Management

Wound closure methods will vary from clinician to clinician and patient to patient. In general though, if there is an open wound such as a laceration or an incision this will need to be cleaned and closed either with steristrips, glue or sutures. In an audit carried out by the authors which reviewed the notes of patients who had presented to the ED with an alleged assault they were surprised to see that a described abrasion had been sutured! Closure of the wound may allow you to think about your documentation too if the wound is being closed it is likely to be an incision or laceration. If the wound isn’t being closed it is likely to be an abrasion or a bruise.

Always consider a tetanus status especially with deep contaminated wounds.

Remember that there maybe foreign bodies in the wounds and the wound may need to be explored and washed out. This is best done under local anaesthetic. If you are unsure then it is always best to ask someone.

The injury may need to be x-rayed to look for foreign bodies or fractures.

Bites should be managed according to local protocol which usually involves thorough cleaning of the wound (sometimes with debridement), treatment with antibiotics, consideration of tetanus cover and Blood Bourne Virus prophylaxis. Don’t forget to consider swabbing the bite for DNA evidence.

Never pass drains or other lines through stab wounds. This can distort the appearance of the injury. Similarly, do not incorporate injuries into surgical incisions – for example a thoracotomy.

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