What are the discharge instructions from the ER for a patient after a dog bite?

From the Guidelines

After a dog bite, keep the wound clean by gently washing with soap and water twice daily, then applying an antibiotic ointment like Neosporin and covering with a clean bandage. Take all prescribed antibiotics exactly as directed, typically amoxicillin-clavulanate (Augmentin) 875/125 mg twice daily for 5-7 days, or doxycycline 100 mg twice daily if you're allergic to penicillin, as recommended by the Infectious Diseases Society of America 1. Manage pain with acetaminophen (Tylenol) 650 mg every 6 hours or ibuprofen (Advil) 600 mg every 6 hours as needed. Watch for signs of infection including increasing redness, swelling, warmth, pus, fever, or red streaks extending from the wound. Return to the ER immediately if these occur or if you develop difficulty moving the affected area. Complete your rabies vaccination series if it was started, and follow up with your primary care doctor in 2-3 days. Dog bites can introduce bacteria deep into tissues, which is why antibiotics are often prescribed preventively, especially for bites to the hands, face, or near joints. Report the dog bite to local animal control as required by law in most areas.

Some key points to consider:

• Irrigate the wound with copious amounts of water, as recommended by the American Heart Association 1.
• Apply a clean occlusive dressing to the wound to promote healing and reduce the risk of infection.
• Take antibiotics as directed to prevent infection, especially if the bite is deep or in a sensitive area.
• Monitor for signs of infection and seek medical attention immediately if they occur.
• Follow up with your primary care doctor in 2-3 days to ensure the wound is healing properly.

It's also important to note that the bacteriology of dog bites can be complex, involving multiple aerobic and anaerobic bacteria, including Pasteurella species, S. aureus, and Bacteroides species 1. Therefore, it's essential to follow the recommended treatment guidelines to ensure the best possible outcome.

From the Research

Discharge Instructions from the ER after a Dog Bite

Discharge instructions from the ER for a patient after a dog bite may vary depending on the severity of the injury and the patient's overall health. However, based on the available evidence, the following points can be considered:

• The patient should be advised to monitor the wound for signs of infection, such as redness, swelling, and increased pain 2, 3.
• The patient should be instructed to keep the wound clean and dry, and to change the dressing daily or as directed by the healthcare provider 2, 3.
• The patient may be prescribed antibiotics to prevent infection, especially if the wound is deep or if the patient has a weakened immune system 4, 5.
• The patient should be advised to seek medical attention immediately if they experience any signs of infection, such as fever, chills, or increased redness and swelling around the wound 2, 3.
• The patient should also be advised to follow up with their healthcare provider in 2-3 days to check on the wound's healing progress and to receive further instructions 2, 3.

Factors to Consider for Discharge Instructions

The following factors should be considered when providing discharge instructions for a patient after a dog bite:

• The severity of the injury: Patients with more severe injuries may require more frequent follow-up and closer monitoring for signs of infection 2, 3.
• The patient's overall health: Patients with weakened immune systems or certain medical conditions may require more aggressive treatment and closer monitoring 4, 5.
• The location of the wound: Wounds on the hands or feet may be more prone to infection and may require more frequent follow-up 3.
• The patient's tetanus status: Patients who are not up-to-date on their tetanus shots may require a booster shot to prevent tetanus infection 2, 3.

Prevention of Infection

Prevention of infection is a critical component of discharge instructions for a patient after a dog bite. The following points can be considered:

• The patient should be advised to keep the wound clean and dry, and to change the dressing daily or as directed by the healthcare provider 2, 3.
• The patient may be prescribed antibiotics to prevent infection, especially if the wound is deep or if the patient has a weakened immune system 4, 5.
• The patient should be advised to seek medical attention immediately if they experience any signs of infection, such as fever, chills, or increased redness and swelling around the wound 2, 3.