Special Operations Forces Medical Handbook

7-7

Perform Detailed Physical Exam
HEENT
Thorax/Heart
Abdomen/GU
Musculoskeletal
Neurological
Identify and Treat all Wounds
Cricothyroidotomy, Tube Thoracostomy, Venous Cutdown
Splint Cutdown Site
9-Line CASEVAC (ASAP)
Field Medical Cord (FMC)

Chapter 29: Trauma: Human and Animal Bites

COL Roland J. Weisser, Jr., MC, USA

Introduction: Human bite wounds have a notorious reputation, based primarily on the risks associated with
a single injury, the “clenched fist” injury. Human bites in other areas of the body pose no greater risks than
animal bites. Institutionalized patients with poor impulse control create an especially high-risk environment for
human bite wounds. Three types of human “bite” wounds may lead to complications:

1. Clenched fist injury: This wound most often results when a clenched fist strikes the mouth/teeth of an
   adversary, and the force of the punch breaks the skin. The hand is flexed when the injury is sustained,
   inoculating bacteria directly into the wound. Then, when the hand is subsequently relaxed, the tendon
   retracts into its sheath, carrying the inoculum into the tendon sheath, making normal irrigation and
   cleansing techniques difficult and less effective. This type of bite wound has the highest risk of infection.


2. Bite to a finger: Fingers are enveloped in only a thin layer of overlying skin that constrains the underlying
   tendons and their sheaths, only a few millimeters beneath the surface. Hence, when a finger is bitten,
   even though the wound may appear to be only a superficial abrasion there is potential for inoculation of
   the tendon sheaths through an unnoticed skin defect.


3. Puncture wounds about the head: This type of injury is usually sustained during “horseplay” among
   children of all ages. The tooth impacts the head, producing the wound. Although the wound may appear
   innocuous on the surface, deep contamination may occur.

Animal Bites: There are an estimated 1-3 million animal bites in the U.S. per year. 80-90% inflicted by
dogs, 5-15% by cats, 2-5% by rodents, and the balance by rabbits, ferrets, farm animals, monkeys, reptiles
and other species (see Toxicology: Venomous Snake Bites). Monkey bites have a notorious reputation,
but the reputation is primarily based on anecdotal reports. Dog bites cause a crushing-type wound due to
their rounded teeth and strong jaws. The pressure may damage deeper structures such as bones, vessels,
tendons, muscle and nerves. Cats, due to their sharp, pointed teeth, usually cause puncture wounds and
lacerations with the inoculation of bacteria into deep tissues. Cats more frequently bite women. Dogs more
frequently bite men. The hand is the anatomical part most frequently bitten.

Bites on the hand have a risk of infection due to the relatively poor blood supply, and anatomic considerations
that make adequate cleansing of the wound difficult. In general, the better the blood supply, the easier the
wound is to clean (e.g., laceration vs. puncture), thus lowering the risk of infection. Nearly any group of
pathogens, including bacteria, viruses, rickettsia, spirochetes, and fungi may cause infection. Dog and cats
are more likely to host pasteurella and staph. aureus, among others. However, many infected bite wounds
are mixed infections, with any of the organisms ultimately having the potential to produce sepsis, meningitis,
osteomyelitis, or septic arthritis.

Subjective: Symptoms
A puncture, laceration or abrasion possibly with contusions, erythema, edema, pain, throbbing or itching.