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