[size=6]A 10-year-old presents to the emergency room after being bitten by a neighbor’s dog on his way to school. The child sustained multiple puncture wounds on the lower extremity. The neighbor has confirmed the dog’s rabies vaccination status. The child’s vaccines are up to date. What is the best next step in the management of this patient?

 

a Primary closure of wounds

 

b Irrigation of wounds

 

c Tetanus vaccination

 

d Intravenous antibiotics

 

e Rabies vaccination[/size]

E

E

correct answer

b Irrigation of wounds

 

Dog bites represent most animal bites seen in the pediatric population. Multiple studies continue to evaluate the most appropriate management of the patient who has sustained a bite wound. These studies look at multiple issues including whether to close the wound and timing of the closure, use of antibiotic therapy and vaccination regimens. While all these topics are important and affect the long-term outcomes of these wounds, one of the most important methods of preventing bacterial infection is proper irrigation. This irrigation can be performed in the emergency room but may require sedation depending upon the extent of the wounds and the patient’s age. Low-pressure irrigation can be used for clean wounds. Most bite wounds can be cleaned with an 18-gauge blunt needle and a 30- or 60-ml syringe. Generally, 100-200 mL of irrigation solution per inch of wound is required. High-pressure irrigation, defined as 7 psi (pounds per square inch), should be utilized for dirty or heavily contaminated wounds. Avoid blind high-pressure irrigation of puncture wounds. Isotonic sodium chloride is an effective irrigating solution. Antimicrobial and anti-infective solutions offer no advantage and may cause tissue irritation. Heavily contaminated wounds may require debridement and removal of foreign material to prevent infection.

B