Diplomate, Board Certification of Emergency Medicine
Chairman, Department of Emergency Medicine Ma'ayenei Hayeshua
Hospital
The next topic may not be an overly relevant one. However,
you never know when such information may help someone. And
besides, it is a very interesting topic.
We will speak about bites. People bites, animal bites,
reptile bites, insect bites, and bites from animals that live
in the waters.
Let's start. The first principle is that the mouths of all
animals are full of bacteria. Bacteria love warm, wet places,
and the lack of oxygen is not a problem at all.
Saliva -- the fluid in our mouths -- does many wonderful
things. It lubricates, it catches foreign invaders, and makes
it easier for us to spit them out, and it has enzymes that
begin the digestion process by breaking up starches. In fact,
Pavlov's famous experiments proved that when smelling or
seeing a tasty starch, the mouth already starts preparing by
increasing saliva. This is where the expression
"mouthwatering" comes from.
The down side is that bacteria proliferate in these places
and, while the mouth deals with this wonderfully (even to the
extent that these dangerous bacteria do not generally cause
infection when there is a cut in the mouth), when these
bacteria get into the wrong places, trouble can start.
Children sometimes bite each other when fighting with each
other. Usually this is of no consequence. Bigger problems
start when people start biting their nails and rip off a
piece of skin with them. This can lead to a paronychia, or a
reddened border of the nail with pus underneath. Worse yet is
when saliva gets under the skin, as in fights when someone
sends a clenched fist into the mouth of someone else, and a
tooth punctures one of the finger joints. This can destroy a
joint.
Lacerations in the mouth are quite common, as in falls and in
seizures. If the cut in the mouth is less than 2 cm. in
length, we generally do not close them surgically unless they
are particularly deep. Tongue lacerations that are less than
one cm. long also do well. We irrigate all mouth lacerations
out, and the use of a penicillin-type antibiotic is
traditional in these cases.
The most common animal that bites civilized man remains the
dog. Dogs differ much in temperament and aggressivity. Pit
Bulls are smaller dogs that are aggressive and unpredictable
-- deaths in children have occurred due to them. German
Shepherds are very amenable to training and will often not
bite unless on command. St. Bernards are friendly dogs who
often do not bite. All dogs will bite if threatened, and all
have the "pack" mentality; that is they hunt in packs. If
they see a child running scared, a few may join together to
chase.
Dogs and their relatives -- coyotes, jackals, hyenas, wolves,
and especially foxes -- all can carry rabies. All can cause
serious bites. We generally advise as first aid for dog bites
to wash the affected part under running water and soap.
Facial wounds can be closed after meticulous cleansing.
Tetanus immunization is given and antibiotics covering the
common bacteria in a dog's mouth are often administered,
sometimes intravenously. The recommendation for the first
line treatment of dog bites is the antibiotic Augmentin.
Write me in care of the Yated.
A message from Glaxo, sponsor of this column.
Augmentin is produced by our sponsor and is now available in
twice a day dosing. This is perhaps the strongest antibiotic
available in oral form. Ease, strength, and safety.
