Author: Nikki Abela/ Editor: Liz Herrieven / Codes: / Published: 24/01/2022
There is something satisfying about seeing minor injuries and while many arent urgent, they almost certainly have the feel-good factor of being able to solve a problem quickly in a physiciany way (yes thats a word).
As Andy Neill put it in a previous blog:
Many of us love the “juicy minor” (a great term, kudos to my former colleague Zeshan Ali) – the minor injury with a clear pathway of what to do.
The patient fell hurting this bit of their limb and you do a pokey-pokey at the sore bit and get an x-ray. You check to see the radiographer hasn’t put a red dot on it and give the patient the wonderful news that their appendage isn’t broken. They feel satisfied that they’ve had a doctory experience and more importantly you feel you’ve done a good doctory thing.
Most minor injuries are orthopaedic problems, foreign bodies (where they shouldnt be) and wounds that need closing.
For orthopaedic problems it is very simple: as Andy put it, you take a history of mechanism, do a bit of pokey-pokey, decide whether to x-ray and take it from there.
Except kids can sometimes be a bit more complicated in that they wont let you poke them, or examination is unreliable. So, try to do the best you can with any tricks you can master. For example, when examining a leg, I always start with the toes this little piggy went to market.., so the child relaxes and when I move on to check for bony tenderness, I know more reliably that if they squirm over their tibia, for example, it is likely to be a toddlers fracture, if the age and mechanism fit. Small children will often give the answer they think will please you, so you might get a Yes to the question Does that hurt? whether it does or not. Watch their face and watch for squirming. Good distraction might be needed, particularly for the child who cries as soon as you approach bubbles or a smartphone work well. When theyre distracted and have stopped crying you can start to examine them.
You will also need to learn some techniques. Here we have outlined hair tourniquet removal, pulled elbows and patellar dislocation for you. Remember good old play therapy for anything you do, including closing lacerations.
Now when it comes to wounds and closure, glue and steri-strips go a long way in children as the alternative is generally under sedation or general anaesthetic. Obviously this wouldnt work for wounds over joints (as it will pull apart), eyebrows and lips and very deep or dirty wounds (bites shouldnt be closed due to the risk of infection, in general). Local anaesthetic (LAT) gel is your friend, along with analgesia (including Entonox if appropriate) and play therapy.
Eye examination is also important to get to grips with, and general principles and trauma are covered very nicely in this video from DFTB.
DFTB also have some excellent tips for when little monkeys put things in places they shouldnt and you should definitely have a look here as there is nothing more satisfying than removing a foreign body from an ear or nose.
The excellent DFTB team are in the process of creating a minor injuries blog book, so watch their space as it will be a good reference point. Most departments will have a handbook for you to follow, and if you dont know, then ask it is what Team ED is for.
