Trauma

Palm laceration from broken glass — wound assessment and management

Foundation

Adult · 28yr · female

Patient Information

Dispatch	You are called to a 28-year-old female (Priya Mehta) at a laneway food festival who has a deep cut to her right hand after reaching into a crate of supplies behind one of the food stalls. She has a cloth wrapped around her hand and there is visible blood soaking through.
Patient	Priya Mehta — 28yr (63kg)
Incident History	Patient was helping a friend at their food stall and reached into a crate of bottles when her palm caught a broken glass shard. Immediate onset of pain and brisk bleeding. She wrapped a cloth around the wound herself. No mechanism for any other injury. Right-hand dominant.
Emergency Contact	Ravi Mehta (Brother) — 0412 338 872

Initial Rapid Assessment

Response	Alert
Airway	Patent. Speaking clearly.
Breathing	Comfortable. RR 14. No respiratory distress.
Circulation	Radial pulse (right) palpable. Skin warm. Blood soaking through cloth wrapping on right hand — bleeding present but not life-threatening. CRT <2s (left hand). No other external haemorrhage.
Disability	GCS 15 (E4V5M6). Alert and orientated. Anxious and in pain.
Exposure	Right palm — approximately 3–4cm laceration to the thenar eminence (base of thumb, ulnar side). Wound edges are gaping. Possible glass fragment visible at wound base on inspection. Surrounding skin is intact. No vascular involvement — capillary bleeding only, no arterial spurting.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	99% (RA)	Nil	14	88	118/74	<2s	15	4 4 ++	36.9	–	6
15 mins	99% (RA)	Nil	14	80	114/72	<2s	15	4 4 ++	36.9	–	4

History Taking

Treatment Response

Diagnosis

Laceration to the thenar eminence of the right dominant hand from a glass foreign body. Approximately 3–4cm, gaping wound edges. Wound requires irrigation, foreign body assessment, and closure strips — it will subsequently need medical review for formal closure (sutures or tissue glue) as gaping lacerations at this size and location are beyond EHS scope to definitively close. Tendon and median nerve function are intact in this scenario but must be assessed. A glass shard is visible at the wound base — removal of superficial visible foreign bodies is within scope, but deep probing is not.

Facilitator Triggers — if trainees miss a critical step

! (If trainees do not irrigate the wound before dressing — prompt: 'The wound is contaminated with glass particles from the crate — what do you need to do before dressing?' Facilitator note: irrigation with clean water or saline removes debris and significantly reduces infection risk. This is a critical step before closure.)
! (If trainees do not assess for a foreign body — prompt: 'You can see the wound base now — is there anything you should be looking for?' Facilitator note: a glass fragment is visible. Visible, accessible foreign bodies should be removed. The patient should be informed that glass can be difficult to detect fully and medical review with possible X-ray is required.)
! (If trainees do not assess tendon function — prompt: 'The laceration is at the base of the thumb — what structures are nearby that you should check?' Expected: trainee should ask patient to flex the thumb, flex and extend fingers, and compare grip strength. All are intact in this scenario.)
! (If trainees do not assess sensation — prompt: 'The median nerve runs in this area of the palm — is there anything you should check?' Expected: assess sensation on the palmar surface of the thumb and index finger. Sensation is intact in this scenario.)
! (If trainees attempt to suture or deeply probe the wound — facilitator note: suturing and deep wound probing are not within EHS scope. Apply wound closure strips to approximate gaping edges and arrange appropriate medical follow-up.)

Treatment Objectives

1. Ensure scene safety — glass shard risk to both patient and EHS officer; move away from crate area.
2. Don appropriate PPE — gloves essential for blood exposure.
3. Perform Primary Survey — confirm no life-threatening haemorrhage. Bleeding is capillary, not arterial.
4. Apply initial direct pressure to control bleeding while preparing for wound assessment.
5. Remove and replace the cloth — inspect the wound under clean conditions.
6. Irrigate the wound thoroughly with clean running water or saline — remove debris, blood, and glass particles. Irrigation is the single most important infection prevention measure.
7. Identify and remove the visible glass shard using forceps if available — do NOT deeply probe the wound. Inform patient that glass foreign bodies can be difficult to fully detect and medical review with possible X-ray is recommended.
8. Assess wound depth and structure involvement — estimate depth, look for exposed structures (tendon, bone, or fat).
9. Assess tendon function — ask patient to flex and extend all fingers and the thumb independently; compare grip strength bilaterally. Document normal function.
10. Assess sensation — light touch to the palmar surface of the thumb and index finger (median nerve territory). Document intact sensation bilaterally.
11. Assess radial and ulnar pulses — both intact.
12. Apply wound closure strips (steristrips) to approximate gaping wound edges — do not close under tension. This is a temporary measure.
13. Apply a non-adherent dressing and a clean dry bandage wrap. The wound will require formal medical closure (sutures or tissue glue) — arrange urgent GP or Emergency Department review.
14. Advise patient: seek medical review within 4–6 hours for formal wound closure; watch for signs of infection (increasing redness, warmth, pus, fever); confirm tetanus status with her GP.
15. Offer Methoxyflurane if pain is significant and patient is cooperative.
16. Document all findings — wound description, foreign body removed, neurovascular assessment results, advice given.
17. Scenario ends when wound is dressed and patient is advised on follow-up.
18. Attention to hand hygiene will be given throughout the scenario.

Clinical references: Wound Management · Primary Survey · Secondary & CNS Survey · Methoxyflurane · Bleeding Control

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Signs/Symptoms	Pain and bleeding from the right palm. No numbness or tingling in the fingers. Able to flex all fingers, including the thumb, with some pain on movement.
Allergies	NKDA.
Medications	Oral contraceptive pill. No anticoagulants.
Pertinent History	No prior hand injuries. Nil bleeding disorder. Right-hand dominant — works as a graphic designer. Last tetanus — approximately 8 years ago (unsure of exact date).
Last Oral Intake	Lunch approximately 2 hours ago.
Events Leading	Patient was assisting at a friend's food stall when she reached into a crate without looking and caught her palm on a broken glass bottle shard. She does not know if any glass remains in the wound.
Treatment Prior	Wrapped a cloth around the hand herself immediately after the injury.

Onset	Approximately 15 minutes ago — immediate after glass contact.
Pain	Sharp pain at the wound site, now a constant aching.
Quality	Sharp, now constant aching.
Radiates	Nil radiation.
Severity	6/10.