1. General Wound Management Union Hospital Emergency Department

2.  Assess-subjective- history, immunizations, medications, mechanism of injury  Assess-objective – physical exam, inspection Specific Surface Trauma Emergencies

3.  Social  Environmental factors  Exposure  Socioeconomic  Pathophysiological disorders affecting healing  Diabetes  Steroids  Immunocompromise  Frequent Infections  Poor Nutrition  Medications Psychological

4.  CBC  Wound Culture and Sensitivity  If bleeding profusely – PT PTT  X-ray Diagnostic Tests

5.  Wound prep tray  Steri strips  Dermabond  Disposable suture trays  Plastics Set  Suture/Staple remover  Dressing  Ring Cutter  Hexaclens  Sterile Saline  Sterile Water Equipment

6.  See policy on wound infiltration Policies

7.  Policy: Nursing staff will perform wound cleansing/irrigation in the emergency department utilizing best practice guidelines  Purpose: To provide standardized guidelines for local wound care to help optimize the healing environment and decrease the potential for infection Cleansing and Irrigation

8.  The wound shall be inspected by the physician and appropriate anesthetic shall be ordered.  Wound cleansing and irrigation are a part of the orientation checklist for ED nursing staff  After local anesthetic infiltration wound management/care shall be done Procedure:

9.  Irrigation: Is fundamental to good wound care and should be performed on all patients requiring wound closure  0.9% NS removes foreign bodies and dilutes bacteria thus reducing risk of wound infection.  High velocity stream of NS is obtained by using a 20 cc syringe with an 18-20 gauge angiocath.  The following formula can be utilized to calculate the amount of fluid for irrigation  100 ml X inches in length X hours since injury = volume to irrigate  Example: 100 ml X 2 inches X 2 hours since injury = 400 ml Saline General Information