extension strapping; two-way extension strapping two layers of extension strapping laid with direction of stretch of second layer at right angles to that of the first; used as part of treatment of bursitis; see Box 1
|O||Operate||Remove the cause of the infection where possible, e.g. remove focal hyperkeratosis/foreign body/nail spike|
|C||Cleanse||Irrigate area/cleanse cavity with Warmasol delivered under pressure from a sterile syringe|
|H||Heat||Assist drainage of pus/exudate by applying heat, e.g. immersion in a warm hypertonic NaCl bath|
|A||Antiseptic||Apply a liquid or powder antiseptic (e.g. Betadine)|
|D||Dress||Cover the lesion with a sterile dressing (e.g. sterile gauze; Lyofoam)|
|R||Rest||Impose rest, e.g. deflective padding; shoe modification; walking cast; crutches, as necessary|
|A||Reappoint||Arrange to review case in 24-72 hours|
|R||Review||At the subsequent appointment, review progress|
If resolution has been initiated, continue to treat as above (O-A) and review weekly until healing is complete
If the infection has not improved, arrange for antibiosis, and continue to review and dress until healing is complete
|R||Refer||Refer for specialist review via GP: remember, slow-to-resolve infection can characterize undiagnosed diabetes, or other 'at-risk' patient category|
Use all normal preoperative procedures; keep infected lesions covered until ready to treat; take a swab for pathology laboratory analysis of any exudate; use a sterile dressings pack; follow the OCH-A-DRARR treatment mnemonic.
'At-risk' patients presenting with infection or patients presenting with acute or spreading infection should be treated using the OCH-A-DRARR protocol, but provided with or referred for immediate antibiosis.