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Trauma Resuscitation - part 7

Theo dõi một cách cẩn thận, và yêu cầu bệnh nhân để ở bàn chân của họ nếu có thể. Vết thương nghiêm trọng bị ô nhiễm cần phải làm sạch đầy đủ trước khi đóng cửa. Vật liệu như dầu mỡ, đất, bụi than, hoặc sơn phải được loại bỏ để tối đa hóa cơ hội chữa bệnh không có biến chứng, | 198 TRAUMA RESUSCITATION eyelids scarring may be disastrous refer to plastic or ophthalmic surgeons pretibial flap lacerations often associated with paper like skin especially in older patients. Better to use taping techniques for closure but risks of complication still high. Follow up carefully and ask patient to stay off their feet if possible. Severely contaminated wounds require adequate cleaning before closure. Material such as grease soil coal dust or paint must be removed to maximize the chances of healing without complications and to give the best cosmetic result. For particulate material grit soil if this is not removed primarily it is usually not possible to get rid of this as a secondary procedure. Unpleasant tattooing of the wound may follow. The principles of adequate wound cleaning are in order of increasing vigour irrigation with clear fluid use of pulsed lavage high pressure irrigation physical removal of material with forceps and scrubbing with a brush. Anaesthesia sufficient to permit the required level of activity will be required. Wounds requiring more than the first level of irrigation should be left open at initial exploration. Wounds may subsequently be closed at an interval of a few days delayed primary closure or longer up to 2 weeks secondary closure . Delayed primary closure gives results that are very similar to those of primary closure with a dramatic decrease in the risk of wound sepsis as a result of the thorough debridement and drainage for a few days while the tissue swelling settles. Extensive lacerations should be referred for assessment by an appropriate surgical specialty. 9.4.2 Suturing a wound You cannot learn to suture a wound from a book but it is reasonable to indicate some of the key points. This technique can be best learnt like most manual skills by having it demonstrated and then practising under supervision. To suture a simple laceration under local anaesthesia you will need the following. Drapes Needle holding suture