Education and follow-up/referral

The patient and family need to be educated on wound care at home. 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.15 Wash the wound with soap and water and pat dry. Do not soak the wound. Instruct patients given antibiotics to take all the medication as prescribed without skipping or doubling doses. 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. Otherwise, patients should follow up with a primary-care provider within 48 hours. Referral to multidisciplinary services, such as plastic surgery, orthopedics, and wound-care specialists, should be made as indicated. Finally, report the incident to animal control as required by local and state law. 

Provide information on dog-bite prevention. This is available from both the American Veterinary Medical Association and the CDC.17,18 It is important to teach young children about safety around dogs and review the information with them regularly in an age-appropriate manner. Families considering adding a dog to the home should be encouraged to speak first with their primary-care provider and veterinarian. It is important to match the temperament of the dog to the age and activity levels of all family members. Unfortunately for many victims, most people do not receive prevention information until the first incident occurs. After a dog bite, all patients and families need to be educated on how to prevent future accidents.

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Dog-bite protocol algorithm

A methodical approach is essential to effectively treat dog bites and help provide the best possible outcomes. An algorithm for use as a tool for the systematic assessment and management appears in Figure 2. The versatility of the algorithm can aid practitioners in multiple settings from primary care and urgent-care clinics to EDs. Even with the algorithm, the practitioner must use reasonable judgment, and treatment may need to be adjusted for special situations.


The best dog bite is one that is prevented. Anyone can learn to reduce his or her chances of being bitten. Education alleviates patient and family suffering and eases the burden on the health-care community. Research shows that proper initial management can reduce adverse sequelae related to dog bites as well as cut health-care costs for repeat treatment. Finally, prompt wound management and judicious use of antibiotics decrease antimicrobial resistance and infection incidence.19

Ms. Rizzo is a family nurse practitioner at Metropolitan Methodist Hospital in San Antonio. Ms. Lefner is a family nurse practitioner in private practice in San Antonio. Dr. Gerardi is assistant professor in the Department of Family Nursing Care at The University of Texas Health Science Center at San Antonio.

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