Wound Care 511469.A 23-year-old man presents to the ED complaining of a wound to his
left lower extremity. He states he was pulling branches out of a flooded creek
in his backyard when he punctured his left calf. He states that his legs were
in the water when the wound occurred. On examination, the puncture wound
is 1 cm in diameter, several centimeters deep, and demonstrates surrounding
erythema. After irrigating the wound, you discover a splinter within the wound.
What is the most appropriate next step in management?
a. Radiograph to map the exact location of the foreign body.
b. Close the wound with 4-0 nylon.
c. Dress the wound with a sterile bandage and treat with a fluoroquinolone.
d. Remove the splinter.
e. Remove the splinter, close the wound, and treat with fluoroquinolone.
470.A 21-year-old woman presents to the ED with a superficial 2-cm-
midforehead laceration sustained from a fall. You irrigate and close the wound.
The patient is an aspiring actress and concerned about her long-term cosmetic
outcome. She requests detailed wound-care instructions. Which of the fol-
lowing statements would be an appropriate wound care instruction to give?
a. Avoid direct sun exposure while the wound is healing.
b. The wound should not be washed until sutures are removed.
c. Sutures should be removed in 7 to 10 days.
d. Appearance of the scar at suture removal will be the final cosmetic outcome.
e. Good suturing technique and meticulous wound care guarantees no scar formation.
471.A 17-year-old man presents to the ED with a lip laceration. He sustained
the laceration during an altercation. On examination, he has a horizontal,
2-cm laceration of the right lower lip crossing the midline. There is significant
swelling of the lower lip. The attending asks you, the intern, to perform a
mental block for anesthesia. Which of the following statements regarding
mental blocks is correct?
a. A mental block is performed by injecting lidocaine into the mental nerve foramen.
b. The patient requires a right-sided mental block.
c. A mental block is not appropriate in this patient because it will lead to worsened
swelling of the lower lip swelling.
d. A mental block anesthetizes the mental nerve which innervates the lower lip.
e. A mental block is performed with a 3-cc syringe attached to an 18-gauge needle.