Imagine you are working a busy shift in the ED when you pick up this patient with a hand laceration. Simple laceration, right? Just some quick sutures and out the door, right? Well thats what happened with this patient at an out-of-state ED.
This photo was taken several hours after the patient arrived home. The patient was discharged with a prescription for keflex. Do you notice the redness starting around the wound? The patient went to the ER again, was started on IV clindamycin, and the sutures were removed. What happened here? Why did this simple hand laceration become almost immediately infected?
The initial photo is pretty classic. This is a “fight bite.” Here’s a few things to remember about treating a “fight bite.”
1. Often times patients will not be honest about how they sustained the laceration out of fear of legal ramifications. If you see a laceration over the knuckles, treat it as a “fight bite.”
2. I would recommend xray for fracture or foreign body.
3. These lacerations need irrigation with copious (at least 300cc) saline (or tap water.)
4. Thorough examination for tendon involvement
5. These wounds should not be closed primarily. 24-48 hour recheck should be mandatory.
6. Antibiotic of choice is Augmentin 875mg twice a day for 7-10 days or clindamycin 450mg three times a day PLUS one of the following: ciprolfoxacin (500mg twice daily), levofloxacin (750mg once daily), moxifloxacin (400mg once daily), or bactrim DS (two tabs twice daily.)
7. Often times, I will give the patient a dose of IV antibiotics in the ED prior to discharge. What are other people’s take on this? I have no literature to support this. I definitely would recommend giving at least the first dose of oral antibiotic in the ED prior to leaving.
The patient did well. After the IV antibiotics, the patient was discharged on Augmentin. There was no long-term impairment of function.