SOFT TISSUE INJURY
MR BRIAN BURGESS
INTRODUCTION
• COMMON PRESENTATIONS TO THE EMERGENCY DEPARTMENT
• CURRENT TREATMENT REGIMES
• POINTS FOR DISCUSSION
WOUNDS
• TAKE FULL HISTORY
• ? FALL – FURTHER EVALUATE UNDERLYING CAUSE
• GLASS / CERAMIC – X-ray
• TETANUS STATUS
• DIABETES / IMMUNOSUPPRESSION
WOUNDS
• EXAMINATION
• SITE OF INJURY
• INCISION v. LACERATION
• DEPTH
• DISTAL NEUROVASCULAR
• FUNCTION
• DOCUMENTATION
INVESTIGATION
• X-RAY – Glass OR Bony Injury
• BLOODS
TREATMENT
• LOCAL WOUND TOILET• DEBRIDEMENT• L.A.• SUTURE / STERISTRIP / GLUE• ANTISEPTIC• ? TOPICAL ANTIBIOTIC• DRESSING• SYSTEMIC ANTIBIOTIC
WOUND INFECTIONS
• ASSESSMENT INCLUDES DOCUMENTING:
• SITE OF WOUND – VASCULARITY (FACE v. LEG)
• NATURE OF WOUND – PUNCTURE, BITES
TREATMENT
• LOCAL TREATMENT
• I&D
• CELLULITIS
• ANTIBIOTIC CHOICE
• ? ADMIT/ CELLULITIS PATHWAY
• TETANUS
INSECT BITE
INFECTED WOUND
BURNS
• FULL HISTORY – EXPLOSION, CLOSED SPACE– ATLS
• THERMAL AIRWAY INJURY
• INHALATION INJURY
• OTHER INJURIES
BURN CLASSIFICATION
• PARTIAL THICKNESS
• DEEP DERMAL
• FULL THICKNESS
• DIFFERENTIATED BY SENSORY LOSS AND APPEARANCE
ERYTHEMA IS NOT A BURN
TREATMENT
• ATLS
• ANALGESIA
• ASSESSING SIZE OF THE BURN (“RULE OF NINES”
• SPECIAL SITES
• FLUID REPLACEMENT CONSIDERATIONS
DRESSINGS
• MEPETIL v. JELONET
• CLINGFILM
• REVIEW
• REFERRAL TO BURNS UNIT
ERYTHEMA & P.T. BURN
P.T. BURN & DEEP DERMAL
PT BURN & MACERATION
SPECIAL CONSIDERATIONS
NAIL COMPLEX
NAIL BED
• NAIL FOLD / GERMINAL MATRIX
• VOLAR OBLIQUE v. DORSAL OBLIQUE
• COMPOUND # / STERILITY
• FUNCTIONAL RESULT
• ? PLASTICS REFERRAL
LAC NAILBED
LAC NAIL
FLAP LACERATIONS
• LOCATION – VASCULARITY
• APEX PROXIMAL v. APEX DISTAL
• SUTURE v. STERISTRIP
DEEP PRE-TIBIAL LAC
FLAP LAC KNEE
TENDON SHEATH INFECTION
SPRAINS
• ANKLE – OTTAWA RULES
• NECK – CANADIAN RULES
• A-C JOINT
• OTTAWA KNEE RULES
• WRIST INJURIES – SPLINT v. X-RAY
(WRISTS IN CHILDREN)
TOE & TUFT FRACTURES
QUESTIONS
SUMMARY
• WIDE RANGE OF INJURY
• CAREFUL ASSESSMENT
• JUDICIOUS REFERRAL TO SPECIALIST COLLEAGUES