Emergency Medicine Book

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Dog Bite

Aka: Dog Bite
  1. See Also
    1. Dog Bite Infection
    2. Rabies Prophylaxis
    3. Cat Bite
    4. Animal Bite
    5. Human Bite
    6. Fight Bite
    7. Insect Bite
  2. Epidemiology
    1. Incidence in United States: 4 Million bites per year
      1. Rate: 103-118 per 100,000 people in U.S.
      2. Dog Bites account for 80-90% of Animal Bites in U.S.
      3. Unprovoked Dog Bites account for 50% of events
      4. Dogs are known the victim in 70% of Dog Bite cases
    2. Mortality: >12 per year in U.S. (most are children)
      1. Pit bulls accounted for 44% fatalities 1979-1988
      2. Rottweilers are also responsible for many of the fatalities
    3. Infection rate: 15-20%
  3. Risk Factors: Bites associated with breed
    1. Aggressive dogs
      1. Dogs associated with fatal attacks
        1. Pit Bull
        2. Malamute
        3. Chow-Chow
        4. Rottweiler
        5. Siberian Husky
        6. German Shepherd
        7. Wolf hybrids
      2. Other Aggressive dogs
        1. Bull terrier
        2. Cocker spaniel
        3. Collie
        4. Doberman Pinscher
        5. Great Dane
    2. Less aggressive breeds (Family dogs)
      1. Boxer
      2. Dalmatian
      3. English Setter
      4. English Springer
      5. Golden Retriever
      6. Irish Setter
      7. Labrador Retriever
      8. Spaniel
  4. Pathophysiology
    1. Crush or avulsion injuries are more typical from Dog Bite
    2. Jaw of a dog can generate pressures up to 1800 psi
  5. Signs: Distribution
    1. Head and Neck (15% of Dog Bites)
      1. Typical site for Dog Bites in children, especially ears
    2. Extremities (arms account for 60% of Dog Bites)
      1. Typical site for Dog Bites in adolescents and adults
  6. Management
    1. See Animal Bite for irrigation and general management
    2. See Dog Bite Infection for antibiotic selection
    3. Wound Repair
      1. Safe to repair all Dog Bite wounds (regardless of location) presenting within 8 hours of bite injury
        1. Infection rates increase significantly after 8 hours (22% infection rate versus 4.5%)
        2. Bite wounds treated with primary closure should be treated with antibiotics (see Dog Bite Infection)
      2. Inform patient of risks of infection, closure options
        1. Primary closure results in significantly better cosmetic results than secondary closure
        2. Dog Bite Infection rates are similar regardless of management
          1. Primary closure (6-9.7%)
          2. Secondary closure (6.9%)
      3. References
        1. Chen (2000) Acad Emerg Med 7(2): 157-61 [PubMed]
        2. Paschos (2014) Injury 45(1): 237-40 [PubMed]
  7. Disposition
    1. Outpatient Wound Check in 24-48 hours Indications
      1. Usually indicated over inpatient care
      2. All hand wounds should be rechecked
  8. Prevention: Dog Bites
    1. Keep dogs updated on Vaccinations (and other routine veterinary care)
    2. Socialize dogs to children
    3. Neutered dogs are less likely to bite
    4. Do not leave young children alone with a dog
    5. Exercise caution with ill pets or those in pain (more likely to bite)
  9. Prevention: Lessons for children
    1. Do not approach an unfamiliar dog
    2. Do not disturb a dog eating or sleeping
    3. Do not disturb a dog caring for puppies
    4. When approached by a dog
      1. Never scream near a dog
      2. Never run from a dog
        1. Be still (Like a tree)
        2. If you fall, become a log
      3. Allow the dog to first sniff you before petting him
      4. Do not make direct eye contact with the dog
    5. Reporting guidelines
      1. Report Dog Bites to an adult immediately
      2. Report stray dogs or unusual behavior immediately
  10. Resources
    1. Dog Bite Prevention (American Veterinary Medical Association)
      1. https://www.avma.org/public/Pages/Dog-Bite-Prevention.aspx
  11. References
    1. Cowling and House (2017) Crit Dec Emerg Med 31(5): 15-20
    2. Swaminathan in Herbert (2014) EM:Rap 14(3): 4
    3. Bradshaw (1996) Vet Rec 138:465-8 [PubMed]
    4. Ellis (2014) Am Fam Physician 90(4):239-43 [PubMed]
    5. Lazzetti (1998) J Pediatr Health Care 12:73-9 [PubMed]
    6. Presutti (2001) Am Fam Physician 63(8):1567-72 [PubMed]
    7. Presutti (1997) Postgrad Med 101(4): 243-54 [PubMed]
    8. Sacks (1996) Pediatrics 97:891-5 [PubMed]

Dog Bite (C0259797)

Concepts Injury or Poisoning (T037)
ICD9 E906.0
ICD10 W54.0
SnomedCT 157935007, 125198007, 217697000
Spanish mordedura de perro (evento), Mordedura de perro, mordedura de perro (hallazgo), mordedura de perro (anomalía morfológica), mordedura de perro, mordida de perro (anomalía morfológica), mordida de perro
Dutch hondenbeet
French Morsure de chien
German Hundebiss
Italian Morso di cane
Portuguese Mordedura de cão
Japanese イヌ咬傷, イヌコウショウ
English dog bite, dog bite (diagnosis), injury caused by dog bite, Bitten by dog, Bite;dog, bites dog, bite dog, bites dogs, Dog bites, Dog Bites, Dog bite (disorder), Dog bite, Dog bite (morphologic abnormality), Dog Bite, Dog bite (finding), Dog bite (event)
Czech Kousnutí psem
Hungarian Kutyaharapás
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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