Clinical Pathways
Clinical Pathways
Acute Traumatic Wounds - Urgent Care
Acute Traumatic Wounds - Urgent Care

Acute Traumatic Wounds - Urgent Care

Tags
EB Urgent Care
Published
August 1, 2022
Author(s)
Keith Pochick, MD, FACEP

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Action

Patient presents with an acute traumatic wound.

Decision

Does the wound have any high-risk factors?

  • Infected (Class I)
  • Contaminated and cannot be cleaned thoroughly (Class II)
  • Not on head or neck (Class I)
  • Sustained >19 hours before presentation

Yes

  • Choose closure method:
    • Delayed primary closure

      • OR

    • Closure by secondary intention
  • If systemic infection is present, transfer to ED

Background

Advanced patient age, diabetes, renal failure, obesity, malnutrition, and immunocompromised status all confer a higher risk for infection.

Patients who are unvaccinated or under-vaccinated require tetanus vaccination and possibly tetanus immune globulin for high-risk wounds. The highest risk for tetanus is in the elderly, immigrants, and persons without education beyond grade school. Wounds that are more prone to tetanus include contaminated wounds, deep puncture wounds, and injuries with crushed and devitalized tissue.

“My patient has diabetes but the laceration on her hand looked fine after I sutured it. I advised her to have the sutures removed in 7 to 10 days.”  There is a higher risk of wound infection associated with diabetes, advanced age, larger wound size, contamination, and a location not on the head or neck. Other conditions that impair wound healing include renal failure, obesity, malnutrition, and immunocompromised status. Prophylactic antibiotics should be considered for patients with these risk factors.

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References
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