Page 8 - Emergency medicine for students ebook

Open wounds
Pre-Hospital Treatment:
• Cut/graze: rinse under water, pat dry with gauze swab and cover with sterile dressing.
• If wound is covered by clothing: remove or cut clothes to gain access.
• If an object is in a severe bleeding wound: do not remove, apply pressure
around object, preferably with sterile cloth and secure with bandage,
elevate above heart level.
• If no object in severe bleeding wound: apply direct pressure on wound,
preferably with sterile cloth and secure with bandage, elevate above heart level.
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Hospital Treatment:
• Clean with 0.9% saline, if ingrained with dirt may require pressure saline irrigation or toothbrush scrubbing
• Devitalized or grossly contaminated wound edges need to be debrided (trimmed back) except on hands or face
• Close wound if required
o Anaesthetise (with 25 gauge needle), then suture, steri strips
• If closure not required, clean and lightly dress it and review in 3-5 days
• If heavily contaminated wound or it is infected but not requiring
admission review in 36hr
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Methods of closure:
Steri strips:
• Wound less than 5cm + no risk factors for infection/tension/wetting
• Adhesive skin closing strips allow skin edges to be opposed with an
equal distribution of forces- useful for pretibial lacerations, inappropriate over joints
Skin glue:
• Useful in children with superficial wounds and scalp wounds. Oppose
dry skin edges apply glue and hold together for 30-60secs. Don’t allow glue into wound or near joints.
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