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CEN and TCRN Extremity Injury

Updated: May 22, 2022


1. Do not remove impaled objects.

2. Do not shave hair around wounds, use clippers (scissors) or ointment to hold hair out of way; irrigate with NS at low pressure to clean, at high pressure to remove bacteria.

3. Avoid xylocaine with epinephrine on digits, ears, nose, avulsion injuries – increases infection.

4. Remove vegetative matter (thorns, splinters, cactus spines) ASAP since they soak in fluid. Do not soak! Do not show on x-ray, so get MRI.

5. Tetanus found in animal excrement, farm accidents highest risk. Administer TIG if dirty wound and unsure of vaccine status.

6. Poor wound healing in decreased tissue perfusion, poor nutrition, vascular compromise (smoker, DM, CAD, anemia), medications that slow collagen formation (steroids, phenytoin), advanced age.

7. Abrasions – pain control and clean thoroughly to prevent scarring/tattooing (stain under skin)

8. Contusions/hematomas – greater infection risk since blood is a medium for bacterial growth.


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