By Ian Greaves, Graham S. Johnson
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FURTHER READING American College of Surgeons Committee on Trauma (1997) Advanced Trauma Life Support. American College of Surgeons, Chicago. , Gwinnutt, C. and Jimmerson, C. (1994) Trauma Resuscitation - The Team Approach. Palgrave, Basingstoke, Hants. Royal College of Surgeons (1988) Management of Major Injuries. Royal College of Surgeons, London. 35 CHAPTER FIVE WOUND MANAGEMENT • • • Introduction Wound healing Principles of wound assessment and management INTRODUCTION Approximately one in four emergency department attendances is for the treatment of wounds.
The objective of this is to provide a baseline assessment of neurological status against which subsequent assessments can be compared for improvement or deterioration. Specifically, the clinical signs of an expanding intracranial haematoma are sought. The classic picture associated with the expansion of an intracranial haematoma is of deteriorating conscious level, an ipsilateral fixed dilated pupil and a contralateral hemiparesis. The latter two signs usually occur at a late stage when substantial deterioration in conscious level has already taken place.
People sustaining wounds whilst working in sewers or where there are rats are at risk of contracting leptospirosis. The appropriate antibiotic prophylaxis is penicillin. In animal bite wounds sustained abroad the need for rabies prophylaxis should be considered. Advice in these cases should be sought from a consultant in communicable diseases. For needlestick injuries local protocols are established for the prevention of hepatitis B and for HIV prophylaxis. An outline of these is given later in this chapter.