Trauma

Question 1

What advise would you give to patients with maxillofacial injuries on discharge?

Answer 1

1. Avoidance of nose blowing as this may produce surgical emphysema.
2. Not to occlude the nose when sneezing
3. Application of ice packs to the area to reduce swelling
4. Take regular analgesia
5. General head injury advice

Question 2

What are tetanus prone wounds?

Answer 2

1. puncture type wounds acquired in a contaminated environment likely to contain tetanus spores
2. wounds with foreign bodies
3. compound fractures
4. wounds or burns with systemic sepsis
5. certain animal bites and scratches (if digging in soil, or an agricultural animal)

Question 3

What are high risk tetanus wounds?

Answer 3

1. heavy contamination with soil/manure
2. wounds/burns with extensive devitalised tissue
3. wounds/burns requiring surgical intervention that is delayed for more than six hours

Question 4

When would you refer to burns unit / centre?

Answer 4

1. Child with any burn greater than 2% TBSA
2. Adult with any burn greater than 3% TBSA
3. Full thickness burn
4. Inhalational injury
5. Special areas*
6. Chemical / electrical burns
7. High pressure steam injury
8. Hydrofluoric acid burn
9. Potentially complex burn**

*Special Areas
Face
Hand
Perineum or genitals
Feet
Flexures (particularly neck or axilla)
Burn over joint which may affect mobility or function

**Complex Burn 
2° to ionising radiation 
Suspicion of NAI 
Coexisting diseases 
Pregnancy
Extremes of age
Circumferential dermal or full thickness burns
Associated major trauma 
Cold injuries