Animal biteMANAGEMENT

INFECTIOUS DISEASE PRESENTATIONS · 12 SECTIONS

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590 items

☷ Legend

01Approach to the Critical Patient/attcp64

Immediate stabilization

›Immediate priorities

›Airway compromise

›Oropharyngeal or neck bite

›Facial swelling

›Expanding hematoma

›Hemorrhage

›Pulsatile bleeding

›Uncontrolled bleeding after direct pressure

›Shock

›Hypotension

›Altered mental status

›Anaphylaxis

›Urticaria

›Bronchospasm

›Hypotension

Time critical threats

›High risk bite patterns

›Hand bite

›Flexor tendon sheath involvement concern

›Septic arthritis concern

›Deep puncture

›Retained tooth or foreign body concern

›Deep space infection concern

›Face and neck bite

›Airway risk

›Cosmetic and functional risk

›Immunocompromised host

›Rapid progression infection concern

›Capnocytophaga sepsis risk

Isolation and exposure precautions

›Zoonotic exposure precautions

›Body fluid exposure

›Gloves and eye protection

›Wound irrigation splash precautions

›Suspected rabid animal exposure

›Local public health notification per policy

Early decision points

›Key decisions

›Rabies post exposure prophylaxis eligibility

›Species and availability for observation or testing

›Exposure category

›Tetanus prophylaxis need

›Vaccination history

›Wound classification

›Antibiotic prophylaxis indication

›High risk wound features

›High risk host features

›Primary closure suitability

›Location and time since bite

›Infection signs

Consultation triggers

›Early specialty involvement

›Hand surgery

›Hand bite with deep structure concern

›Flexor tenosynovitis concern

›Plastics

›Face bite needing layered closure

›Tissue loss

›Orthopedics

›Suspected joint penetration

›Suspected osteomyelitis

›Ophthalmology

›Eyelid or globe proximity injury

›Infectious diseases

›Severe infection

›Unusual host risk

›Public health

›Rabies risk assessment support

02History/hx92

Core history elements

›Exposure timeline and setting

›Time since bite

›Less than 8 hours

›8 to 24 hours

›More than 24 hours

›Location of event

›Urban

›Rural

›Travel outside region

›Provoked vs unprovoked

›Unprovoked aggression

›Animal acting strangely

Animal details and rabies risk

›Animal factors

›Species

›Dog

›Cat

›Human

›Bat

›Raccoon

›Skunk

›Fox

›Rodent

›Livestock

›Ownership status

›Known domestic

›Unknown domestic

›Wild

›Availability

›Available for 10 day observation

›Available for testing

›Not available

›Vaccination status

›Documented current

›Unknown

›Not vaccinated

Bite mechanics and wound contamination

›Bite characteristics

›Number of bites

›Single

›Multiple

›Mechanism

›Crush

›Puncture

›Tear or avulsion

›Clothing barrier

›No barrier

›Thin barrier

›Thick barrier

›Saliva contamination

›Visible saliva

›Wound licked

Host risk factors

›Patient risk factors

›Immunocompromised state

›Asplenia

›Cirrhosis

›Chemotherapy

›Chronic steroids

›HIV

›Transplant

›Diabetes

›Poor glycemic control history

›Peripheral vascular disease

›Chronic limb ischemia

›Lymphedema

›Prior lymph node dissection

›Prosthetic material near bite

›Prosthetic joint

›Vascular graft

Vaccination and prophylaxis history

›Immunization status

›Tetanus vaccination history

›Last dose within 5 years

›Last dose 5 to 10 years

›Last dose more than 10 years

›Unknown series completion

›Prior rabies vaccination

›Pre exposure series completed

›Prior post exposure series completed

Symptoms suggesting infection or deep injury

›Current symptoms

›Pain progression

›Increasing pain

›Pain out of proportion

›Functional impairment

›Reduced range of motion

›Weakness

›Numbness

›Systemic symptoms

›Fever

›Chills

›Malaise

›Local symptoms

›Erythema spreading

›Purulent drainage

›Lymphangitic streaking

03Physical Exam/exam56

Wound assessment

›Local wound features

›Location and depth

›Hand and fingers

›Face and scalp

›Lower extremity

›Tissue injury pattern

›Puncture

›Laceration

›Avulsion

›Contamination

›Visible debris

›Devitalized tissue

›Infection signs

›Erythema

›Warmth

›Swelling

›Purulence

›Crepitus

Neurovascular and functional exam

›Distal function

›Sensation

›Two point discrimination if hand bite

›Motor function

›Tendon integrity

›Grip strength limitation

›Perfusion

›Capillary refill

›Distal pulses

›Compartment features

›Pain with passive stretch

Deep structure involvement

›High risk findings

›Joint involvement concern

›Pain with passive range of motion

›Effusion

›Flexor tenosynovitis features

›Fusiform swelling of digit

›Finger held in flexion

›Pain with passive extension

›Tenderness along flexor sheath

›Bone involvement concern

›Point bony tenderness

›Exposed bone

Systemic assessment

›Systemic status

›Vital signs abnormalities

›Fever

›Tachycardia

›Hypotension

›Sepsis features

›Altered mental status

›Poor perfusion

PITFALLS

›Common misses

›Small puncture with deep inoculation

›Minimal surface findings early

›Hand bite underestimation

›Tendon sheath and joint proximity

›Cat bite infection progression

›Rapid onset cellulitis within 24 hours

04Differential Diagnosis/ddx28

Life threatening and limb threatening

›Critical diagnoses

›Necrotizing soft tissue infection

›ICD-10 M72.6

›Severe pain

›Systemic toxicity

›Sepsis

›ICD-10 A41.9

›Hypotension or organ dysfunction

›Septic arthritis

›ICD-10 M00.9

›Pain with passive motion

›Flexor tenosynovitis

›SNOMED CT flexor tenosynovitis concept

›Kanavel features

Mimics and alternate etiologies

›Alternative diagnoses

›Cellulitis non bite related

›ICD-10 L03.90

›Allergic reaction

›ICD-10 T78.40XA

›Fracture or dislocation

›ICD-10 site specific fracture codes

›Retained foreign body without infection

›ICD-10 T16 to T19 site specific foreign body codes

Rabies related considerations

›Rabies exposure outcomes

›Rabies exposure without prophylaxis

›Fatal encephalitis risk with true exposure

›Alternative viral encephalitis

›Non rabies etiologies in symptomatic patients

05Laboratory Tests/lt26

Infection severity and sepsis evaluation

›Infection labs

›Complete blood count for systemic infection concern

›Leukocytosis support for infection

›Normal count does not exclude early infection

›C reactive protein for deep infection concern

›Trend utility for admitted patients

›Lactate for sepsis concern

›Elevated lactate supports hypoperfusion

Culture strategy

›Microbiology tests

›Wound culture for established infection

›Purulent drainage sampling preferred

›Superficial swab limitations

›Blood cultures for systemic toxicity

›Fever

›Hypotension

Baseline safety monitoring

›Medication safety labs

›Creatinine and electrolytes for IV antibiotics

›Dose adjustment need

›Nephrotoxic regimen monitoring

›Liver enzymes for hepatotoxic antibiotic concern

›Amoxicillin clavulanate cholestatic risk context

PITFALLS

›Test limitations

›Normal inflammatory markers early in deep infection

›Clinical exam priority

›Negative culture after antibiotics

›Culture before antibiotics when feasible in severe infection

06Diagnostic Tests/dt47

Scoring Systems

›Risk stratification tools

›Rabies exposure category framework

›Category 1

›Touching or feeding animal

›Licks on intact skin

›Category 2

›Nibbling of uncovered skin

›Minor scratches without bleeding

›Category 3

›Transdermal bites or scratches

›Saliva to mucosa

›Bat exposure with uncertain contact

›Tetanus prophylaxis algorithm

›Clean minor wound

›Td or Tdap if last dose 10 years or unknown

›Tetanus immune globulin if unknown or incomplete series

›Dirty or major wound

›Td or Tdap if last dose 5 years or unknown

›Tetanus immune globulin if unknown or incomplete series

MRI

›MRI indications

›Deep infection evaluation

›Suspected osteomyelitis

›Suspected deep abscess

›Hand bite complications

›Tenosynovitis extent

›Septic arthritis extent

›Performance and limits

›High sensitivity for osteomyelitis

›Limited availability for unstable patients

›CT indications

›Facial bite with deep structural concern

›Orbital involvement concern

›Skull fracture concern

›Deep space infection

›Gas in soft tissue concern

›Complex abscess mapping

›Foreign body detection

›Tooth fragments in deep tissue

Ultrasound (or US)

›Ultrasound applications

›Soft tissue abscess evaluation

›Fluid collection identification

›Guidance for drainage when appropriate

›Foreign body evaluation

›Radiolucent foreign body detection

›Localized hyperechoic focus with shadowing

›Vascular evaluation

›Pseudoaneurysm concern near major vessel

07Disposition/dispo36

Admission and transfer criteria

›Higher level care indications

›Systemic toxicity

›Sepsis physiology

›Hemodynamic instability

›Rapidly progressive infection

›Spreading erythema despite initial care

›Necrotizing infection concern

›Deep structure involvement

›Septic arthritis concern

›Tenosynovitis concern

›Osteomyelitis concern

›High risk host

›Immunocompromised

›Asplenia

›Advanced cirrhosis

›Need for operative management

›Extensive debridement need

›Complex repair need

Discharge criteria

›Safe discharge features

›No systemic toxicity

›Stable vital signs

›No deep structure concern

›Normal neurovascular exam

›Preserved function

›Reliable follow up

›Reassessment within 24 to 48 hours if high risk

›Clear prophylaxis plan

›Rabies plan finalized with public health

›Tetanus plan completed

Follow up planning

›Follow up needs

›Wound check timeline

›24 to 48 hours for hand bites and punctures

›48 to 72 hours for low risk wounds

›Specialty follow up

›Hand surgery for hand bites

›Plastics for facial wounds

08Treatment/t127

Wound cleansing and repair

›Local wound care

›Irrigation and decontamination

›High volume irrigation with sterile saline

›Puncture wound irrigation focus

›Devitalized tissue debridement when needed

›Exploration and foreign body management

›Depth evaluation in adequate anesthesia

›Retained tooth fragment removal when identified

›Closure strategy

›Primary closure for selected low infection risk wounds

›Delayed primary closure for higher risk wounds

›Secondary intention for puncture and infected wounds

›Hemostasis and dressing

›Non adherent dressing

›Elevation for hand injuries

Antibiotic prophylaxis and treatment

›Antibiotic indications

›Prophylaxis indications

›Hand bite

›Deep puncture

›Crush injury

›Face bite with primary closure

›Immunocompromised host

›Asplenia

›Prosthetic joint or vascular graft proximity

›Treatment indications

›Established cellulitis

›Abscess

›Lymphangitis

›Systemic symptoms

›Oral antibiotic regimens

›First line for dog and cat bites

›Amoxicillin clavulanate adult

›875 mg amoxicillin with 125 mg clavulanate PO every 12 hours

›Duration 3 to 5 days prophylaxis

›Duration 5 to 7 days uncomplicated cellulitis

›Penicillin allergy non anaphylaxis

›Cefuroxime PO

›500 mg PO every 12 hours

›Add metronidazole

›500 mg PO every 12 hours

›Penicillin allergy anaphylaxis

›Doxycycline PO

›100 mg PO every 12 hours

›Avoid in pregnancy

›Avoid in children under 8 years

›Trimethoprim sulfamethoxazole PO

›1 double strength tablet PO every 12 hours

›Add clindamycin

›300 mg PO every 6 to 8 hours

›Human bite coverage option

›Amoxicillin clavulanate adult

›875 mg amoxicillin with 125 mg clavulanate PO every 12 hours

›Duration 5 to 7 days prophylaxis

›IV antibiotic regimens

›Severe infection or deep structure concern

›Ampicillin sulbactam

›3 g IV every 6 hours

›Adjust for renal function

›Piperacillin tazobactam

›4.5 g IV every 6 to 8 hours

›Broad polymicrobial coverage

›MRSA risk or severe purulence

›Vancomycin

›15 to 20 mg per kg IV every 8 to 12 hours

›Trough based institutional protocol

›Nephrotoxicity monitoring

›Beta lactam anaphylaxis severe infection

›Levofloxacin

›750 mg IV every 24 hours

›Add metronidazole

›500 mg IV every 8 to 12 hours

Rabies post exposure prophylaxis

›Rabies prophylaxis framework

›Immediate steps

›Copious wound irrigation as first line rabies prevention

›Public health coordination for animal testing and observation

›Post exposure prophylaxis for not previously vaccinated

›Human rabies immune globulin

›20 IU per kg once

›Infiltrate as much as feasible into and around wound

›Remaining volume IM at site distant from vaccine

›Avoid same syringe and same anatomical site as vaccine

›Rabies vaccine IM

›Day 0

›Day 3

›Day 7

›Day 14

›Immunocompromised modification

›Add day 28 dose

›Serologic confirmation per public health

›Post exposure prophylaxis for previously vaccinated

›Human rabies immune globulin omission

›Not indicated

›Rabies vaccine IM

›Day 0

›Day 3

Tetanus prophylaxis

›Tetanus prevention

›Vaccine selection

›Tdap preferred once in adulthood if not previously received

›Td acceptable booster when Tdap already given

›Tetanus immune globulin

›250 IU IM once for indicated patients

›Separate site from vaccine

Pain control and supportive care

›Symptom management

›Analgesia options

›Acetaminophen PO

›1000 mg PO every 6 to 8 hours

›Maximum 3000 mg per day for most adults

›Ibuprofen PO

›400 mg PO every 6 to 8 hours

›Avoid in renal failure and high bleeding risk

›Immobilization

›Splint for hand bite with pain and swelling

›Elevation to reduce edema

Evidence levels and recommendations

›Antibiotic prophylaxis evidence

›High risk wounds benefit from prophylaxis

›Hand bites

›Cat bites

›Deep puncture wounds

›Immunocompromised hosts

›ACEP Level C recommendation for prophylaxis in high risk bite wounds

›Consensus based emergency wound management practice

›Rabies prophylaxis evidence

›Class I recommendation for rabies vaccine and immune globulin when exposure risk present

›Public health guideline based

›Tetanus prophylaxis evidence

›Class I recommendation for tetanus booster and immune globulin based on wound and immunization history

›Immunization guideline based

09Special Populations/sp32

Pregnancy

›Pregnancy considerations

›Antibiotic selection

›Amoxicillin clavulanate compatible in pregnancy

›Doxycycline avoidance in pregnancy

›Rabies prophylaxis

›Rabies vaccine acceptable in pregnancy when indicated

›Human rabies immune globulin acceptable in pregnancy when indicated

›Tetanus prophylaxis

›Tdap acceptable in pregnancy when indicated

Geriatric

›Geriatric considerations

›Higher complication risk

›Delayed presentation

›Comorbid vascular disease

›Medication adjustments

›Renal dosing adjustment for beta lactams

›Fall risk considerations with sedating analgesics

›Lower threshold for admission

›Frailty

›Limited self care capacity

Pediatrics

›Pediatric considerations

›Weight based antibiotics

›Amoxicillin clavulanate

›25 to 45 mg per kg per day amoxicillin component divided every 12 hours

›Maximum per institutional pediatric dosing limits

›Doxycycline age restriction

›Avoid in children under 8 years unless specific indication

›Rabies prophylaxis dosing

›Human rabies immune globulin 20 IU per kg

›Rabies vaccine schedule same as adults

›Non accidental trauma concern

›Injury pattern inconsistent with history

›Safety assessment needs

10Background/b30

Epidemiology

›Bite epidemiology

›Common species

›Dogs most common bites

›Cats higher infection rate than dogs

›Infection risk patterns

›Hand bites higher infection risk

›Puncture wounds higher infection risk

Pathophysiology

›Microbiology and inoculation

›Typical organisms

›Pasteurella species

›Rapid onset cellulitis association

›Capnocytophaga canimorsus

›Severe sepsis risk in asplenia and cirrhosis

›Anaerobes

›Polymicrobial infection common

›Human bite organisms

›Eikenella corrodens

›Injury mechanics

›Crushing injury tissue devitalization

›Puncture inoculation into deep planes

Therapeutic Considerations

›Treatment principles

›Irrigation importance

›Mechanical reduction of bacterial load

›Antibiotic spectrum goals

›Gram positive coverage

›Gram negative coverage

›Anaerobic coverage

›Closure approach rationale

›Primary closure infection risk tradeoff

›Face wounds benefit from primary closure after adequate irrigation

11Patient Discharge Instructions/pdi26

copy discharge instructions

›Discharge instructions

›Wound care

›Keep clean and dry for first 24 hours

›Gentle washing with soap and water after 24 hours

›Daily dressing change

›Activity

›Elevation for hand and extremity bites

›Limit use if pain and swelling

›Antibiotics

›Take exactly as prescribed

›Do not stop early unless instructed

›Rabies plan

›Follow public health instructions for vaccine appointments

›Return immediately if unable to receive scheduled doses

›Return to emergency criteria

›Fever

›Increasing redness or swelling

›Pus or foul drainage

›Red streaks up the limb

›Worsening pain

›Numbness or weakness

›Trouble moving fingers or joints

›New confusion or fainting

›Follow up

›Wound check in 24 to 48 hours for hand bites and punctures

›Primary care follow up for tetanus series completion if needed

12References/r26

Clinical guidelines and key sources

›Rabies prevention guidance

›CDC rabies post exposure prophylaxis guidance

›Vaccine schedule and immune globulin dosing

›Skin and soft tissue infection guidance

›IDSA guidance for bite wound infection management

›Antibiotic selection and duration

›Immunization guidance

›National immunization guidance for tetanus prophylaxis by wound type

›Booster and immune globulin indications

Coding and terminology

›ICD-10 and SNOMED CT mapping

›Dog bite

›ICD-10 W54.0

›Cat bite

›ICD-10 W55.01

›Other mammal bite

›ICD-10 W55.81

›Human bite

›ICD-10 W50.3

›Cellulitis

›ICD-10 L03.90

›Sepsis

›ICD-10 A41.9

›Necrotizing fasciitis

›ICD-10 M72.6

›Septic arthritis

›ICD-10 M00.9

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Reviewed by SymptomDx Medical Team · Last reviewed June 16, 2026

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