Open Wound

Non-pharmacological

• Appropriately suture fresh wound (i.e., < 12 hours old)
• Do not suture penetrating wound to chest or abdomen
• Refer to the next level of care

NOTE:

• Any skin damage overlying a fracture makes it an open fracture
• It is important to ascertain the cause of the wound

Pharmacological

• Always remember to give Tetanus Toxoid Vaccination (Section 12.3)
• If patient has signs of tetanus, give Tetanus Antitoxin Serum (ATS) 1,500 IU s/c or IM
• If wound is grossly contaminated give Tetanus Antitoxin Serum 3,000 IU s/c or IM (alongside copious washing
• Clean fresh wounds with large volumes of normal saline or sterile water.
• High risk wounds may be irrigated with Cetrimide 15%+ Chlorhexidine Solution 1.5% (Savlon) diluted 1 in 20 parts water or diluted iodine.

Wound repair

• For local infiltration or as a peripheral nerve block use Lignocaine Hydrochloride injection 1% , maximum dose: adults 4mg/ kg body weight; children 3mg/kg (= 0.3ml/kg of 1%)

Or use Lignocaine 1% (10mg per 1ml) + adrenaline 1:200,000 injection around the wound

• Maximum dose: adults 7mg/kg, children 7mg/kg

Note: Do not use anaesthetics containing adrenaline for anaethesia in digits or appendages due to risk of ischaemic necrosis