Animal Attacks
Recommended oral antibiotics for prophylaxis of domestic animal and human bite wounds are listed in Appendix J.
Wound Care
1. Irrigate the wound, preferably using normal saline solution. Alternatively, use boiled or otherwise treated and potable water (see Chapter 20 for more irrigation discussion).
2. If possible, add a germicidal agent to the irrigating solution. In order of preference, use 1% povidone-iodine solution (not “scrub”), 1% benzalkonium chloride, or ordinary hand (camping) soap. In a heavily contaminated wound, a 5% to 10% povidone-iodine solution may be used.
3. Complete the irrigation with a germicide-free solution (e.g., plain water) to rinse all irritating chemicals from the wound. Use 2% benzalkonium chloride to cleanse wounds inflicted by animals suspected of being rabid (see Chapter 43).
4. Clean the wound, if necessary, by swabbing with a soft, clean cloth or sterile gauze. Follow with a repeat irrigation.
5. Determine whether the injury is high or low risk for infection to make decisions about closure, need for antibiotics, and evacuation (Box 42-1).
6. If the wound edges are macerated, crushed, or extremely contaminated, perform sharp debridement.
7. If the wound must be closed to control bleeding, to allow dressing, or to facilitate evacuation, do so in a manner that allows drainage. Use tape, surgical adhesive strips, or loose approximating sutures or staples in preference to a tight closure.
