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

▪ Allergy nil

▪ Medication nil

▪ Past health good, tetanus status not sure

▪ Last meal 2 hours ago

▪ Event chopped 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?

Radial N

Left forearm

What structures may beinjured?

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 havebeen 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 withthe 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

The end