Bite-Sized Care: Managing Cat Bite

Summary:This scenario involves managing a patient who presents with a cat bite injury. The doctor’s role includes history-taking, assessing potential infection risks (particularly for tetanus and rabies), wound management, and providing patient education on necessary precautions and follow-up.

Key Points

History and Data Gathering

Incident Details: Ask about the circumstances of the bite (e.g., wild or domestic cat, provocation, and immediate response).
Vaccination History: Inquire about tetanus and rabies vaccinations. This should be prioritized, especially if the cat's health status is unknown.
Relevant Medical History: Obtain past medical history, allergies (especially antibiotic allergies), and medications to tailor treatment.
Avoid Unnecessary Questions: Limit questions to those directly related to injury (e.g., avoid social and diet history unless clinically relevant).

Physical Examination

Wound Assessment: Inspect the wound for signs of infection (swelling, redness, pus).
Vital Signs: Check for fever and other vital signs as potential infection indicators.
Lymph Node Examination: Assess for regional lymphadenopathy, which can indicate infection spread.

Important Considerations

Time Management: Limit data gathering to essential points. Prioritize reaching the management phase promptly within the allocated time.
Avoidance of Stock Phrases: Use natural language for empathy; avoid rehearsed or bookish expressions to build genuine rapport.
Safety Netting: Emphasize signs of infection progression, advising the patient to return if symptoms worsen.

Diagnostic Approach

Immediate Wound Examination: Inspect wound and surrounding areas.
Infection History: Review any symptoms suggesting systemic infection.
Vaccination Verification: Confirm or update tetanus and rabies status based on history and exposure risk.
Laboratory Tests: Consider if the wound appears infected or systemic symptoms are present.

Management

Wound Care: Clean with saline solution, avoiding strong antiseptics that could damage tissue.
Antibiotic Therapy:
- For penicillin-allergic patients, doxycycline and metronidazole are recommended alternatives.
- Prophylactic antibiotics (e.g., amoxicillin/clavulanate) may be advised.
Pain Management: Provide appropriate analgesics.
Vaccination:
- Tetanus: Administer if the patient’s last booster was over five years ago.
- Rabies: If the cat's status is unknown, consult with a senior physician.
Patient Education: Educate on wound care, signs of infection, and when to seek further medical help.

Communication Skills

Empathy: Use natural empathetic language and avoid overly formal phrases. Demonstrate genuine understanding by acknowledging the patient’s concerns.
Clear Instructions: Ensure the patient understands the importance of wound care, signs of infection, and follow-up procedures.
Rapport: Engage the patient with active listening and body language, showing attentiveness without interrupting.

Additional Resources

GMC Good Medical Practice Guidelines: Provides detailed standards on patient care and communication.
PLAB 2 Examiner Tips: Guidance on avoiding common errors such as over-reliance on rehearsed phrases and ineffective time management.