The Hugest of the Huge Hematomas

Welcome to our new series, “Guts and Gore.” That title should serve as a warning that some of the videos we will use as teaching tools may be controversial and not for weak stomachs. We hope, however, that part of why you became an emergency provider was to handle sticky situations like the ones we will present. People like us have the ability to ignore blood and copious discharge, and instead focus on saving and improving the lives of our patients. Rarely are you thanked for this ability, and we hope this series on guts and gore will improve your technique, even when the going gets tough.   The Approach n Proper identification of hematoma requiring drainage n If unsure, use ultrasound-guided technique to identify fluid collection. Note: Much of the blood is a clot, with some free blood. n Consider the use of IV or PO pain medication. n Incision and drainage (I&D) n Packing application n Knowing the signs of compartment syndrome. n Follow up with packing removal (if indicated) and/or surgical follow-up.   The Procedure n Obtain a marking pen, mask, sterile gloves, gown, suture kit (for use of tools only), gauze, ACE bandage wrap, ¼-inch packing, and 1% lidocaine with epinephrine. n Always have the patient lay supine for any I&D procedure to avoid vagal response. n Mark the area with a pen. Highlight the area that encompasses the hematoma. This area should be carefully watched for the next 24-48 hours if you are concerned about compartment syndrome...
Source: The Procedural Pause - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs