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Principles of management

Basically, it goes: irrigate, anaesthetise, clear, suture. Or IACS (pronounced YAKS - pretty terrible, eh?)

  • Irrigation - an lots of it! Use 0.9% saline solution and really give it a good clean.
  • Anaesthetise - Infiltrate with local anaesthetic - lidocaine 4mg/kg plain or 7mg/kg with adrenaline. Adrenaline is used where vasconstriction is required. Wait for both anaesthetic (3m) and vasoconstrictor (7m).
  • Clear - remove debris, foreign bodies, necrotic tissue; ragged/shelved skin needs trimming. Be careful around the face (try calling plastics).
  • Suture - the "putting it back together" bit. Avoid skin tension and wound inversion in call cases.
  • Removal of stutures - get 'em out after the appropriate amount.