Question 5
Describe how you would clean a wound after someone has stepped on a nail and has a deep puncture wound in his foot.
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Answer 5
Initially wash with soap and plenty of water, use a nail brush to remove any ingrained dirt. A puncture wound is particularly at risk for development of tetanus, so it is important to also excise the wound with a scalpel, curette the track and leave it open.

In any wound which is severe, delayed primary closure of the skin at 3 days is recommended rather than immediate suture, especially if they are contaminated. If someone presents with an infected wound, 8 hours or more after the injury then wound toilet should be more gentle and the patient should be given antibiotics first before more vigorous cleaning, otherwise organisms may be spread further.

Don’t forget to give adequate analgesia to allow proper, thorough wound toilet. This is particularly important in children, where general anaesthesia, using ketamine may be necessary. Older children may tolerate local nerve blocks or local anaesthetic.