Synopsis
Assess and clean acute wounds, select and perform safe simple closure, administer calculated local anaesthetic and recognise neurovascular, infectious and systemic complications.
- Control major bleeding and assess ABCDE before detailed wound care; tourniquet or operative haemorrhage control requires trained escalation.
- Record mechanism, time, contamination, foreign body, bite, tetanus risk, comorbidity and pre-procedure distal neurovascular and tendon function.
- Adequate analgesia, lighting, exposure, irrigation and exploration precede closure; never probe blindly near nerves, vessels, tendons, joints or body cavities.
Key red flags
Shock, spurting flow or expanding haematoma despite pressure requires immediate emergency or surgical control.
Abnormal sensation, movement, perfusion, exposed tendon or joint penetration requires specialist assessment before closure.
A deceptively small puncture after powered injection can cause extensive tissue damage and needs immediate surgery.
Neurological prodrome, seizure, hypotension or arrhythmia after injection requires immediate LAST response.
Reasoning priorities
Establish baseline and detect structure injury.
Document named movement, sensation and perfusion before anaesthetic obscures findings.
Worked reasoning
A 60-kg adult needs infiltration with a plain 1% lidocaine product whose SmPC gives 3–5 mg/kg and a general maximum of 200 mg.
- Confirm exact product, 10 mg/mL concentration, absence of adrenaline, weight, comorbidity and any other local anaesthetic already given.
- Calculate weight range 180–300 mg, then reason that the product’s lower 200-mg cap governs; 200 mg divided by 10 mg/mL equals 20 mL maximum.
- Use less than the maximum when adequate, label the syringe, inject incrementally with observation and never transfer the 20-mL figure to another formulation.
- Verify cumulative administered volume, monitor for toxicity, document calculation/product and keep LAST response available.