History

A limited, injury-specific history should determine when the trauma occurred. The mechanism of the injury helps determine the degree of injury, as well as the likelihood of injury to underlying tissue. High-energy injuries (e.g., a lawnmower injury) and crush injuries have a greater complication rate. The risk of a retained foreign-body and contamination risk should be determined. For example, was the laceration sustained by a farming accident ( Clostridium perfringens contamination) or when wading in a freshwater stream (Aeromonas hydrophila infection)? High-pressure water systems used for cleaning surfaces cause severe laceration-injection injuries that are at risk for Acinetobacter calcoaceticus infection. Animal bites require consideration of infection by the rabies virus or bacterial pathogens such as Pasteurella multocida and Capnocytophaga canimorsus (formerly called DF-2 bacillus). The circumstances surrounding the injury are usually of limited concern unless dangerous activities are involved (e.g., knife-throwing contests among adolescents). Finally, the complaint of any new paresthesia, anesthesia, weakness, or the loss of function suggests a neurovascular or tendon injury, prompting a rigorous examination of the affected site.

The past medical history should include questions concerning tetanus immunization status and conditions that increase the risk for infection or delayed wound healing (diabetes mellitus, immunosuppression, valvular heart disease, and asplenia). The patient with diabetic neuropathy is at risk for recurrent trauma. Asplenic patients with a dog bite require prophylactic antibiotic treatment against C. canimorsus.4

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