TVTRAUMAVAULTCASE-BASED TRAUMA JUDGMENT
Teaching image withheldThe image will be revealed when it becomes clinically available in the case.
ED external clinical photograph of the right arm showing multiple deep, contaminated puncture-laceration wounds with tissue disruption and blood. The image is an external examination photograph obtained during the initial emergency-department evaluation; it is not a radiograph, CT, or operative image. teaching visual
ED external clinical photograph of the right arm showing multiple deep, contaminated puncture-laceration wounds with tissue disruption and blood. The image is an external examination photograph obtained during the initial emergency-department evaluation; it is not a radiograph, CT, or operative image. • TEACHING IMAGE
Trauma—Animal BiteMultiple deep puncture and laceration wounds to the right arm after an unprovoked dog attackIntermediate

Deep Dog Bite to the Right Arm: Neurovascular Assessment, Consultation, and Infection Prevention

SCENARIO

A 34-year-old right-hand-dominant adult presents to the emergency department approximately 2 hours after being attacked by an unfamiliar dog. Bleeding was controlled with a pressure dressing before arrival. The dog cannot immediately be located for verification of vaccination status. On arrival, the patient is alert and hemodynamically stable. The right arm has several deep punctures and lacerations with gross contamination and swelling. During the initial examination, the clinician obtains the displayed external wound photograph; it is not an operative image or diagnostic scan. Before analgesia, the patient reports numbness along the dorsoradial forearm and difficulty extending the wrist and fingers. Radial and ulnar pulses are palpable, capillary refill is normal, and the hand is warm.

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