Wound evaluation and cleansing.

The approach to wound management in the Emergency Department does not differ from that used in evaluating other complaints. This consists of a problem-directed history and physical examination. The history should probe for host and wound factors that increase the risk of a poor outcome. The examination should emphasize a search for the involvement of underlying structures. Appropriate cleansing remains the foundation for good wound management. Until a rapid inexpensive test is available to identify wounds with low bacterial counts, the clinician should assume that all wounds have bacterial loads capable of causing infection. Therefore, most wounds should be cleansed by irrigation with at least 200 mL of normal saline. Larger quantities or 1% povidone-iodine solution may be used in wounds that have high wound or host risk factors. Wound exploration should occur in a well-lit environment and combine good hemostasis with appropriate analgesia and anesthesia.