SOFT-TISSUE INJURIESMusculoskeletal and Soft-tissue Emergencies 319(b) 10 mL of a 2% solution again containing 200 mg lignocaine
(lidocaine).
(iv) Signs of lignocaine (lidocaine) or other local anaesthetic toxicity
include:
(a) perioral tingling, a metallic taste, restlessness, dizziness and
slurred speech
(b) confusion, seizures and coma
(c) bradycardia, hypotension and circulatory collapse.
(v) Treat seizures with midazolam, diazepam or lorazepam i.v.,
and circulatory collapse with inotropes or by commencing
cardiopulmonary resuscitation if needed (see p. 2).4 Exploration, irrigation, debridement and haemostasis
(i) Look carefully for evidence of foreign bodies, and severed tendons,
vessels or nerves within the wound. Seek assistance from the senior
emergency department (ED) doctor if any of these are found.
(ii) Irrigate the wound using a 20 mL syringe filled with saline and
fitted with a 23-gauge blue needle to provide a high-pressure jet.
Repeat this procedure until the wound is clear of debris
(a) use protective eyewear to prevent eye splash contamination
with body fluids.
(iii) Excise any dead or contaminated tissue and remove local dirt on
the skin by swabbing briskly
(a) make certain all ingrained gravel and grit is removed to avoid
permanent tattooing of the skin. A general anaesthetic may
be necessary.
(iv) Achieve haemostasis by local pressure. Avoid using mosquito
forceps to clamp a bleeding area, as this may cause further local
tissue damage.
5 Sutures
(i) The aim is to appose the edges of the wound without tension
using interrupted sutures, starting in the middle of the wound
and halving the remaining distance each time.
(ii) The choice of suture material depends on the type of tissue being
repaired and local practice
(a) use an absorbable suture such as polydioxanone or
polyglactin when closing deep wounds, to first close the deep
space, and bury the knot at the depth of the wound
(b) silk was traditionally most popular for skin closure, although
it is more likely to cause micro-abscess formation with
scarring
(c) use non-absorbable synthetic monofilament sutures such
as nylon or polypropylene instead. Although harder to tie,
requiring an initial double throw and multiple knots, they
cause much less of a foreign-body reaction.