Animal and Snake Bites

These include bites by humans, dogs, and other domestic animals, as well as wild animal bites.

Management

This will depend on the extent of tissue loss and the site of injury. Most bites consist of cuts and simple lacerations. Other animals(hippopotamus, and crocodiles)inflict major tissue destruction(lacerations, avulsions, and amputations).

Immediate Care

If not already acted upon at lower health facilities, stop all bleeders by pressure and ligature while preparing for thorough toileting. Administer a pain reliever, e.g.,pethidine 100mg IM for an adult.

Local care

1. Clean cuts and lacerations thoroughly with chlorhexidine 5% or hydrogen peroxide6%. Nota Bene:Hydrogen peroxide is indicated for septic wounds only. One may use detergent only and dress.
2. Update status toxoid 0.5ml IM STAT immunization.
3. Give analgesia as appropriate, e.g ibuprofen 400mg TDS 
4. Give amoxicillin 500mg TDS (25-50mg/kg)+metronidazole 400mg TDS for 5 days.
5. Give rabies vaccine where indicated {check on rabies management}
6. Give antivenom for snake bites in appropriate cases.
7. Consider urgent referral if rabies vaccines or anti snake venom is not available in the facility. Ensure adequate documentation and availability of resuscitation equipment during the actual referral phase.
8. For large bites, carry out surgical toileting under anaesthesia. DAILY dressing is advised and later skin grafting or flap repair is performed. Open chest injuries will require underwater seal drainage. Open abdominal wounds will necessitate an exploratory laparotomy.
9. In the case of amputated extremities, carry out toileting and stump refashioning where necessary followed by appropriate rehabilitation.
10. Should the patient be in shock, treat aggressively with saline infusions, blood transfusions, and vasopressor agents.
11. In major tissues destruction, administer antibiotics, e.g crystalline penicillin 1g 6 hourly, gentamicin 80 mg TDS, and metronidazole 400mg TDS for 7 days;Piperacillin 2g is an alternative. IMPORTANT: This will cover clostridium, Gram-negative, and anaerobic bacteria, which colonize the mouths of most animals.