Surgery and Emergency Revision for AHW in Nepal: Assessment, First Aid and Referral

Ensure scene safety, use infection-prevention measures and assess the patient using a recognized emergency sequence. Identify catastrophic bleeding, airway obstruction, breathing failure, circulatory shock, altered neurological status and major exposure or environmental risk.

Call for help early. Stabilization and transport should happen in parallel when definitive care is not available. Reassess after every intervention and document changes.

Control external bleeding with firm direct pressure and an appropriate dressing. If life-threatening limb bleeding is not controlled, use a tourniquet only according to current emergency guidance and training, record the time and expedite transfer.

Assess contamination, depth, tissue damage, neurovascular function and possible foreign material. Wound closure, drainage, antibiotics and tetanus prophylaxis depend on the wound and patient; they should not be applied automatically from a revision note.

Stop the burning process and cool a recent thermal burn with cool running water, while avoiding hypothermia. Remove constricting items when safe, cover the burn with a clean non-adherent material and assess airway involvement, depth, extent and associated trauma.

Do not apply ice, toothpaste, mud, oil or other harmful substances. Significant burns, electrical or chemical injury, inhalation injury, circumferential burns and burns affecting critical areas need specialist advice or referral. Fluid decisions require current guidance, accurate assessment and monitoring.

Suspect fracture when trauma causes pain, swelling, deformity, tenderness or loss of function. Cover open wounds, immobilize the limb in the position found when appropriate and assess pulse, skin colour, warmth, movement and sensation before and after splinting.

Do not attempt reduction unless a current protocol, training and clinical situation clearly authorize it. With significant trauma, protect the cervical spine and minimize movement while maintaining the airway. New weakness, numbness, loss of bladder control or altered consciousness requires urgent transfer.

Assess consciousness repeatedly with a recognized scale, pupils, vomiting, seizure, neurological deficit and signs of skull injury. Deterioration, anticoagulant use, significant mechanism or persistent symptoms can require urgent higher-level assessment.

Severe or worsening abdominal pain, guarding, rigidity, persistent vomiting, distension, gastrointestinal bleeding, shock, pregnancy-related pain or an irreducible painful hernia are referral warnings. Keep the patient appropriately monitored and avoid delays for an uncertain bedside label.

The uploaded material gives step-by-step incision, wound packing, sedation, manual reduction and medicine regimens. Publishing these as universal instructions could encourage care outside competence and overlook contraindications, allergies, antimicrobial resistance and updated protocols.

For examination preparation, learn indications, contraindications, required equipment, asepsis, complications, aftercare and referral boundaries. For patient care, use the current protocol, supervision and facility system. Educational recall is not procedural authorization.