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Clinical Summary

Both domestic and wild animals can attack humans. Injuries are caused by combinations of penetrating and blunt trauma. Penetrating injuries can be inflicted by teeth, claws, and horns, while severe blunt injuries may result from the victim being knocked over, trampled or otherwise crushed, thrown into the air, or dragged. Injuries may involve massive tissue injury or avulsion often associated with neurovascular damage and long bone fractures.

Management and Disposition

Evaluation and treatment are the same as for any other multiple trauma victim with a high-energy mechanism. The first priorities are to stop life-threatening hemorrhage, secure the airway, and manage other bleeding and circulation (the ABCs), which may be complicated by injuries of the face, neck, or chest. Victims should then be evaluated for less obvious blunt traumatic injuries. Open fractures and injuries to internal organs may not initially be clinically apparent, as with any victim of multiple trauma.


  1. Wounds often require operative debridement and repair by appropriate specialists. Consider tetanus and rabies prophylaxis in addition to antibiotic treatment for high-risk wounds.

  2. Bite wounds can penetrate the skull or joints. Displaced teeth or claws may remain imbedded in wounds. Evaluation should include x-rays, ultrasound, and/or computed tomography (CT) scanning along with appropriate surgical consultations.

FIGURE 16.31

Cougar Mauling. This patient sustained large wounds as a result of a cougar attack. Here, the weight and force of this large animal has resulted in severe shearing injuries. Penetrating injuries from large animals may be deeper than they appear. (Photo contributor: Alan B. Storrow, MD.)

FIGURE 16.32

Pit Bull Mauling. The left arm of a pit bull mauling victim. Note the open fracture of the radius. The patient sustained multiple severe defensive wounds to both arms, resulting in extensive soft-tissue and neurovascular injuries. (Photo contributor: R. Jason Thurman, MD.)

FIGURE 16.33

Grizzly Bear Attack—Open Scapula Fracture. Although grizzly claws are not very sharp, they can exert considerable force. This innocuous appearing injury was complicated by an open scapula fracture. (Photo contributor: Luanne Freer, MD.)

FIGURE 16.34

Himalayan Black Bear Attack—Facial Trauma. Himalayan black bears often attack the face. Airway management may be facilitated by use of a surgical airway, as in this case from Bhutan. (Photo contributor: Charles Haviland Mize, MD.)

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