Contents:
Hand Injuries
Treat aggressively for good results.
Apart from the most trivial wounds, all hand injuries should be assessed
by a Surgical registrar. During working hours, the Plastics Registrar should
be requested to review hand injuries. After hours, the Duty Surgical Registrar
should be contacted. All minor hand injuries should be checked by the Emergency
Registrar before discharge.
ABSOLUTE INDICATION FOR ADMISSION.
- Suspected involvement of tendons, nerves, muscles or vessels.
- High speed injuries e.g. spray guns, drill, auger, router, lawn mower, angle grinder, chain saw, circular saw etc.
- Crush injuries
- Amputations - partial or complete
- Compound fractures.
- Penetrating injuries, especially of the thenar or palrnar spaces.
- Nail bed injuries.
- Pulp Injuries.
- Injuries with skin loss.
- Dirty wounds/foreign bodies.
- Injuries to more than one digit.
- Full thickness or deep partial thickness burns.
- Injuries in non-English speaking patients where the history is unclear.
MANAGEMENT
Hand wounds are not 'explored' in emergency.
- X-ray
- Tet toxoid / lmmunoglobulin as necessary
- Parenteral antibiotics via the non-injured arm; Penicillin and Flucloxacillin,
with Metronidazole added in the case of bites.
- Analgesia
- Wet saline dressings; avoid encircling dressings which act as tourniquets
when blood dries. Do not encircle with tape. Leave finger tips visible if
possible.
- Elevate suspended from an IV pole
- Make the patient more comfortable with the hand immobilised in the
'glass-holding' position with a volar slab.
- Admit under the plastic surgeon of the day.
- Fast, and if appropriate consent must be obtained by the person doing
the procedure.
If in doubt admit the patient, it is better to review a patient who
requires no further treatment than one who needed it yesterday or last week.
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