Wound Care Answers 517are often polymicrobial and include aerobes and anaerobes. Antibiotics
should be considered in all high infection risk patients (ie, elderly, diabetics,
immunocompromised patients, puncture wounds, and wounds of the
hands and feet). (e)The most commonly used antibiotic for dog and cat
bites is amoxicillin/clavulanate. Clindamycin with a fluoroquinolone can be
used for dog bites in penicillin allergic patients. Doxycycline can be used for
cat bites in penicillin allergic patients.
469.The answer is d.(Singer and Hollander, pp 196-197. Tintinalli, p 322.)
Foreign bodies with potential to cause infection and inflammatory response
require immediate removal(examples include thorns, splinters, spines,
teeth, soil-covered objects). These materials may cause intense and exces-
sive inflammatory responses. If the foreign body cannot be removed by the
ED physician, the appropriate specialist should be consulted.
(a)Since organic materials are radiolucent, radiographs will not assist in
locating organic foreign bodies. Thorough direct visual inspection is necessary
to locate and remove all organic foreign bodies. (c)Treating with antibiotics
is necessary but less important than the removal of the foreign body. After
the splinter is removed the patient should be treated with an outpatient flu-
oroquinolone. Wounds with stagnant freshwater exposure are at high risk
of infection with gram positive, Pseudomonas,andAeromonasspecies and
require empiric antibiotic coverage.(b and e)Closing a puncture wound,
especially with a retained foreign body, will lead to an inflammatory response
and likely infection. Closing this patient’s wound would not be appropriate
management.
470.The answer is a.(Tintinalli, pp 328-331.)Direct sun exposure during
healing can lead to permanent hyperpigmentation. Therefore, avoiding
direct sun exposureand using sun block for up to 12 months can improve
cosmetic outcome.
(b)Patients should be instructed to wash the wound with gentle soap
and water as early as 8 hours after sutures are placed. Although the wound
should be kept dry, instructing against washing is inappropriate. Healing
wounds should be patted dry to avoid dehiscence from forceful wiping. (e)
The patient should be informed that all lacerations scar. Good repair and
wound care will improve the appearance of the scar but will not inhibit scar
formation. Wounds that heal by delayed closure have the poorest cosmetic
outcome. Good edge approximation, using appropriate suture material,
and early suture removal all lead to better cosmetic outcomes. (d)The early