"THE HEART OF THE MATTER"
a special program of the National Emergency Medicine Association (NEMA)


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Week: 585.6 Pt. 2  

Guest: Dr. Ron Charles, Asst. Prof. Emergency Medicine, U. of Texas Med. Sch.  

Topic: Animal bites/Nose bleeds  

Host/ Producer: Steve Girard    

NEMA: Everyone has an animal bite story. I’ve been bitten by a dog ...when I was younger, a German Sheppard grabbed my right side, right above my waist and kind of shook me around a bit, and everybody has little stories like that. My aim is to find out what people can do to stay away from getting bitten first of all, if that’s possible, and find out what kinds of things they should do after they are bitten. Today we’re with Dr. Ron Charles of the University of Texas Southwestern Medical Center emergency department. So, the first thing - do you have any words of wisdom as to how to avoid being bitten by a dog or cat or animal?  

CHARLES: Right. The first thing is you don’t ever want to go near a dog that you don’t know. Especially any wild animals dogs that don’t have any owners, just running about, there’s a very high likelihood that they’re scared of you and when you reach out there’s a good chance that they’ll bite you. Even your pets that love you, you need to be careful when they’re eating. When they’re in the trash trying to get food or their bone, sometimes they’ll take that the wrong way and snap at you. So when...even with pets...when animals are eating, you need to be very careful so that they don’t bite you.  

NEMA: Now when an animal bites you, for instance a dog bite, that’s the most prevalent type of bite...  

CHARLES: Dog bites are the most common. Out of all emergency visits, about 1 percent occur, about 1 percent of patients come to the emergency department because of animal bites. Dog bites are the most common because they are the most common pet. We don’t know how many people get bit that don’t come to the emergency department, which could also be a fairly high number. But the estimate is about 1.5 million animal bites each year.  

NEMA: Now everybody should be able to look at the bite and figure out what to do. Are there some parameters...that they can look at the wound and say, "well what should I do with this?".  

CHARLES: Well even before you look at the wound you have to know what bit you. If it’s a known pet, then the chance of getting rabies is very small and there are some precautions you’ll take...as long as the dog continues to act normally you’re okay. But if it’s a dog that’s wild, a dog that you don’t know, then you need to take precautions. Call the county health department or local health department see about the prevalence of rabies. There’re certain animals that give you a higher chance of getting rabies. Those are foxes, bats, raccoons, those types of things that can give you rabies. If you get bit by a squirrel or a rat they don’t give you rabies, because they get killed by...any animal that gives them rabies will kill them while they are giving them the rabies, so they’re not vectors, they don’t transmit rabies. So the first question you have to ask is, "is this a rabies prone wound or not"? Then you look at the wound and you look at where it is and you look at the type of wound. Certain areas need antibiotics even if they can’t do anything else. Cat bites generally themselves need antibiotics because of the type of wound,their teeth are long and thin, and when they bite you, they produce a puncture wound injury. And at the bottom of the end of their teeth is where they will inoculate you with bacteria that will cause infection. And so, any cat bite generally needs antibiotics. Dog bites less so, but still might, depending on where you’re bit. If you’re bit on the hands where the blood supply is not at as great, then you probably should be put on antibiotics to prevent infection. So the location is important, and the type of injury, type of bite. The puncture wounds carry a greater likelihood that you need antibiotics. If it’s a slash wound, those can be cleaned out, irrigated and you might not need antibiotics, that’s up to the doctor that treats you. How quickly you come to see him and how quickly he can get it. But those are wounds that might need suturing or that might need other things to improve the cosmetic affects.

The worst, though, is human bites. Those are the worst. Dog bites have 64 organisms, human bites can approach 250 different organisms in your mouth.  

NEMA: So the general rule would be if you’re bitten by a cat you pretty much should go see your doctor and get it taken care of.  

CHARLES: Usually you’ll get bit, especially by cats, around the hand. Hand has a very poor blood supply. The blood supply brings what the body produces to fight infection. So if the blood, there’s not enough blood supply to bring those things that fight infection, there’s also a greater chance for infection. So bites to the hand, whether it’s a human bite, a dog bite or animal bite can really become infected...and very quickly. And a lot of times you need to go to the operating room to be cleaned, in order to treat the infection, and try to make sure that hand’s going to recover.Infections of the hands are bad and cause irreparable damage to jobs and income.    

NEMA: What to do in between the injury and going to see a doctor. Is there something you can do to help out?  

CHARLES: Soap and waters a great thing. Just clean that bite as quickly as you can. So you want to clean it as quickly as you can. The other thing we really didn’t talk about is tetanus and tetanus prone wounds. It’s a slightly controversial debate for a doctor...it’s five to ten years. You’re generally covered for ten years unless you’re elderly, or you’re immuno-compromised. But if you have not had a tetanus shot in ten years, you definitely need to make sure you get one to keep everything up to date.  

NEMA: Our thanks to Dr. Ron Charles, Assistant Professor of emergency medicine at the University of Texas Medical School.  

SPOT: 15 years in the prevention of heart disease, stroke and trauma - The National Emergency Medicine Association. This show is just part of what NEMA does. We send out millions of pieces of prevention information to people around the country, give grants to organizations in research, public information and emergency services, and have been instrumental in the creation and expansion of the Chest Pain Emergency Room movement. To play a role, call 800-332-6362.  

NEMA: Thanks for joining us for today’s program. If you have any comments or suggestions, contact this station. Or visit our home page at:

www.nemahealth.org/

...for a look at transcripts of this or past programs, or to find out more about the National Emergency Medicine Association. I’m Steve Girard at The Heart of the Matter.