Resident Manual of Trauma to the Face, Head and Neck

y y Human bites are typically complicated by Eikenella corrodens or Bacteroides sp. y y Typically, patients may be discharged with a broad-spectrum oral antibiotic with anaerobic coverage. Good choices include amoxicillin- clavulanate, clindamycin, and ciprofloxacin. y y Mupirocin® ointment can be applied topically to the wound and utilized for approximately 1 week post-repair. c. Testing for Communicable Diseases Human bites may transfer hepatitis B and C, herpes virus, and human immunodeficiency virus (HIV). It is good practice to treat a human bite as a possible HIV exposure. An HIV test should be performed on both patient and attacker, if possible. Eliciting a history of other communi- cable diseases in both patient and attacker is also prudent. d. Scar Revision Recipients of human bites should be made aware of probable less than An intravenous bolus of a second-generation cephalosporin (cefurox- ime, cefoxitin) should be administered for all penetrating soft tissue bite wounds. If penicillin sensitivity cross-reaction is a major concern with a cephalosporin, then parenteral ciprofloxacin is a good choice. Alternatively, clindamycin may be considered. f. Parenteral Antibiotic Therapy If wounds are severe, consider continued parenteral antibiotic therapy, either as inpatient treatment or home intravenous therapy. g. Adhesive Dressings Bite wounds should not be concealed by adhesive dressings, as it is important to observe the wound for infection and allow slight laxity of the wound margins for seepage of serous fluid. E. Burn Injuries Burn injuries may result from thermal injury, ingestion of caustic agents, and electrical shock. When they occur, they are more commonly seen in the pediatric population. Burn injuries tend to propagate beyond the focus of the insult, and damage may escalate for some time after the traumatic event. Management is complex and ongoing over time. However, some tenets must be followed early on in the emergency setting. ideal wound healing, and probable need for scar revision. e. Intravenous Bolus of a Second-Generation Cephalosporin

211

www.entnet.org