Tuesday, September 17, 2019

Wounds and Lacerations

emDocs - September 16, 2019 - By Bryant J and Thoppil J
Edited By: Montrief T; Koyfman A and Long B
"Take Home Points:
  • Evaluation of the wound begins with the history, continues with full exploration of the wound to assess the extent of repair needed, physical exam to assess structural integrity, and imaging as needed for foreign body/vascular injury.
  • Warming anesthetics to body temperature can reduce pain with injection.
  • LET jelly is another adjunct to avoid pain on injection.
  • Local infiltration of ketamine may be just as efficacious as other topical anesthetics.
  • Important considerations not to miss: open fracture, open joint, tendon injury, vascular injury, nerve injury, muscle injury, compartment syndrome.
  • Update tetanus prophylaxis if >5 years have passed since prior immunization.
  • Irrigation with potable tap water is just as effective as saline irrigation.
  • Antibiotics for higher risk patients (diabetes, poor circulation, HIV/AIDS, immunocompromised), with wounds in higher risk areas (axilla, perineum, hands, feet), and high-risk wounds (human bites anywhere, mammalian bites to hand).
  • If transferring a digit for reimplantation, do not place digit directly on ice! Wrap amputated digit in moist gauze and place in a plastic bag which then goes on ice."