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A man with multiple chop wounds

HKCEM College Tutorial. A man with multiple chop wounds. Author Dr. tw wong Revised by Dr. clarence CHU Kwok Keung Nov 2013. Triage. M 24 chopped by several gangsters Multiple wounds BP 130/80 P 100/min. Triage Category I. Primary Survey. ABCD normal. AMPLE History.

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A man with multiple chop wounds

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  1. HKCEM College Tutorial A man with multiple chop wounds Author Dr. twwong Revised by Dr. clarence CHU Kwok Keung Nov 2013

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

  3. Primary Survey ABCD normal

  4. 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

  5. Now proceed with secondary survey Head and neck normal Chest and abdomen normal

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

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

  8. Radial N

  9. Left forearm What structures may be injured? How to test?

  10. Median Nerve injury Opposition test

  11. Other tests Oschner Prayer sign

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

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

  14. How to test finger flexors ?

  15. Flexor tendon tests Profundus Sublimis

  16. What other underlying structures may be injured? How to assess?

  17. Ulnar nerve injury Froment cone

  18. Ulnar Nerve tests Intrinsic muscle Abduction test

  19. Ulnar nerve tests Palm sweep Froment sign

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

  21. 2 point discrimination

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

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

  24. Back injury What underlying injuries may be present?

  25. Torso injuries Penetration to retroperitoneum Kidney injury

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

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

  28. 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

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

  30. The end

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