Accurate H&P Report Crucial to Treat Puncture Wounds

A deep wound caused by a sharp and pointed object (for example, a nail) is known as puncture wound. The opening of the skin would be small and such wounds may not bleed much. However, delayed diagnosis or inappropriate management can put puncture wounds at the risk of infection, osteomyelitis (inflammation of bone or bone marrow) or other complications. Wound care physicians should conduct a proper physical examination and check out the patient’s history to provide effective treatment at the right time. Accurate and complete history and physical examination (H&P) report is crucial for treating puncture wounds. Here is a detailed view on the importance of H&P reports.

Better Evaluation

Careful inspection of the puncture wound is essential to avoid infection and for that a proper physical examination and effective documentation is required. For example, penetration into deep structures including tendons and joint capsule may allow infectious organisms to thrive because of the relative avascularity with these structures. Estimating the true depth of the wound and recording it properly will help physicians identify the risk quickly and provide proper treatment. Evaluation of wound edges and their documentation is also very crucial. If there is lesser chance for clean wound edges or margins to harbor bacteria, jagged, irregular wound margins can lead to skin necrosis (a complication that leads to the death of skin tissue).

Preventing Complications

Accurate patient history is very important for preventing complications and/or reducing the spread of infectious processes, in case of puncture wounds. For example, when it comes to managing pedal puncture wounds, one should begin with a comprehensive medical history that includes the patient’s current medications and allergies. It is crucial to ascertain the time and date of the injury and any treatment that may have been given, which would be documented in the patient’s history. The history report will help to determine the environment in which the wound occurred and also the type of object that caused the wound. You can also determine the shoe gear that the patient wore, if any. All this information will help you identify the type of organism that can cause infection and determine whether there is the possibility of a foreign body. You can get the patient’s tetanus status from the history, which is very useful since puncture wounds can be Clostridium-prone.

A unique set of factors need to be considered in the case of a diabetic patient who presents with a puncture wound. Such patients often remain unaware of the initial injury because of a loss of protective sensation. Tetanus immunization history is also very relevant. Peripheral neuropathy, immunopathy and peripheral arterial disease can also contribute to a greater risk for complications. With a comprehensive medical history report, it is easy to identify the possibility of such complications and take precautions as early as possible.

Treatment Decisions

The most critical factor that determines whether or not an infection develops and the severity of complications that follows a puncture wound is the delay between the time of the injury and the initiation of treatment. A problem-focused history and physical examination that gives specific attention to the details of the source and time-lapse of injury helps physicians give special consideration to puncture wounds with co-morbidities and take appropriate treatment decisions. If the wound is presented in the delayed setting, is deep or has significant clinical contamination, incision and drainage will have to be performed. Triangulation with fluoroscopy and/or ultrasound can be helpful in the case of a retained foreign body. If the patient is presented early (less than six hours) with a clean, non-infected puncture wound and has no medical co-morbidities, clinical treatment is required. All these decisions are taken based on the details specified in the H&P report.

Rather than using a general EMR, you can use wound EMR that supports only wound-specific templates. This will help you to quickly enter and access details in the H&P report, take treatment decisions promptly and expedite wound healing. If the EMR system is supported with a physician and nurse interface, you can further reduce the communication gap.