Minor Injuries in Primary Care

Minor Injuries in Primary Care
- Lacerations, abrasions, burns, and puncture wounds are common in the outpatient setting.
- No Need To Refer Every Case
Takeaway message:
- Because wounds can quickly become infected, the most important aspect of treating a
minor wound is irrigation and cleaning.
- There is no evidence that antiseptic irrigation is superior to sterile saline or tap water
Skin injury
Types of Skin Injuries
Abrasion
- Scraped skin caused by friction against a rough
surface.
- Involves only the epidermis, characterized by

• Minimal bleeding, pain, and usually do not scar.
- Treatment:
• Skin irrigation and removal of foreign bodies, topical antibiotic,
occlusive dressing; aggressive injuries may require topical and oral antibiotics and
consultation with plastic surgeon.
Laceration
- Laceration: Straight or jagged skin tear; caused by
blunt trauma (e.g., fall, collision)
- Clinical features:
• Little to profuse bleeding; ragged edges may not readily align.
- Treatment:
• Sutures, stapling, tissue adhesive, bandage, or skin closure tape
Incision
- Incision is a sharp cut with clean edges,
caused by a clean, sharp-edged object
such as a knife, razor, blade, scalpel or
glass splinter.
- Treatment:
• Sutures, stapling, tissue adhesive, bandage, or skin closure tape
Bite or puncture wound

- Broken skin caused by penetration of sharp
object.
- Typically more bleeding internally than
externally, causing skin discoloration
- Treatment:
• High-pressure irrigation and removal of foreign bodies
• tetanus prophylaxis with possible antibiotics
• human bites to the hand require prophylactic antibiotics
• plantar puncture wounds are susceptible to pseudomonal infection.
Burns
- Burn: Thermal dynamic injury, may progress two to three days after
initial injury
- Depends on degree and size;

• in general, first-degree burns do not require therapy (topical
nonsteroidal anti-inflammatory can be helpful)
• deep second- and third-degree burns require topical
antimicrobials and referral to burn subspecialist
Avulsion
- Avulsion
• is an injury in which a body structure is forcibly detached
from its normal point of insertion by either trauma or
surgery.
- most commonly refers to a surface trauma where all layers of the
skin have been torn away, exposing the underlying structures (i.e.,
subcutaneous tissue, muscle, tendons, or bone.
SUMMARY:
Treatment of Minor Injuries

- The first step in the care of cuts, scrapes (abrasions) is to stop the bleeding.
• Most wounds respond to gentle direct pressure with a clean cloth or bandage.
• Hold the pressure continuously for approximately 10-20 minutes.
- Thoroughly clean the wound with soap and water.

• There is no evidence that antiseptic irrigation is superior to sterile saline or tap water
• Hydrogen peroxide and povidone-iodine (Betadine) products may be used to clean
the wound initially, but may inhibit wound healing if used long-term.
- Remove any foreign material in the wound, such as dirt, bits of grass, which may lead to
infection.
• Tweezers (look to pic) can be used (clean them with alcohol
first) to rem ove foreign material from the wound edges
• but do not dig into the wound as this may push bacteria
deeper into the wound.
- Cover the area with a bandage to help prevent infection and dirt from getting in the
wound. A
- first aid antibiotic ointment can be applied to help prevent infection and keep the wound
moist.
• Any redness, swelling, increased pain, fever, or pus draining from the wound may
indicate an infection.
- Pain management:
• Paracetamol, hydrocodone or other opioid
• NSAID may delay bleeding; so try to avoid them.
- Do Not Forget to:

• Control bleeding.
• Palpate for foreign body
• Check for fracture.
• Check for tendon, nerve, vessel or duct injury.
• Exclude substance abuse, physical abuse,HIV or hepatitis(B or C).
- SUTURE:
Wound lacerations Sutures size Timing of removal (days)

Face 5-0 or 6-0 Three to five
Scalp 3-0 or 4-0 5-7 days
Trunk or extremities 4-0 or 5-0 7 to 10
Over joint surfaces 3-0 or 4-0 10 to 14
Palms or soles 3-0 or 4-0 14 to 21
- Tetanus Prophylaxis
Clean and minor wound All other wounds(dirty)
Previous doses of
Tetanus Toxoid- Tetanus Immune Tetanus Toxoid- Tetanus Immune
tetanus toxoid
vaccine Globulin vaccine Globulin
<3 doses or
unknown
Yes No Yes Yes
Only if last dose No Only if last dose

given ≥10 years given ≥5 years ago
≥3 doses No
ago
Muscle and tendons Injuries

- Strains
• are caused by overstretching or tearing the tendons or
muscles that help support and move a joint. Many strains
are minor - just small tears in the tissue - but some can be
severe.
- Sprains
• are likewise caused by overstretching or tearing, but they
occur in ligaments.
- Bruises happen when a muscle, ligament, or tendon sustains a blow forceful enough to
injure capillaries, so they break open and cause blood to collect under the skin and in the
injured tissue.
• Most bruises are minor and heal with treatment at home.
• But some can be severe and take weeks or months to heal.
• Bruising can even occur in vital organs, if the injured tissue is a vital organ.
Evaluation & Management of Muscle and tendons Injuries
- Begin RICE immediately.
• Rest: Cut back on normal daily activities and avoid putting weight on the injured
body part.
• Ice: Use an ice pack on the injured area for 10 to 20 minutes at a time, anywhere
from four to eight times per day. Don't use the ice pack for longer than 20 minutes,
and wrap it in a T-shirt or thin towel so you don't burn your skin.
• Compression: To reduce pain and swelling, wrap the injured area with an elastic
bandage not too tightly, though.
• Elevation: Use pillows or blankets to raise the injured limb above the level of the
heart to minimize swelling.
- Delaying RICE treatment could mean more pain and swelling and a longer recovery
period.
Head Trauma
- Head injuries include both injuries to the brain and those to other parts of the head, such
as the scalp and skull
- Brain injuries may be diffuse, occurring over a wide area, or focal, located in a small,
specific area.
- Brain injury can be at the site of impact, but can also be at the opposite side of the skull due
to a countercoup effect
- Traumatic subdural hematoma, a bleeding below the

dura mater which may develop slowly.
- Traumatic extradural, or epidural hematoma, bleeding
between the dura mater and the skull
- Traumatic subarachnoid hemorrhage
- Cerebral contusion, a bruise of the brain
- Concussion, a loss of function due to trauma
- A severe injury may lead to a coma or death
- Red Flags of Head Trauma

• Becomes very drowsy
• Behaves abnormally
• Develops a severe headache or stiff neck
• Loses consciousness, even briefly
• Vomits more than once
• There is severe head or face bleeding
• Apnea
• Changes in vision, taste or smell
• Muscle weakness
• Inability to concentrate
• Decreased reading comprehension
• Diminished auditory comprehension
• Irrational fears
• Problems with judgment
Needle stick injury-Post exposure prophylaxis

(PEP):
HIV
- Post exposure prophylaxis is Indicated if:
• Source patient is individual with known HIV infection or
• unknown HIV status who is epidemiologically at higher risk of having HIV.
- HIV testing should be performed in all patients before starting antiretroviral PEP.
- Antiretroviral PEP should be initiated as soon as possible after exposure:

• Within 72 hours
• given for 28-day.
- PEP- HIV Drugs:
• Perform HIV testing to all patients before starting antiretroviral PEP.
• Preferred antiretroviral PEP regimen includes all of:
o Tenofovir 300 mg plus emtricitabine 200 mg orally once daily.
o Dolutegravir 50 mg orally once daily or raltegravir 400 mg orally twice daily
o Initiation of PEP ≥ 72 hours after exposure generally not recommended
- Follow-up with HIV antigen/antibody testing at 3 and 6 months.
PEP: Hepatitis B
Source Patient Hepatitis Healthcare Provider Status

BStat
(No need to test source if HCP Immuned: Not immuned
is immuned). HBab titer ≤ 10 Not vaccinated or titer
milliunits/ml. <10.
Negative No treatment Complete
vaccinationseries
Positive No treatment HBIG
+Complete
vaccination
series.
Hepatitis C Post Exposure prophylaxis

- For HCV PEP , the HCV status of the source and the exposed person should be determined.
- if HCV positive source, or source unknown but high risk, follow-up HCV testing should be
performed to determine if infection develops by testing HCV Ab at baseline and then at 3
and 6 months.

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Minor Injuries in Primary Care

- Involves only the epidermis, characterized by

Bite or puncture wound

- Depends on degree and size;

Treatment of Minor Injuries

- Thoroughly clean the wound with soap and water.

- Do Not Forget to:

Wound lacerations Sutures size Timing of removal (days)

Clean and minor wound All other wounds(dirty)

Only if last dose No Only if last dose

Muscle and tendons Injuries

- Traumatic subdural hematoma, a bleeding below the

- Red Flags of Head Trauma

Needle stick injury-Post exposure prophylaxis

- Antiretroviral PEP should be initiated as soon as possible after exposure:

- Follow-up with HIV antigen/antibody testing at 3 and 6 months.

Source Patient Hepatitis Healthcare Provider Status

Hepatitis C Post Exposure prophylaxis

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