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Treatment according to Pakistani brands
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The image shows a scalp laceration - a crescent-shaped, ~4-6 cm blunt-force wound on the vertex/parietal scalp with active oozing and dried blood. Here is the full treatment plan using Pakistani brand names:
Scalp Laceration - Treatment Protocol (Pakistani Brands)
STEP 1 - Wound Cleaning & Irrigation
| Purpose | Drug/Product | Pakistani Brand | Dose/Use |
|---|---|---|---|
| Wound irrigation | Normal Saline 0.9% | Hilton Saline / Baxter NS | Copious irrigation (50-100 mL minimum) |
| Antiseptic wash | Povidone-Iodine 10% | Betadine (Boehringer/Global) | Diluted 1:10, clean around wound |
| Antiseptic solution | Chlorhexidine 4% | Hibiscrub / Savlon | Apply around wound edges |
STEP 2 - Pain Management (Before Suturing)
| Drug | Pakistani Brand | Dose |
|---|---|---|
| Lidocaine 2% Injection (local anaesthetic) | Xylocaine 2% (AstraZeneca Pak) | 1-2% infiltration around wound edges |
| Lidocaine + Adrenaline 2% (with epinephrine - useful for scalp hemostasis) | Xylocaine with Adrenaline | 1:100,000 adrenaline - inject pericranially |
STEP 3 - Wound Closure
- Scalp lacerations are closed with interrupted non-absorbable sutures or staples
- Recommended: 2-0 or 3-0 Prolene (polypropylene, Ethicon available in Pakistan) or Vicryl 2-0 for deeper layers if galea is torn
- Sutures: 4-6 simple interrupted stitches across the laceration
STEP 4 - Systemic Antibiotics (Post-closure, 5-7 days)
| Drug | Pakistani Brand | Dose |
|---|---|---|
| Amoxicillin/Clavulanate | Augmentin (GSK Pak) / Clavam (Getz) | 625 mg TDS x 5 days |
| OR Cephalexin 500 mg | Keflex / Sporidex (Highnoon) | 500 mg QID x 5 days |
| Metronidazole (if heavily contaminated) | Flagyl (Sanofi Pak) / Metrozine (Macter) | 400 mg TDS x 5 days |
STEP 5 - Analgesics / Anti-inflammatory
| Drug | Pakistani Brand | Dose |
|---|---|---|
| Paracetamol 500 mg | Panadol (GSK) / Febrol (Sami) | 1 g (2 tabs) TDS-QID |
| Ibuprofen 400 mg | Brufen (Abbott Pak) / Ibufen (Sami) | 400 mg TDS with food |
| Ketorolac 10 mg (for stronger pain) | Toradol / Ketolac (Macter) | 10 mg TDS, max 5 days |
| Tramadol 50 mg (if severe pain) | Tramal (Grunenthal) / Tramol (Searle) | 50-100 mg TDS PRN |
STEP 6 - Tetanus Prophylaxis
| Drug | Pakistani Brand | Dose |
|---|---|---|
| Tetanus Toxoid (TT) | TT Vaccine (National Institute of Health, Islamabad) | 0.5 mL IM deltoid (if not vaccinated in last 5 years) |
| Tetanus Immunoglobulin (TIG) (if wound heavily contaminated/unknown status) | Hypertet / Tetavax | 250-500 IU IM |
STEP 7 - Wound Dressing
| Product | Pakistani Brand | Use |
|---|---|---|
| Sterile gauze + saline dressing | Surgipad / Mediplast gauze | Cover wound after suturing |
| Antibiotic ointment | Fucidin (Leo Pharma Pak) / Bactroban (GSK) | Apply on suture line twice daily |
| Adhesive dressing/tape | Leukoplast / Band-Aid | Secure dressing |
STEP 8 - Head Injury Assessment
This patient must be assessed for traumatic brain injury (TBI):
- Check GCS (Glasgow Coma Scale)
- Look for: confusion, vomiting, unequal pupils, loss of consciousness
- If any signs: CT scan head is mandatory
- Consider CT Brain at any major hospital (Aga Khan, Shifa, PIMS, Services Hospital etc.)
Suture Removal
Remove scalp sutures/staples at 7-10 days post-closure.
Disclaimer: This is clinical guidance only. The patient must be seen by a qualified doctor for proper examination, especially to rule out skull fracture or brain injury. Do not attempt suturing without trained personnel in a sterile setting.
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