Pediatric emergency medicine trisk 2029 2029
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Leukocytosis and coagulopathy can also develop. EKG changes if present are
usually consistent with myocardial infarction. Acute kidney injury has also been
reported. No antivenom is commercially available, and treatment is mainly
symptomatic with analgesia, plasma expanders, and epinephrine or other pressors.
MAMMALIAN BITES
Goals of Treatment
Treatment aims to decrease the overall morbidity of mammalian bites in terms of
infectious complications, cosmesis, disability, psychological trauma, and medical
expenses.
CLINICAL PEARLS AND PITFALLS
Cat and human bites have a high infectious complication rate.
Wound closure can be delayed when there is a high risk of infection.
Local wound care is more important than prophylactic antibiotics in
prevention of infection.
Current Evidence
At least 1 to 2 million people in the United States are bitten each year, and about
1% of ED visits are prompted by bite wounds. Dog bites account for the
overwhelming majority (80% to 90%) of mammalian bites. An estimated 4.5
million dog bites occur in the United States annually, with approximately 885,000
people seeking medical care. The most common dog attacks involve 5- to 14year-old boys close to home, large-breed or mixed-breed canines, and head, neck,
and upper extremity injuries. The dog’s owner can be identified 85% to 90% of
the time; in fact, in 15% to 30% of cases, the dog belongs to the victim’s family.
Usually, the dog has been provoked, although most often unintentionally. Animal
jealousy has been implicated in unprovoked biting of infants and accounts for
about 10 fatal cases each year in the United States.
Other mammalian bites are perpetrated by cats (3% to 15%), rodents (2% to
3%), humans (2% to 3%), and other wild or domesticated animals such as ferrets.
Human and cat bites both have high infectious complication rates.
Clinical Considerations
Anatomic wound characteristics and the microbiologic inoculum of the offending
species determine the pathologic consequences of the bite. Many dog bites cause
