What is the mechanism of injury? Sharp/penetrating injuries with lacerations may have wider zones of injury and also injury to deeper structures than what may be obvious based on skin injury. Chemical burns require immediate removal of clothing and significant cleansing of skin with saline/water. Frostbite injuries require rapid warming. Crush injuries often compromise microvasculature to the skin and result in delayed tissue necrosis. Animal or human bites require specific antibiotic coverage and based on the location possible surgical intervention.

What is the neurovascular exam? Lacerations may result in arterial injury which may require emergent intervention. Injury to peripheral nerves typically result in focal deficits. Crush or burn injuries may have more global deficits. A major complication of frostbite injury is vascular thrombosis.

What is the exact location of the injury? Dorsal hand lacerations have a very different acuity and spectrum of injuries compared to palmar lacerations. The skin injury caused by “fight bites” may appear more proximal than when the fingers were flexed during impact, obscuring potential joint involvement.

How long ago was the injury? Especially with injuries involving the blood supply to the hand, temporality is important when considering revascularization, thrombolysis, rewarming, etc.

Consistent direct pressure placed onto site of active bleeding.

A blood pressure cuff which can be placed proximally as a tourniquet during wound exploration for hemostasis.

Rapid rewarming of patient (warm IV saline, forced-air warming unit, increased room temperature) and extremity (in water with temperatures around 40–42 °C) if frostbite has occurred or if there is consideration for a vascular repair.

Tetanus prophylaxis.

Removal of all clothes if chemical burn.

Patient should be immobilized until you arrive.

Analgesia for comfort.

Local anesthetic (e.g., lidocaine) for local or peripheral nerve block.

Hold antibiotics until a culture can be obtained (for infections).

Dysvascular limb (from laceration or thrombosis)