SU10.4 | Basic First Aid, Suturing and Minor Procedures — Summary & Reflection

KEY TAKEAWAYS

Basic first aid, suturing and minor procedures are the widest-reaching, most frequently used surgical skills, and where avoidable harm most often occurs. In first aid, assess and treat by ABCDE, controlling external haemorrhage with direct pressure first (tourniquet only for catastrophic uncontrolled limb bleeding). The safety-critical principle is local anaesthesia: maximum safe doses are lignocaine 3 mg/kg plain and 7 mg/kg with adrenaline and bupivacaine 2 mg/kg (most cardiotoxic) — always calculated in mg/kg, aspirating before injection, with local-anaesthetic systemic toxicity treated by 20% intralipid. Choose absorbable sutures for buried layers and non-absorbable monofilament for skin and contaminated wounds, and give tetanus prophylaxis for tetanus-prone wounds (contaminated, devitalised, puncture, or >6 h). The technique is wound toileting (irrigate and debride), the simple interrupted suture (perpendicular entry, equal everted bites, flat instrument tie), and abscess incision and drainage healing by secondary intention. Interpreting the wound dictates closure: primary for clean recent wounds, delayed primary for contaminated or late but viable wounds, and secondary intention for tissue loss, infection or drained abscesses — never closing infection in, and referring complex wounds. These are mastered in simulation before reaching a patient.

REFLECT

Think back to a wound or injury you have seen managed. Could you now calculate the safe local-anaesthetic dose for that patient in mg/kg, and would you have chosen the right closure — primary, delayed primary or secondary — for that wound? When you next practise on a suturing pad or in a skills lab, slow down at the two danger points: the dose calculation (state the weight, do the mg/kg arithmetic out loud, aspirate) and the closure decision (is this wound clean enough to close now?). Reflect on one habit you will deliberately build now — always calculating and stating the local-anaesthetic maximum before drawing it up, or always asking 'should this wound be closed at all?' — so that the safe rules are automatic before you treat a real injured patient.