Management of common bites in the emergency centre The most common animal bites to present in emergencies are dog and bites.

Andreas Engelbrecht, MB ChB, FCEM, MMed (Fam Med), Dip PEC, DA, DTM&H Adjunct Professor and Head, Division of Emergency Medicine, Department of Family Medicine, University of Pretoria and Steve Biko Academic Hospital Professor Engelbrecht’s current fields of interest are bites, stings and poisonous plants.

Correspondence to: Andries Engelbrecht ([email protected])

In there are a variety of Dog breeds associated with more aggressive flora of the human.Pasteurella multocida, that have the potential to inflict injuries. behaviour are pit bull terriers, Rottweilers, staphylococci, streptococci and anaerobes However, such injuries are relatively rare German shepherds and Dobermans.5 are most frequently involved in wound compared with dog bites, which are by far Several countries and states in the USA infections. Wound infection with Pasteurella the most frequently encountered animal bites have ‘dangerous breed’ legislation that multocida usually occurs early (within 12 managed in our emergency centres. Many of prohibits ownership of a variety of attack hours) with significant erythema and pain the principles in the management of dog bites dogs, including pit bull terriers. There is and can cause sepsis if left untreated. Wound also apply to bites from other animals. Snake no ‘dangerous breed’ legislation in South infection with Capnocytophagia canimorsus, bite victims may require specific medical Africa. a gram-negative bacillus, can cause a severe interventions such as the administration of septic shock syndrome with fulminant . For these reasons the focus of this Pathology and microbiology purpura and gangrene to the limbs. This article will be on dog bites and snake bites. Dogs are natural scavengers, capable of type of infection is not common in immune- eating and biting through hard bones. As competent individuals. Risk factors include Dog bites such they have powerful jaws and are able to immunosuppression, alcohol abuse, Dog bites are a major public health concern exert biting power of between 30 kg and 70 corticosteroid therapy and splenectomy. and are responsible for approximately 1% of kg per square centimetre.1 When puncture Devitalised tissue is a good breeding ground emergency centre visits in the United States.1 wounds overlie bone an open fracture for Clostridium tetani and prophylaxis The magnitude of the problem in South should always be suspected and radiological should be considered. The rabies virus can be Africa is likely to be similar, and Dwyer et examination is mandatory. Common transmitted from rabid dogs. al. found that dog bites accounted for 1.5% injuries caused by dog bites are abrasions, of all trauma unit presentations at the Red simple lacerations, deep puncture wounds, Management Cross War Memorial Children’s Hospital in crush injuries and fractures. Injuries to deep Patients who have sustained severe injuries Cape Town over a 13.5-year period.2 structures such as nerves and blood vessels (Fig. 1) should be resuscitated first. Immediate can occur. direct pressure should be applied to bleeding In 2006 more than 31 000 patients required wounds. Intravenous lines should be inserted reconstructive surgery in the USA as a The pathogens in dog bite injuries originate and blood taken for cross-matching. Attention consequence of dog bites. The estimated from the oral flora of the dog and the skin should be given to the airway and breathing direct and indirect cost of dog bites amounts to around $250 million per year in the USA.3

South African and international studies have shown repeatedly that children are the highest risk group for attacks by dogs.2,4 Children younger than 7 years are more