Initial Management

Assessment regarding whether hospital treatment is necessary should be made as soon as possible. Always refer if the wound is bleeding heavily or fails to stop when pressure is applied. Penetrating bites involving arteries, nerves, muscles, tendons, the hands, or feet, resulting in a moderate to serious facial wound, or crush injuries, also require immediate referral.

If management within custody is appropriate, ask about current tetanus vaccine status, HBV vaccination status, and known allergies to antibiotics.

Wounds that have breached the skin should be irrigated with 0.9% (isotonic) sodium chloride or Ringer's lactate solution instead of antiseptics, because the latter may delay wound healing.

A full forensic documentation of the bite should be made as detailed in Chapter 4.

Note if there are clinical signs of infection, such as erythema, edema, cellulitis, purulent discharge, or regional lymphadenopathy. Cover the wound with a sterile, nonadhesive dressing. Wound closure is not generally recommended because data suggest that it may increase the risk of infection. This is particularly relevant for nonfacial wounds, deep puncture wounds, bites to the hand, clinically infected wounds, and wounds occurring more than 6-12 hours before presentation. Head and neck wounds in cosmetically important areas may be closed if less than 12 hours old and not obviously infected.

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