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A man with multiple chop wounds
AUTHOR
DR. TW WONG
REVISED BY
DR. CLARENCE CHU KWOK KEUNG
NOV 2013
HKCEM College Tutorial
Triage
▪ M 24
▪ chopped by several gangsters
▪ Multiple wounds
▪ BP 130/80
▪ P 100/min
Triage Category I
Primary Survey
ABCD normal
AMPLE History
▪ Allergy nil
▪ Medication nil
▪ Past health good, tetanus status not sure
▪ Last meal 2 hours ago
▪ Event chopped by a gang outside a restaurant, able to run away
Now proceed with secondary survey
Head and neck normal
Chest and abdomen normal
R arm wound
What underlying structure may be injured? Please assess...
Radial Nerve injury
Look for drop wrist, fingers
Where is the area of sensory loss?
Radial N
Left forearm
What structures may beinjured?
How to test?
Median Nerve injury
Opposition test
Other tests
Oschner Prayer sign
R hand is dressed
Without looking at the wound, what
structure may havebeen injured?
The hand posture suggests...
Cut tendons to Ring Finger and Little Finger
How to test finger flexors ?
Flexor tendon tests
Profundus Sublimis
What other underlying structures may be injured?
How to assess?
Ulnar nerve injury
Froment cone
Ulnar Nerve tests
Intrinsic muscle Abduction test
Ulnar nerve tests
Froment sign
Palm sweep
Palm wound
What is the best way to test finger sensation?
2 point discrimination
Left thumb wound
Part of the thumb is chopped off.
How do you deal withthe amputated part ?
Keeping Amputated Part
▪ Wrap with gauze
▪ Put in a plastic bag
▪ Put in a container with ice + water.
▪ NB: not ice alone
Back injury
What underlying injuries may be present?
Torso injuries
Penetration to retroperitoneum
Kidney injury
Right leg wound
What underlying structure is at risk ?
Tibial Nerve
You have seen all the wounds
How would you manage the patient?
Patient management
▪ Activate trauma team (per local protocol)▪ orthopedic surgeon for limb and hand wounds▪ general surgeon for loin wound
▪ IV line
▪ Analgesics
▪ Dress wound to control bleeding
▪ Tetanus
▪ Consider prophylactic antibiotics
Summary
We have covered:
1. Evaluation of limb wounds
2. Neurovascular examination in limbs
3. Management of amputated finger
The end