More than 20 Class III exposure traumas throughout the body
In the early morning of April 15, a tragedy occurred in Baipu Town, Rugao: 60-year-old Mr. Wu (pseudonym) was accidentally bitten by two adult dogs raised by his family, causing multiple traumatic injuries to his limbs and left ear, and was immediately sent to a local hospital by his family for treatment. According to the family, "the two dogs are about half a meter tall and weigh about fifty or sixty pounds, and they are extremely ferocious."
However, the patient was covered with more than 20 wounds all over his body, many skin were torn, tendons and blood vessels were exposed, and blood was dripping, which the local hospital could not handle, so he was urgently transferred to the Third People's Hospital of Nantong City for rescue. After examining the patient, Deputy Chief Physician Chen Qiang, the on-duty physician of the Department of Emergency Surgery, comprehensively assessed that the patient belonged to a dog bite and rabies grade III exposure wound, and the injury was very serious.
>> 伤情局部。
The patient had more than 20 grade III exposed wounds all over his body, among which the largest irregular avulsion wound was 6 cm long, and the tendons and blood vessels were exposed.
Injuries are extremely rare
Timely and correct disposal is key
Rabies exposure is divided into three levels: I., II., III., and most of the patients are grade I exposure wounds (touching or feeding animals, or licking intact skin) and grade II exposure wounds (bare skin being bitten, or minor scratches and abrasions without obvious bleeding), and grade III exposure wounds (single or multiple penetrating skin bites or scratches, or broken skin being licked, or open wounds, Contamination of mucous membranes with saliva or tissue, or direct contact with bats) is extremely rare.
The greatest danger after a dog bite is the possibility of contracting the rabies virus (RV). In fact, almost all mammals are susceptible, and 99% of confirmed cases of rabies are transmitted from rabies dogs to humans. At present, there is a lack of effective treatment for rabies in the world, and the case fatality rate is nearly 100%, so it is important to implement post-exposure treatment including wound treatment and vaccination in a timely and correct manner after rabies exposure.
It lasts 3 hours
Twenty-three wounds were sutured one by one
In view of the patient's injury, Dr. Chen Qiang immediately treated the patient in accordance with the latest "Rabies Exposure Prevention and Treatment Work Specification (2023 Edition)" issued by the National Health Commission and the National Bureau of Disease Control and Prevention: arranged for the outpatient nursing staff of animal injuries to thoroughly rinse and disinfect all wounds, intramuscular injection of rabies vaccine, tetanus vaccine, human tetanus immune globulin and intra-wound infiltration injection of rabies patient immunoglobulin, and then improved relevant examinations and preoperative preparations, and expanded multiple wounds on the limbs and left ear under emergency local anesthesia+Proximity flap reconstruction.
>> According to the specific requirements for the use of rabies immunoglobulin, combined with the actual weight of the patients, a total of 8 rabies immunoglobulins were injected into them.
Dr. Chen Qiang went to the National Trauma Medical Center of Peking University People's Hospital for further study, under the tutelage of Professor Wang Chuanlin, a well-known trauma treatment expert in mainland China and deputy director of the National Trauma Medical Center, a senior talent of the National Trauma Medical Center, a member of the China Trauma Treatment Training (CTCT), a member of the Animal Injury Treatment Branch of the Chinese Medical Rescue Society, a member of the Neurosurgery Branch of the Jiangsu Medical Doctor Association, a member of the expert database of the Nantong Vaccination Teaching Lecturer Group, and a member of the Nantong Stroke Society. He has rich clinical experience in the diagnosis and treatment of multiple injuries such as hand and foot trauma, limb fracture and dislocation, severe head injury, and head, neck, chest and abdomen acute and critical diseases caused by hypertension, cerebral hemorrhage, car accidents, and falls from heights. With his skill, Dr. Chen Qiang spent a total of 3 hours on the patient's limbs and left ear for a total of 23 grade III exposed wounds to be closed in the first stage.
The first case was disposed of in accordance with the latest "Specification".
Patients with multiple grade III exposure traumas throughout the body
It is worth mentioning that in the past, according to the requirements of the 2016 edition of the "Rabies Exposure Prevention and Treatment Work Specification", for severe large-scale trauma (grade III exposure wounds), it is generally required to avoid primary sutures as much as possible to promote wound drainage, but this will lead to continuous bleeding and infection of the wound, cause necrosis of the wound soft tissue and skin, and even lead to the risk of limb dysfunction and disability. In September 2023, the National Health Commission (NHC) and the National Bureau of Disease Control and Prevention (CDC) jointly issued the fully revised Specifications for the Prevention and Treatment of Rabies Exposure. As the latest "guidelines" for the prevention and management of rabies exposure, the new version of the Code has made significant changes in the concept of wound management compared with the 2016 version.
The new version of the "Specification" clearly states: "When the wound is large or the facial injury affects the appearance or function, the wound should be closed in one phase as much as possible." Debridement and infiltration injection of passive immunologic agents should be completed before the wound is closed" - this patient is also the first patient with multiple rabies grade III exposure trauma in the hospital in strict accordance with the requirements of the latest specifications.
>> Compared with the 2016 version of the "Rabies Exposure Prevention and Treatment Work Specification", the new version of the "Specification" has a significant change in wound management: "should be stitched to the end" has become the treatment principle of grade III exposure wounds.
At present, the patient's mood is stable and he is actively recovering. The medical staff of Nantong Third Hospital followed up in a timely manner and strictly followed the latest norms and instructions in the professional field to carry out professional and scientific treatment, fully protecting the life safety of patients at the first time, and also won unanimous affirmation and praise from patients and their families.
Popular Science Time:
How to deal with injuries caused by animals
Experts especially remind the general public that at the turn of spring and summer, the weather is getting warmer, people's clothing is gradually thin, and during this period, dogs, cats and other small animals are in estrus, and they are emotionally irritable and restless, and cat scratches and dog bites are on the rise, so it is necessary to pay more attention and beware, once accidentally scratched and bitten by dogs, cats and other small animals, they should be in accordance with the latest "Rabies Exposure Prevention and Treatment Work Specifications (2023 Edition)" for timely, scientific and thorough post-exposure prevention and treatment.
According to the requirements of the new version of the Specification, the disposal after re-exposure is as follows:
Wound Disposal:
For any exposure, the wound should be treated first, promptly and thoroughly.
Vaccination:
(1) If the re-injury occurs during the immunization process, the remaining doses of vaccination should be completed in accordance with the original immunization schedule;
(2) If you are injured again within 3 months after full vaccination, you generally do not need to be boosted;
(3) If you are injured again 3 months or more after full vaccination, you should get 1 dose of rabies vaccine on day 0 and 3, a total of 2 doses.