This arrangement creates a sort of grotesque, crinkly “hot pocket,” allowing blood to accumulate and congeal while eliminating or greatly reducing spillage.
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ACEP News: Vol 32 – No 08 – August 2013Your absorbable hemostat will help a clot form and stabilize, and the bacitracin will reduce infection rates while preventing the dressing from tearing the entire wound back open when the patient eventually removes it.
After an additional 10 minutes of pressure, you must now create a reassuring illusion by covering entire effective-but-hideous ensemble with a cosmetic gauze dressing (Fig. 3).
Tell the patient that s/he may change the outer gauze daily if desired, but to leave the Tegaderm/Gelfoam/bacitracin dressing in place for 48-72 hours to allow the clot to stabilize.
After this time, the patient may soak the entire area in warm water and gently peel off the occlusive dressing. Any residual bleeding should be minimal at this point, and easily controlled with a simple standard dressing.
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Dr. Fisher practices Emergency Medicine in New England and New York.
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