Bites

Question 1

Name the 2 types of human bite injuries

Answer 1

• Occlusal injuries: inflicted by actual biting
• Clenched-fist injuries: clenched fist hits teetch
  
  • particularly prone to infection

Question 2

Describe the injuries that occur with dog bites

Answer 2

• Puncture wounds from canine teeth
• Stretch lacerations from other teeth

Question 3

Describe the injuries that occur with cat bites

Answer 3

Wounds penetrate bone and joint capsules

Question 4

Name 3 complications of bite injuries

Answer 4

1. Wound infection*
2. Septicaemia
3. Septic arthritis
4. Tenosynovitis
5. Tetanus
6. Psychological: anxiety, nightmares, PTSD
7. Disfigurement

Question 5

Name 5 factors that increase the risk of infection from bite injuries

Answer 5

• Hand wounds
• Diabetes
• Asplenic
• Cirrhosis
• Immunosuppressed

Question 6

Outline the management of bite injuries

Answer 6

• Removal of any foreign bodies
• Encourage bleeding of the wound
• Thorough irrigation with warm, running water
• Analgesia if required
• Human: prophylactic ABX if <72hr
• Animal: prophylactic ABC if <48 and high risk of infection
• Seek immediate advice if at risk of HIV or Hep B
• Refer to A&E for further assessment and management if wound closure necessary
• Consider need for tetanus and rabies prophylaxis

Question 7

When should tetanus prophylaxis be given?

Answer 7

• Primary immunisation incomplete, or boosters not up-to-date
• Not immunised
• Immunisation status uncertain

Question 8

How is an infected bite treated?

Answer 8

• Send pus or wound swab for culture
• Empirical oral antibiotics for 7 days
• Admit anyone with severe infection, or systemically unwell for IV antibiotics

Empirical ABX: co-amoxiclav or metronidazole + doxycycline

Question 9

When should bite injuries be considered for x-ray?

Answer 9

• Clenched fist injuries: tooth and bone fragments
• Crush injury: possibility of fracture or foreign body
• Penetrating scalp injuries

Question 10

Name 3 organisms seen in bite injuries

Answer 10

• Pasteurella multocida: almost all animal mouths
• Staphylococcus spp.
• Streptococcus spp.
• Staphylococcus aureus: humans

Question 11

What is tetanus?

Answer 11

Infection with Clostridium tetani resulting in the characteristic severe muscle spasms and rigidity.

Risk: wounds contaminated with soil, or caused by rusty metal

Notifiable disease

Question 12

How many injections are in a tetanus vaccination?

Answer 12

Full course requires 5 injections