467.A 27-year-old man presents to the ED with the laceration shown below
after an altercation. There are no dental fractures and his tetanus immunization
is up to date. What are the most appropriate next steps in management?
510 Emergency Medicine
a. Infraorbital nerve block and then approximation of the vermilion border
b. Infiltration of local anesthesia into the lip and then approximation of the ver-
milion border
c. Infraorbital nerve block and closure of mucosal defects prior to the approxima-
tion of the vermilion border
d. Infiltration of the lip with local anesthesia, closure of dermis and mucosal
defects, and then approximation of the vermilion border
e. Closure with a commercially available tissue adhesive and Steri-Strips to avoid
distorting tissue architecture
468.A 44-year-old woman presents to the ED with a deep puncture
wound to her left forearm from a dog bite. The dog is appropriately vacci-
nated. Which of the following statements regarding management of animal
bite wounds is true?
a. Infection after dog and cat bites is rare.
b. Irrigate the wound thoroughly and place deep sutures to prevent infection.
c. Delayed primary closure can be used for bite wounds.
d. Dog bite infections are most commonly secondary to Pasteurella multocida.
e. Clindamycin is the most commonly used antibiotic for dog bites.
(Reproduced, with permission, from Knoop KJ, Stack LB, Storrow AB.Atlas of Emergency
Medicine. New York, NY: McGraw-Hill, 2002: 162.)