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10. Medical and minor surgical procedures
Technique
– S ettle th e p atient co m fo rtably in an area w ith go o d ligh ting and ensure all th e
necessary m aterial is p rep ared .
– E xp lain the p ro ced ure to the p atient and ensure his co -o p eratio n.
– If the p atient is a y o ung child , arrange to have an assistant ho ld the child if necessary .
Initial cleaning
– W ear suitable clo th ing: sterile glo ves fo r all w o und s and a go w n and p ro tective
glasses if there is a risk o f p ro jectio n fro m a bleed ing wo und .
– S tart by washing the wo und , p ro lo ng the cleaning if the wo und is p articularly so iled .
U se o rd inary so ap o r polyvidone iodine scrub solution and water and rinse.
– If necessary use a sterile brush. C leaning with running water is p referable to cleaning
by im m ersio n.
– If the wo und is infected and the p atient has general signs o f infectio n (fever, chills,
ch anges in th e o verall co nd itio n) sy stem ic antibio tic th erap y m ay be required .
A d m inister antibio tics at least o ne ho ur p rio r to starting care.
Exploration
– W ash hand s and p ut o n sterile glo ves.
– D isinfect the wo und and surro und ing area with 10% polyvidone iodine.
– C o ver the wo und with a fenestrated sterile to wel.
– L o cal anaesthetic: infiltrate 1% lidocaine into the ed ges o f the wo und and wait at least
2 m inutes fo r the anaesthetic to tak e effect.
– P ro ceed carefully fro m the sup erficial to the d eep est p arts o f the wo und to exp lo re
the extent o f the wo und , if necessary , aid ed by an assistant.
– C o nsid er the anato m ical lo catio n o f the wo und and lo o k fo r injury to any und erly ing
structures (the clinical exam inatio n o f a lim b m ust includ e evaluatio n o f sensitivity
and m o to r functio ning, as w ell as th at o f tend o ns in o rd er to o rient surgical
exp lo ratio n):
• a wo und that co m m unicates with a fracture is an o p en fracture, 10
• a wo und clo se to a jo int m ay be a jo int wo und ,
• a wo und o n the hand s o r feet m ay affect the nerves and / o r tend o ns.
– L o o k fo r and rem o ve any fo reign bo d ies.
– In the event o f significant p ain o r bleed ing, the exp lo ratio n m ust be co m p leted in an
o p erating ro o m .
257
Technique
– S ettle th e p atient co m fo rtably in an area w ith go o d ligh ting and ensure all th e
necessary m aterial is p rep ared .
– E xp lain the p ro ced ure to the p atient and ensure his co -o p eratio n.
– If the p atient is a y o ung child , arrange to have an assistant ho ld the child if necessary .
Initial cleaning
– W ear suitable clo th ing: sterile glo ves fo r all w o und s and a go w n and p ro tective
glasses if there is a risk o f p ro jectio n fro m a bleed ing wo und .
– S tart by washing the wo und , p ro lo ng the cleaning if the wo und is p articularly so iled .
U se o rd inary so ap o r polyvidone iodine scrub solution and water and rinse.
– If necessary use a sterile brush. C leaning with running water is p referable to cleaning
by im m ersio n.
– If the wo und is infected and the p atient has general signs o f infectio n (fever, chills,
ch anges in th e o verall co nd itio n) sy stem ic antibio tic th erap y m ay be required .
A d m inister antibio tics at least o ne ho ur p rio r to starting care.
Exploration
– W ash hand s and p ut o n sterile glo ves.
– D isinfect the wo und and surro und ing area with 10% polyvidone iodine.
– C o ver the wo und with a fenestrated sterile to wel.
– L o cal anaesthetic: infiltrate 1% lidocaine into the ed ges o f the wo und and wait at least
2 m inutes fo r the anaesthetic to tak e effect.
– P ro ceed carefully fro m the sup erficial to the d eep est p arts o f the wo und to exp lo re
the extent o f the wo und , if necessary , aid ed by an assistant.
– C o nsid er the anato m ical lo catio n o f the wo und and lo o k fo r injury to any und erly ing
structures (the clinical exam inatio n o f a lim b m ust includ e evaluatio n o f sensitivity
and m o to r functio ning, as w ell as th at o f tend o ns in o rd er to o rient surgical
exp lo ratio n):
• a wo und that co m m unicates with a fracture is an o p en fracture, 10
• a wo und clo se to a jo int m ay be a jo int wo und ,
• a wo und o n the hand s o r feet m ay affect the nerves and / o r tend o ns.
– L o o k fo r and rem o ve any fo reign bo d ies.
– In the event o f significant p ain o r bleed ing, the exp lo ratio n m ust be co m p leted in an
o p erating ro o m .
257
