Presentation on theme: "A man with multiple chop wounds AUTHOR DR. TW WONG REVISED BY DR. CLARENCE CHU KWOK KEUNG NOV 2013 HKCEM College Tutorial."— Presentation transcript:
A man with multiple chop wounds AUTHOR DR. TW WONG REVISED BY DR. CLARENCE CHU KWOK KEUNG NOV 2013 HKCEM College Tutorial
Triage M 24 chopped by several gangsters Multiple wounds BP 130/80 P 100/min Triage Category I
Primary Survey ABCD normal
AMPLE History Allergynil Medication nil Past healthgood, tetanus status not sure Last meal2 hours ago Eventchopped by a gang outside a restaurant, able to run away
Now proceed with secondary survey Head and neck normal Chest and abdomen normal
R arm wound What underlying structure may be injured? Please assess...
Radial Nerve injury Look for drop wrist, fingers Where is the area of sensory loss?
Left forearm What structures may be injured? How to test?
Median Nerve injury Opposition test
Other tests Oschner Prayer sign
R hand is dressed Without looking at the wound, what structure may have been injured?
The hand posture suggests... Cut tendons to Ring Finger and Little Finger
How to test finger flexors ?
Flexor tendon tests Profundus Sublimis
What other underlying structures may be injured? How to assess?
Ulnar nerve injury Froment cone
Ulnar Nerve tests Intrinsic muscle Abduction test
Ulnar nerve tests Froment sign Palm sweep
Palm wound What is the best way to test finger sensation?
2 point discrimination
Left thumb wound Part of the thumb is chopped off. How do you deal with the amputated part ?
Keeping Amputated Part Wrap with gauze Put in a plastic bag Put in a container with ice + water. NB: not ice alone
Back injury What underlying injuries may be present?
Torso injuries Penetration to retroperitoneum Kidney injury
Right leg wound What underlying structure is at risk ? Tibial Nerve
You have seen all the wounds How would you manage the patient?
Patient management Activate trauma team (per local protocol) orthopedic surgeon for limb and hand wounds general surgeon for loin wound IV line Analgesics Dress wound to control bleeding Tetanus Consider prophylactic antibiotics
Summary We have covered: 1. Evaluation of limb wounds 2. Neurovascular examination in limbs 3. Management of amputated finger