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.

Photos and patient consent obtained by Lourdes Adame,
SFGH Visual Aid Project photographer.
Michelle Lin, MD
ALiEM Founder and CEO
Professor and Digital Innovation Lab Director
Department of Emergency Medicine
University of California, San Francisco
Michelle Lin, MD


Professor of Emerg Med at UCSF-Zuckerberg SF General. ALiEM Founder @aliemteam #PostitPearls at https://t.co/50EapJORCa Bio: https://t.co/7v7cgJqNEn
Michelle Lin, MD