Wound care mantra: “The key to pollution is dilution.”
High-pressure irrigation best reduces the patient’s risk for a wound infection. Open fractures are unique in the ED in that they require quick, high-volume irrigation before going to the operating room for more definitive wash-out. Often times a 30 mL syringe and 18-gauge angiocatheter is too cumbersome and slow for high-volume, high-pressure irrigation.
In this patient, who is being pre-op’d for operative washout and repair of a grade 1 open tib-fib fracture, high-volume irrigation should be performed quickly. This can be done by punching several holes through the plastic cap of sterile saline bottles, using an 18-gauge needle. Multiple people can help with irrigation, while the patient is being mobilized to the OR.
SFGH Visual Aid Project photographer.
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