ER NOTE
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General ER Note
Sepsis
Trauma
Mammalian Bite
Chest Pain
Abdominal Pain
Eye Injury
Bite Risk
LOW
Rabies
—
Tetanus
—
WHO Cat
—
HN
ER Note — Mammalian Bite
1
สัตว์และสถานการณ์การถูกกัด (Animal & Bite Circumstances)
🇹🇭
Thailand is rabies-endemic
— provoked/unprovoked and healthy/sick animal distinctions are
not
used for PEP decisions. All mammalian bites from reservoir species are treated as potential rabies exposure.
สัตว์ที่กัด (Animal)
🐕 Dog
🐈 Cat
🐒 Monkey
🐀 Rodent
🧑 Human
Other
วันที่/เวลาที่ถูกกัด (Date / time of bite)
ตำแหน่งที่ถูกกัด (Location)
Head / Neck / Face
Hand / Finger
Upper limb
Lower limb
Trunk / Genitalia
สถานะของสัตว์ (Animal status)
Available for 10-day observation
Stray / Unknown
Treat as rabies exposure
Dead / Unavailable
Treat as rabies exposure
ถูกยั่ว? (Provoked?) —
for documentation only
Yes
No
Unknown
2
Wound Assessment (WHO Category)
WHO Category
saliva
intact — no breach
Cross-section
saliva
surface — intact
Isometric
Cat I — Lick on intact skin
abrasion — epidermis
Cross-section
surface — scratches
Isometric
Cat II — Minor scratches / abrasions (no bleeding)
transdermal — through
Cross-section
surface — bite wounds
Isometric
Cat III — Transdermal bite / mucosa contact
Wound characteristics
Puncture
Laceration
Crush / avulsion
Contaminated
Deep / through fascia
Hand / face / genitalia
Irrigation
Other wound care
3
Rabies PEP Regimen Selector
🇹🇭
Endemic logic:
Since Thailand is rabies-endemic, provoked/unprovoked and healthy/sick animal status are NOT used to determine PEP. For reservoir species (dog, cat, monkey, other mammal), Category II/III exposure always requires PEP. Rodent and human bites do not require rabies PEP.
Prior rabies immunization
Naive (no prior vaccine)
Previously vaccinated (documented)
Rabies PEP plan:
— select animal, category, prior immunization —
RIG details (if indicated)
Product
— select —
Human rabies immunoglobulin (HRIG)
Equine rabies immunoglobulin (ERIG)
None — previously vaccinated or not indicated
Dose (IU/kg)
Infiltration
Vaccine schedule
4
Tetanus Prophylaxis (CDC 2024)
Wound type
superficial — epidermis
Cross-section
surface — minor cut
Isometric
Clean minor
Superficial, ≤1cm, no contamination
deep + contaminated
Cross-section
surface — deep wound
Isometric
Dirty / Major / Bite wound
Deep, contaminated, necrotic tissue, >6h old
Immunization history
≥3 doses, last ≤10 yr
≥3 doses, last >10 yr
≥3 doses, last >5 yr (dirty)
<3 doses / Unknown
Tetanus prophylaxis:
— select wound type + history —
5
HPI · PMH · Allergies · PE
6
Investigations & Treatment
Indications for prophylactic antibiotics
Hand / face / genitalia
Deep puncture / crush
Immunocompromise
Presentation >8–12 hr
None — superficial, early, low-risk
Antibiotic regimen
— select —
Amoxicillin-clavulanate 875/125 mg PO q12h x 5 days
Amoxicillin-clavulanate IV / inpatient (severe)
Metronidazole + doxycycline / moxifloxacin (PCN allergy)
Not indicated
Disposition
— select —
Discharge with wound care + PEP advice
Observation / infection risk
Admit for IV antibiotics
Follow-up / public-health notification
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