General Guideline Principles for Human Bites, Animal Bites and

Associated Lacerations for workers compensation patients

The New York State workers compensation board has developed these guidelines to help physicians, podiatrists, and other healthcare professionals provide appropriate treatment for Human Bites, Animal Bites and Associated Lacerations.

These Workers Compensation Board guidelines are intended to assist healthcare professionals in making decisions regarding the appropriate level of care for their patients with ankle and foot disorders.

The guidelines are not a substitute for clinical judgement or professional experience. The ultimate decision regarding care must be made by the patient in consultation with his or her healthcare provider.

Human Bites, Animal Bites and Associated Lacerations of Hand, Wrist and Forearm Injuries

Despite the fact that the majority of bites come from animals the victim is familiar with, certain professions—such as veterinarians, animal handlers, police officers, utility service workers who enter private property, mail carriers, and others—may be more susceptible to animal bites than others.

The majority of caretakers, educators, and law enforcement personnel experience human bites. and in cases of accident or workplace violence where the hand or fist could be cut by coming into contact with teeth.

The risk of infection is the main worry with regard to animal bites, aside from the extensive tissue damage requiring reconstruction. Other zoonotic illnesses like rabies, cat scratch fever, and exposure to human blood-borne pathogens should also be taken into account.

Rates may be higher in cases of hand injuries, deep penetration into the skin, and a delay in irrigating and cleaning the wound. For the purposes of this recommendation, discussion and recommendations are made regarding rabies risk to the extremities or trunk as well based on bites and/or contact with saliva.

Physical Exam of Human Bites, Animal Bites and Associated Lacerations

It is important to carefully record the circumstances surrounding the bite and/or saliva contact in order to inform clinical judgments regarding prophylaxis. If at all possible, details regarding the species of animal, its state of health, and the events leading up to the bite should be gathered.

The status of tetanus and rabies vaccinations should be determined, and prophylaxis should be administered as needed.

It’s crucial to have a thorough medical history regarding tetanus, animal bites, saliva exposure, rabies vaccination status, and underlying medical conditions like diabetes mellitus or other immune-compromising conditions. If necessary, tetanus vaccination and rabies prophylaxis should be administered in accordance with CDC recommendations.

The majority of wounds are puncture wounds, but suturing may be an option for some wounds.

Diagnostic Studies of Human Bites, Animal Bites and Associated Lacerations

Diagnostic Studies of Human Bites, Animal Bites and Associated Lacerations Routine Wound Culture and Sensitivity of Animal and Human Bites

Diagnostic Studies of Human Bites, Animal Bites and Associated Lacerations Routine Wound Culture and Sensitivity of Animal and Human Bites is not recommended as it has not been demonstrated to be a reliable indicator of infection or the subsequent care of wounds that are infected.

Medications of Human Bites, Animal Bites and Associated Lacerations

  1. Non-Steroidal Anti-inflammatory Drugs (NSAIDs) for Treatment of Acute, Subacute, or Chronic Animal or Human Bites Pain

    Non-Steroidal Anti-inflammatory Drugs (NSAIDs) for Treatment of Acute, Subacute, or Chronic Animal or Human Bites Pain is recommended for the treatment of pain from animal or human bites that is acute, subacute, or chronic

    Indications – NSAIDs are advised as a treatment for wrist sprains that are acute, subacute, or chronic. First, try over-the-counter (OTC) medications to see if they work.

    Frequency/Duration: Many patients might find it reasonable to use as needed.

    Indications for Discontinuation: the symptom’s resolution, the medication’s ineffectiveness, or the emergence of side effects that require stopping.

     

  2. NSAIDs for Patients at High Risk of Gastrointestinal Bleeding

    NSAIDs for Patients at High Risk of Gastrointestinal Bleeding is recommended for patients at high risk of gastrointestinal bleeding to take misoprostol, sucralfate, histamine Type 2 receptor blockers, and proton pump inhibitors concurrently

    Indications: Cytoprotective drugs should be taken into consideration for patients with a high-risk factor profile who also have indications for NSAIDs, especially if a longer course of treatment is planned. Patients who have a history of gastrointestinal bleeding in the past, the elderly, diabetics, and smokers are at risk.

    Frequency/Dose/Duration:H2 blockers, misoprostol, sucralfate, and proton pump inhibitors are advised. dosage recommendations from the manufacturer. It is generally accepted that there are no significant differences in effectiveness for preventing gastrointestinal bleeding.

    Indications for Discontinuation: Intolerance, the emergence of negative effects, or the stopping of NSAIDs.

     

  3. NSAIDs for Patients at Risk for Cardiovascular Adverse Effects

    The advantages and disadvantages of NSAID therapy for pain should be discussed with patients who have a history of cardiovascular disease or who have multiple cardiovascular risk factors.

     

    • NSAIDs for Patients at Risk for Cardiovascular Adverse Effects

      NSAIDs for Patients at Risk for Cardiovascular Adverse Effects are recommended as far as adverse cardiovascular effects go, acetaminophen or aspirin as first-line therapy seem to be the safest options.

       

    • NSAIDs for Patients at Risk for Cardiovascular Adverse Effects

      NSAIDs for Patients at Risk for Cardiovascular Adverse Effects is recommended If necessary, non-selective NSAIDs are preferred to COX-2-specific medications. To reduce the chance that an NSAID will negate the protective effects of low-dose aspirin in patients receiving it for primary or secondary cardiovascular disease prevention, the NSAID should be taken at least 30 minutes after or eight hours before the daily aspirin.

       

  4. Acetaminophen for Treatment of Animal and Human Bites Pain

    Acetaminophen for Treatment of Animal and Human Bites Pain is recommended for the relief of pain from both human and animal bites, especially in patients who have NSAID contraindications.

    Indications: Acute, subacute, chronic, and post-operative pain in patients who have been bitten by animals or people.

    Dose/Frequency: As per the manufacturer’s recommendations; can be used as required. Over four gm/day, there is evidence of hepatic toxicity.

    Indications for Discontinuation: pain, side effects, or intolerance are gone.

     

  5. Opioids of Human Bites, Animal Bites and Associated Lacerations

    Opioids of Human Bites, Animal Bites and Associated Lacerations are not recommended for the treatment of animal and human bites pain.

Treatments of Human Bites, Animal Bites and Associated Lacerations

Initial Care

  1. Initial Care is Blood Borne Pathogen Protocol for Human Bites

    Initial Care is Blood Borne Pathogen Protocol for Human Bites is recommended Blood borne pathogen protocols should be used to evaluate and treat exposures that could be deemed high risk for the transmission of viral blood borne pathogens.

    Rationale for Recommendation- Injuries with HIV-contaminated blood carry a significantly lower risk of transmission if prophylactic anti-virals are given promptly, so exposures that could be considered high risk for transmitting viral blood borne pathogens (HIV, HBV, HCV), such as traumatic bite lacerations, should be considered for testing and prophylaxis according to standard protocols.

     

  2. Prophylactic Antibiotics for Dog Bite Wounds

    Prophylactic Antibiotics for Dog Bite Wounds is recommended to treat dog bite injuries.

    Indication – All dog bites.

    Dose/Frequency – The quality studies have made use of a variety of antibiotics, such as cephalexin, cloxacillin, dicloxacillin, erythromycin, penicillin VK, and amoxicillin/clavulanate. A strong Gram positive coverage is necessary

     

  3. Prophylactic Antibiotics for Treatment of Human Bite Wounds

    Prophylactic Antibiotics for Treatment of Human Bite Wounds are recommended for the treatment of bite wounds on people.

    Rationale for Recommendation – The weight of the evidence suggests prophylactic treatment is appropriate given the reported higher incidence of wound infections linked to human bites. The majority of common staphylococcal and streptococcal species are typically gram-positive bacteria, so prophylactic coverage from a broad-spectrum oral antibiotic is advised.

     

  4. Prophylactic Antibiotics for Treatment of Cat Bite Wounds

    Prophylactic Antibiotics for Treatment of Cat Bite Wounds is recommended to treat cat bite injuries.

    Rationale for Recommendation – According to reports, cat bite-related infections occur 20 to 40% of the time, and cat bite-related complications may be more serious. Since Pasteurella multocida is the most common pathogen acquired from cat bites, broad spectrum antibiotics with coverage for it may be necessary.

What our office can do if you have workers compensation injuries

We have the experience to help you with their workers compensation injuries. We understand what you are going through and will meet your medical needs and follow the guidelines set by the New York State Workers Compensation Board.

We understand the importance of your workers compensation cases. Let us help you navigate through the maze of dealing with the workers compensation insurance company and your employer.

We understand that this is a stressful time for you and your family. If you would like to schedule an appointment, please contact us so we will do everything we can to make it as easy on you as possible.

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I am fellowship trained in joint replacement surgery, metabolic bone disorders, sports medicine and trauma. I specialize in total hip and knee replacements, and I have personally written most of the content on this page.

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