Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
A human bite is generally obvious, but on occasion the victim is unaware (for example, the bite occurred while the victim was drunk) or reluctant to tell others
(for example, a hand injury due to a fight). Use caution in ignoring cuts over the knuckles if there is the chance
the cut happened in a fight, especially if the cuts came from hitting another
person in the mouth. Otherwise, the two most important things to know about a bite are whether there is a skin break or signs of infection.
Signs of a skin break
A skin break increases the risk of infection, and it also makes it necessary to give a
tetanus booster if the
affected person's tetanus status is not up to date. A skin break is often obvious but can be difficult to tell in some cases. Any skin area that looks like the top layer of skin has come off should be considered a skin break. When in doubt, seek a
health care pracitioner's opinion. A raw appearance to the area or the oozing of clear fluid is a sign of a skin break.
Signs of infection (note that infection can occur even in properly treated bites)
Increasing pain and tenderness: Although all bites hurt initially, the pain usually gets steadily better. If a bite begins to hurt more
after time passes, this can be the first sign of infection. Increased pain from an infection is usually matched by increased tenderness when the area of the bite is touched. Typically, this begins 1-2 days after the bite but can occur even later with deeper infections.
Increased or new redness: Some color changes can be expected at the beginning, particularly bruising and some redness, but this usually does not get much worse after the first few hours. An increase in redness is a warning sign of infection.
Increased swelling: Some swelling is expected initially, but this usually peaks in the first day. If the bite swells up more after the first day, it may be a sign of infection.
Fever: A new fever in someone with a bite should be cause for
concern. However, waiting for a fever to be sure there is an infection is also wrong. Most people with human bite infections do not get a fever until
the infection has spread significantly. If the area around the bite itself feels very warm, even if there is no actual rise in the whole body temperature, this could
also be a sign if an infected wound bite.
Pus drainage: Pus is yellow and will generally be a late sign of infection. This drainage needs to be distinguished from clear oozing that can occur during the first few hours if the skin is scraped by teeth. This clear oozing is not a sign of infection.
If in doubt, the affected person should consult a health care practitioner.
Red streaks: When you can see thin red streaks running toward the center of the body from a wound, infection is usually present. This condition is sometimes called
blood poisoning (the medical term for this condition is
lymphangitis), even though this has nothing to do with the bloodstream. What is
occurring is an inflammation of the
lymph vessels, part of the body's defense system against infection that includes the lymph glands or nodes.
Signs and symptoms of lymphangitis should trigger an immediate visit to your
health care practitioner or emergency department.
These may occur in areas near the bite as the lymph glands react to protect
the body. For example, if a hand is infected, sore, swollen glands on the inside of the
elbow or armpit of the same arm as the bite may develop.