Breathing
Circulation
Disability
Expose
Wound care: irrigate, wash, debride, dress, splint
Field management and care of the attack victim
Evacuation and facility choice
Transport options: walk, carry out, wheeled litter, vehicle, helicopter
Not necessarily based on "seriousness" of apparent injury
Trauma management and definitive wound care
ATLS principles
Wound Care
Explore
Cleanse
Irrigate
Debride
To close or not to close?
Trauma management and definitive wound care: High risk wounds
Consider surgical consultation
Special concerns
Hand wounds
Bites
Retained foreign bodies
Puncture wounds
Trauma management and definitive wound care: Hand wounds
Frequently injured in self defense
Complex anatomy, relatively poorly vascularized
Functional recovery paramount
Infection more likely
Trauma management and definitive wound care: Bites
Inoculated with oral flora/contaminated
Punctures
CDC recommends rabies prophylaxis
Site of bite important re: closure options and antibiotic prophylaxis
Consider radiologic evaluation for retained foreign body
Trauma management and definitive wound care: Rabies prophylaxis
Real risk varies--CDC recommends prophylaxis in ALL large wild animal bites
Consider animal motivation for attack
Incorporate patient in decision for prophylaxis
Pre-exposure and post-exposure prophylaxis available
Trauma management and definitive wound care: Rabies
Pre-exposure prophylaxis- for high risk groups
HDCV series (ID or IM preps available)
Post-exposure prophylaxis- initiate treatment within 48 hrs.
HRIG: passive immunity 20 IU/kg
FULL dose infiltrated in bite wound
HDCV, RVA, or PCEC series days 0, 3, 7, 14, 28
Trauma management and definitive wound care: Tetanus
Tetanus prophylaxis
Tetanus immune globulin if inadequately or not immunized
Update dT booster
Trauma management and definitive wound care: Antibiotic prophylaxis
Consider likely pathogens
Consider length of time to treatment
Consider patient immune status
Use only in moderate to high risk cases
