Wound Care
Answers
460.The answer is c.(Tintinalli, pp 318-319.)80% to 90% of foreign
bodies can be seen on plain films. Glass >2 mm is visible on plain film.
(a)A foreign body sensation has a sensitivity of 43% and specificity of
83%. Therefore, lack of a foreign body sensation cannot be used to rule out
a foreign body. (b)Retained foreign bodies may lead to a local granulomatous
inflammatory response or to local and systemic infection. (d)CT is capable
of detecting more types of foreign bodies than plain film but it is not commonly
used given the time needed and expense. (e)Plain film can usually locate
metal, bone, teeth, pencil graphite, gravel, sand, and aluminum. Plain film
cannot detect wood, thorns, some plastics, and other organic matter.
461.The answer is b.(Tintinalli, p 290.)To achieve low bacterial counts
through irrigation, a pressure of 5 to 8 psi is recommended.This pressure
can be generated with an irrigation syringe or a 35-mL syringe and a 19-gauge
needle. Water (sterile or tap) is as efficacious as sterile normal saline.
The common recommendation for the amount of irrigant used is 60 to
100 cc per 1-cm wound length.Using normal saline bottles or bags with
holes(a)may not generate adequate pressure. Soaking (d)is ineffective in
cleansing wounds. Disinfectants, (e)such as povidone-iodine should not
be used on an open wound because they can impair host defenses and promote
bacterial growth. Lastly, irrigation is necessary (c)regardless of the method
of the sustained injury.
462.The answer is b.(Tintinalli, p 329.)Tetanus toxoid is contraindicated in
patients who have had a severe allergic reaction including respiratory distress
or cardiovascular collapse. Tetanus immunoglobulin can be used in these
patients.Local reaction at injection site resulting in redness, pain and swelling
is not considered a contraindication.
463.The answer is e.(Tintinalli, pp 298-300.)Facial lacerationsshould
be closed with a 6-0 nylon suturein interrupted fashion.
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