Pediatric emergency medicine trisk 3374 3374

anatomic locations with poor blood supply, contaminated or crush wounds, and
those involving immunocompromised hosts should be closed promptly, within 6
hours of injury. Some contaminated wounds (e.g., animal or human bites or those
occurring on a farm) in an immunocompromised host should not be sutured, even
if the patient presents immediately for care. Some wounds should be allowed to
heal by secondary intention (secondary closure), although scar formation may be
more unsatisfactory. Infected wounds, ulcers, and many animal bites are best left
to heal by granulation and reepithelialization. Human bites over the
metacarpophalangeal joints (clenched-fist bites) are especially prone to infection
and risk infection with primary closure. Puncture wounds to the foot, with only a
small laceration and a low concern for cosmetic results, may also be left open. A
small sterile wick of iodoform gauze may be placed inside the wound to keep the
edges open. This gauze can be removed after 2 to 3 days, and the subsequent
granulation tissue will aid healing.
TABLE 110.2
WOUND ASSESSMENT—GENERAL PRINCIPLES
Primary survey—control bleeding
Secondary survey—other injury?
History
Mechanism
Age of wound—time of injury
Possible foreign body
Environment
Health status—tetanus immunization
Physical examination
Location
Muscle function
Tendon involvement
Vascular injury
Nerve injury
Foreign material

Laboratory
Consider radiographs or ultrasound if a foreign body or fracture is suspected