Management of Monkey Bite injury
1. Inspect the wound under local anesthesia (to reduce pain) for severity of the injury and retained foreign body.
2. Stop any bleeding
3. Irrigate the wounds with at least 5L of normal saline and chlorhexidine solution.
4. X ray of the injured site if indicated (in suspicious of fracture or retained foreign body)
5. Immobilize the limb if there is any fracture.
6. Blood and wound for culture and sensitivity and also ELISA@ PCR for Herpes siamese virus.
7. Baseline blood investigation (FBC to look evidence of Leukocytosis)
8. Admit patient to wards for preparation of wound debridement and observation.
9. Analgesic, IV Tramadol for pain relieving if necessary.
10. Keep patient nil by mouth while waiting for operation and put patient on maintenance fluid therapy (100 ml/kg/day for first 10 kg + 50 ml/ kg/day for second 10 kg and + 20 ml/kg/ day for the subsequent kg)
11. Wound debridement under general anesthesia and delayed primary healing.
12. If it associates with open fracture, consider external fixator.
13. Exclude risk of rabies virus.
14. If possible, monkey responsible for the bit is sent to vet for further investigation.
15. Some set-up may require notification to infectious disease unit.
16. Depends on the site and severity, a multiple disciplinary approach may be needed to manage the patient.
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