Dog Bites: A Medical Emergency You Haven’t Considered
As discussed in Feral Dog Packs: A Rising Epidemic for this Nation, wild dog packs are not only an issue in post-disaster situations, they are already a large concern in urban areas. No doubt many of you have read the news headlines of packs of wild, abandoned dogs rummaging all over Detroit.
Sadly these abandoned animals will only continue to roam the streets of Detroit and continue to wreck havoc. Due to the city’s financial woes, the city’s animal control department’s budget has also been cut, leaving the city no choice but to allow the animals to roam. The Humane Society of the United States director visited Detroit recently, saying
“It was almost post-apocalyptic, where there are no businesses, nothing except people in houses and dogs running around. The suffering of animals goes hand in hand with the suffering of people.”
Medical Issues Arise From Dog Bites
The Washington Times reports, “Stray dogs are literally terrorizing the city as the ratio of humans to animals continues to balance out.” To make matters worse, dog bites have increased as well. Last year, there were 903 dog bites in Detroit. This canine aggressiveness has forced some U.S. mail deliveries to halt in certain neighborhoods. One Detroit resident was scalped by two stray dogs who attacked her on her porch.
Outbreaks of rabies is a major concern for city’s that have a large population of unvaccinated street dogs as they are one the most common carriers of the painful and often fatal disease. That said, rabies isn’t the only medical issue to be concerned with:
- Parvovirus should be suspected if bitten by an unknown animal.
- Bacterial infections of soft tissues or bone (osteomyelitis) which can become life threatening if untreated.
- Capnocytophaga canimorsus transmission (a gram-negative bacterium) can cause overwhelming sepsis in asplenic patients, the elderly, and the immunocompromised. Empriric treatment for this bacteria following a dog bite, consisting of a third-generation cephalosporins early in the infection, should be instituted in these patient populations, or following deep bites or dog bites to the hand.
Treating a Dog Bite
If the skin is not disturbed, or if there is a minimal abrasion present, it may be reasonable to watch for signs of infection (pain, redness, warmth, swelling, and drainage of pus or fluid) before seeking medical care.
Medical care should be accessed if the dog bite disrupts the skin causing a puncture, laceration, or tear. As well, if there is pain at or near the injury site, underlying structures may have been damaged and medical care may be needed.
Essentials of dog bite treatment are: inspection, debridement, irrigation, and closure.
- Carefully inspect bite wounds to identify depth of injury and devitalized tissue. Obtaining an adequate inspection of a bite wound without it first being anesthetized is nearly impossible. Care should be taken to visualize the bottom of the wound and, if applicable, to examine the wound through a range of motion.
- Debridement is an effective means of preventing infection. Removing devitalized tissue, particulate matter, and clots prevents these from becoming a source of infection, much like any foreign body. Clean surgical wound edges result in smaller scars and promote faster healing.
- Irrigation is another important means of infection prevention. A 19-gauge blunt needle and a 35-mL syringe provide adequate pressure (7 psi) and volume to clean most bite wounds. In general, 100-200 mL of irrigation solution per inch of wound is required. Heavily contaminated bite wounds require more irrigation. Isotonic sodium chloride solution is a safe, available, effective, and inexpensive irrigating solution. Few of the numerous other solutions and mixtures of saline and antibiotics have any advantages over saline. If a shield-like device is used, take care to prevent the irrigating solution from returning to the wound, which decreases the effectiveness of the irrigation.
- Primary closure may be considered in limited bite wounds that can be cleansed effectively (this excludes puncture wounds, i.e., cat bites). Other wounds are best treated by delayed primary closure. Facial wounds, because of the excellent blood supply, are at low risk for infection, even if closed primarily, but the risk of superinfection must be discussed with the patient prior to closure. Bite wounds to the hands and lower extremities, with a delay in presentation, or in immunocompromised hosts, generally should be left open.
- If a bite wound involves the hand, consider immobilizing in a bulky dressing or splint to limit use and promote elevation.
If seen at a medical facility, professionals will suggest administering a tetanus booster, may initiate anti-rabies treatment and a round of antibiotics as a preventative for bites from animals with unknown vaccination records. Other animals that may carry the rabies virus are cats, foxes, bats, raccoons, or skunks in the Americas.
After the wound has been treated, regularly inspect it and if fever, sepsis, spreading cellulitis, severe edema, crush injury, or loss of function is present, seek medical assistance.
The threat of feral dog packs do exist and will only increase from the poor economic downturn we are experiencing. Prepare accordingly for this issue and understand the mannerisms of a feral dog, attack behavior and feeding habits.