EnVC8, Environmental emergencies MRCEM syllabus; TC6 Trauma MRCEM syllabus

	Headline
History	Who/what bit?!
Examination	Site/depth of wound Does it look infected?
Diagnostic investigations	Swab if pus present
Immediate management	- Risk assessment for Tetanus, Rabies or other BBVs. - Consider safeguarding - D/w micro if: exotic animal bite (including birds, non-traditional pets); unfamiliar domestic/farm animal bites - Prophylaxis - see below. If prophylaxis indicated, go for co-amox or doxycycline + metronidazole (adults) or co-trimoxazole (children)
Ongoing management

decision re abx prophylaxis

copied shamelessly from NICE guidelines - visual summary (NG184):

Type of bite	Bite has not broken the skin	Bite has broken the skin but not drawn blood	Bite has broken the skin and drawn blood
Human bite	Do not offer antibiotics	Consider antibiotics if it is in a high-risk area or person at high risk	Offer antibiotics
Cat bite	Do not offer antibiotics	Consider antibiotics if the wound could be deep	Offer antibiotics
Dog or other traditional pet bite	Do not offer antibiotics	Do not offer antibiotics	Offer antibiotics if it has caused considerable, deep tissue damage or is visibly contaminated (for example, with dirt or a tooth) Consider antibiotics if it is in a high-risk area or person at high risk

High risk areas: hands, feet, face, genitals, skin overlying cartilaginous structures or an area of poor circulation...

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