Typically opioid pain control
Fentanyl (preferred initially for trauma patients with concern for possible hemorrhagic shock) or morphine (for longer-acting control)
Fentanyl (preferred initially for trauma patients with concern for possible hemorrhagic shock) or morphine (for longer-acting control)
Initiate as soon as possible; increased infection rate when delayed
Cefazolin (Ancef) 2 g IV (immediately and q8 hours x 3 total doses)
Cephalosporin allergy: clindamycin 900 mg IV (immediately and q8 hours x 3 total doses)
Ceftriaxone 2 g IV (immediately x 1 total dose) PLUS vancomycin 1 g IV (immediately and q12 hours x 2 total doses)
Cephalosporin allergy: aztreonam 2 g IV (immediately and q8 hours x 3) PLUS vancomycin 1 g IV (immediately and q12 hours x 2 total doses)
Concern for clostridium (soil contamination, farm injuries, possible bowel contamination): additionally add penicillin
Fresh water wounds: fluoroquinolones OR 3rd/4th generation cephalosporin
Saltwater wounds (vibrio): doxycycline + ceftazidime OR fluoroquinolone
Surgical debridement and washout within 24 hours.
Thorough ED irrigation and debridement appears safe for hand (metacarpal, phalanx) fractures without excessive contamination
Irrigation may be started in the ED for grossly contaminated wounds
Place a sterile dressing over wound to decrease continued contamination
Tetanus prophylaxis
Thorough ED irrigation and debridement appears safe for hand (metacarpal, phalanx) fractures without excessive contamination
Place a sterile dressing over wound to decrease continued contamination
Open fracture
Compartment syndrome
Open joint injury
Contusion
Straddle pelvic fracture
Crush syndrome
Chance fracture
Degloving injury