Management

After the patient has been stabilized, an airway is assured (if necessary), and treatment for shock (if needed) is implemented, a careful initial examination of the wound and the surrounding structures needs to be performed to define the extent of the bite and injury to adjacent tissues. In children and in exten-

Table 31.1. Worldwide variety in animal wounds.

Location

Body part

Adult or child

Animal(s)

Indiana, USA

Abdomen (fatal) Neck (fatal) Arm and shoulder

Children

Dog Cats Dog Pet tiger

Illinois and

Hands, arms and legs

Children

Pet dogs

Missouri, USA

Males>females

Philadelphia

Limbs

Children and adults

Rats

San Francisco

Human genitalia

Adults

Dogs Humans

USA

Spinal cord

Children

Pet tiger

Czech Republic

Thorax (26.6%) Head (23.3%) Limbs (17.7%) Neck (17.3%) Abdomen (14.3%)

Farm animals

Germany

Mostly limbs

Children and adults

Dogs Cats Horses Other farm animals

Great Britain

Limbs

Children and adults

Dogs Humans Squirrels Farm animals

Switzerland

Limbs

Children (home) Adults (farm animals)

Dogs Cats

Farm animals

Brazil

Limbs, head, neck

Male adults more than females or children

Vampire bats

Thailand

Legs and foot 64.2% Hands and fingers 21.2%

Most are children

Dogs

Iran

Hands, arms, legs

Children and adults

Dogs Cats Rats

Farm animals Jackals Foxes Wolves

South Africa

Entire body

Leopard

Zebra

Musk elephant

Source: Data from Demetriades (1), Isotalo et al. (2), Durrheim et al. (3), Zeynali et al. (4), Mit-moonpitak et al. (5), Sinclair et al. (6), Clark et al. (7), Steinbok et al. (8), Hanna et al. (9), Baranyiova et al. (IG), Matter (11), Hirshhorn et al. (12), Wyatt (13), and Schneider et al. (14).

Source: Data from Demetriades (1), Isotalo et al. (2), Durrheim et al. (3), Zeynali et al. (4), Mit-moonpitak et al. (5), Sinclair et al. (6), Clark et al. (7), Steinbok et al. (8), Hanna et al. (9), Baranyiova et al. (IG), Matter (11), Hirshhorn et al. (12), Wyatt (13), and Schneider et al. (14).

sive injuries, local or general anesthesia may be necessary before a complete examination of the wound can be performed. It is important to examine the entire body because multiple bites are common, especially from wild animals. Hemostasis must be assured and the immune status of the patient documented. Diabetes, immunological disorders, chronic wasting, and malnutrition can delay the healing process and predispose to severe infections. Wound cultures should be taken, if possible, to guide long-term antibiotic therapy. Once the airway has been assured and the patient treated for shock, attention needs to be paid to wound care, tetanus prophylaxis, infection control, and rabies prophylaxis (16,17).

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