General Bite Wound Management Procedures
1. Cleanse the wound. Povidone-iodine solution is recommended for periphery cleansing. The standard solution is diluted 10:1 with saline and can serve as both the cleansing agent and irrigant.
2. After thoroughly scrubbing the wound periphery, irrigate copiously with high pressure using a 19-gauge needle, catheter or splash shield attached to a 20 ml or 35 ml syringe. Deliver diluted povidone-iodine solution directly into the wound.
3. Debride all devitalized tissue and wound edges. This is essential to reduce the possibility of wound infection.
4. Irrigate after debridement to provide greater exposure of the wound.
5. To facilitate effective irrigation of fang wounds, particularly slender cat teeth wounds, the entry site can be widened with a simple 1 to 1.5 cm incision across the puncture with a #15 knife blade. Retract the new wound with a hemostat or forceps to permit irrigation. Leave these incisions to close without sutures. If the edges are devitalized, trim back to viable skin.
6. Culture purulence or suspected infection. If antibiotics appear advisable, a beta-lactam with lactamase inhibitor or second-generation cephalosporin is recommended. Consult the table (see p. 38) for alternatives.
7. Ensure proper tetanus immunization.
8. Assess and treat for rabies exposure if necessary.
Source: Trott A. Wounds and Lacerations: Emergency Care and Closure. 2nd ed. St. Louis: Mosby; 1997.
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