Managing dog bites (2)

In the first part of this piece, it was said that a large percentage of dog bite victims are children and it was emphasised that it is appropriate to begin prevention education with children and parents. Infants and children should, therefore, be evaluated after a dog bite.

History

After confirming that the victim is medically stable, the doctor will begin primary assessment by obtaining information that can help determine the patient’s risk of infection, including the time of the injury, whether the animal was provoked or unprovoked. This will help to establish whether or not the dog has rabies.

The doctor will also ascertain if the dog has been biting other people concurrently, which may suggest that it has rabies.

Physical examination

The measurement and classification of the wound and the range of motion of the affected part and adjacent areas should be documented. Nerve, vascular and motor function must be recorded.

A general examination of all the systems should be done also, and the doctor should use this information to allay the fears of the patient.

The doctor may take photographs that are useful, especially in situations where the wounds present as irregular, or where there are signs of infection. He may also take photographs in cases that may involve litigation, such as a wound inflicted by an unleashed dog.

Treatment

The wound must be rinsed with normal saline or Ringer’s lactate solution in order to reduce the rate of possible infection. Some dead tissues must also be cut off. Patients who have been bitten by a dog should be instructed to elevate and immobilise the area involved.

Most bite wounds should be re-examined in 24 to 48 hours, especially bites to the hands. Wound suturing and closure should be delayed in an infected person, and also in wounds that are more than 24 hours old.

Radiographs (X-Rays) may be obtained, especially with puncture wounds near a joint or bone.

Plastic surgery, general surgery or maxillofacial surgery may be necessary for deep wounds involving the face. Orthopaedic consultation may also be considered for wounds that directly involve the joints or other bony structures.

Antibiotics

Treatment with prophylactic antibiotics for five to seven days is appropriate for dog bite wounds, unless the risk of infection is low or if the wound is superficial. A 10-14-day course of oral antibiotic treatment is more appropriate.

Prevention of rabies

The patient’s risk of infection with the rabies virus must be addressed immediately. Because of the serious risk a rabid animal on the loose poses to the public, it is important to document the conditions surrounding the attack.

Patients with a bite from an unprovoked dog should be considered being at higher risk for rabies infection than patients with a bite from a provoked dog. If the dog owner is reliable and can confirm that the animal’s vaccination against rabies virus is current, the dog may be observed at the owner’s home.

Observation by a vet doctor is appropriate when the vaccination status of the animal is unknown. The animal should be quarantined for 10-14 days.

Exposure to a rabid animal does not always result in rabies if treatment is initiated promptly following an exposure to rabies. And that’s why we say rabies can be prevented. If an exposure to rabies is not treated and a person develops clinical signs of rabies (headache, irritability, photophobia, barking), the disease almost always results in death.

Rabies immunisation consists of an active immune response with a vaccine and a passive immune response with rabies immune globulin (RIG). Once the vaccine series has begun, it is usually completed with the same vaccine type. Vaccine is administered on days 0, 3, 7, 14, 28 and 90.

Rabies immunisation should begin within 48 hours after the bite, but it can be subsequently discontinued if the animal is certified free of the rabies virus.

Tetanus immunisation

Victims of dog bites should be immediately covered with tetanus immunisation once their immunisation status is known.

Preventing dog bites

An older dog should not be introduced into a household with children because the dog’s behaviour cannot be predicted. Prospective dog owners should obtain breed-specific information before getting a new dog. This is because some breeds of dogs are more likely to attack, despite training.

Dogs have the tendency to chase a moving object. Therefore, children need to learn to avoid running and screaming in the presence of a dog. Educate children and adults to remain calm when threatened by a dog. Direct eye contact should be avoided, because the dog may interpret that as aggression. If a dog perceives no movement, it will lose interest and go away.

Still on Omonigho

Meanwhile, Omonigho, the four-year-old victim of a dog bite mentioned in the first part of this piece, whose scalp was torn by two dogs, is now stable and communicates freely with the parents. However, he is still on admission at the surgical ward.

A special appeal for the boy and his brothers who were also injured is still open to the public.

Omonigho’s dad’s account details:

Name: Abraham Odia

Email: abraham.odia@gmail.com

A/C Number: 2057755102

Bank: UBA

Tel: 07061833256