Quiz: Are You Prepared to Confront Animal Bites?

Richard H. Sinert, DO

August 18, 2015

Determining the exact incidence of animal bite wounds in the United States is difficult, because many are never reported. Each year, an estimated 4.5 million dog bites occur, which result in hundreds of thousands of emergency department visits. Do you know the concerns associated with such injuries and how best to treat them? Test yourself with this short quiz.

以下哪种咬伤最常见于狗咬伤？

Which of the following types of bites are a most often associated with dogs?

答案：挤压型咬伤 Crush-type bite

The bite of a dog can yield between 150-450 lb of pressure per square inch, depending on the dog and its training. Therefore, although a dog bite may appear as a laceration or avulsion, it most likely has components of a crush injury. In this type of injury, debridement is required to remove any crushed tissues. Once debrided, the laceration injury is then amenable to suturing and primary closure.

根据犬的种类及其接受的训练不同，犬类撕咬的力量大约为每平方英寸150-450磅。因此，尽管犬咬伤可以表现为撕裂伤或撕脱伤，但更可能为挤压伤。对于挤压伤而言，需要进行清创以清除所有受累组织。一旦完成清创，即可对撕裂伤进行修补，缝合伤口并进行一期闭合。

For more on animal bites, read here.

有关动物咬伤的更多内容请参见此处.

以下哪个部位咬伤感染风险最高？

A bite to which of the following regions carries the highest risk for infection?

答案：手部 The hand

Bites of the hand generally have a high risk for infection because of the relatively poor blood supply of many structures in the hand and anatomical considerations that make adequate cleansing of the wound difficult. In general, the better the vascular supply and the easier the wound is to clean (ie, laceration vs puncture), the lower the risk for infection.

手部咬伤的感染风险通常较高，因为手部很多结构的血流功能相对较差，而且手部的解剖特点造成伤口彻底清创非常困难。总之，血液供应越好，伤口清创（即撕裂伤与穿通伤）就越容易，感染风险就越低。

For more on the risk for infection with animal bites, read here.

有关动物咬伤感染风险的更多内容，请参见此处.

以下哪种细菌是猫咬伤最常见的感染？

Which of the following is the most common infection contracted from cat bites?

答案：巴斯德氏菌感染 Pasteurella infection

多杀巴斯德氏菌感染（猫咬伤最常见的感染）也可以并发全身性感染。咬伤后伤口可以并发脑膜炎、骨髓炎、腱鞘炎、脓肿、肺炎、心内膜炎及感染性关节炎。一旦发生狂犬病，几乎无一例外导致患者死亡。

Pasteurella multocida infection (the most common infection contracted from cat bites) also may be complicated by sepsis. Meningitis, osteomyelitis, tenosynovitis, abscesses, pneumonia, endocarditis, and septic arthritis are additional concerns in bite wounds. When rabies occurs, it is almost uniformly fatal.

For more on the mortality/morbidity associated with animal bites, read here.

有关动物咬伤病死率/罹患率的更多内容请参见 此处。

以下哪种类型的咬伤感染风险最高？

Which of the following types of bites is associated with a higher rate of infection?

答案：穿通型伤口 Puncture wound

The sharp, pointed teeth of cats usually cause puncture wounds and lacerations that may inoculate bacteria into deep tissues. Infections caused by cat bites generally develop faster than those of dogs. It may be difficult to appropriately irrigate small puncture wounds, especially those inflicted by the teeth of a cat. Given that these have a higher rate of infection, consideration should be given to opening the wound with a number 15-blade scalpel and creating a 1- to 1.5-cm incision that can be well irrigated and left open to heal by secondary intention.

猫的牙齿尖锐锋利，常常导致穿通型伤口及撕裂伤，导致细菌植入深部组织。猫咬伤引起的感染发病较犬咬伤更快。适当冲洗小的穿通型伤口可能非常困难，尤其是猫的牙齿造成的伤口。由于感染率很高，应考虑用15号手术刀将伤口切开一个1至1.5 cm的切口，这样可以进行冲洗，并开放待其愈合。

For more on the treatment of animal bites, read here.

有关动物咬伤治疗的更多内容请参见 此处 。

以下哪种伤口应当保持开放或延迟一期闭合？

Which of the following wounds should be left open or treated by delayed primary closure?

答案：手部咬伤伤口就诊延迟> 8-12小时 A bite wound to the hand with a delay in presentation > 8-12 hours

Primary closure should be considered only in bite wounds that can be cleansed effectively. Bite wounds to the hands and lower extremities, with a delay in presentation (>8-12 hours old), or in immunocompromised hosts, generally should be left open or treated by delayed primary closure. Closure management decisions should be at the discretion of the provider after discussion with the patient and consultation with specialists if available. Deep sutures should be avoided because they can act as a nidus for infection.

仅有能够充分冲洗的咬伤伤口才能考虑进行一期缝合。手部及下肢咬伤伤口如果就诊延迟（>8-12小时）或免疫抑制宿主，通常应当保持开放，或延迟一期缝合。有关闭合伤口处理，主管医生应当在与患者进行充分讨论，并请专科医生会诊后作出决定。应避免深部缝合，因为容易形成感染灶。

For more on the treatment of animal bites, read here.

有关动物咬伤治疗的更多内容请参见 此处 。