Continue washing the wound until all contamination is removed, then send the patient to the emergency room for management of the wound.
There are several situations in which contamination is difficult to remove. First, a particle of radioactive material may be embedded within the wound. This particle may be so small that it is impossible to see. Alternatively, the particle may be embedded deeper within the tissue. A thorough exploration of the wound and vigorous irrigation with saline solution is often effective in removing loose particles. Should the particle be visible, it should be extracted using forceps and saved as a sample.
Another situation that may result in difficult to remove contamination occurs when tissues have been crushed or macerated. In this event, contamination is impregnated deeply into the substance of the tissue. It is almost impossible to remove this contamination except by debridement of the area. Even so, some residual contamination may remain. The decision to debride more tissue or to leave the contamination in place requires knowledge of the isotope involved and the amount remaining in the wound. Based on this information, an estimate of the regional exposure over the remaining lifetime of the patient can be calculated.
The decision to continue washing is incorrect since the contamination is persistent and the wound requires definitive management.