First Aid PAEF 312.

Dog Bites 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. Ive learnt a lot of new things that will improvise my knowledge and skills in this field. Im 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.

09DPH0007

First Aid PAEF 312.1

Dog Bites Johor Specialist Hospital

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.

09DPH0007

First Aid PAEF 312.1

Dog Bites Johor Specialist Hospital

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 3rd 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.

09DPH0007

First Aid PAEF 312.1

Dog Bites Johor Specialist Hospital

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.

09DPH0007

First Aid PAEF 312.1

Dog Bites Johor Specialist Hospital

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.

09DPH0007

First Aid PAEF 312.1

Dog Bites Johor Specialist Hospital

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 dogs mouth or teeth touching skin or clothing.

09DPH0007

First Aid PAEF 312.1

Dog Bites Johor Specialist Hospital

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

09DPH0007

First Aid PAEF 312.1

Dog Bites Johor Specialist Hospital

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.

09DPH0007

First Aid PAEF 312.1

Dog Bites Johor Specialist Hospital

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.

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

09DPH0007

First Aid PAEF 312.1

Dog Bites Johor Specialist Hospital

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.

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

09DPH0007

First Aid PAEF 312.1

Dog Bites Johor Specialist Hospital

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.

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.

09DPH0007

First Aid PAEF 312.1

Dog Bites Johor Specialist Hospital

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. Theyre 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.

iv.

Lack of good/positive training

09DPH0007

First Aid PAEF 312.1

Dog Bites Johor Specialist Hospital

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.

9.0 DOGS WARNING SIGNS

09DPH0007

First Aid PAEF 312.1

Dog Bites Johor Specialist Hospital

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. ii. iii. iv. v. vi. vii. viii. ix. x. xi. xii. xiii.

When a dog's ears are pulled back against his head. When his legs are very stiff. When dog's fur is raised up, his ears erect and tail high. When a dog growls and barks aggressively with his teeth showing. When a dog is intensely looking directly at a human's face. When a dog licks his chops while you approach or interact with him. When a dog suddenly starts scratching or licking himself. When a dog lowers its tail (held stiffly) and wags it slowly. When dog is standing forward and up on its toes. (unclear) When a dog's body is stiff and leans forward toward the target. When snarling with its teeth uncovered. When the dog is cowering. When a dogs tail is tucked completely under his body.

09DPH0007

First Aid PAEF 312.1

Dog Bites Johor Specialist Hospital

xiv. xv. xvi. xvii.

When a dog is ill or old. When a dog gets up and moves away from you. When a dog turns his head away from you. When a dog yawns while you are approaching

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.

09DPH0007

First Aid PAEF 312.1

Dog Bites Johor Specialist Hospital

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.

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 patients risk of infection including:

09DPH0007

First Aid PAEF 312.1

Dog Bites Johor Specialist Hospital

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. 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.

09DPH0007

First Aid PAEF 312.1

Dog Bites Johor Specialist Hospital

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 (amoxicillinclavulanate 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. 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 patients 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 animals vaccination against rabies virus is current, the dog may be observed at the owners 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.

09DPH0007

First Aid PAEF 312.1

Dog Bites Johor Specialist Hospital

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.

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

09DPH0007

First Aid PAEF 312.1

Dog Bites Johor Specialist Hospital

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.

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.

09DPH0007

First Aid PAEF 312.1

Dog Bites Johor Specialist Hospital

12.1 Drugs profile

a) Tablet Augmentin 625 mg

Trade name Content Classification

: Augmentin : Per 625 mg tab Co-amoxiclav: Clavulanate K 125 mg, amoxicillin trihydrate 500 mg : Penicillins : 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-

Indication

Dosage and Frequency Route of administration Side effect Contraindication Date On Date Off

abdominal sepsis : 1 tab BD : Oral : Headache, dizziness, nausea, vomiting, skin rashes. : History of hypersensitivity to -lactams eg, penicillins and cephalosporins and Augmentin-associated jaundice/hepatic dysfunction.acidosis : 03/05/2011 : 09/05/2011

09DPH0007

First Aid PAEF 312.1

Dog Bites Johor Specialist Hospital

Visual profile

b) Infanrix Hexa

Trade name

: Infanrix Hexa : 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) : Vaccines, Antisera & Immunologicals : Primary immunisation against diphtheria, Tetanus, Pertussis, Hepatitis B, Poliomyelitis & Haemophilus influenzae type b in infants from the age of 6 weeks & in infants who received a 1st dose of hepatitis B vaccine at birth. : 0.5ml : Intramuscular : Pain, Redness, Swelling : Encephalopathy of unknown etiology and Acute severe febrile illness acidosis : Stat : Stat

Content

Classification

Indication

Dosage and Frequency Route of administration Side effect Contraindication Date On Date Off

09DPH0007

First Aid PAEF 312.1

Dog Bites Johor Specialist Hospital

Visual profile

c) Verorab Vaccine Trade name Generic Name Classification Indication : Verorab : Pethidine Hcl : Vaccines, Antisera & Immunologicals : Active immunisation against rabies 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). Dosage and Frequency 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 Route of administration Side effect doses of 1 ml should be given on days 0 and 3. : Intramuscular Headache, dizziness, malaise, abdominal pain, nausea, myalgia. Inj-site reactions such as itching, swelling, pain.

09DPH0007

First Aid PAEF 312.1

Dog Bites Johor Specialist Hospital

Contraindication Date On Date Off

: Lactation, pregnancy : stat : stat

Visual profile

d) Povidone Iodine

Trade name Generic Name Classification

: Betadine Antiseptic Solution : Povidone Iodine : Antiseptic Cuts and bruises Wounds and burns Cold sores, skin infections, Herpes Simplex, Herpes Genitalis Disinfection of Perineal wounds and skin. For the skin Use full strength.

Indication

Dosage and Frequency

09DPH0007

First Aid PAEF 312.1

Dog Bites Johor Specialist Hospital

Soln Irrigation of body cavities Use 1:10 times dilution for peritonitis, urethritis, cystitis, symptomatic treatment of trichomonal, monilial & nonspecific vaginitis.

Route of administration Side effect Contraindication Date On Date Off

Use 1:100 for thoracic irrigation. Plaster Apply as necessary. : Topical : Local irritation Hypersensitivity Thyroid and patients with non-toxic nodular colloid goitre. : 03/05/2011 : 09/05/2011

Visual profile

e) Tablet Arcoxia 120 mg

Trade name Content Classification Indication Dosage and Frequency Route of administration Side effect Contraindication

: arcoxia 120 mg : Etoricoxib : Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) Acute & chronic treatment of signs & symptoms of osteoarthritis (OA) & Rheumatoid Arthritis(RA), Ankylosing spondylitis (AS), Acute gouty arthritis & acute pain : 1 tablet OD/ PRN : Oral : Asthenia/fatigue , Dizziness, Hypertension and Dyspepsia Hypersensitivity Pregnancy.

09DPH0007

First Aid PAEF 312.1

Dog Bites Johor Specialist Hospital

Date On Date Off

: 03/05/2011 : 07/05/2011

Visual profile

13.0 MEASURES FOR PREVENTING DOG BITES 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

09DPH0007

First Aid PAEF 312.1

Dog Bites Johor Specialist Hospital

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. 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 its 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 dogs aggression.

13.3 Preventive measures for parents

09DPH0007

First Aid PAEF 312.1

Dog Bites Johor Specialist Hospital

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: 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

09DPH0007

First Aid PAEF 312.1

Dog Bites Johor Specialist Hospital

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 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 animalcontrol officers locate the dog.

09DPH0007

First Aid PAEF 312.1

Dog Bites Johor Specialist Hospital

14.0 HEALTH EDUCATION

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.

09DPH0007

First Aid PAEF 312.1 i.

Dog Bites Johor Specialist Hospital

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 woundcare specialists, should be made as indicated

vi.

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

09DPH0007

First Aid PAEF 312.1

Dog Bites Johor Specialist Hospital

15.0 CONCLUSION

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 lifesaving 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 anybodys 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.

09DPH0007

First Aid PAEF 312.1

Dog Bites Johor Specialist Hospital

16.0 REFERENCES 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 Babys 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

09DPH0007

First Aid PAEF 312.1

Dog Bites Johor Specialist Hospital

Mims

Malaysia

2011,

Infanrix

Hexa,

viewed

03

May

2011,

http://mims.com.my/Malaysia/drug/info/Infanrix%20Hexa/Infanrix%20Hexa%20prefilled %20syringe 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-biteinjuries/article/119815/

09DPH0007

First Aid PAEF 312.1

Dog Bites Johor Specialist Hospital

13.0 APPENDICES

09DPH0007