Wound care

HEENT emergencies

EMKF

HEENT Emergencies

A great summary of HEENT emergencies (Facial and Scalp Lacerations, Mandibular Dislocations, Auricular Lacerations, Auricular Foreign Bodies, Eyelid Lacerations, Epistaxis, Nasal Bridge Fracture Reduction, Nasal Septum Haematoma, Nasal Foreign Body, Peritonsillar Abscess

 

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Hand Injuries

EMKF

handpain

  • When considering when to remove sutures in the hand, leave sutures that are over areas of tension (i.e. over a joint) for longer (at least 12 days) so they heal completely.
  • If controlling bleeding is an issue, do NOT clamp any digital arteries, as the digital nerve is very nearby and hard to visualize. Use pressure, limited tourniquet and elevation to control bleeding safely.
  • Prophylactic antibiotics are indicated for for all animal bites to the hand, and for certain complex injuries (crush wounds, wounds over a joint, or for immune compromised patients).
  • If referring a hand abscess to a clinic, consider swabbing the drained fluid so MRSA status can be determined.
  • Immobilizing the PIP joint in extension can stiffen the collateral ligaments causing permanent disability, so don’t splint PIP joint for greater than 1–2 weeks unless necessary, and if splinting, ensure an early referral time. (within 1–2 weeks).

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Quick Tip: Finger tip dermal avulsion injuries

EMKF

Fingertip InjuriesQuick Tip: For finger tip dermal avulsion injuries the first step in caring for any minor wound is controlling the patient’s pain. As a means of anesthesia, have the patient dip the injured finger in 1% lidocaine with epinephrine for 5 minutes. One can pour 10-20 cc of this solution into a small medicine cup or urine specimen cup, and the patient simply soaks the afflicted finger. Epinephrine has the added benefit of vasoconstricting the troublemaking-little bleeders

Gunshot Injuries in the Emergency Department

EMKF

gsw

Zones of injury of Gunshot wounding:

  1. Primary wound tract – Permanent cavity; dead, crushed tissue
  2. Contusion zone – Tissue adjacent to primary wound tract; in inflammatory state with cellular debris
  3. Concussion zone – Temporary cavity; Tissue damage occurs by stretching, shearing, and compression. Inelastic tissues (liver, bone, brain) are most susceptible due to little intrinsic ability to dissipate transferred energy even if remote to the path of injury

 

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Which tongue lacerations do I need to repair?

EMKF

You should repair those that cause problems with breathing, speech and/or gustation/swallowing:

  • Bisect the tongue extending through the free edge – creating the “snake” look
  • Have large mobile flaps or U-shaped defects (>1-2cm)
  • Won’t stop bleeding
  • Are avulsion or amputation injuries – which may require a surgeon (ENT, OMFS etc.) if complex.