TOPIC 14. KINDS OF WOUNDS – CRUSHING, SLASH, PUNCTURE, BITE AND FIREARM
Specific management principles
A. Crush injuries
- Assess for prolonged entrapment, muscle pain/swelling, weakness, dark urine and systemic instability.
- Look for compartment syndrome: severe pain out of proportion, pain on passive stretch, tense compartments and evolving sensory/motor deficits; pulses may remain present early.
- Monitor ECG, potassium, renal function, creatine kinase, acid–base status and urine output when crush syndrome is suspected.
- Resuscitate and treat hyperkalaemia or other life-threatening metabolic abnormalities urgently; obtain surgical assessment for compartment syndrome and necrotic tissue.
B. Puncture and stab wounds
- Do not assume a small wound is superficial. Establish direction, depth, body region and possible penetration.
- Do not remove an impaled object in the field if it may be controlling bleeding; stabilise it and arrange controlled removal.
- Assess for chest, abdominal, vascular, tendon, nerve and joint penetration; use imaging and exploration according to stability and suspected injury.
- Antibiotics and tetanus prophylaxis depend on wound characteristics and site.
C. Bite wounds
- Human bites can contain mixed oral flora, including Eikenella; animal bites commonly involve Pasteurella and mixed aerobes/anaerobes.
- High-risk sites include hands, face, wounds over joints/tendons, deep punctures, immunocompromised patients and delayed presentations.
- Copious irrigation, exploration for deep injury and removal of devitalised tissue are important. Hand bites require careful assessment for joint/tendon penetration.
- Amoxicillin–clavulanate is commonly used for prophylaxis or treatment when antibiotics are indicated; alternatives depend on allergy and local guidance.
- Assess tetanus status and rabies exposure risk; urgent public-health assessment and post-exposure prophylaxis may be required.
D. Firearm wounds
- Treat life-threatening haemorrhage and follow trauma priorities; do not be reassured by a small entry wound.
- Assess trajectory and possible exit wound; investigate for vascular, thoracic, abdominal, spinal and skeletal injury.
- Do not blindly explore the tract or remove deep fragments without indication. Surgical debridement and antibiotics depend on injury, contamination, tissue viability and fracture status.
- Open fractures, vascular injury and compartment syndrome require urgent specialist management.
Exam point: Crush injury can cause systemic rhabdomyolysis and acute kidney injury. Puncture wounds can be deep despite a small opening. Bites are contaminated wounds. Firearm injury severity depends on trajectory and energy transfer, not just skin appearance.