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Superficial injuries

Clinical Discipline(s)/Organ System(s)
Emergency Medicine
Progress Test Topic(s)
Skin
Description
A 64 year old NZ European woman attends the Emergency Department after cutting her hand when the knife slipped while slicing vegetables. She is expecting to have sutures. You are a medical student who goes to see the patient with the junior doctor, who asks you to take a history.
Applied Science for Medicine 
   - Anatomy of skin and underlying soft tissue
   - Mechanisms controlling haemostasis: platelets and coagulation factors
   - Terminology for describing an injury: e.g. laceration, contusion
   - Different types of suture and classification of suture materials
   - Process of wound healing
   - How vaccinations induce an immune response
   - Pharmacology of local anaesthetics, paracetamol, non-steroidal anti-inflammatory drugs, opioids
Clinical and Communication Skills 
   - History from a patient with minor trauma; assess for symptoms of early cognitive decline; consider risk factors for deliberate self-harm and non-accidental injuries
   - Recognise and respect different expectations regarding management (e.g. if you think the patient doesn't need sutures)
   - Perform an examination of a wound and recognise complications
   - Differential diagnosis of superficial injury
   - Perform an intramuscular injection
   - Interpret hand X-ray, full blood count
   - Management of superficial injury including animal/human bites, obtaining consent
   - Complications of a superficial injury
   - Acknowledge the pain and fear of needles
   - Role of the surgical team and plastic surgeon
Personal and Professional Skills 
   - Role of the Accident Compensation Corporation (and completion of paperwork: ACC45)
Hauora Māori 
   - Rongoā and wounds
   - Differential ACC claims and rehabilitation for Māori vs non-Māori
   - Differential impact of injuries on employment/income for Māori (i.e. more likely to be employed in ‘manual’ jobs)
Population Health 
   - Epidemiology of deliberate self-harm and domestic violence
   - Strategies for preventing cutting and piercing injuries
   - Strategies for prevention of tetanus (vaccination)
   - Epidemiology of early cognitive decline
Conditions to be considered relating to this scenario
Common
accidental trauma, animal bites, human bites, blunt trauma, fall, assault, domestic violence
Less common but 'important not to miss'
non-accidental injury, road traffic crash, tetanus, wound infection, penetrating injury, deliberate self-harm