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?