Presenter: Andrew Linklater DVM DACVECC Diplomate, American College of Veterinary Emergency & Critical Care Residency and Intern Supervisor, Clinical Specialist, Lakeshore Veterinary Specialists, Port Washington, Wisconsin
The title says it all, if you want to make the right decisions the next time a bite wound comes through the door, this is the webinar for you. Andrew Linklater delivered such extensive coverage on managing the bite wound, there is no way I can come close to summarising the information and advice offered within this blog. Instead I can offer some ‘little gems’ divulged by Andrew in the hope it will tempt you to log in, enjoy and learn.
The first ‘little gem’ is found within the discussion, centred around the primary assessment of the bite wound patient which generally involves assessing their airway, breathing and circulation. If necessary intravenous fluids can be administered but Andrew advises caution on the amount and rate of fluid given, as too much could be detrimental especially in the presence of underlying head injuries and/or lung injuries, and has been shown to disrupt blood clots in the field of human trauma. For this reason Andrew advises being conservative, and uses rates anywhere between 10-20mls/kg of crystalloids. If the response is poor then colloids can be administered at a rate of 2-5mls/kg.
The next tip involves the secondary assessment of the patient where it is important to ensure there is no development of any underlying injuries. If concerned, Andrew informed us of a rapid technique of trauma evaluation using ultrasound known as AFAST (abdominal ultrasound) and TFAST (thoracic ultrasound). The abdominal ultrasound involves using four simple points on the abdomen demonstrated within the webinar to assess for any signs of free fluid developing. The thoracic ultrasound is more challenging and involves using a couple of points on the chest to check for the ‘glide sign’. This is a bright white line which sits between the ribs and usually slides back and forth being the interface between the pleura and viscera. Andrew suggests, for practice, checking this sign in normal patients because in the trauma case, when not present, it can be indicator of thoracic trauma including conditions such as pneumothorax.
Once a primary and secondary assessment has been performed, decisions need to be made about whether a wound needs to be surgically explored. For this reason Andrew recommends always probing wounds, and if disrupted tissue extends further than 1-2 cm, surgical exploration is warranted. Andrew also reminded us there may be no disruption of the skin after some bite wounds despite there being significant underlying trauma. These cases require hospitalisation and assessment to decide if surgical exploration is warranted.
Lavage is an important component of wound management and is key in converting contaminated wounds into clean contaminated wounds which can then be surgically closed. Lavage is an excellent tool for removing debris and bacteria, and hydrating tissues. It was advised to use a 35ml syringe with an 18-19 gauge needle to deliver the ideal pressure of 8-9PSI for safe and effective lavage. However Andrew also warned that some lavage can make matters worse by driving bacteria further into a wound. For this reason he advises never lavaging blindly into a puncture wound and to always clean outside the wound, and only use lavage if surgically opening a wound.
This blog delivers just a fraction of the information given within this webinar and if you want to find out more about assessing bite wound patients, providing analgesia, surgically repairing wounds, and the non-surgical approach to wounds including dressings, then log into ‘The Webinar Vet’ and find out ‘what you need to know’.
The Stethoscope (MRCVS)