First generation cephalosporin for low grade open fracture
Cefazolin dosing per local protocol
Early administration priority
Add gram negative coverage for severe open injury
Gentamicin per local protocol
Monitor renal function
Tetanus prophylaxis
Tetanus prevention
Vaccine indications based on wound type and immunization history
Clean minor wound thresholds
Dirty major wound thresholds
Tetanus immune globulin indications
Unknown or incomplete immunization with dirty major wound
Immunodeficiency with non minor clean wound
Vaccine product choice
Tdap when never received as adult
Td for boosters per schedule
Pain control after discharge
Analgesia plan
Acetaminophen scheduled or as needed
Maximum daily dose counseling
Avoid duplication with combination opioids
NSAID as needed if no contraindication
Renal and GI risk counseling
Avoid in high bleeding risk
Short course opioid for severe pain
Small quantity
Avoid driving and alcohol
Special Populations
Pregnancy
Pregnancy considerations
Imaging selection
Radiograph shielding when feasible
Ultrasound preference for soft tissue questions
Medication safety
Acetaminophen preferred first line analgesic
Avoid NSAID in later pregnancy when possible
Antibiotic selection
Beta lactams preferred when indicated
Avoid doxycycline in pregnancy
Geriatric
Older adult considerations
Fragile skin and poor perfusion
Gentle tissue handling
Higher dehiscence risk
Anticoagulant use prevalence
Bleeding control planning
Medication review and reversal pathway awareness
Delayed healing risk
Longer suture retention planning
Close follow up scheduling
Pediatrics
Pediatric considerations
Cooperation and analgesia needs
Child life support
Procedural sedation pathway
Weight based medications
Local anesthetic maximum dose calculation
Antibiotic dosing by weight
Non accidental trauma consideration
Inconsistent history
Pattern injuries
Background
Epidemiology
Epidemiology overview
Common ED presentation
Occupational and kitchen injuries
Sports and glass related injuries
Infection risk modifiers
Bite wound higher infection rates
Delayed presentation higher infection rates
Functional impact
High risk of missed tendon injury
High risk of missed nerve injury
Pathophysiology
Injury anatomy
Skin and subcutaneous disruption
Dead space and hematoma formation
Bacterial inoculation risk
Tendon injury patterns
Flexor tendon retraction risk
Extensor tendon superficial exposure
Neurovascular injury patterns
Digital nerve transection causing sensory loss
Digital artery injury causing perfusion compromise
Therapeutic Considerations
Key therapy principles
Infection prevention balance
Irrigation and debridement primary
Antibiotics targeted to high risk scenarios
Function preservation
Early detection of tendon and nerve injuries
Immobilization when indicated
Local anesthetic choices
Duration matching procedure and pain
Epinephrine use individualized to perfusion risk
Patient Discharge Instructions
Copy discharge instructions
Discharge instructions for chart
Wound care
Keep dressing clean and dry for first 24 hours
After 24 hours gentle soap and water rinse allowed unless instructed otherwise
Activity
Elevation above heart for swelling for 24 to 48 hours
Avoid heavy use until cleared
Splint care if provided
Keep splint on as directed
Return if splint feels too tight or fingers become pale or numb
Pain control
Acetaminophen as directed
NSAID as directed if safe for you
Return to ED now for
Increasing pain not controlled by medication
New numbness or inability to move finger
Fingers turning blue pale or cold
Spreading redness warmth swelling
Pus drainage or fever
Bleeding that will not stop with 10 minutes of firm pressure
Follow up
Wound check timing per plan
Suture removal timing per plan
Tetanus
Vaccine update given today if indicated
Future booster scheduling reminder
References
Guidelines and key sources
Evidence and guidelines
CDC tetanus wound management guidance
Clean minor versus dirty major wound stratification
Vaccine and TIG indications by immunization history
Canadian immunization guidance for tetanus prophylaxis
TIG plus vaccine recommendation in some immunodeficiency scenarios
Wound based prophylaxis tables
Digital nerve block epinephrine safety literature
Systematic review evidence in healthy digits
Caution in compromised circulation
Flexor tendon laceration evaluation references
Two point discrimination before anesthesia
Capillary refill and digital Allen test utility
Bite wound antibiotic prophylaxis references
Amoxicillin clavulanate first line
Alternatives for beta lactam allergy
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.