›Vitals every 5 to 15 minutes initially
›Rash and bronchospasm surveillance
Infection prophylaxis and antibiotics
›Antibiotics
›Human bite
›Amoxicillin clavulanate PO 875 mg every 12 hours
›If severe, ampicillin sulbactam IV 3 g every 6 hours
›Cat bite
›Amoxicillin clavulanate PO 875 mg every 12 hours
›Hand bite prophylaxis favored
›Dog bite
›Amoxicillin clavulanate PO 875 mg every 12 hours
›Prophylaxis if hand, deep puncture, or immunocompromised
›Penicillin allergy options
›Doxycycline PO 100 mg every 12 hours
›Metronidazole PO 500 mg every 12 hours
›Marine wound risk
›Doxycycline PO 100 mg every 12 hours
›Third generation cephalosporin per protocol
Rabies and tetanus prophylaxis
›Rabies and tetanus
›Rabies post exposure prophylaxis
›Indicated if high risk exposure and animal not available
›Local public health guidance
›Rabies immune globulin
›Infiltrate into wound when possible
›Remainder IM at distant site
›Rabies vaccine series
›Day 0
›Day 3
›Day 7
›Day 14
›Tetanus immunization
›Td or Tdap booster per schedule
›Tetanus immune globulin if indicated
›Reassessment loop
›Repeat vitals at least every 30 to 60 minutes for evolving envenomation
›Repeat focused neuro exam for bulbar progression
›Repeat limb measurements every 30 to 60 minutes initially
›Repeat coagulation labs every 4 to 6 hours if hemotoxicity concern
›Escalate disposition if progression despite therapy