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Case 331

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A 45-year-old male patient, previously healthy, had a sickle accident in the rural area 40 minutes ago. Search Basic Health Unit with left index finger injury (photo).

Regarding the most appropriate approach for the patient, it is INCORRECT to state:

a) In the case of a tetanus-ignored vaccination regimen, tetanus vaccine and immunoglobulin are required.

25%

b) The case can be conducted in the basic health unit with wound washing and dressing with the use of gauze soaked in saline solution.

25%

c) In these cases of deep laceration, one of the alternatives for treatment is partial skin grafting.

25%

d) The fact that the lesion occurred in rural areas is decisive in the choice of antibiotic.

25%
   

Image Analysis

 

Image 1: Photograph of the left-hand index finger after trauma evidencing deep soft tissue lesion with distal phalange bone exposure and nail bed involvement

Highlights

Correct approach in cases of extremity injuries:

- If skin avulsion is <1cm, without bone involvement: pressure to stop the bleeding + washing with saline + dressing with gauze soaked in saline solution;

- If the skin avulsion is >1cm: stop bleeding with compression + washing with saline solution + dressing with gauze soaked in saline + refer for the trauma reference;

- Always check the vaccination situation for tetanus;

- In case of bone involvement or doubts: conventional radiography at least two incidences - posteroanterior and lateral;

- The choice of antibiotic therapy depends on the situation in which it occurred and the presence of associated fracture.

References

- Sexton D. UpToDate [Internet]. Uptodate.com. 2018 [cited 12 October 2018]. Available from: https://www.uptodate.com/contents/tetanus?source=history_widget#H1917252

- Caetano EB, Almagro MAP, Camargo Neto AA, Franco RM, Santalla TP. Lesions of the extremities of the fingers, nails and nail bed. Rev. Fac. Ciênc. Méd. Sorocaba, v. 12, n. 4, p. 1 - 5, 2010.

- Schmitt S. UpToDate [Internet]. Uptodate.com. 2018 [cited 12 October 2018]. Available from: https://www.uptodate.com/contents/osteomyelitis-associated-with-open-fractures-in-adults?topicRef=13798&source=see_link

- Pires EMSG, Souza Junior JL, Oliveira MDC. Trauma of extremities. São Paulo: Albert Einstein; 2018. p. https://pubdiretrizes.einstein.br/download.aspx?ID=%7BB50C30F3-7FA9-4BCE-BC6C-9FD76EE256A5%7D.

- Braga Silva J, Gehlen D. Management of lesions of the extremities of the fingers.Revista da AMRIGS, Porto Alegre, 52 (3): 223-230, jul.-set. 2008.

Authors

Ariádna Andrade Saldanha da Silva, 6th year medical student at Universidade Federal de Minas Gerais

E-mail: ariadna.andrade[at]hotmail.com

 

Maria Thereza de Bastos Almeida, 6th year medical student at Universidade Federal de Minas Gerais

Email: mariathe_[at]hotmail.com

Supervisor

Túlio Vinícius de Oliveira Campos, Assistant Professor at Universidade Federal de Minas Gerais.

Email: tuliovoc[at]gmail.com

Reviewers

Bernardo Finotti, Lucas Cantaruti, Prof. José Nelson Mendes Vieira, Profa. Viviane Santuari Parisotto Marino

Translated by

Eduardo José Paolinelli, 6th year medical student at Universidade Federal de Minas Gerais

E-mail: eduardopaolinelli[at]gmail.com

 

Test question

(MEDICAL ASSOCIATION OF RIO GRANDE DO SUL - 2015) While working on a lettuce plantation, a 36-year-old man suffers an accident with extensive wounds, exposing a fracture of the distal end of the tibia. At the physical examination, there is great bleeding in the area of the wound, but with good perfusion of the toes. Which of the following antibiotic regimens is most appropriate in this situation?

a) Cefazoline and gentamicin.

25%

b) Cefazoline and vancomycin.

25%

c) Cefazoline and penicillin.

25%

d) Cefazoline, gentamicin and penicillin.

25%

e) Amikacin and vancomycin.

25%
   

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