First Aid : Dog Bites

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First Aid Dog BitesPAEF 312.1 Johor Specialist Hospital

1.0 APPRECIATION

Alhamdulillah, I thanked to Allah for giving me such a great opportunity to gain the

experience during my clinical attachment at Johor Specialist Hospital. I’ve learnt a lot of new

things that will improvise my knowledge and skills in this field. I’m glad my practical and all the

tasks that were given are done successfully. I would like to express my special thanks to those

people who had helped me during the clinical posting and contributed many brilliant ideas for

my First Aid assignment.

I would love to express my gratitude to Madam Puspa Kuna Raja, our course coordinator

for her determination and guidance from beginning till the end of the posting. Besides that she is

also understandable and supportive. I also want to give fully gratitude to Mr Abdullah, my cohort

in charge for his wonderful efforts to give the best for us especially when it comes to this clinical

posting. He should be credited for being so approachable and understanding all this while.

My next gratitude goes to Madam. Noor Fauzana Mat Radi, lecturer in charge of this

subject for being very approachable and helpful during the completion of my assignment. Plus

she is very understandable and full of courage.

I also would like to express my special gratitude to Mdm. Siti Hanisah, our preceptor for

being very communicable and approachable. She is undeniably professional and enables to help

for the completion of this assignment. She deserves my deeply compliment because of her

dedication and fully support.

Not forgotten million thanks to Nursing Education and Accident and Emergency

Department (A&E) of Johor Specialist Hospital for their help and cooperation. I really appreciate

their kindness and guidance. I completely sure my assignment would not be done as scheduled

without their help. Special thank to Nurse Instructors especially to Sister Umi, Sister Fauziah,

Sister Rozela, Sister Zarina and all staff from A&E. All of you are amazing. Your cooperation is

greatly appreciated. Thanks a lot.

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2.0 LEARNING OBJECTIVES

At the end of this case study I will be able to:

State definition of Wound and Cut

Define Puncture Wound and Animal bites.

Identify the classification of wound

List down classification of dog bites

Explain the causes of dog bites

Recognize warning signs of dog before they are going to bite.

Discuss the First Aid of Dog Bites

Discuss the management of dog bites

Explain the treatment given to patient with dog bites.

List the measures for preventing dog bites.

Appreciate the Health Education given for the patient in home care planning.

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3.0 INTRODUCTION

First aid is the immediate care given to a person who has been injured or suddenly taken

ill. It includes self-help and home care if medical assistance is not available or is delayed. It also

includes well-selected words of encouragement, evidence of willingness to help, and promotion

of confidence by demonstration of competence.

Having studied First Aid, we are prepared to give others some instruction in first aid.

Thus, we can promote among them a reasonable safety attitude, and to assist them wisely if they

are stricken. There is always an obligation on a humanitarian basis to assist the stricken and the

helpless. There is no greater satisfaction than that resulting from relieving suffering or saving a

life.

First aid training not only provides us with knowledge and skill to give life support and

other emergency care but also helps to develop safety awareness and habits that promote safety

at home, at work, during recreation, and on the streets and highways. In the promotion of safety

awareness, it is important to closely relate three terms: cause, effect, and prevention.

The causes of an accident indicate what accident-producing conditions and activities

require attention. Accident effects indicate why such conditions and activities deserve concerted

attention. Preventive measures should include a consideration of how these conditions and

activities can be eliminated, controlled, or avoided.

For this Year 3 Semester 1, I prefer to explore more about First Aid entitled “Dog Bites”.

My case started when Mrs. C was transported to A&E department on May 3 rd 2011 at 1205

hours. She was complaint of being bitten by a native dog during her visit to Larkin Perdana. The

dog has bitten her right upper thigh and causing a puncture wound. Dr. V has treated her to

prevent from infection by giving tetanus injection, antibiotics and dressing.

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4.0 BACKGROUND INFORMATION

Chief complaint:

A 25 years old woman was rushed to emergency for puncture wound at right upper thigh after

being bitten by a native dog.

History:

Mrs. C, 25 years old was transported by her family to Accident and Emergency

department (A&E) of Johor Specialist Hospital after being bitten by a native dog. She was bitten

in the upper thigh while visiting her brother in Larkin Perdana. She arrived at 1205 hours at A&E

after 1 hour of being bitten by the dog.

In the emergency room, Mrs. C was suffering pain. She had a deep puncture, but did not

require suture. She was given anti-rabies shot and tetanus shot. Her vital signs were modest:

Blood pressure = 130/74; Pulse = 60 beats/min; Respiratory rate = 20 breaths/min.1 dose of

Infanrix is given to prevent tetanus was injected immediately. For prophylaxis of rabies, a dose

of Verorab injection was given to her.

Her wound was also washed, cleaned with povidone iodine and bandaged. Dr. V advised

her to keep it dry for 24 hours. Dr. V was prescribed Tab Augmentin 625 mg, Bacitracin cream

20 g, and Betadine solution. She require to come again for follow up on her anti-rabies shot 7

days and 28 days after the exposure to dog bite.

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5.0 DISCUSSION

5.1 Definition of Wound

According to Dealey and Cameron (2008) a wound is a loss of continuity of the skin,

which may occur as a result of injury, impaired blood supply or deliberate wound such as

surgery.

While Rutty (2004) defines a wound as an injury to the surface of the body, caused by a

cut, blow, hard or sharp impact etc, especially one in which the skin is cut or broken, an external

injury.

In addition, Mondofacto ( 1998) classifies wound as a hurt or injury by violence,

specifically, a breach of the skin and flesh of an animal, or in the substance of any creature or

living thing, a cut, stab, rent, or the like.

Furthermore, wound is defined as an injury in which your skin or flesh is damaged,

usually seriously. When a wound gets better it heals (Combley et al 2007).

5.2 Definition of Cut

A cut or laceration is an injury that results in a break or opening in the skin. It may be

near the surface or deep, smooth or jagged. It may injure deep tissues, such as tendons, muscles,

ligaments, nerves, blood vessels, or bone (Heller and Ziere 2009).

While Rutty (2004) states cut as a long, narrow opening in a surface, especially the skin,

made by something sharp, an incision, a gash.

Other than that, Soanes et al (2003) defines as make an opening, incision, or wound in

(something) with a sharp tool or object.

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5.3 Definition of Puncture Wound

Keim (2004) states puncture wounds are deeper than they are wide are typically caused

by an object that may contain significant enough bacteria to seed the deep tissue.

While Heller and Ziere (2009) claim a puncture is a wound made by a pointed object (like

a nail, knife, or sharp teeth).

Most puncture wounds are caused by nails, pins, knives, needles, splinters, animal or

human bites, sharp pieces of glass, or fish hook (Antoon and Tompkins 2000).

5.4 Definition of Animal Bites

Animals typically cause puncture and shearing wounds with subsequent inoculation of

bacteria in the wound (Keim 2004).

While Palika (2004) defines a dog bite as the dog’s mouth or teeth touching skin or

clothing.

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6.0 CLASSIFICATION OF WOUND

Generally, wound can be classified into two groups, which is Open wound and Closed Wound.

6.1 Open Wound

This type of wound can be classified according to the object that caused wound. There are six

types of open wound

i. Abrasions

Abrasions are made when the skin is rubbed or scraped off. Rope burns, floor burns, and

skinned knees or elbows are common examples of abrasions. This kind of wound can

become infected quite easily because dirt and germs are usually embedded in the

tissues.

ii. Incisions

Incisions, commonly called cuts, are wounds made by sharp cutting instruments

such as knives, razors, and broken glass. Incisions tend to bleed freely because the

blood vessels are cut cleanly and without ragged edges. There is little damage to the

surrounding tissues. Of all classes of wounds, incisions are the least likely to become

infected, since the free flow of blood washes out many of the microorganisms (germs)

that cause infection

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iii. Lacerations

These wounds are torn, rather than cut. They have ragged, irregular edges

and masses of torn tissue underneath. These wounds are usually made by blunt, rather

than sharp, objects. A wound made by a dull knife, for instance, is more likely to be a

laceration than an incision. Bomb fragments often cause laceration. Many of the

wounds caused by accidents with machinery are lacerations; they are often

complicated by crushing of the tissues as well. Lacerations are frequently

contaminated with dirt, grease, or other material that is ground into the

tissue they are therefore very likely to become infected.

iv. Punctures

Punctures are caused by objects that penetrate into the tissues while leaving a small

surface opening. Wounds made by nails, needles, wire, and bullets are usually punctures.

As a rule, small puncture wounds do not bleed freely; however, large puncture

wounds may cause severe internal bleeding. The possibility of infection is great in all

puncture wounds, especially if the penetrating object has tetanus bacteria on it. To

prevent anaerobic infections, primary closures are not made in the case of puncture

wounds.

v. Avulsions

An avulsion is the tearing away of tissue from a body part. Bleeding is usually heavy. In

certain situations, the torn tissue may be surgically reattached. It can be saved for medical

evaluation by wrapping it in a sterile dressing and placing it in a cool container,

and rushing it, along with the victim, to a medical facility. Do not allow the

avulsed portion to freeze and do not immerse it in water or saline.

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vi. Amputations

A traumatic amputation is the nonsurgical removal of the limb from the body.

Bleeding is heavy and requires a tourniquet, to stop the flow. Shock is certain to develop

in these cases. As with avulsed tissue, wrap the limb in sterile dressings, place it in

a cool container, and transport it to the hospital with the victim. Do not allow the limb

to be in direct contact with ice, and do not immerse it in water or saline. The

limb can often be successfully reattached.

6.2 Closed Wound

Closed wounds have fewer categories, but are just as dangerous as open wounds. The types of

closed wounds are:

i. Contusions

Contusions are more commonly known as bruises, caused by a blunt force trauma that

damage tissue under the skin.

ii. Hematomas

It is also called a blood tumour, caused by damage to a blood vessel that in turn causes

blood to collect under the skin.

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http://en.wikipedia.org/wiki/Blood_vessel

http://en.wikipedia.org/wiki/Skin

http://en.wikipedia.org/wiki/Blood

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iii. Crush injury

This kind of injury is caused by a great or extreme amount of force applied over a long

period of time.

iv. Chronic and Acute

Acute or traumatic wounds are the result of injuries that disrupt the tissue. Chronic

wounds are those that are caused by a relatively slow process that leads to tissue damage.

Chronic wounds include pressure, venous, and diabetic ulcers. Typically, an insufficiency

in the circulation or other systemic support of the tissue causes it to fail and disintegrate.

Infection then takes hold of the site and becomes a chronic abscess. Once the infection

hits a critical point, it can spread locally or become systemic (sepsis).

7.0 CLASSIFICATION OF DOG BITES

World Health Organization (WHO) classified Dog Bites into three categories:

1. Category 1

Including touching or feeding suspect animals, but skin is intact.

2. Category 2

It is caused minor scratches without bleeding from contact, or licks on broken skin.

3. Category 3

Cause one or more bites, scratches, licks on broken skin, or other contact that breaks the

skin, or exposure to bats.

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http://en.wikipedia.org/wiki/Chronic_wound

http://en.wikipedia.org/wiki/Chronic_wound

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8.0 DOG BITES: THE UNDERLYING CAUSES.

It is important to understand the causes of dog bite injuries before we can attempt to think of the

preventive measures or ways to at least reduce the bites if not completely stop the bites.

Dogs will bite as a result of the following reasons among others:

i. Dominance and Authority

Dogs will bite to establish leadership and order within their rank. They’re being assertive

by using their teeth to determine who is the strongest, and will to power are genetic

behavior traits which are peculiar to all canine groups. This dominance behavior being

demonstrated by dogs is as a result of survival instinct. They feel they are in charge and

need to keep other members of their group along without excluding other people. Who in

most cases will be the member of family of the dog owner and neighbours.

ii. Warning Message

Dogs usually send warning notes in the form of non-serious bites before any serious

attack. If you step over a dog who's resting or try to move a dog off the bed for any

purpose you should know what to expect.

iii. Security and Protection

Some dogs feel insecure as a result of some of human actions like invading a dog's

territory, riding on his back like pony, showing off with ferocious displays, blowing puffs

of air in his face, taking her food or disturbing a mother dog and her puppies. They

believe these human actions can cause them harm.

It could also be from being continuously chained. Continuous chaining of dog can cause

physiological problem and thus the affected dog may not know how to behave when it's

released. So in other to protect themselves, they result to aggressive acts like biting.

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iv. Lack of good/positive training

Dog bites are a result of the lack of good and positive training. Some dog owners employ

forceful, fear inducing and painful training methods. The dog will perceive this as

threatening their life and result to aggressive acts in order to protect

Itself.

v. Fear Biting

Just like human beings, if a dog is in any threatening situation they will feel the need to

protect themselves. This is often directed toward strangers. Thus threatening a dog or it's

family, bending over it when it's resting, hugging it when it's sleeping, teasing and

awakening a dog will surely cause a bite as a response to these actions.

vi. Physical Pain

Depending on the degree of pain, a dog will bite a beloved owner, member of the family

or neighbors when suffering from physical problems like chemical imbalances in the

brain, external infections like otitis, tumor, hip dysphasia among others. A fighting dog is

sure to be in a serious painful condition and attempt to break the fight by pulling the dog

will possibly result in a bite.

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9.0 DOG’S WARNING SIGNS

Before any dog bites he will give warning signs which, if apprehended, can prevent a bite

at all. They usually make sure that these warnings are very clear using body language whenever

they feel frightened or threatened by situations.

It's advisable to watch and listen to the warning signs a dog gives you when he is upset.

Let make it clear here once again that a healthy dog will never bite without being provoked.

However, if your dog bites without provocation, seek professional help immediately.

Below are some of warning signs the dog gives which you have to notice:

i. When a dog's ears are pulled back against his head.

ii. When his legs are very stiff.

iii. When dog's fur is raised up, his ears erect and tail high.

iv. When a dog growls and barks aggressively with his teeth showing.

v. When a dog is intensely looking directly at a human's face.

vi. When a dog licks his chops while you approach or interact with him.

vii. When a dog suddenly starts scratching or licking himself.

viii. When a dog lowers its tail (held stiffly) and wags it slowly.

ix. When dog is standing forward and up on its toes. (unclear)

x. When a dog's body is stiff and leans forward toward the target.

xi. When snarling with its teeth uncovered.

xii. When the dog is cowering.

xiii. When a dog’s tail is tucked completely under his body.

xiv. When a dog is ill or old.

xv. When a dog gets up and moves away from you.

xvi. When a dog turns his head away from you.

xvii. When a dog yawns while you are approaching

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10.0 FIRST AID OF DOG BITES

There are several steps need to be taken when facing the victims of dog bites. First Aid

management is essential to prevent infections. The steps are as below:

i. Calm and reassure the person. Wear latex gloves or wash your hands thoroughly before

attending to the wound. Wash hands afterwards, too.

ii. The wound itself has to be cleaned of the dog's saliva especially if the latter is suspected

as rabid. The used cloth must not be touched at all.

iii. If the bite is not bleeding severely, wash the wound thoroughly with mild soap and

running water for 3 to 5 minutes.

iv. After drying it up, the lesion must not be closed especially if it is a puncture wound. If

there is some laceration or cut, cover it using a dry dressing.

v. If the bite is actively bleeding, apply direct pressure with a clean, dry cloth until the

bleeding stops. Raise the area of the bite.

vi. Cover the wound with a clean, dry dressing. You can put antibiotic ointment on the

wound before covering.

vii. Watch for signs of infection: Redness, swelling, heat and weeping pus.

viii. Go to the nearest hospital for a more professional medical touch. The doctor will have to

administer a tetanus vaccine injection.

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11.0 MANAGEMENT OF DOG BITES

11.1 Initial Wound Management

After confirming that the victim is medically stable, physician will begin a primary assessment by

taking a history. Several medical conditions place us at high risk of wound and rabies infection from a

dog bite as stated in Table 1 below.

No Medical Conditions

1 Chronic disease

2 Chronic edema of the extremity

3 Diabetes mellitus

4 Immunosuppressant

5 Liver dysfunction

6 Previous mastectomy

7 Prosthetic valve or joint

8 Splenectomy

9 Systemic lupus erythematosus

Table 1: Medical Conditions Associated with a High Risk of Infection After a Dog Bite

This kind of information is essential to determine the patient’s risk of infection including:

a) Time of injury

b) General health status including current medications and allergies.

c) Immunization status

d) Current location of the animal

e) Physical examination – measure and classify the wound.

Puncture wounds, wounds that appear clinically infected and wounds more than 24 hours old

may have a better outcome with delayed primary closure or healing by secondary intention.

Some physicians close wounds that are less than eight hours old and wounds located on the face.

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The success of closing facial wounds can probably be attributed to the enhanced blood

supply to the face and the lack of dependent edema. General surgery or plastic surgery may be

necessary for deep wounds or those requiring significant debridement and closure. Orthopedic

consultation should be considered for wounds that directly involve joints or other bony

structures.

Cultures are usually not helpful unless the wound appears infected or is unresponsive to

appropriate antibiotic therapy. When a culture is necessary, aerobic and anaerobic cultures

should be obtained and observed for a minimum of seven to ten days to allow for slow-growing

pathogens.

11.2 Antibiotic Treatment

Crush injuries, puncture wounds and hand wounds are more likely to become infected

than scratches or tears. Most infected dog bite wounds yield polymicrobial organisms.

Pasteurella multocida and Staphylococcus aureus are the most common aerobic organisms,

occurring in 20 to 30 percent of infected dog bite wounds.

Other possible aerobic pathogens include Streptococcus species, Corynebacterium

species. Anaerobic organisms, including Bacteroides fragilis, Fusobacterium species and

Veillonella parvula, have also been implicated in infected dog bites.

Treatment with prophylactic antibiotics for three to seven days is appropriate for dog bite

wounds, unless the risk of infection is low or the wound is superficial. Augmentin (amoxicillin-

clavulanate potassium) is the antibiotic of choice for a dog bite.

For patients who are allergic to penicillin, doxycycline (Vibramycin) is an acceptable

alternative except for children younger than eight years and pregnant women. Erythromycin can

also be used, but the risk of treatment failure is greater because of antimicrobial resistance.

Other acceptable combinations include clindamycin (Cleocin) and a fluoroquinolone in

adults or clindamycin and trimethoprim-sulfamethoxazole in children. When compliance is a

concern, daily intramuscular injections of ceftriaxone (Rocephin) are appropriate.

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Sometimes outpatient treatment is occasionally falls and the patient need to be

hospitalized and treated intravenously with antibiotics. Reasons for hospitalization include

systemic signs of infection, fever or chills, severe or rapidly spreading cellulitis or advancement

of cellulitis past one joint, and also involvement of a bone, joint, tendon or nerve.

Consultation with plastic surgeon may be required if the patient has a facial or other

highly visible wound. For patients hospitalized with cellulitis or abscess formation on an

extremity, surgical consultation should be considered immediately because of the risk of

worsening infection and tissue damage. Other than that, Tetanus Immunization and tetanus

immunoglobulin should be administered if appropriate.

11.3 Assessing the Risk of Rabies

The patient’s risk of infection with rabies virus must be addressed immediately. Because

of the serious risk to the public of a rabid animal on the loose, it is important to document the

conditions surrounding the attack. Patients with a bite from a non provoked dog should be

considered at higher risk for rabies infection than patients with a bite from a provoked dog.

If the dog owner is reliable and can confirm that the animal’s vaccination against rabies

virus is current, the dog may be observed at the owner’s home. Observation by a veterinarian is

appropriate when the vaccination status of the animal is unknown. If the animal cannot be

quarantined for 10 days, the dog bite victim should receive rabies immunization.

Rabies immunization should begin within 48 hours after the bite, but it can be

subsequently discontinued if the animal is shown to be free of rabies virus. Rabies immunization

consists of an active immune response with a vaccine and a passive immune response with rabies

Immune globulin (RIG).

11.4 Follow up

Patients who have been bitten by a dog should be instructed to elevate and immobilize the

involved area. Most bite wounds should be re-examined in 24 to 48 hours especially bites to the

hands.

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12.0 TREATMENT OF DOG BITES

After being bitten by an animal, it is important to quickly and carefully clean the wound

thoroughly with soap and a large amount of water. This can help to prevent infection. If there is

bleeding, a clean towel or gauze should be pressed to the wound to slow or stop the bleeding.

The treatments for Mrs. C are as below:

i. Antibiotics

The most common complication of an animal bite is infection. Antibiotics are generally

recommended to prevent infection in people with high-risk wounds, facial wounds,

wounds involving a bone or joint, and for people with other health problems, such as a

weakened immune system or diabetes, which could increase the risk of serious infection.

Medication given to Mrs. C are Augmentin tablet 625 mg and topical antibiotic

Bacitracin 20 g.

ii. Tetanus immunization

Tetanus is a serious, potentially life-threatening infection that can be transmitted by an

animal or human bite. Adults who are bitten should receive a tetanus vaccine (called a

tetanus toxoid vaccine) if the last tetanus vaccine was greater than 5 years ago. In

addition, tetanus immune globulin may be recommended if the person is not sure of the

date of their last tetanus vaccination. The immune globulin provides additional protection

against tetanus infection.

Medication given is Infanrix Hexa

iii. Rabies immunization

People who are bitten by an animal who could be infected with rabies are encouraged to

have a series of injections to prevent becoming infected with rabies

Medication given is Verorab.

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iv. Wound management

Mrs. C undergo cleaning and dressing of her puncture wound. Immediate suturing is not

recommended for this type of wound.

Medication given is Povidone Iodine solution.

v. Pain management

Mrs. C is given Tablet Arcoxia 120 mg to control her pain.

12.1 Drugs profile

a) Tablet Augmentin 625 mg

Trade name : Augmentin

Content: Per 625 mg tab Co-amoxiclav: Clavulanate K 125 mg, amoxicillin

trihydrate 500 mg

Classification : Penicillins

Indication

: Short term treatment of bacterial infections at the following sites:

Upper respiratory tract infections [including ears, nose, throat

(ENT)] eg, recurrent tonsillitis, sinusitis, otitis media.

Lower respiratory tract infections eg, acute exacerbation of

chronic bronchitis, lobar and bronchopneumonia.

Skin and soft tissue infections eg, boils, abscesses, cellulitis,

wound infections.

Bone and joint infections eg, osteomyelitis.

Tablet/Vial: Genitourinary tract infections eg, cystitis, urethritis,

pyelonephritis.

Other infections eg, dental infections (eg, dentoalveolar abscess

with spreading cellulitis), septic abortion, puerperal sepsis, intra-

abdominal sepsis

Dosage and Frequency : 1 tab BD

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Route of administration : Oral

Side effect : Headache, dizziness, nausea, vomiting, skin rashes.

Contraindication

: History of hypersensitivity to β-lactams eg, penicillins and

cephalosporins and Augmentin-associated jaundice/hepatic

dysfunction.acidosis

Date On : 03/05/2011

Date Off : 09/05/2011

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b) Infanrix Hexa

Trade name : Infanrix Hexa

Content

: Adsorbed diphtheria toxoid not <30 iu, adsorbed tetanus toxoid not

<40 iu, adsorbed pertussis toxoid 25 mcg, adsorbed filamentous

haemagglutinin 25 mcg, adsorbed pertactin 8 mcg, adsorbed

recombinant HBsAg protein 10 mcg, 40 D-antigen units of type 1

(Mahoney), 8 D-antigen units of type 2 (MEF-1) & 32 D-antigen

units of type 3 (Saukett) of the poliomyelitis virus, adsorbed purified

capsular polysaccharide of HiB (PRP) 10 mcg (covalently bound to

tetanus toxoid 20-40 mcg)

Classification : Vaccines, Antisera & Immunologicals

Indication : Primary immunisation against diphtheria, Tetanus, Pertussis,

Hepatitis B, Poliomyelitis & Haemophilus influenzae type b in

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infants from the age of 6 weeks & in infants who received a 1st dose

of hepatitis B vaccine at birth.

Dosage and Frequency : 0.5ml

Route of administration : Intramuscular

Side effect : Pain, Redness, Swelling

Contraindication: Encephalopathy of unknown etiology and Acute severe febrile

illness acidosis

Date On : Stat

Date Off : Stat

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c) Verorab Vaccine

Trade name : Verorab

Generic Name : Pethidine Hcl

Classification : Vaccines, Antisera & Immunologicals

Indication : Active immunisation against rabies

Dosage and Frequency Pre-exposure vaccination: A primary course consists of 3 doses; 1

ml on days 0, 7 and 28 (3rd dose may be given on day 21 if

needed). Booster dose: 1 ml based on antibody titers (for

continuous exposure: serology should be done every 6 mth

(immunise when antibody titer falls below acceptable levels); for

frequent exposure: booster immunisation or serology every 2 yr;

for infrequent exposure: no recommendation).

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Post-exposure vaccination: Clean the wound with soap and water

immediately. Vaccinate as soon as possible after exposure and

may be stopped if it is shown that the patient was not at risk. For

persons who did not receive proper primary immunisation: 5

doses of 1 ml each should be given on days 0, 3, 7, 14 and 28

(patients should also receive rabies immunoglobulins with the 1st

dose); for persons who have received primary immunisation: 2

doses of 1 ml should be given on days 0 and 3.

Route of administration : Intramuscular

Side effect Headache, dizziness, malaise, abdominal pain, nausea, myalgia.

Inj-site reactions such as itching, swelling, pain.

Contraindication : Lactation, pregnancy

Date On : stat

Date Off : stat

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d) Povidone Iodine

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Trade name : Betadine Antiseptic Solution

Generic Name : Povidone Iodine

Classification : Antiseptic

Indication

Cuts and bruises

Wounds and burns

Cold sores, skin infections,

Herpes Simplex, Herpes Genitalis

Disinfection of Perineal wounds and skin.

Dosage and Frequency

For the skin Use full strength.

Soln Irrigation of body cavities Use 1:10 times dilution for

peritonitis, urethritis, cystitis, symptomatic treatment of

trichomonal, monilial & nonspecific vaginitis.

Use 1:100 for thoracic irrigation. Plaster Apply as necessary.

Route of administration : Topical

Side effect : Local irritation

Contraindication Hypersensitivity

Thyroid and patients with non-toxic nodular colloid goitre.

Date On : 03/05/2011

Date Off : 09/05/2011

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e) Tablet Arcoxia 120 mg

Trade name : arcoxia 120 mg

Content : Etoricoxib

Classification : Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Indication

Acute & chronic treatment of signs & symptoms of osteoarthritis

(OA) & Rheumatoid Arthritis(RA),

Ankylosing spondylitis (AS), Acute gouty arthritis & acute pain

Dosage and Frequency : 1 tablet OD/ PRN

Route of administration : Oral

Side effect : Asthenia/fatigue , Dizziness, Hypertension and Dyspepsia

Contraindication

Hypersensitivity

Pregnancy.

Date On : 03/05/2011

Date Off : 07/05/2011

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13.0 MEASURES FOR PREVENTING DOG BITES

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There is no guarantee that the dog will never bite someone under any condition which

you may not even foresee. However, we can reduce the risk of a dog biting. The popular saying

is that prevention is better than cure.

Since prevention of dog bites is not the responsibility of dog owners alone, here we will

be discussing preventive measures that prospective dog owners, dog owners, parents and general

member of the public can make immediate use of.

13.1 Preventive measures applicable to potential dog owners

For those who are willing to take dog as a pet, they must evaluate their environment and

lifestyle.

Though there is no breed that will not bite under any condition, it is still very important

for you to consult professionals like a veterinarian, dog behaviorist or breeder to determine the

breed that will be suitable for you, your family and especially that will besuitable for your

environment. Obtaining breed specification will help you a lot in avoiding any possible trouble.

13.2 Preventive measures for dog owners

As a dog owner it is very important that you socialize your dog. If you socialize your dog

well it will be much less likely that you will experience a dog bite. Socializing you dog helps

boost it's confidence and reduces it's being nervous or frightened under normal circumstances.

Dog training will also help you in preventing dog biting. You have to learn proper

training techniques by attending dog training classes. Attending these classes will help you

socialize your dog. Train your dog to respond to some basic commands such as "stay, "leave it"

and "come". Also train you dog to drop his toys on command. If you don't do this you will have

to retrieve it from his mouth. Thus taking the risk of your finger being bitten.

Teach your dog acceptable behaviors by enrolling in an obedience class. By attending this class

your dog will be trained to be submissive and respect your leadership in the house.

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Make sure that your dog is not allowed to run free, especially at the parks. Obey dog

leash laws by making sure your dog is always on it’s leash. Allowing your dogs to move free in

public is dangerous. Putting your dog in a situation where it feels threatened or teased is asking

for trouble. As a dog owner you should maintain you dog's health with proper vaccinations

against parasites. If your dog is in pain it's likely to bite. So make sure your dog is healthy.Using

physical punishment to stop inappropriate behavior will only encourage your dog’s aggression.

13.3 Preventive measures for parents

It is a must for parents to teach their children to never approach an unfamiliar dog,

especially when it's off its leash.

Teach your children not to run or scream if a dog approaches them. If they run, naturally

the dog will chase them. So teach them to ‘stay still like a tree’ with hands at their sides. They

should avoid eye contact with the dog and they should not speak to the dog at this time. Teach

them not to play with a dog even if it's yours except if an adult is present. And if they are to play

at all they should let the dog sniff them first.

Also teach them to never disturb a dog that is sleeping, eating or tending to puppies.

Parents should never leave a baby or small child alone with a dog. Teach your children to not

approach a strange dog and ask permission from a dog's owner before petting the dog As a

parent, before you buy a dog make sure that your child is at least 6 years old

13.4General preventive measures for adults:

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Don't approach an unfamiliar dog under any circumstances. Don't run away from a dog

and avoid direct eye contact with a dog. Any dog displaying unusual behavior should be reported

immediately to animal controlauthorities.

Don't disturb a dog that is sleeping, eating, tending to puppies or in any relaxed mood. It

will view this action as a threat and you know the meaning of that.

Allow a dog to sniff you first before attempting to pet the dog. Don't hug or kiss a dog. It

expresses a sense of submission to the dog. This may lead to aggressive behavior because the

dog will feel that it is in charge. Never try to intervene when two dogs are fighting.

13.5 Tips on how to reduce chances of being attacked by a dog

If you enter an area where you suspect or see a dog, the following tips may help you:

i. Don't run past a dog. Dogs naturally love to chase and catch things. Don't give them a

reason to become excited or aggressive.

ii. Never disturb a dog that's caring for puppies, sleeping or eating

iii. If a dog approaches to sniff you - stay still. In most cases, the dog will go away when it

determines you're not a threat.

iv. If a dog threatens you, remain calm. Don't scream. If you say anything, speak calmly and

firmly. Avoid eye contact. Try to stay still until the dog leaves, or back away slowly until

the dog is out of sight. Don't turn and run.

v. If the dog continues the attack after your preventive measures and you feel you can not

escape, use Shock Dog Repellant. Aim and spray the dog repellant in the face. Dog

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repellant is not injurious to dogs, but will cause them to retreat. This will allow time for

you to get to a safe place.

vi. If you fall or are knocked to the ground, curl into a ball with your hands over your head

and neck. Protect your face.

vii. If a dog bites you - treat the wounds immediately. Contact the authorities and tell them

everything you can about the dog: the owner's name, if you know it; color of the dog;

size; where you saw it; if you've seen it before, etc. These details may help animal-

control officers locate the dog.

14.0 HEALTH EDUCATION

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The patient and family need to be educated on wound care at home. There are certain steps need

to be considered in order to give better result.

i. To help reduce pain and swelling, apply ice to the affected area for 15 minutes every hour

for the first 24 hours. Keep the wound elevated and immobilized for 48 hours.

ii. Wash the wound with soap and water and pat dry. Do not soak the wound.

iii. Instruct patients given antibiotics to take all the medication as prescribed without

skipping or doubling doses.

iv. Tell the patient and family to return to the clinic if any signs or symptoms of infection

emerge or if severe pain continues beyond 24 hours

.

v. Referral to multidisciplinary services, such as plastic surgery, orthopedics, and wound-

care specialists, should be made as indicated

vi. report the incident to animal control as required by local and state law.

15.0 CONCLUSION

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Knowledge of first aid is a civic responsibility. It not only helps to save lives and prevent

complications from injuries but also helps in setting up an orderly method of handling

emergency problems according to their priority for treatment, so that the greatest possible good

may be accomplished for the greatest number of people.

First aid is the provision of initial care for an illness or injury. It is usually performed by a

non-expert person to a sick or injured person until definitive medical treatment can be accessed.

Certain self-limiting illnesses or minor injuries may not require further medical care past the first

aid intervention. It generally consists of a series of simple and in some cases, potentially life-

saving techniques that an individual can be trained to perform with minimal equipment.

However, being able to administer effective first aid does not simply involve having a first aid

kit on hand. Effective first aid also involves having the appropriate skills as well as good

judgment and the ability to keep a clear head when confronted with a medical emergency.

The knowledge of first aid, when properly applied, can mean the difference between

temporary or permanent injury, rapid recovery or long-term disability, and the difference

between life and death. Learning about first aid gives us the confidence to not react in shock

when emergency arises but act as necessary to help the patient. Knowledge of first aid helps us

stay safe!

Dog bites is such a preventive injury. Thus, we must increase our level of consciousness

and alertness when facing the situation. Parents should be more careful and do not let their

children playing alone without supervision. This can avoid them from being bitten by anybody’s

dog. The owners of the dog itself should take their pets vaccinated in order to lower the risk of

rabies. Moreover, community must have a comprehensive initiative to educate themselves about

preventive measures as well as to implement first aid through their daily life.

16.0 REFERENCES

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American Veterinary Medical Association 2001, ‘A community approach to dog bite

prevention’,JAVMA, vol. 218, pp. 1732-1749.

Antoon, A.Y and Tompkins, D.M 2000, A Parents Quick Reference to Baby’s Health: Birth to

Age Five, Lowell House, Illinois United State of America.

Brouhard, R 2011, How to treat dog bites, viewed 04 May 2011,

http://firstaid.about.com/od/bitesstings/ht/07_Dog_Bites.htm

Chapman, S et al 2000, “Preventing dog bites in children: randomised controlled trial of an

educational intervention”, BMJ, vol. 320, pp. 1512-1513.

Davies, H.D 2000, ‘When your best friend bites: A note on dog and cat bites’, Can J Infect, Vol.

11, no. 5, pp. 227-229.

Dealey, C and Cameron, J 2008, Wound management, Blackwell, United Kingdom.

Heller, J.L and ziere, D 2009, Cuts and puncture wounds, viewed 03 May 2011,

http://www.umm.edu/ency/article/000043.htm

Mims Malaysia, 2011, Arcoxia, viewed 03 May 2011, http://www.mims.com/Page.aspx?

menuid=mng&name=Arcoxia%20filmcoated

%20tab&brief=true&h=arcoxia&CTRY=MY&searchstring=arcoxia

Mims Malaysia 2011, Augmentin, viewed 03 May 2011,

http://mims.com.my/Malaysia/drug/info/Augmentin/?type=full#Actions

Mims Malaysia 2011, Betadine, viewed 06 May 2011,

http://www.mims.com/Malaysia/drug/info/Betadine%20Topical/?q=Betadine

%20Topical&type=brief

Mims Malaysia 2011, Infanrix Hexa, viewed 03 May 2011,

http://mims.com.my/Malaysia/drug/info/Infanrix%20Hexa/Infanrix%20Hexa%20prefilled

%20syringe

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http://mims.com.my/Malaysia/drug/info/Infanrix%20Hexa/Infanrix%20Hexa%20prefilled%20syringe

http://mims.com.my/Malaysia/drug/info/Infanrix%20Hexa/Infanrix%20Hexa%20prefilled%20syringe

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http://www.umm.edu/ency/article/000043.htm

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Mims Malaysia 2011, Verorab, viewed 03 May 2011,

http://mims.com.my/Malaysia/drug/info/vaccine,%20rabies/?type=full&mtype=generic#Actions

Olajide, L 2005, How to stop your puppy or older dog from biting, Success Brothers Enterprise,

USA.

Presutti, J.R 2001, ‘ Prevention and treatment of dog bites’, American Family Physician, vol. 63,

no. 8, pp. 1567-1572.

Rizzo, T.R, Lefner, J and Gerardi, M.B 2008, Clinical management of dog-bite injuries, viewedn

04 May 2011, http://www.clinicaladvisor.com/clinical-management-of-dog-bite-injuries/article/

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13.0 APPENDICES

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First Aid : Dog Bites

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