation. It should not be closed unless thoroughly irrigated and debrided.
  • Review the patient's tetanus immunisation history. Consider the need for a booster in Tetanus prone wounds.
  • Antibiotics required:
    • Prophylaxis, or mild to moderate infection: Amoxycillin / clavulanic acid.
    • Severe infection or injury: Piperacillin / tazobactam.

Human Bites

Common pathogens:
  • Staphylococcoci, Streptoccoci, Bacteroides, Anaerobic cocci, Eikenella corrodens.

Animal Bites

  • Most common cause is dog bite, then cat bite.
  • Increased risk of infection – Staphyloccoci, Streptococci, Bacteroides, Anaerobic cocci and 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). Includes Bali from August 2008. See WHO: Rabies enzootic areas (external site). Refer to Rabies and Lyssavirus.

Nursing

  • Apply EMLA if patient condition is suggestive of requiring 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

  1. WA Health Child and Adolescent Health Service. Skin, Soft Tissue and Orthopaedic Infections ChAMP Empiric Guidelines Version 2, August 2014
  2. Nelson Textbook of Pediatrics, 20th edition by Robert Kliegman
  3. Textbook of Paediatric Emergency Medicine, 2nd edition, Cameron Elesevier, 2012

Endorsed by:  Director, Emergency Department  Date:  Feb 2018


 Review date:   Jan 2021


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