Aims For The Week

  • Perform a comprehensive hand examination

  • Discuss the management of bite injuries

  • Recognise and describe the management of flexor tendon sheath infections

  • Describe the management of wrist wounds

  • Explain the initial management of major burns

  • Describe burns and implement surface area calculations

  • Initiate the immediate management of minor burns

  • Recognise and assess significant skin lesions

  • Describe complex wound suturing techniques

  • Discuss the management of nailbed injuries and complaints


What do we see?

Hand and wrist injuries are common presentations to the emergency department – be it through deliberate self-harm or through accidental means. Nailbed injuries and skin lesions are seen daily in the minors department. Burn victims are not uncommon to find in resus. We also see plenty of trauma that involves having an adequate and timely suturing technique.


HAnd examination

Hand injuries are a common presenting problem in emergency departments. Accurate evaluation and treatment are essential to prevent short and long-term dysfunction. Typically, plastic surgeons are interested in dealing with injuries distal to the carpal bones.

Hand anatomy.jpg


Hand injuries account for 5-10% of attendances to EDs in the UK. So here are some hand-y guides to managing hand-y digit injuries and knowing when to refer to the plastics team.



Bite injuries to the hand be it from a fight-bite or from animals, particularly cats and dogs, often present to the ED. Though they may seem benign, these can lead to devastating infections and adverse consequences for hand function, if not managed with care.


Wrist wounds

Wounds to the wrist, be it through deliberate self-harm or unintentional must be treated promptly in order to maintain normal hand function. We must also consider the devastating psychological impact of these wounds for our patients.


Major burns

It is a widely accepted fact that severe fluid loss is the greatest problem faced following major burn injuries and appropriate fluid management directly improves the survival rates of burn patients. Therefore, this is one of the cornerstones of modern burn treatment that should be initiated in the ED.

Corrosive substance attacks are on the increase, as reflected in the media. A helpful resource has been produced by our colleagues at St Emlyn’s.

As we are all aware ‘children are not small adults’ and, therefore, our approach and care toward this population differs. Please refer to this helpful document on how to manage burns in these patients.

Electrical burns can be misleading in their depth. Why not increase your depth of knowledge on them with this RCEM tutorial?

Remember, remember….exam fodder on burn’s



The extent of a burn is expressed as the percentage of the body surface area affected, total burn surface area (TBSA). There are several standard methods for estimating TBSA:

  1. The Rule of Palm assumes that the palm (including the fingers) of the person who is burned is about 1% of the body.

  2. Lund and Browder

  3. Rule of 9's



Patients often present to the emergency department with skin lesions that concern them, either due to their unusual appearance or the rate at which they have grown. It is important to recognize the more sinister of these lesions and refer for assessment with potential removal. Plastic surgeons specialise in removing skin lesions, both cancerous and non-cancerous.



Timely referral to plastic surgeons is essential as they play an important role in the treatment of complex wounds by adopting early surgical treatment and, hence contributing to the effective resolution of cases.


Nail injuries

Handy guides to rapidly relieving the pain from these well known injuries.


Test Your Knowledge


All mapped to the ACCS & Emergency Medicine HST curriculum!

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Hannah Bell