Treatment of a purulent wound after a dog bite. Dog bite: what you need to know

The injury caused by this animal can threaten not only health, but also human life. What to do if bitten by a dog? How to give the victim first aid? This is extremely important to know in order to prevent tragic consequences.

Why are dog bites dangerous?

Depending on the severity, doctors divide them into superficial and deep. In a superficial dog bite, the animal's teeth pierce only the skin of the victim, and a puncture wound is formed. With a deep injury, muscle tissue, blood vessels are affected, and due to a laceration, a person can lose a lot of blood. Most often, dogs bite people on the legs and arms. Wounds in the neck and head are much more dangerous, since internal bleeding with a fatal outcome is possible due to bone fractures and ruptures of large vessels.

Pathology most often manifests itself in two main variants. At best, the wound is shallow and infected with pathogenic bacteria that multiply in the animal's mouth. In such a situation, the inflammatory process begins with suppuration of the tissues. Wound infection usually develops during the first or second day after injury. When pathogenic flora enters the circulatory system, there is a risk of sepsis - infection of the whole body, but this rarely happens.

The most dangerous bite option is infection of the wound with the rabies virus. People bitten by dogs are usually primarily driven by fear. You need to try to overcome it and determine whether the bitten animal is vaccinated against a deadly disease. As a rule, it is not so easy. If bitten by a domestic dog, you can find out from its owner if it is vaccinated. What to do if the dog has bitten the owner? This sometimes happens, especially when cruelty to animals. And in this case, the possibility of rabies can never be ruled out.

Homeless, stray dogs pose the greatest risk, especially if they stray in packs. You should know the characteristic symptoms of a rabid dog, which are immediately evident. She has:

saliva flows profusely from the drooping jaw;
eyes squint;
the body twitches at times with convulsions;
there is a need to gnaw the earth, inedible objects.

It is important to consider which part of the body the dog injured. Bites to the neck and head are the most dangerous, as rabies viruses penetrate the brain very quickly. According to medical statistics, the disease develops in 90% of such cases and reaches its apogee in 9-10 days. With leg injuries, the disease occurs in 20-25% of cases and much later, a few months after the bites.

Signs of pathology

What you need to know about the symptoms after a dog bite? The development of a bacterial infection in the wound is evidenced by:

redness, swelling;
the appearance of pus;
enlargement of nearby lymph nodes;
rise in temperature;
moderate discomfort.

Quite different symptoms in the development of rabies. Once in the brain, its viruses multiply intensively and gradually cover the entire body, damaging the nervous system. First of all, the salivary glands, muscles, lungs, intestines, and kidneys are affected.

You need to know that rabies develops in 3 stages, and each of them has its own characteristic manifestations. For the initial period, which lasts several days, the following symptoms are typical:

pain in the area of an already healed wound, which occurs much later than the bite;
headache;
loss of appetite;
insomnia;
depressed mood, increased irritability;
general weakness;
sometimes - an increase in temperature.

During the period of active development of the pathology, which also lasts 2-3 days, there are short-term, but more frequent attacks of psychophysical arousal of the patient. They are usually provoked by the sight and sound of water, bright lights, loud noises, and sharp gusts of wind. At the time of seizures:

muscle cramps occur;
pupils dilate;
the face twists into a grimace of horror;
breathing becomes rapid, noisy;
saliva, foam are intensely secreted from the mouth;
behavior becomes extremely aggressive;
crazy ideas, hallucinations appear.

After that, the disease ends with a period of imaginary improvement:

convulsions stop;
excitement is replaced by calmness;
consciousness clears up;
due to paralysis of the respiratory center of the brain or cardiac arrest, the death of the patient occurs.

First aid

When bitten by dogs, what is the first thing to do?

If the victim suspects that he or she has been bitten by a rabid dog, it is important to induce some bleeding. To do this, you need to strongly massage the injured area or even incise the skin so that blood flows. Only then should the wound be disinfected and bandaged.

Competent first aid for a dog bite allows you to block the infection of the body and minimize its consequences. After that, you should immediately deliver the victim to the trauma center. The doctor, having assessed his condition, will prescribe adequate treatment.

For lacerated wounds, surgical sutures must be applied. To eliminate the risk of sepsis, you need to inject an antibiotic (Amoxicillin, Clavulanate or Doxycycline, Metronidazole). If it is known for certain that the dog has been vaccinated against rabies, a shot against tetanus is sufficient. And how to treat a dog bite at the slightest suspicion that it may be terminally ill?

Rabies vaccination

Thanks to its implementation, many human lives have been saved. When bitten by a dog, it is important to start treatment as early as possible, no later than 8 hours after receiving such an injury. If the wounds are deep or shallow, but the head, neck, toes, hands, genitals of a person are affected, immunoglobulin injections should be given. This drug neutralizes the rabies virus. Sometimes after a day or two and even a week after its introduction, allergic reactions of varying severity may appear.

Then the traumatologist prescribes a course of injections of the rabies vaccine to the victim. This is an effective drug, thanks to which the body forms an immune defense against a deadly virus. Vaccination is not necessary only if the owner of the dog presents a certificate confirming that it has been vaccinated against rabies.

The number of injections is determined depending on the information about the dog that bit the patient. If this is an unknown stray animal, 6 injections are prescribed. The first is done immediately on the day of treatment of the victim. He receives the rest, arriving at the trauma center on the 3rd, 7th, 14th day, then after 1 and 3 months.

Vaccination is carried out according to a different scheme, when the dog that bit the person is known, not vaccinated, but outwardly healthy. She is isolated and the animals are monitored. If within 10 days he does not show signs of rabies, the victim is given only 3 injections: on the day of treatment, on the 3rd and 7th day. During the course of vaccination and another six months later, one should not drink alcoholic beverages, overwork excessively, sunbathe and go to the bathhouse, and allow hypothermia of the body.

After each injection, the victim should be under medical supervision for about half an hour. If necessary, he receives anti-shock treatment. At the end of the vaccination course, the patient receives a certificate that indicates the type and series of the vaccine, possible post-vaccination side effects.

Such reactions, though rare, do happen. Can be:

redness, swelling, itching at the injection site;
headache;
rise in temperature;
slight enlargement of the lymph nodes;
malaise.

Pregnancy and childhood are not grounds for refusing vaccinations. They are mandatory even a few months after the dog bite. Vaccination is provided free of charge.

Article content: classList.toggle()">expand

In surgical practice, visits to doctors due to the presence of bitten wounds occupy one of the first places in terms of frequency. Their treatment presents many difficulties, since when bitten into damaged tissues, a huge number of various microorganisms penetrate, most of which are pathogenic and can cause quite serious inflammation.

Why are bitten wounds dangerous, how to properly treat an injury resulting from a bite, what treatment is available after first aid - you will find the answer to these and other questions in this article.

Description and causes of bite wounds

A bite wound is an injury to the skin and other tissues resulting from bites by animals or another person.

Paradoxical as it may seem, but bites from human teeth are not at all rare in medical practice.. They occur under different circumstances and can be both intentional and accidental, for example, when a person is hit in the jaw, you can damage your hand on his teeth and this will be considered a bitten wound.

But most of the visits to clinics occur due to dog bites. Such wounds may have a different nature and complexity, but they always have a strong contamination with a variety of microorganisms.

Many of the dog bites are dangerous to humans and can cause serious consequences, such as rabies and even septic syndrome, which are fatal.

Cat bites are less common, but create no less complications than dog bites, although they do not cause such serious damage to a person. Cat bites are usually small puncture wounds, but carry a serious infection risk that does not show up immediately and can have serious consequences.

Much less common are applications for bites by rodents, such as mice, hamsters, rats, squirrels, guinea pigs. Such bites are usually not as traumatic as the bites of dogs and even cats, but for humans they can be quite dangerous, especially when it comes to wild animals.

Bites from other animals are rare. But it is important to remember that any bitten wound has a serious risk of infection and various microorganisms, therefore, when receiving such injuries, it is important to consult a doctor without delay.

Signs and symptoms

As a rule, the signs of a bitten wound can be varied and largely depend on which animal (or person) caused tissue damage. Any bite causes severe pain.

In human bites, in most cases there is a serious hematoma with severe swelling of the tissues and imprints of teeth, but severe damage to the skin usually does not occur, unless the bite was intentional with the intent of violence.

When a dog bites, the wound can have a different character, for example, it can be stab with a weak bite, when only the fangs of the animal penetrate the human body. It can be quite deep and large-scale, if all the dog's teeth have penetrated the body. In this case, there may be severe bleeding, swelling of tissues, torn edges of the bite, hematoma, swelling.

A wound after a dog bite may turn out to be torn, including with the loss of part of the soft tissues.

With cat bites, multiple scratches, which can be quite deep, are often observed simultaneously with small stab wounds. In this case, an inflammatory process appears very quickly, expressed in a fairly strong pain syndrome, the appearance of hyperemia, swelling, swelling, blood can ooze from the wounds.

When bitten by rodents, the damage is usually small, but deep enough and dangerous., as well as multiple ones, since such animals have especially sharp teeth and can act very quickly, inflicting damage at an incredible speed.

First aid after a bite

First aid for bitten wounds involves, first of all, the fastest possible local treatment of the resulting wound.

It is important to treat the wound after a bite as early as possible and as carefully as possible.

First you need to wash the wounds with ordinary laundry soap, treating not only the existing injuries, but also the skin around them, which could also get the saliva of the animal.

It is soap that should be the first means of treating a bitten wound., because it is able to inactivate the rabies virus that may have entered the wound from the animal's mouth.

Treatment after first aid

An important point is that bite wounds in most cases are not sutured. The only exceptions here are cases where there are large wounds and loss of part of the tissue. Also, bite wounds localized on the surface of the head are subject to suturing, since in this case there is intense bleeding. Stitching of such wounds is not carried out due to the frequent occurrence of purulent complications.

In medicine, there is a certain rule according to which during the first three days, no sharp objects should be climbed into the wound after a bite, that is, it is impossible to carry out operations to excise the edges of existing injuries, suture or make any incisions. Except in emergency cases, when there are very extensive and deep wounds.

During the first three days, only the treatment of wounds is carried out, which consists in washing them and changing dressings. After this period, the doctor assesses the condition of the person and the existing injuries and makes the necessary appointments.

An important point in the treatment of bitten wounds is antimicrobial therapy by applying special ointments that have anti-inflammatory and bactericidal effects. The use of such agents is necessary to prevent the appearance of a purulent process or its treatment, while it is important to observe the regimen for changing dressings and properly treat bites, cleaning them from exudate and pus, as well as disinfecting with special solutions, for example, Chlorhexidine or pharmacy hydrogen peroxide.

Do I need to get vaccinated after being bitten by an animal?

It is important to remember that human disease with rabies leads to inevitable death and it is not possible to treat this disease when it occurs and develops by any means.

The duration of such a vaccination is only 10 days after the bite, so it is best to consult a doctor immediately, without delaying.

You can often hear objections, especially from the owners of the bitten dog, that this measure would be unnecessary, because their animal is not sick with anything. This position is erroneous.

It is possible to be sure that the dog does not have rabies only if the animal has been blood sampled for research and its result is negative. But such an analysis takes time, and it is very valuable. Therefore, vaccination is not at all a superfluous measure, as well as the introduction of a vaccine to prevent the occurrence of a possible tetanus, especially if for some reason it was not carried out in a planned manner.

A dog is a friend of man, but sometimes it turns into a formidable enemy and attacks. In this case, the wounds can be very deep with damage to bones, tendons, blood vessels and nerves. First aid for a bite should be aimed at stopping severe bleeding, after which the victim should be immediately taken to the nearest emergency room.

You will need

- sterile dressing;
- rubber band;
- iodine;
- hydrogen peroxide;
- alcohol or alcohol solutions.

Instruction

The most formidable complication that occurs after a bite is rabies. It can be fatal due to extensive damage to the central nervous system, if all methods are not taken in a timely manner to prevent it. Therefore, regardless of whose dog bit you, you must go to the hospital.
If the wounds are superficial, tissue rupture is minor, treat the bite site with a 3% hydrogen peroxide solution or any antiseptic solution that is contained in your first aid kit. Suitable diluted medical alcohol, alcohol solutions of calendula, chamomile, sage. Lubricate the wound with iodine, apply a sterile bandage and consult a doctor immediately.
Do not treat wound surfaces with iodine, brilliant green - this will lead to burns of damaged tissues, which will significantly lengthen the healing period.
Deep wounds with extensive ruptures cannot be treated with anything. Apply a tourniquet or tight bandage to prevent severe blood loss, cover the wound with a sterile dressing, take the victim to the emergency room yourself or call an ambulance.
In a hospital, the wound will be sewn up and treated according to all medical rules. Then the patient will be given dressings and injections to prevent rabies. Previously, it was necessary to do 40 injections. Currently, modern pharmaceuticals are used that make it possible to get by with 6 injections according to a specific scheme prescribed by a doctor.
In case of complications, you will be prescribed a course of antibiotic therapy on an outpatient or inpatient basis.
Do not neglect a visit to the doctor and do not think that everything will heal on its own. The incubation period for rabies lasts from 10 to 15 days, so when the first signs of the disease appear, it may be too late.

In any city there are homeless or lost animals, and not all owners lead their pets on a leash. In addition, it is not always possible to predict the aggressive mood of the dog in advance and successfully avoid meeting him. If a person has been bitten by a dog, it is important to have information on what to do and not waste time. The consequences of such a bite are likely to be quite harmless, but there are complications, up to death.

The following symptoms are considered characteristic signs in a person after a dog bite:

Redness, swelling at the site of the bite from the first to the third day.
Heat.
Discharge of pus.
Aches in muscles and bones.
Itching and irritation after a dog bite.
Nausea.
Emotional stress.
Enlarged lymph nodes.
If the lesion is large, bleeding is profuse.
Difficulty moving an injured arm or leg.
A person cannot swallow saliva, a spasm appears.
Insomnia.
Loss of appetite.
The rabies virus in humans damages the muscles, kidneys, intestines, lungs, and salivary glands.
Fear of water, sound or light.
The worst symptoms after being bitten by a rabid dog are paralysis that causes death.

But remember that a dog bite is dangerous. The disease occurs gradually, signs of the disease may appear even after a year. Do not delay treatment. When dog bites are not accompanied by any of the above symptoms, go to the doctor anyway.

First aid for a dog bite

What is first aid for a person who has been bitten by a dog?

If severe bleeding occurs, immediate treatment of the wound after a dog bite is not needed. Blood will wash away the saliva of sick animals if it gets on the wound. Let your body clear out the infection on its own.
First you need to wash the damaged area with water and laundry soap, which can kill viruses and bacteria, due to the alkali content.
Then the wound of the bitten person is treated. How to treat a dog bite at home? This may be a solution of potassium permanganate or hydrogen peroxide, if there is no iodine and brilliant green.
On the skin around the wound, we apply synthomycin or another ointment containing an antibiotic.
Wrap the damaged area with a gauze bandage, but do not bandage it heavily - harmful bacteria will leave with the ichor.
When dog bites are not accompanied by heavy bleeding, first aid is to slightly cut the wound and bleed to avoid infection.
Keep track of what complications the injured person will experience during the bite.
If you think that the bone is damaged, you need to fix it and go to the emergency room.

Basic help for a dog bite is provided. Now you need to take care of the emotional health of the bitten person. Give him a sedative if needed.

Do not make the victim feel severe pain, offer pain medication.

The above measures are needed immediately after a dog bite, then go to the doctor. He will tell you what to do next and recommend effective means. If the victim was bitten by a dog with a history known to him, it will be necessary to tell the specialist about the vaccinations made, the period during which they are still valid. This will help to get rid of additional unpleasant procedures.

If your friend has been bitten by a dog and there is an opportunity to observe her behavior from a safe place, you can roughly determine whether she has rabies or not. A sick animal will behave too aggressively or, conversely, very calmly. It will not be able to drink - spasms in the throat will interfere with it. But she will want to gnaw on the ground or other inedible objects. Strong salivation, squinting eyes, body spasms are a sure sign of rabies. The pet may whine or howl, but cannot bark. In this case, no one is trying to cure the animal anymore: how to treat a dog bite at home, the owner also does not need to know. Seek qualified help immediately.

First aid for an injured child from a dog bite

Adults often wonder why a previously calm dog bit a child. Children treat the animal like a toy. They can pull their pet by the tail or accidentally hit, he remembers such features of children well. It is difficult for a child to understand that this is bad, so do not be surprised if a calm and kind dog bit the child.

This is a very devoted animal, but sometimes her love is too much. The pet may be jealous. Nothing can be done here: the dog has bitten the child, because he irritates her, takes away the love of the owners. Animals bite children in the face, neck or forearm. Do not ask what to do, it is necessary to make a decision in favor of the child. To avoid such conflicts, such an animal will have to be given to someone. The question “how to treat a child’s wound after a dog bite” becomes relevant when the pet considers himself the head of the pack. This is a pack animal, and in each pack there is a certain gradation, so it demonstrates its superiority.

First aid for a dog bite at home is usually required by parents. They start to panic and act incorrectly. If you feel panicky, take a sedative and calmly decide what to do with the child after a dog bite.

First aid for a bite by an unknown dog is similar to the case with an adult. The wound is carefully treated with soap and water, make a tight bandage if the bleeding is heavy. For dog bites, first aid is to treat with an antiseptic (Levomikol or boric ointment). Parents calm the child and go to a specialist.

Bitten by a domestic dog

The object of attack is not always a stranger. It also happens that the dog bit the owner. No owner is immune from this. A pet, when playing, may not calculate its strength. The reason for the aggressive behavior of the animal can be pain, hunger, the negative attitude of the breeder. There are owners who complain that the dog bit the hand, and do not understand: they are the reason for this behavior.

Pets are usually vaccinated in a timely manner. Therefore, if you decide not to visit a medical facility where medical care is provided, first aid for a dog bite should be carried out at home. First you need to isolate yourself from the bitten pet, so if the dog has bitten, try to close it in the room.

Prepare a healing cream. To do this, chop 3 walnuts, grind the onion to a pulp and take a little salt. Mix everything. Apply ointment and lightly bandage. This mixture acts as an antidote for dog bites. There are other means than you can treat the wound.
Drink vitamin C daily, eat more foods that contain it. Reception can be stopped when the skin tightens.
Chopped garlic and a spoonful of honey is the best anti-inflammatory remedy that you can do with a dog bite - either homemade or yard.
A good help will be turmeric powder with honey. Honey has a calming effect, turmeric is an excellent antiseptic.
Cook 50 grams of eucalyptus leaf in a small amount of water, after boiling it will be enough for 4 minutes. Then strain the broth, wait until it cools down, put 2 tablespoons of honey.
Grind the onion, add a little honey, you get a healing ointment.
Make healing oil. To do this, pour 75 g of burdock root with 1 glass of oil. Leave the mixture for a day. Then the composition must be boiled, strained, drained into another bowl. Damaged areas are lubricated 2 times a day.
These remedies can be used at home, but what if you get bitten on the street by a domestic dog? It is enough to pick a sheet of celandine, put it on the site of damage.

Another treatment is needed for a bite from a domestic dog, when the wound turned out to be very deep: all that needs to be done in this case is to call an ambulance.

Treatment

The doctor knows that a treated wound reduces the risk of serious consequences, how dangerous a dog bite is, and how to treat a human wound. This is usually an antiseptic or alkaline solution. Your doctor will stitch you when:

Affected and bleeding vessels;
The wounds are on the face
The lacerations are deep.

It is possible to completely eliminate the likelihood of infection with bites only when the owner provides documents on the latest vaccinations at the veterinary clinic. If there are no such documents, there is a high probability of getting sick with rabies. In the emergency room, you will be vaccinated against rabies. Everyone has probably heard about rabies injections - 40 injections, one daily. Do not worry, now this is already a relic of the past, medicine is gradually developing. Now only six injections are enough - on the third day, 7 days after the bite, after 2 weeks, after a month and after 3 months. Such a rabies vaccine has no contraindications, it can be administered to absolutely everyone, even pregnant women, but there is one limitation: at this time and six months later, you can not drink alcohol. When the victims are treated in a timely manner, and they know how to treat a dog bite, all measures taken are effective. After the introduction of the vaccine, it is necessary to stay in a medical facility for some more time so that there is no poisoning. Drug poisoning (or allergies) appear within the first 30 minutes.

The vaccination is done immediately in the wounded place, and then in the shoulder. If you decide not to install it, fill out a written refusal. During the examination, the doctor himself will decide how to treat the dog bite. When the wound has not been washed well from dirt, an injection against tetanus is needed. A course of antibiotics is often prescribed. If a bone fracture occurs or teeth remain in the body, an x-ray is taken.

It is good when there is an opportunity to follow the behavior of the pet for a long time. If the animal is calm for about two weeks, you should again consult a doctor. He may stop further treatment. Be careful: if a dog bite heals slowly (there are a lot of wounds that do not heal longer than the due date), it is better not to take risks and consult a doctor. Do not wait for a self-healed wound - if the treatment does not give results for a long time, but it only gets worse - this is also the first sign of a dangerous disease. Remember that if you do not come to a specialist within the first three days, the vaccine may not help, and the person is doomed. It is better to start treating the wound left by a dog bite no later than 8 hours than to regret the lost time later.

Prevention

There are categories of people who definitely need preventive vaccinations. These are foresters, slaughterhouse workers, hunters, veterinarians, dog catchers. In this case, do not wait for what will happen after a dog bite, it is better to immediately prevent bad consequences. First, they give an injection on the first day, after a week, a month, a year. Then only one vaccine is administered every three years. But there are also contraindications:

Allergy (to an antibiotic or to a previous injection).
Acute chronic diseases. It is necessary that the exacerbation ends, and the person fully recovers.
Pregnancy.

It is best to avoid contact with unknown or known aggressive animals whenever possible, especially if they are not muzzled. Not worth:

Teasing a dog, even a chain dog. He experiences strong aggression, the dog at this moment becomes stronger and can break the chain.

Approach the pet when he is eating or guarding the puppies.
Wave your arms, run, shout loudly, show your fear or smile.
Sharply wake up a sleeping animal - she may be frightened.
Approach him while intoxicated.
Separate fighting animals.
Approach a pack of stray dogs. They can attack without any reason, aiming at the hips, ankles or arms of a person.
Allow children to stroke mutts or leave them alone with them.

Respect the territory that the animal considers its own.

What can scare off an aggressive dog:

Reciprocal anger towards her.
A call for help, but only in a low voice, not a loud squeal.
Confident team: "No!"
A little earth or sand thrown into the eyes.

How dangerous is a dog bite?

Damage after a collision with an animal can be different.

Superficial abrasions heal the fastest. The animal damages only the skin, so the wound is shallow.

How dangerous is a ragged dog bite for a person? Severe bleeding begins, if it is not stopped, a person may die.

The location of the injury plays an important role. A person may not always become infected, it depends on the degree of infection and other factors. The head and neck are the most traumatic, the virus enters the brain faster. Rabies affects 90% of cases and 10 days are enough for the development of the disease. After a dog bite in the leg, the risk of infection is 25%, the signs of the disease appear much later - after a few months. The disease is not transmitted from person to person, it can only be contracted from an animal.

Consequences of a dog bite

The consequences of a bite are the most unpleasant:

Painful sensations and the need to treat the injury site,
If there is an infection in the wound, then there is a risk of sepsis.
Rabies disease.
Bleeding.
Negative psychological state of a sick person.
Rupture of large vessels.
Bone fractures.
Death.

Males most often suffer from aggressive behavior of animals, and injuries also occur in children. An increase in the number of victims is observed from June to September. In any case, the most dangerous are fighting breeds (Rottweilers, Pit Bull Terriers, Dobermans). It is worth being careful and taking all the necessary precautions.

About 80% of bites are inflicted by dogs. Infection complicates 15-20% of these bites. Most of the victims are dog owners or their acquaintances, most of the attacks are provoked. Often this happens when trying to pull apart fighting dogs. Men suffer more often. Leg bites predominate. Wound infection usually develops 8-24 hours after the bite. Pain, inflammation, purulent discharge, sometimes with an unpleasant odor, appear at the site of the bite. If a joint or bone is injured during a bite, arthritis and osteomyelitis are possible.

Wound infection is often accompanied by fever, swollen lymph nodes, lymphangitis. It mostly has a mixed etiology: viridescent streptococci, staphylococci, Pasteurella multocida, Eikenella corrodens, Capnocytophaga canimorsus. In bitten wounds, anaerobic bacteria are often found - Actinomyces spp., Fusobacterium spp., Prevotella spp. and Porphyromonas spp. Dog bites are usually complicated by local infections, although many bacteria entering the wound can also cause systemic infections (bacteremia followed by meningitis, brain abscess, infective endocarditis, or chorioamnionitis). Such infections are more common in immunocompromised individuals (during treatment with glucocorticoids, systemic lupus erythematosus, acute leukemia, cirrhosis of the liver), as well as in violation of the lymphatic drainage (for example, after radical mastectomy).

When bitten by dogs and scratches caused by them, infection with rabies and tetanus is possible. In addition, bite wounds serve as an entry gate for the bacterium Capnocytophaga canimorsus, which causes fulminant sepsis, DIC, and kidney failure, especially in liver dysfunction, immunosuppression, and asplenia. This bacterium is a thin Gram-negative rod that grows poorly on most dense media, but is able to grow on liquid media. In patients with sepsis, it is sometimes found inside neutrophils when staining blood smears according to Wright. Dog bites are similar to puncture or laceration wounds, only the likelihood of infection is always greater. A dog's teeth are very sharp, and when it bites, germs enter deep into the wound and then into the blood.

If the dog does not look into the eyes of a person, it may attack. If a dog has bitten a person once, it will definitely bite again. Animals should never be approached if they are eating, fighting or grooming each other. Never let cats or dogs lick an open wound. Pets must be vaccinated against rabies.

Dog bites are especially dangerous for children. Some American publications give the percentage of children bitten by a dog at least once in their lives, ranging from 25 to 40%. Hospital statistics for dog bites show between 0.5 and 1% of cases requiring consultation and 5% of wounds in surgical emergency departments.

More than 50% of all dog bites in the population occur between 0-18 years of age, but there are two frequency peaks (between 1-4 years of age and between 10 and 13 years of age) and male predominance (56-65%), especially in aged 1-4 years.

Biting occurs throughout the year, but with a peak frequency from June to September. These are primarily domestic cases, inside the home (15-20%), or in close proximity (35-40%), usually at the home of family or friends. Other places (parks, squares, street) give from 15 to 20% of bites. The child was alone in the room or garden with the dog in 20-25% of cases, and in more than 50% of cases the incident occurred in the absence of adult supervision.

Allocate four reasons for the attack dogs:

Aggression out of fear

An incident occurs when a child wants to play with a dog to manipulate it, pull it by the fur, etc. or when, for whatever reason, the animal cannot avoid it and cannot escape, or when a child on a leash approaches the dog, wanting to cuddle or embrace it. Other situations have been reported: the child lies down in the place of the dog or wants to pull its tail.

Aggression due to a change in family hierarchy

If the hierarchical place in the family is left to the dog, an aggressive reaction may develop to keep things as they are, most often this concerns a poorly socialized dog serving as a substitute for a child in the family and who feels that her place has changed with the appearance of a child. The introduction of a child into the living space of a dog (privatization by him of her place, her food) can also cause a defense reaction in the animal.

disease-related aggression

The dog is irritated by painful sensations or a very long-term illness that remains unrecognized: chronic otitis media, dermatosis, osteoarticular disease that is not noticed. The bite is usually preceded by a long phase of aggressive behavior.

pathological behavior

This type of aggressiveness is very rare and is more likely to refer to stray dogs who have become real robbers, as is the case in some regions of the United States, or to dogs with neurological lesions such as encephalitis, a brain tumor, or a vascular tumor.

Bite site varies depending on the age and the victim himself. In a small child, the face is most often affected (70-85%): lips, cheeks, nose, eyelids, nose, then the back of the head, neck and upper limbs. In older children, localizations are more varied, including the lower limbs (calves), upper limbs (hand, base of the thumb), and finally the face. Double localizations are not uncommon, which corresponds to repeated attacks, and most often to an attack by two dogs with a simultaneous bite.

The severity of lesions While most dog bites turn out to be favorable in outcome, some turn out to be quite severe, especially with regard to the aesthetic consequences on the face. Wounds simple linear or uneven at the edges are the most common. Possible loss of substance (loss of skin or muscle).

The bite is usually superficial, but may be deep penetrating or transfixed (cheeks) in large animals, and subcutaneous detachments may go unrecognized unless a thorough examination is made. For every 100 bites that require medical attention, 5 to 10% require hospitalization for examination under anesthesia. The medical cause of death statistics published by Inserm give zero to two deaths per year in France since 1985 (10 to 15 annual deaths in the US). The number of consequences (functional or aesthetic) is from 1 to 3% of all bites.

Surveys show the predominance of large dogs and, above all, German Shepherds (40-50%) outperforming all other breeds in this: terriers, cockers, huskies, labradors, dachshunds. This accusation of being particularly aggressive in German Shepherds must be tempered by two considerations: crossbreeds are often unnecessarily included in this category, and bites from large dogs are more often a matter for consultation, due to the more severe lesions in relation to their size and jaws. Some dogs with a reputation for being "ferocious", such as the Doberman, Rottweiler, Pitt Bull Terrier, give a minority of all bites (less than 2%), although the wounds they inflict are often more pronounced. Aggressive dogs are most often young and male.

Treatment of patients is often delayed: 30% of children are brought for consultation after 24 hours. The prognosis is directly related to the delay in treatment.

Gathering as accurate information as possible is essential and includes answering questions about the circumstances of the incident and previous incidents with the child.

Animal: Is it wild or domestic? Is the owner known? Upon contact with the owner, you can get information regarding the animal: has it already shown aggressiveness? Was her behavior normal in the previous days? Has the dog been vaccinated?
Place: did the incident occur in an area with a known risk of rabies?
About the child himself: Is the child immunocompetent? What is his vaccination status?
Bite: at what time did it happen? What was the treatment?

During the clinical examination, the site of the injury and its connection with the neurovascular bundles, tendons and joints are specified, its appearance is clear or bruised, the possible presence of subcutaneous detachment and its depth is determined. Tendon injuries are not uncommon and can easily be missed on the first clinical examination.

During the examination, signs of severity are determined depending on the aesthetic consequences (on the face or there is tissue loss), functional (damage to the nerve, eyeball, muscle destruction) or infectious (bruised skin, ecchymotic, detachment), dislocation, rupture of the joint or flexor tendon sheath.

Urgent measures

There are two types of bites: superficial and deep.

At superficial bites you need to wash the area around the bitten place with warm water and soap for 5 minutes. Then dry the area and apply a clean bandage.

At deep bites first of all, calm the victim and stop the bleeding (direct pressure, tourniquet, bandage). Then call an ambulance or take the victim to the nearest medical facility.

At home, to the measures mentioned above, you can add washing the wound with warm water with tincture of echinacea or potassium permanganate. Disinfection carried out as quickly as possible, ammonium quaternaire or a solution of iodine or chlorhexidine is suitable for this, after washing the wound with plenty of water. This rinsing shortens the time that droplets of infected animal saliva remain in the wound and reduces the risk of infection.

Soothe and relieve pain Often, even under the influence of shock, the child is in a state of excitement and should be calmed down. Analgesics are freely prescribed.

Place of antibiotic therapy The saliva of an animal, in particular that of dogs, contains a polymorphic microbial flora with the presence of pyogenic microorganisms (staphylococci, streptococci) and anaerobes; 30 to 60% of dogs are asymptomatic carriers of various strains of Pasteurella. The frequency of infections after a dog bite is generally determined to be in the range of 5-15%. More than 50% of cous-related wounds in animals requiring urgent hospitalization are contaminated (presence of microflora in direct examination or on cultures). A Cummings meta-analysis of eight studies found infection rates (microorganisms plus clinical manifestations) after a dog bite from 3.2 to 45.8%.

Several wound features correlate with an increased risk of infection: an inflamed wound, deep, painful; the presence of subcutaneous detachment or loss of substance, the percentage of positive tissue sampling reaches 25% with a predominance of Pasteurella. Wounds of the hand become infected most often. A delay of more than six hours from the time of the bite to the first local treatment reflects the time the animal's saliva is in the wound and is associated with a higher risk of infection. Causative microorganisms can be varied. In 60-75% of cases, contamination is polymicrobial. Pasteurella (Pasteurella canis et multocida) are the most frequent (40-50%), followed by streptococci (Streptococcus mitis, mutans, pyogenes; 35-45%), staphylococci (Staphylococcus aureus, epidermidis, warneri; 30-40%). Anaerobic microorganisms (Fusobacterium, Bacteroides, Porphyromonas, Prevotella, Propopionibacterium) are detected in 20-30% of cases, and most often in association with anaerobic microorganisms.

The place of antibiotic therapy in the prevention of secondary infection to a dog bite has been the subject of numerous studies, with often conflicting findings. Some authors recognize systematic antibiotic therapy, others reserve it for bites that pose a particular risk of infection, the relevant risk factors are associated either with the localization (face, hands) or with the aspect of the wound (inflamed whole, contaminated, deep, bruised skin or loss of substance).

A significant reduction (44%) in the incidence of infectious complications with prophylactic antibiotic therapy was demonstrated in the Commings meta-analysis, provided that it begins one hour after the bite. Many families of antibiotics that meet the criteria for the required effectiveness (distribution in tissues, spectrum overlapping pasteurella and pyogens, oral administration) can be used for this: tetracyclines, amoxicillin-clavulanic acid, quinolones. The therapeutic regimen for amoxicillin-clavulanic acid is 50 mg/kg for seven to ten days. Tetracyclines are used in older children and adolescents.

If the systemic use of antibiotics of the first intention for the purpose of prevention is controversial, then its use is not disputed in the presence of local or loco-regional signs of inflammation.

Early and painful swelling around the wound, with lymphangitis and adenopathy, indicates infection with Pasteurella, while more distant manifestations (more than 48 hours) are most often associated with pyogenic microorganisms.

The suturing of the wound remains the subject of controversy. It seems reasonable to apply them when the wound is old (after 48 hours) and surincted (suturing may be scheduled on the third day if the wound is clean). And, conversely, when the wound looks fresh and is clearly not contaminated, then you can sew it together, but do not bring the edges of the wound too close together or simply apply a greasy antiseptic bandage. The use of steristrip may be interesting.

Conversely, early suturing is desirable for facial bites in order to limit aesthetic consequences. It is preceded by surgical treatment.

Surgical examination is expected with each deep bite, and even more so if it is located near the tendon or neurovascular bundle.

Rabies Prevention defined by law and must be systematic. You should inquire about the animal that bit. After a bite, three options can occur, on which further behavior depends.

If the owner is identified

The dog is properly vaccinated. Ideally, a photocopy of the bitten animal's vaccination certificate would be included with the medical record. Vaccination of the bitten is not carried out.

The dog is not vaccinated and its vaccination status is not known. Veterinary supervision is carried out within the statutory period of 15 days. (Decree of 13 September 1976) and three veterinary certificates must be obtained on day 1, day 7 and day 14. There are three options:

The dog is alive and well at the first examination: no vaccine treatment is undertaken. If rabies is not detected by the end of the observation period, then the bite is considered not infected. Otherwise, vaccination is carried out in the anti-rabies center, this vaccination treatment is carried out according to a single principle (two injections on day 0, one on day 7 and one on day 21);

The animal is alive, but there is a suspicion at the first examination; vaccination treatment is carried out; it is interrupted if the animal is healthy;

The animal suddenly died or was killed after being bitten: the head of the animal must be urgently sent to the Pasteur Institute where three types of examination are carried out (histological, virus particle detection by immunofluorescence, inoculation of suspected brain homogenate). Vaccine treatment begins pending test results.

If the animal is not found or its corpse is destroyed

Complete vaccination treatment.

Bite Prevention

Never leave a small child alone with a dog
Never disturb your dog while eating
Respect your dog's peace and sleep
Never approach a mother dog guarding her babies.
Do not deprive the dog of any opportunity to get out (leave him the opportunity to run away)
Don't leave one child who wants to teach his dog
Forbid your child to touch an unfamiliar dog
Teach your child to recognize the signs of a dog's aggressiveness so he doesn't annoy her unnecessarily.
Don't let your child interfere in a fight between two or more dogs
Teach your child to respect the dog's territory (place, bowl...)

There is no breed of dog naturally dangerous, but only the conditions of education or maintenance make the animal aggressive. "The behavior of the owner determines the behavior of the dog." Dogs listed in the genealogical book of the Central Society of Dog Breeders of France are subject to controlled selection and are almost never genetically dangerous. Conversely, crossbreeds (such as pitt bulls) are at risk of becoming dangerous, as the mixture of breeds can disrupt the genetic mechanisms for suppressing aggression towards humans. Owners of potentially dangerous dogs should be aware of the established rules: keep a dog on a leash in public places.