Wounds injury.
33 years old male patient presented in Emergency department with a big cut wound in posterior right heel caused by glass piece fall on the floor and he walk over the broken glass without seen. Patient was vitally stable as following (BP: 127/70mmhg, HR:77, SPO2:99%, Tem:37 C) Pain score was 7 according to numerical rating scale. Patient is do not have any medical or surgical history.
A big laceration wound at the posterior right heel with moderate active bleeding. The wound was around 8/3 cm, the superficial veins were exposed, bone not exposed. The wound is fresh, so there was no sign of infection. Dorsalis Pedis pulse of the right heel was present, Achilles’ tendon was also intact.
Compartment syndrome: the 6 Ps is negative (Pain, Paresthesia, Pallor, Paralysis, Pulseless, Polar).
Management:
- Pressure was applied to the affected area with gauze and bandage.
- Tetanus Toxoid 0.5ml IM STAT given.
- The wound is cleaned with normal saline sutured (sutured size 3-0 type silk, 6 stitches done).
- Dressing with Paraffin gauze applied.
- IV cannula inserted, Inj. Ceftriaxone 2gm diluted in 100ml NS and given over 30min.
- Paracetamol tablet as oral analgesic given.
Possible complications and health education:
- Contamination and infection due to site of the wound.
- Instructed protect the dressing from the water and restrict the movement as possible.
- The patient also is instructed for alternative day wound cleaning and dressing at LHC and suture removal after 14 days.
- To Keep the leg elevated while sleeping to maintain good blood circulation.
References:
Future learn (2017).
Type of wounds. Retrieved from:
https://www.futurelearn.com/info/courses/basic-first-aid/0/steps/27028.
