Minor Injuries in

Primary Care
Dr. Othman Beni Yonis
2023
10/6/16
• Lacerations, abrasions, burns, and
puncture wounds are common in
the outpatient setting.
• No Need To Refer Every Case

10/6/16
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 .
 Types of Skin Injuries

1- 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.
 2- 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
 3- 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
 4- 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.
 5- 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
 6- 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.
 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 can be used (clean them with alcohol first) to
remove 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 opioids.
•
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 selection and timing of removal

Wound location Suture 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 Tetanus Tetanus
Tetanus Tetanus
toxoid Immune Immune
Toxoid-vaccine Toxoid-vaccine
Globulin Globulin

<3 doses or
Yes No Yes Yes
unknown

Only if last Only if last

≥3 doses dose given ≥10 No dose given ≥5 No
years ago years 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.
 Evaluation & Management of Muscle and
tendons Injuries

 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
Red Flags of Head Trauma
•
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:
– Tenofovir 300 mg plus emtricitabine 200 mg orally once daily.
– Dolutegravir 50 mg orally once daily or raltegravir 400 mg orally twice daily
– 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 B Healthcare Provider Status

Status
(No need to test source if HCP is immuned).

Immuned: Not immuned

HBab titer ≤  10 milliunits/ml. Not vaccinated or titer <10.

Negative No treatment Complete vaccination

series

Positive No treatment HBIG +Complete

vaccination series.

10/6/16
Hepaitis C Post Exposure prophylaxis
(last slide)

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.
 LAST SLIDE

10/6/16