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How Much do You Know About First Aid for Bites?

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People biting people. People biting animals. Animals biting people. Various sorts of insects biting anything and everything. Somewhere around the world, at any particular moment in time, you can rest assured something getting bitten by something else. The big problem with bites is not necessarily the pain or physical damage. What you really have to worry about is the infection or even toxin that might be delivered through the bite.

What is a bite? Here’s what Wikipedia has to say on the matter.

A bite is a wound received from the mouth (and in particular, the teeth) of an animal, including humans. Animals may bite in self-defense, in an attempt to predate food, as well as part of normal interactions. Other bite attacks may be apparently unprovoked. Self inflicted bites occur in some genetic illnesses such as Lesch-Nyhan syndrome. Biting is an act that occurs when an animal uses its teeth to pierce another object, including food, flesh and inanimate matter. A person bitten by an animal potentially carrying parvovirus or rabies virus should consult a medical doctor immediately. A bite victim may also incur serious bacterial infections of the bone called osteomyelitis which can become life threatening if untreated, whether or not the animal has parvovirus or rabies virus.

Bites are usually classified by the type of creature causing the wound. Many different creatures are known to bite humans.

  • Arthropods
  • Spider bite
  • Insect bites and stings
  • Flea bites are responsible for the transmission of bubonic plague.
  • Mosquito bites are responsible for the transmission of dengue fever and malaria.

Vertebrates other than humans also like to bite humans. Here are the most common culprits.

  • Bites from dogs are commonplace, with children the most common victims and the face the most common target. About 4.7 million dog bites are reported annually in the United States.
  • Other companion animals, including cats, ferrets, and parrots, may bite humans.
  • Wildlife may sometimes bite humans. The bites of various mammals such as bats, rabbits,wolves, raccoons, etc. may transmit rabies, which is almost always fatal if left untreated.

Involuntary biting injuries due to closed-fist injuries from fists striking teeth (referred to as reverse bite injuries) are a common consequence of fist fights. These have been termed “fight bites”. Injuries in which the knuckle joints or tendons of the hand are bitten into tend to be the most serious.

Here are a few other things that like to bite as well.

  • Snakebite
  • Leech bite

Signs and symptoms of a bite wound. Bite wounds raise a number of medical concerns for the physician or first aider including:

  • Generalized tissue damage due to tearing and scratching.
  • Serious hemorrhage if major blood vessels are pierced.
  • Infection by bacteria or other pathogens, including rabies.
  • Introduction of venom into the wound by venomous animals such as some snakes.
  • Introduction of other irritants into the wound, causing inflammation and itching.


Bite wounds should be cleaned and debrided as necessary but not closed. Ampicillin/sulbactam is indicated as HACEK endocarditis, specifically Eikenella, is the most worrying complication. A punctate wound over a joint surface should be regarded as an open joint injury until proven otherwise. Bite wounds are washed, ideally with povidone-iodine soap and water. The injury is then loosely bandaged, but is not sutured due to risk of infection.

Antibiotics prophylaxis is recommended for dog and cat bites of the hand and human bites if they are more than superficial. Evidence for the need for antibiotic prophylaxis for bites in other areas inconclusive. For empirical therapy, the first choice is amoxicillin with clavulanic acid, and if the person is penicillin allergy doxycycline and metronidazole. The anti-staphylococcal penicillins (e.g.,cloxacillin, nafcillin, flucloxacillin) and the macrolides (e.g., erythromycin, clarithromycin) are not used for empirical therapy, because they do not cover Pasteurella species.

Animal bites inflicted by some animals, including carnivorans and bats can transmit rabies. The animal is caught alive or dead with its head preserved, so the head can later be analyzed to detect the disease. Signs of rabies include foaming at the mouth, self-mutilation, growling, jerky behavior, and red eyes. If the animal cannot be captured, prophylactic rabies treatment is recommended in most places. Certain places, such as Hawaii, Australia and the United Kingdom, are known not to have native rabies. Treatment is generally available in North America and the Northern European states.

Tetanus toxoid is indicated for virtually any bite that punctures the epidermis and tetanus immune globulin is indicated in patients with more than 10 years since prior vaccination. Tetanus boosters (Td) should be given every ten years.

Some people don’t realize that the human bite might be one of the nastiest of all. Human saliva contains as many as 100 million organisms per milliliter, representing as many as 190 different species. That’s a lot of microscopic stuff just itching to make you sick. According to the Medscape reference website, approximately 10-15% of human bite wounds become infected.

If you find yourself the victim of either an accidental or intentional bite, you should seek medical attention promptly. The prognosis is very good in these cases. The flip side of that is the patient who waits days or weeks before deciding to let a medical professional have a look at it, allowing the infection plenty of time to take hold. It’s difficult for the inexperienced to assess the severity of such a wound.

When it comes to treating human bites, thank goodness for antibiotics. They have proven to literally be a life and digit saver. It should be noted that, prior to the development of antibiotics, as much as 20% of hand bites could be expected to result in amputation of the finger. Today, only extreme cases result in the same unfortunate conclusion.

Patients must clearly understand the signs and symptoms of wound infection that signal a need to return for immediate reevaluation. These include, but are not limited to, the following:

• Fever
• Odor
• Drainage
• Purulence
• Swelling
• Cellulitis
• Warmth
• Pain
• Decreased mobility

Patients must also clearly understand the importance of early and regular follow-up care for this seemingly minor injury, as well as the rationale for providing antibiotics and the importance of compliance with this recommendation. Moreover, patients need to be informed of potential complications that may develop even with complete compliance with the care plan, and they should understand that wound revision for cosmetic or functional purposes may be desirable at a later date.

Bites, stings, and other injuries of this type are not something we like to dwell upon, but regardless of our preference, this kind of thing happens. Your best bet, as Holistic Survival founder Jason Hartman likes to say in regard to almost any topic, is to be armed with the appropriate knowledge. Education is survival! (Top image: Flickr | Walt Stoneburner)

The Holistic Survival Team


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