Question of the Week # 465

465) A 6-year-old boy is brought to the emergency department 2 hours after he was bitten by a peer in kindergarten in a fight. The child’s mother is frantic and wants to “sue the center for allowing such behavior!” The child is up-to-date on his vaccinations. The other child is very healthy and his vaccinations are current. On physical examination, there is puncture wound on the right hand. You gently clean the wound and consult with the hand surgeon who says that there does not appear to be any damage to the nerves, muscles, tendons, or joints of the hand. What is the most appropriate next step?

A. close the wound with a suture
B. obtain a wound culture
C. provide ampicillin-sulbactam
D. send him home with a follow-up appointment within 48 hours
E. vigorously irrigate and debride the wound

13 Responses

  1. Provide ampicillin sulbactam to prevent infection by eikenella corrodens. Bite wound = dirty wound. Esp. This one is a puncture wound also and on the hand. All roads point to antibiotic prophylaxis.

    • So, which one?

      • augmentin – amox-clav

  2. On second thought, the wound does need to be thoroughly cleaned first – so probably irrigate it and debride the wound prior to starting antibiotic prophylaxis.

    • wish we could choose more than one answer in this exam!!!

  3. C

  4. C

  5. C

  6. i think its C… because its not a closed abcess or anything that the ABX wont penetrate…

  7. E.
    1st. irrigation very well,
    2nd. do not close unless the open wound
    is large and the subQ tissue is protruding,
    3rd. if not up to date on his vaccines, give
    tetanus vacc. ,
    4th. D/C home on augmentin X 3-5 days + ibuprofen + an advice to take probiotic for one week go to the nearest ER if the child develops fever, swelling…

  8. C.
    its a bite, recent wound. it has been already irrigated by physician.

    you do debridement of wound where there is non-viable tissue , grossly infected tissue and as such.
    its a puncture wound, since they did not give the size and any more description of it I would avoid picking suture option.

  9. C

  10. C

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