Skip to Main Content

++

ESSENTIAL TIPS FOR DEALING WITH TRAUMA

++

Common traps

++

  • 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

++

Stab wounds

++

Always assume (and look for) the presence of nerve, tendon or artery injury.

++

Foreign bodies

++

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.

++

Cut finger or toe

++

Always look for a peripheral nerve injury.

++

Finger tourniquet

++

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.

++

OTHER CAUTIONARY TIPS

++

  • 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.

++

FINGER TIP LOSS

++

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.

++

Large skin loss

++

Apply a split skin graft, preferably using a Goulian knife with three spacing devices.

++

AMPUTATED FINGER

++

In this emergency situation, instruct the patient to place the severed finger directly into a fluid-tight sterile container, such as a plastic bag ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.