The trauma patient: assessment, emergency management and wound care

image of The trauma patient: assessment, emergency management and wound care
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Wounds may be caused by a number of different insults to the body, and may involve just the skin, or many body systems. Correct management of trauma relies on being able to make a fairly rapid assessment of the patient as a whole, identifying injuries, coming up with a plan for treatment, estimating the prognosis, and conveying all that to the client, together with an estimation of the costs involved. This chapter looks at triage and emergency stabilization, an approach to the road traffic accident case, wound management and fractures.

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10.1 An approach to triage for the trauma patient. This allows division into those patients that require immediate treatment or else death may ensue, and those for whom treatment can be delayed. Note that ‘delayed’ treatment does not mean that the patient may be sent home and seen later: any trauma patient should be admitted and assessed every 5–10 minutes. The acceptable delay will depend on the nature of the injury and treatment required.
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10.6 Placement of a urinary catheter is a priority when there is damage to the urethra and external genitalia. This 3-year-old male cross-breed dog suffered extensive trauma to the hindlimbs and penis. Treatment involved amputation of one hindlimb and a perineal urethrostomy. The dog went on to make a good recovery.
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10.9 A flushing catheter can be easily constructed from a sterile saline bag, giving set, three-way tap, 20 ml syringe and large-bore needle.
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10.11 This 5-year-old female neutered Greyhound suffered a full-thickness burn over the ventral chest while lying on a heat pad at the owner’s kennel. The wound has been treated with wet-to-dry dressings for 48 hours and is now being prepared for delayed primary closure.
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10.12 This dog bite wound on the flank of a 7-year-old male Golden Retriever had been sutured 5 days previously using inadequate wound care. Infection is present and the wound is reopening. The wound has been extensively debrided and flushed and a Penrose drain is being placed prior to closure. The drain was removed after 3 days and the wound healed uneventfully.
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