Emergency Cases Northwest Group

027 Chip of the old Block

Situation

Flecks of paint in scalp wound were actually flecks of skull.

Background

An elderly man fell and cut his head. On cleaning the wound small flecks of white material were washed out. His relative thought they were chips of paint from the wall against which he fell. On reaching and examining the bottom of the wound, the skull was visible with obvious scrapes on its surface.

Assessment

The material was flecks of bone not paint.

Recommendation

When suturing a scalp wound, reach to and examine the deepest part.

Know that the layers look like:

skin: looks like skin

connective tissue: looks fatty, maybe roots of hair follicles too

aponeurosis [flat tendon]: at the top of the scalp flat continuos layer, front and back of scalp this layer is essentially muscle

periosteum: looks like skull but has yellow tinge so its not quite bone

skull bone: bright white, that's how you can tell it apart from the periosteum

PLEASE DO NOT INCLUDE ANY PATIENT IDENTIFIABLE DATA OR GEO-LOCATION DATA IN THE SUBMISSION OR IN ANY ATTACHED IMAGES

Emergency Cases Northwest Group