A 25-year-old man presents to the emergency department (ED) with a right forearm laceration that he sustained from a piece of glass during a bar fight. He complains of pain at the laceration site, but denies foreign body sensation. On examination, the laceration is superficial and 4 cm in length. The patient demonstrates intact strength and sensation distally. Which of the following statements regarding radiographic imaging of this patient is true?
a. Imaging can be omitted because he does not have foreign body sensation.
b. Imaging is not indicated because retained glass does not cause an inflammatory reaction.
c. Plain films are the next best step in the management of this patient.
d. Computed tomographic (CT) scan is the most commonly used modality to rule out foreign body.
e. Plain films cannot rule out bone, teeth, or glass fragments larger than 2 mm in soft tissues.
The answer is c. On plain films, 80% to 90% of foreign bodies can be seen. Glass larger than 2 mm is visible on plain film.
Foreign body sensation (a) 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. Retained foreign bodies may lead to a local granulomatous inflammatory response or to local and systemic infection (b). 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 (d). Plain film can usually locate metal, bone, teeth, pencil graphite, gravel, sand, and aluminum (e). Plain film cannot detect wood, thorns, some plastics, and other organic matter.
A 30-year-old woman presents to the ED with a left hand laceration. She reports cutting herself while attempting to slice a bagel. She has a superficial 2-cm laceration over the left thenar eminence. No deeper structures are involved. What is the best way to clean the wound?
a. Punch holes in a normal saline bag or bottle and irrigate the wound
b. Use a high-pressure syringe and irrigate with water
c. Wound cleaning is unnecessary because the wound was sustained from a clean knife
d. Soak her hand in normal saline for 30 minutes
e. Apply povidone-iodine to the wound
The answer is b. To achieve low bacterial counts through irrigation, a pressure of 5 to 8 psi is ...