Soft Tissue Injuries and Infections Content Neck injuries

Soft Tissue Injuries and Infections

Content Ø Neck injuries Ø ? Scaphoid fracture Ø Cellulitis Ø Paronychia Ø Bites Ø Wounds and how to close them Ø Tetanus Ø Compartment syndrome

Neck strains (“whiplash”) Ø Extremely common Ø The history Ø The examination Ø The management Ø Don’t miss a fracture!

Canadian cervical spine rule Any high-risk features? Y N Any low-risk features? Maintain immobilization N Radiological imaging Y Active rotation left and right >45 degrees? Y No imaging required N

Canadian cervical spine rule – High Risk Features Ø GCS <15 Ø Focal Neurological Deficit Ø Paraesthesia in the extremities Ø Age >65 Ø Dangerous mechanism of injury The presence of any of these mandates imaging

Canadian cervical spine rule – Low Risk Features Ø Simple rear end shunt Ø Sitting position in the department Ø Ambulatory at any time since the injury Ø Delayed onset of neck pain Ø Absence of midline tenderness In the absence of high risk features, the presence of any of the above indicates that active movements may be safely assessed

Canadian cervical spine rule Ø If the patient can then rotate the neck to 45 degrees both to the left and right, no imaging is required

Ø If in doubt, ask Ø If in doubt, maintain in-line immobilisation and d/w senior re imaging Ø XR v CT Ø Do not leave people lying on spinal boards

? Scaphoid fracture Ø Risk: development AVN Ø Positive examination findings mandates further imaging even if XRs (4) are normal Ø Futura splint Ø Fracture clinic f/u for MRI

Compartment Syndrome Ø Pathophysiology Ø Causes Ø Presentation Ø Management

Soft Tissue Infections and Wound Infections

Cellulitis Ø Very common Ø 1 st line Rx: flucloxacillin Ø If requiring IV abx but well patient, consider ambulatory care (once daily iv abx)

Paronychia Ø Usually from biting nails/skin around nail Ø staph. aureus Ø Mx: abx v I&D

Bites Ø Are very prone to infection Ø Prophylactic abx (augmentin) Ø If human bite, consider need for hep B cover ? ? PEP

Ø Don’t forget that tooth fist injuries are also bites

Wound management Ø Dressings v Glue v steristrips v sutures Ø Glue and steris must stay dry Ø Suture size and time to ROS dependent on site of wound Ø Ask for advice from ENPs, seniors, nurses Ø Generally straight wounds not under tension will glue or steri even if FT. Ø Don’t suture pre tibial lacerations unless you’ve asked a senior first.

Tetanus-prone wounds include: Wounds or burns that require surgical intervention that is delayed for > six hours Ø Wounds or burns that show a significant degree of devitalised tissue or a puncture-type injury, particularly where there has been contact with soil or manure Ø Wounds containing foreign bodies Ø Compound fractures Ø Wounds or burns in patients who have systemic sepsis High risk is regarded as heavy contamination with material likely to contain tetanus spores and/or extensive devitalised tissue Ø

(http: //www. dh. gov. uk/asset. Root/04/14/13/52/04141352. pdf )