Simulated Patient Scenario

Scenario Details

MDT Information

• Non-Urgent Response - Minor Injury / Cut
• 30-year-old male cut hand while cooking
• Bleeding reportedly controlled with pressure
• Patient is conscious and alert
• Location: Home address

On Arrival

You arrive at an apartment and are greeted by the patient, a 30-year-old male. He is sitting at the kitchen table, holding a tea towel wrapped around his left hand. There are some blood spots on the tea towel and the table. He appears calm but slightly concerned about the cut.

Initial Impression and Primary Survey

Secondary Survey and Simulation Progression

History (obtained from patient)

Vital Signs/Assessment (Initial)

Physical Examination (Wound Assessment)

• General Appearance: Alert, cooperative.
• Left Hand Wound: (After carefully removing tea towel) Linear laceration (~2.5 cm long) located on the palmar aspect, over the thenar eminence (base of thumb). Edges appear clean/tidy. Depth appears superficial to subcutaneous tissue, no obvious tendon, nerve, or vessel involvement visible. Minimal ongoing capillary ooze easily controlled with direct pressure. No foreign bodies visible.
• Neurovascular Status (Left Hand - Distal):
  • Circulation: Hand warm, pink. Capillary refill < 2 seconds in fingers. Good radial pulse.
  • Motor: Able to flex/extend thumb and fingers fully (assess opposition, flexion/extension at IP/MCP joints). Good grip strength.
  • Sensation: Sensation intact to light touch over thumb, index, middle, ring, and little fingers (median, ulnar, radial nerve distribution). Two-point discrimination intact if tested.
• Other: No other injuries noted.

Assessment and Treatment

Appropriate Management Focus

• Primary Survey (ABCDE): Confirm stability.
• Wound Assessment: Carefully expose and assess the wound - location, size, depth, edges, contamination, foreign bodies, neurovascular status distal to injury.
• Haemorrhage Control: Apply direct pressure with sterile gauze. Elevate hand if needed. Confirm bleeding is controlled (likely minor capillary ooze).
• Wound Cleaning: Gently clean the wound and surrounding skin with sterile saline or water.
• Wound Closure (Consideration):
  • Assess suitability for prehospital closure (if within scope/protocols). This wound (linear, clean, <12 hrs old, easily approximated edges, low tension, no deep structure involvement) might be suitable for steri-strips or tissue adhesive.
  • If closing: Ensure wound is clean and dry. Approximate edges carefully. Apply steri-strips or tissue adhesive according to training/protocol.
  • If not closing prehospital (or if closure fails/unsuitable): Apply sterile non-adherent dressing and bandage.
• Tetanus Status: Enquire about tetanus vaccination history. Advise patient to check status with GP, especially as last dose >10 years ago.
• Pain Management: Offer simple analgesia (e.g., Paracetamol, Ibuprofen) if required and not already taken effectively.
• Patient Advice: Provide advice on wound care (keep clean and dry), signs of infection (redness, swelling, pus, increased pain, fever), need for follow-up (GP review, tetanus booster).
• Transport Decision: For a simple, clean laceration with intact neurovascular function, easily controlled bleeding, and suitable for basic closure/dressing, transport to ED may not be mandatory *if* patient is reliable, understands advice, and has follow-up arranged (e.g., GP). Discuss risks/benefits. Offer transport. If any doubt about depth, contamination, function, or if prehospital closure not performed/appropriate, recommend transport for formal assessment/closure.
• Documentation: Record detailed wound assessment, neurovascular status, cleaning method, closure method (if performed) or dressing type, tetanus advice, wound care advice, and disposition plan (including patient understanding).
• Teamwork & Communication: Explain findings and treatment options to patient. Ensure patient understands follow-up advice.

Debrief Focus Points

• Systematic wound assessment (location, size, depth, edges, contamination, neurovascular status).
• Principles of haemorrhage control for minor wounds.
• Wound cleaning techniques.
• Indications and contraindications for prehospital wound closure (steri-strips, tissue adhesive).
• Importance of assessing and advising on tetanus status.
• Providing effective wound care and follow-up advice.
• Criteria for determining appropriate disposition (transport vs. non-transport) for minor lacerations.
• Documentation requirements for wound management.