Dog Bite Management in the ED: Bark with a Bite

-Case-
A 43-year-old woman presents to the ED after being bitten on the hand by a neighbor’s dog while walking down her street. She’s otherwise healthy, and the bite occurred about three hours ago. The wound is a shallow laceration with minimal bleeding but surrounding erythema, and there are no signs of deep tissue damage or tendon involvement. She’s up to date on her tetanus vaccination. 

-Evaluation-
Dog bites account for the majority of mammalian bites seen in the ED. Most patients are bitten on the hands, arms, or face. While infection is the primary concern, assessing for deep structure involvement (e.g., tendons, joints, nerves) is critical.

  • Bacteria involved: Polymicrobial
    • Pasteurella species (most common)
    • Staphylococcus, Streptococcus species
    • Anaerobes (e.g., Fusobacterium, Bacteroides)
  • Key Exam Elements:
    • Assess neurovascular status
    • Check for signs of infection or retained foreign bodies
    • Evaluate range of motion and tendon function
    • Consider imaging for deep or joint-involved wounds

-Management-

-Fast Facts-

  • Infection rates up to 20%, especially in hand wounds
  • Always consider rabies exposure when the dog’s vaccination status is unknown
  • Augmentin is your go-to antibiotic
  • Avoid closing bite wounds on the extremities unless absolutely necessary

A minor wound with big potential complications. With good wound care, appropriate antibiotics, and some key questions about the animal, most of these patients go home safely. But never forget: a simple bite can become a big problem if missed.

Want to learn more? Listen to our in-depth podcast episode and read our high-yield study guide!

Cheers,

Tamir Zitelny, MD

-References-

  1. Rothe K, Tsokos M, Handrick W. Animal and human bite wounds. Dtsch Arztebl Int. 2015;112(25):433-442. doi:10.3238/arztebl.2015.0433
  2. Morgan M. Management of animal bite wounds: an overview. Am Fam Physician. 2007;75(6):1067-1072
  3. Goldstein EJ. Bite wounds and infection. Clin Infect Dis. 1992;14(3):633-638. doi:10.1093/clind/14.3.633
  4. Medeiros I, Saconato H. Antibiotic prophylaxis for mammalian bites. Cochrane Database Syst Rev. 2001;(2):CD001738. doi:10.1002/14651858.CD001738
  5. Malone P, Kaufman J, Myers RA. Dog bites of the hand: a retrospective review of 150 patients. Am J Emerg Med. 2012;30(5):801-803. doi:10.1016/j.ajem.2011.05.029
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