An Evidence Based Approach to Wound Irrigation

  • Tap water is equally efficacious as saline for routine wound irrigation in uncomplicated wounds and immunocompetent patients.
  • Ideal irrigation pressure can be achieved using a tap faucet; avoid IV bags and bottles.
  • Very little data exist regarding ideal volumes of irrigation – texts recommend 60 cc/cm.

When your child (> 6 months) is burning up…

  • “Fever is not a disease. It is merely the child’s immune system APPROPRIATELY responding to an infectious process which is viral the majority of the time.”
  • “We treat fever with anti-pyretics because it makes the child feel bad, not because fever in and of itself is bad.”
  • “The “number” on the thermometer is not nearly as important as how the child looks (interactivity, energy, hydration).”
  • “Length of the fever is actually more concerning than height in most cases. If the fever lasts for more than 5 days, the child should at least have a repeat physical exam by a clinician.”
  • “Come back if you are worried about the child.”

If a patient appears delirious, you should search for the underlying cause. The mnemonic DELIRIUM is helpful to recall some of them:

D rugs: Medication side effects
E lectrolyte abnormalities
L ack of drugs – Withdrawal from a medication
I nfection
R educed sensory input – Patients who are hard of hearing or have impaired vision
I ntracranial pathology
U rinary or fecal retention
M yocardial and pulmonary – Infarction, CHF exacerbation, COPD exacerbations, and other disease processes that cause hypercapnia or hypoxia