Chapter 75: Common Injuries

Wound management begins with understanding the four-phase healing process—coagulation and hemostasis, inflammatory cell infiltration, epithelialization with cellular migration, and tissue remodeling through contraction and collagen deposition—which informs decisions about closure timing and follow-up care. Assessment prioritizes establishing mechanism of injury, immunization status, and potential involvement of underlying structures like tendons or neurovascular bundles, with management centered on high-pressure saline irrigation, debridement of nonviable tissue, and selection of appropriate closure methods based on location and contamination risk. Animal bites demand particular attention because certain bite patterns carry substantially elevated infection rates; specifically, feline bites create deep puncture wounds that frequently become infected despite appearing minor, while human fight bites over the knuckles pose distinct risks for joint space inoculation and septic arthritis. Arthropod injuries range from localized reactions manageable with ice and analgesia to life-threatening anaphylaxis, an immunoglobulin E-mediated hypersensitivity response requiring intramuscular epinephrine as the definitive emergency treatment. Burns require classification by depth—superficial burns affecting epidermis only, partial-thickness burns creating fluid-filled blisters, and full-thickness burns destroying all dermal structures—and triage based on total body surface area involvement, with major burns necessitating transfer to specialized burn centers and chemical burns requiring extended irrigation protocols. Head trauma assessment relies on the Glasgow Coma Scale for baseline neurological documentation, with computed tomography indicated when scores fall below fifteen or when loss of consciousness occurs; specific traumatic intracranial lesions including epidural hematomas with characteristic lucid intervals, subdural hematomas with variable temporal progression, and increased intracranial pressure with its progressive clinical manifestations demand rapid recognition. Thoracic injuries including pneumothorax and hemothorax present with dyspnea and reduced breath sounds, with tension pneumothorax representing a medical emergency requiring immediate needle decompression to relieve mediastinal shift and restore cardiac filling. Foreign body management varies significantly by anatomical location, from insect immobilization in ear canals to recognition that ingested button batteries represent true emergencies due to rapid mucosal injury potential, with clinical suspicion for non-accidental insertion guiding assessment in sensitive body areas.