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A man with multiple chop wounds AUTHOR DR. TW WONG REVISED BY DR. CLARENCE CHU KWOK KEUNG NOV 2013 HKCEM College Tutorial.

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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:

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2 A man with multiple chop wounds AUTHOR DR. TW WONG REVISED BY DR. CLARENCE CHU KWOK KEUNG NOV 2013 HKCEM College Tutorial

3 Triage M 24 chopped by several gangsters Multiple wounds BP 130/80 P 100/min Triage Category I

4 Primary Survey ABCD normal

5 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

6 Now proceed with secondary survey Head and neck normal Chest and abdomen normal

7 R arm wound What underlying structure may be injured? Please assess...

8 Radial Nerve injury Look for drop wrist, fingers Where is the area of sensory loss?

9 Radial N

10 Left forearm What structures may be injured? How to test?

11 Median Nerve injury Opposition test

12 Other tests Oschner Prayer sign

13 R hand is dressed Without looking at the wound, what structure may have been injured?

14 The hand posture suggests... Cut tendons to Ring Finger and Little Finger

15 How to test finger flexors ?

16 Flexor tendon tests Profundus Sublimis

17 What other underlying structures may be injured? How to assess?

18 Ulnar nerve injury Froment cone

19 Ulnar Nerve tests Intrinsic muscle Abduction test

20 Ulnar nerve tests Froment sign Palm sweep

21 Palm wound What is the best way to test finger sensation?

22 2 point discrimination

23 Left thumb wound Part of the thumb is chopped off. How do you deal with the amputated part ?

24 Keeping Amputated Part Wrap with gauze Put in a plastic bag Put in a container with ice + water. NB: not ice alone

25 Back injury What underlying injuries may be present?

26 Torso injuries Penetration to retroperitoneum Kidney injury

27 Right leg wound What underlying structure is at risk ? Tibial Nerve

28 You have seen all the wounds How would you manage the patient?

29 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

30 Summary We have covered: 1. Evaluation of limb wounds 2. Neurovascular examination in limbs 3. Management of amputated finger

31 The end


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