ESSENTIAL TIPS FOR DEALING WITH TRAUMA
Failure to diagnose a foreign body
Failure to diagnose a ruptured tendon
Exposed joint capsule in the fist
Beware of bites, high pressure guns and puncture wounds
Always assume (and look for) the presence of nerve, tendon or artery injury.
Buried wooden splinters, gravel and slivers of glass are old traps—if suspected and not found on simple exploration, order high-resolution ultrasound, which is good at detecting wood and glass. CT is best.
Falling on the outstretched hand
Consider the following fractures: Colles (distal radius); scaphoid; radius and ulna shafts; head of radius; supracondylar (children); neck and shaft of humerus, clavicle and the dislocations—lunate and shoulder.
Jumping or falling from a substantial height onto feet
Always consider a fractured calcaneum, talus, spine (especially lumbar) or pelvis and central dislocation of hip. Concussion can follow.
Always look for a peripheral nerve injury.
If using a small tourniquet such as a rubber band for haemostasis, clip on a small artery forcep so it is not forgotten when you finish.
You can get concussion from a heavy fall onto the coccyx/sacrum.
Think of a sewing needle in the knees of women and in the feet of children for unexplained pain.
Treat (evacuate) haematomas of the nasal septum and ear because they can collapse cartilage.
Beware of pressure gun injuries into soft tissue, especially those involving oil and paint.
Beware of a painful immobile elbow in a child—look for a fracture that can cause trouble later.
Beware of the scaphoid fracture after a fall onto an outstretched hand.
Finger injuries can be treated by simple means, providing there is neither tendon nor nerve injuries complicating the lacerations or compound fractures involved.
Not all finger tip loss demands an immediate graft or tidy-up amputation. If there is no exposed phalanx tip and the area of exposed subdermal tissue is small, conservative management is best. Remember that a grafted finger tip is insensate. If the amputated skin tip is available it should be replaced (use Steri-strips or a couple of small sutures), as it may take as a graft or merely act as a good biological dressing.
Apply a split skin graft, preferably using a Goulian knife with three spacing devices.
In this emergency situation, instruct the patient to place the severed finger directly into a fluid-tight sterile container, such as a plastic bag ...