Bites in the ED

You are examining a patient who presents with EMS from home after an apparent dog bite injury. He states he spent 7 hours trying to get the “cutest” picture of his dog for reddit so he could get some reddit gold and upvotes -- but that his dog became agitated by all the picture taking and he alleges that his dog proceeded to bite him. His friend who accompanies him thinks the real reason his dog bit him is because he feeds his dog a #vegandiet and his dog has become tired of this.  

In which of the following is true?

A. Tetanus vaccination is only indicated if vaccination has not occurred in <10 years

B. Hand lacerations can be closed for cosmesis if no infection is present and if <12 hours

C. Antibiotic prophylaxis is always indicated in hand injuries

D. When closing wounds, subcutaneous sutures are preferred

E. Wound cultures should be acquired on initial ED presentation in case of infectious complication in the future.

References:

  1. Aziz H, Rhee P, Pandit V, et al. The current concepts in management of animal (dog, cat, snake, scorpion) and human bite wounds. J Trauma Acute Care Surg 2015; 78:641.

  2. Boenning DA, Fleisher GR, Campos JM. Dog bites in children: epidemiology, microbiology, and penicillin prophylactic therapy. Am J Emerg Med 1983; 1:17.

  3. Brook I. Human and animal bite infections. J Fam Pract 1989; 28:713.

  4. De Munnynck K, Van de Voorde W. Forensic approach of fatal dog attacks: a case report and literature review. Int J Legal Med 2002; 116:295.

  5. Faciszewski T, Coleman DA. Human bite wounds. Hand Clin 1989; 5:561.

  6. Fleisher GR. The management of bite wounds. N Engl J Med 1999; 340:138.

  7. Goldstein EJ. Management of human and animal bite wounds. J Am Acad Dermatol 1989; 21:1275.

  8. Kannikeswaran N, Kamat D. Mammalian bites. Clin Pediatr (Phila) 2009; 48:145.

  9. Moran GJ, Talan DA. Hand infections. Emerg Med Clin North Am 1993; 11:601.

  10. Phair IC, Quinton DN. Clenched fist human bite injuries. J Hand Surg Br 1989; 14:86.

  11. Talan DA, Citron DM, Abrahamian FM, et al. Bacteriologic analysis of infected dog and cat bites. Emergency Medicine Animal Bite Infection Study Group. N Engl J Med 1999; 340:85.

Blake Briggs