SOFT TISSUE INJURY

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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
• ID
• 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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(No Transcript)
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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