Wednesday, May 23, 2012

Mangy Mutt Bit Me: Treatment of Dog Bites

Some mangy mutt bit you and you're off to the ED. Dog Bites can be devastating, particularly when it's a child, and if you have a character that has been bitten by a dog-- or any animal-- certain care is required.

First, I'm going to talk mainly about dog bites but you could lump other animal bites into this category. Unfortunately, dog bites tend to be more destructive than say cat or other animals.

The first consideration is how extensive is the injury? Dog bites are reportable injures though this may depend on the county of which the dog bite took place. Generally, we have the parent fill out a "dog bite form" that includes information about the owner, the dog, and the nature of the events surrounding the injury.

Just because a dog bite is reported does not mean that in the next breath the police are at the house taking the animal away. Though, it likely is filed away for those states that forgive the first dog bite but hold the owner responsible for all subsequent bites. These reports are faxed to animal control of the jurisdiction where the bite took place.

If the injury is extensive, a report can be made to the police for "serious bodily injury". I actually didn't know this until I spoke to my brother who works for a large sheriff's department. So, if parents insist, then we will contact police. Medical staff can initiate this report as well.

In kids, we will apply a topical numbing gel called LET. It has three medications in it: Lidocaine (to numb), Epinephrine (to vasoconstrict and decrease bleeding) and Tetracaine (that also numbs). The gel is left in place for a minimum of 20-30 minutes. Adults can go to straight injection with lidocaine if sutures are required. Once the patient is numb, the wound is then irrigated with copious amounts of sterile saline. For a simple laceration we usually use 450ml. Dog bites require twice that for each wound. The wound is then stitched and an antibiotic ointment is placed over top. The wound is dressed as needed.

One special note: If the wound is more of a puncture, it may not even be stitched at all. Puncture wounds can run deep and again, we don't want to trap potential infection.

Dog bites are high risk for infection so they are never glued shut. This is so that any infection that develops can be seen as it drains from the wound. Most often, due to the concern for infection, a patient will be placed on an antibiotic like Keflex.

Rabies prophylaxis is rarely given. There is a window of opportunity to start rabies injections if concern is warranted but it is definitely not a standard treatment for all dog bites. Rabies infection related to dog bites is rare due to widespread vaccination of the canine population but is more prominent in developing countries.

Have you ever written a scene where someone was bitten? If so, what kind of animal was it?


  1. I've written lots of scenes where people get bitten. But vampire bites tend to either kill you straight away or heal very well by themselves!

    1. I hadn't thought of those other types of bites-- vampires, werewolves, zombies. Hmmm, maybe a Halloween post in the making!

  2. You know, it just occurred to me that nobody has ever been bitten in one of my stories, not even by a werewolf.:-) But this information is very handy for future reference.

  3. Lidocaine??? Yeesh, I go to the wrong medical health professionals . . . around here it's straight into the betadine solution. I've had both cat and dog bites, (and on one unfortunate occurrence both at the same time, one to each hand), and the big difference between the two in my experience was the cat bites were harder to clear up without antibiotics. A compassionate vet tech told me to soak for 20 minutes 3x/day in the hottest water I could stand with a healthy squirt of either Dawn or betadine. It keeps the wounds open and draining.

    A good plot device might be the heroine's beloved dog being attacked by a stray and she tries to rescue it by reaching into the fray (common, but a bad idea in real life) or a stray cat may spook and bite the hero trying to bring it in from the cold.

    Jordyn, thanks for another excellent glimpse into procedures! Could I cast a vote for a follow up on infected bites (abscesses, swelling, spreading infection)?

    1. Shandiss-- I do work with kids so we try to be nicer-- I guess! Still, I might ask for some lidocaine. Interesting plot points.

      And absolutely-- I could do something on infected bites. Probably be July/August. Blog calendar is full until then.

      Thanks so much for leaving the idea!

    2. Combine the two and have the heroine's beloved pet bite the hero. Could make for some interesting tension.

  4. I've written as least one bite scene (mountain lion), but since it was set in the 18th century the treatment was more primitive and less effective. Infection was a huge factor. I second the suggestion for a post on treating infected bites.

    I used to work at a boarding kennel. I was only ever bit by a cat (a little mop of a dog tried, but that's another story that still makes me laugh). But that cat... it latched on with teeth and claws and tried disembowel my arm. WHILE I was trying to feed it. I was more afraid of cats than a kennel full of Akitas.

  5. That's an excellent idea for a manuscript Carrie-- always good to look for ways to increase tension/conflict.

    Lori-- okay-- July I'll do treatment of infected bites, abcesses, etc...