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