Acute Traumatic Wounds: Evaluation, Cleansing, and Repair in Urgent Care -

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Publication Date: August 2022 (Volume 1, Number 5)

CME Credits: 4 AMA PRA Category 1 Credits™. CME expires 08/01/2025.

Specialty CME: Included as part of the 4 credits, this CME activity is eligible for 4 Trauma CME and 1 Pharmacology CME credits, subject to your state and institutional requirements.

Case Presentations

A 69-year-old man presents to UC after sustaining a laceration to the palmar surface of his left hand…

• Before entering the room, you read in the EMR that he has diabetes.
• The patient reports that he accidentally cut himself on broken glass while discarding trash.
• You examine the wound and find no palpable foreign bodies, no evidence of neurovascular injury, and no injury to deeper structures in his hand. You wonder whether you should obtain imaging or proceed to wound preparation and closure...

A 38-year-old woman presents to UC with a laceration through the vermillion border of her upper lip…

• She tells you that she sustained the laceration approximately 12 hours prior while playing recreational softball.
• Given the location of the laceration and the length of time since the injury, you wonder if primary closure is appropriate for this wound...

Introduction

Many of the wound care techniques used today were first practiced by ancient Egyptian, Greek, and Roman physicians, but certain aspects of wound management have evolved as medical technology has improved and new evidence has emerged, particularly in recent decades.^1-3 Traumatic wounds are among the most common conditions treated in the emergency department (ED), accounting for >5% of all ED visits annually.⁴ A 2014 study found that 17.2 million medical visits to hospital and outpatient settings in the United States were related to acute wounds.⁵

Complications of wound care that may lead to malpractice claims include missed foreign bodies, wound infection, joint capsule violation, and failure to detect nerve or tendon injury.⁶ Although the economic burden of an individual malpractice case may be relatively small, the overall financial impact of these claims is significant due to the large numbers of patients who present with wounds; litigation associated with wound management complication has been found to account for 3% to 11% of all dollars paid out in malpractice claims.⁶

This issue of Evidence-Based Urgent Care reviews the evaluation and treatment of minor traumatic wounds in urgent care (UC), with a focus on evidence-based recommendations for the evaluation, cleansing, and repair of wounds.

Introduction

The American Burn Association (ABA) reports that nearly half a million people suffer thermal burns each year in the United States.¹ According to World Health Organization estimates, as many as 265,000 people worldwide die annually from thermal burns.² The economic burden of thermal burn injury is also substantial: In the United States in 2000, the annual direct-care cost of treating pediatric burns alone was $211 million.² This does not take into account the economic impact of rehabilitation and long-term disability. Although efforts to prevent thermal burns through regulation and public health initiatives have reduced the incidence in developed countries, burn injuries still account for approximately 0.5% of annual emergency department (ED) visits in the United States.³ This issue of Evidence-Based Urgent Care reviews the guidelines on assessment of burns, the latest evidence on burn wound care, pain control, and the criteria for referral to specialized care.

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.