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Wounds, Open Trauma

Open trauma wounds (abrasions, avulsions, crush wounds, lacerations, missile injuries, and punctures) are injuries that commonly result from home, work, or motor vehicle accidents and from acts of violence.

Signs and symptoms

In all open wounds, assess the extent of injury, vital signs, level of consciousness (LOC), obvious skeletal damage, local neurologic deficits, and general patient condition. Obtain an accurate history of the injury from the patient or witnesses, including such details as the mechanism and time of injury and any treatment already provided. If the injury involved a weapon, notify the police.

Also assess for peripheral nerve damage-a common complication in lacerations and other open trauma wounds, as well as for fractures and dislocations. Signs of peripheral nerve damage vary with location as follows:

• radial nerve-weak forearm dorsiflexion, inability to extend thumb in a hitchhiker's sign
• median nerve-numbness in tip of index finger; inability to place forearm in prone position; weak forearm, thumb, and index finger flexion
• ulnar nerve-numbness in tip of littie finger, clawing of hand
• peroneal nerve-footdrop, inability to extend the foot or big toe
• sciatic and tibial nerves-paralysis of ankles and toes, footdrop, weakness in leg, numbness in sole.

Most open wounds require emergency treatment. In those with suspected nerve involvement, however, electromyography, nerve conduction, and electrical stimulation tests can provide more detailed information about possible peripheral nerve damage.

Treatment

• If hemorrhage occurs, stop bleeding by applying direct pressure on the wound and, if necessary, on arterial pressure points. If the wound is on an extremity, elevate it if possible. Don't apply a tourniquet except in a life-threatening hemorrhage. If you must do so, be aware that resulting lack of perfusion to tissue could require limb amputation.