A 45-year-old construction worker presents to the emergency department after his hand got caught and pulled by a rotating machine, resulting in a severe degloving injury. The skin and soft tissues are extensively peeled back from the underlying muscles. In managing this wound, what is the most appropriate initial intervention?
Cover the injury with a clean, moist sterile dressing and elevate the extremity.
Apply a tourniquet above the site of the injury to minimize blood loss.
Clean the wound aggressively with iodine and cover with a dry bandage.
Immediately suture the degloved skin back to its original position.
The correct answer is 'Cover the injury with a clean, moist sterile dressing and elevate the extremity.' This approach helps to protect the wound from further contamination and desiccation. Moist dressings support the viability of any remaining tissue and potentially aid in the reattachment efforts. Elevation helps reduce swelling and decrease pain. Immediate suturing is inappropriate without thorough cleaning and assessment by a specialist, and using antiseptics directly can cause tissue damage and impair wound healing. Applying a tourniquet is incorrect unless there's life-threatening hemorrhage, which was not indicated in the scenario.
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BCEN CEN
Musculoskeletal and Wound Emergencies
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