|
back from vacation and ready to talk......
for that type of injury to the wrist, first see how much pain there is while in the 'neutral' position, apply splint, likely do a local block if needed. As long as the patient is neuro/vascularly intact, can continue to operate a weapon and protect themselves and evac when appropriate.
issues:
- splint, as well as one can in neutral position
-leave the impailed object alone......may be tamponading the radial artery and you would have a hell of a time explaining the touniquet on this one and..... YOU RUIN A PHOTO OPPPORTUNITY!!
- if it will be more than 4 hrs to evac and care, needs antibiotics.
Note: medic should have a supply of meds, po and IV/IM that covers the usual bugs for the usual injuries and alternate meds for allergies.
Down and dirty field test, flex and extend all digits, check for increased pain with movement and limit it based on that. Local block if needed but lidocaine will only last 30-60 minutes, 60-90 min. with epinephrine, 4-5 hrs if you use marcaine.
__________________
'Revel in action, translate perceptions into instant judgements, and these into actions that are irrevocable, monumentous and dreadful - all this with lightning speed, in conditions of great stress and in an environment of high tension:what is expected of "us" is the impossible, yet we deliver just that.
(adapted from: Sherwin B. Nuland, MD, surgeon and author: The Wisdom of the Body, 1997 )
Education is the anti-ignorance we all need to better treat our patients. ss, 2008.
The blade is so sharp that the incision is perfect. They don't realize they've been cut until they're out of the fight: A Surgeon Warrior. I use a knife to defend life and to save it. ss (aka traumadoc)
|