Trauma - Soft tissue injury ( 1 ) -

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Trauma- Soft tissue injury ( 1 ) -

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Another Open Wound
Penetrating injury, Gunshot wound
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Complex soft tissue injury with bone destruction
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Primary Secondary Survey

• Sequential survey
• Provide adequate management

A B C D E
How to deal with the wound?
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• Close
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• open
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Closed injury, Contusion
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Open wound, Laceration
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Open wound, Avulsion
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Avulsion, with skin defect
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(No Transcript)
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• ???(mammalian) ????????????
• Staphylococcus ? Steptococcus ???
• Dog bite ? pasteurella multocida

Hand wound ? easily infected!
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• Septic bite
• Puncture bite
• Hand wounds

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• 3-5 days
• Augmentin
• Ampicillin Cloxacillin
• Tetracycline
• Cephalosporin
• Tetanus prophylaxis if indicated
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• Cellulitis, fascitis
• Hepatitis, AIDS, syphilis, TB
• Rabies

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• ??Erythromycin or Aminoglycoside ?????
• Resistance()
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• Primary repair is safe

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Developed compartment syndrome?fasiotomy
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???????? 1

• Local and wound examination
• Related structures
• Drawings, photograohs
• Decide on tetanus and antibiotics
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• ??4????????2-3?
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(No Transcript)
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??????? 1.DPT???????????????
2.?????????(DT,7???????)
3.???????????(Td,7?????? ??????
1.TAT-?????? 2.TIG-????????
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???????? 2

• Wet 4x4s while in x-ray and preparing
• Wound irrigation
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• Decide on plan
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OR Vs. ER

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???????? 3

• Skin preparation
• Hair removal?
• Shaving
• Clipper
• Foreign body
• Local anesthesia
• Xylocaine
• 2?0.5
• Complications?

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Xylocaine (Lidocaine)

• Onset 1-5 mins
• Duration 30-120mins
• Max Dose 4.5mg/kg
• 1ml(2)x1000mg20mg
• 60kgX4.5mg/kg270mg

CNS ???? ?? ?? ?? ??
Cardiopulmonary ??? ???? ????
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A ??

• No closure
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B ??

• Steri-Strips
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How to use it?

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C ??

• Reapproximation
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D ??

• Plastic surgery closure
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• ?????RTSL(relaxed tension skin line)?
• ??????RTSL

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RTSL-Skin tension lines followed during
elective incision-Offers best cosmetic
result-Most narrow and strongest scar
line-Parallel to dermal collagen
bundles-Perpendicular to muscle contraction
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PLASTIC SURGERY CLOSURE

• Wound excision
• Incorporated with RTSL
• No tension on skin edge
• 3-layered skin closure

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Wound Preparation

• 0.5 Xylocaine (2 is not better!)
• Epinephrine (for vasoconstriction)
• Skin prepare
• Scalp
• Eyebrow
• Wound lavage
• Antibiotic solution?
• H2O2 solution?
• B-I solution?
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(No Transcript)
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• Protection of the wound
• Antisepsis of the wound
• Pressure
• Immobilization
• Debridement
• Physiologic environment
• Absorption of fluids
• Maintenance of spaces (packing)
• Relief of pain
• Improvement in appearance
• Information

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• Inner layer
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• Second layer
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• Outer layer
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• No dressing
• Vaseline gauze, or B-I gauze, 4x4s
• Vaseline gauze, wet 4x4s, fluffs, roller gauze
  remove at 12 hours and start t.I.d. clean and
  ointment
• Need plaster splint over joint
• etc

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• Greasy Gauze Extremity Dressings
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• Sloppymylon Dressings
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• ??????????(Sulfamylon)
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• ?2-3????Saline, ????
• ?12???????????

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• Hand Dressings
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• Head Dressings
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• Wet-to-Dry Dressings
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• Dry out ? Change Dressing t.I.d.

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• Wet-to-Wet Dressings
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• Change Dressing t.i.d.

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• DuoDerm
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• ?????????, ??Steri-Strips??????
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• ?????(subcuticular suture)?????????????

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To Be Continued