Box 1: Timeline of events and interventions undertaken for the care of a patient with an injury from a scalpel blade
TimelineEvent/intervention
Day of injury
14:00Patient sustains scalpel injury
Postinjury day one
05:48Patient presents to triage at emergency department
08:18

  • Patient assessed by emergency department physician

  • Plastic surgery consulted for possible tenosynovitis

08:39Patient given ceftriaxone (2 g intravenously)
11:06

  • Patient first assessed by plastic surgery service

  • Initial incision and drainage performed

  • Infectious disease consultation suggested

14:04

  • Patient assessed by infectious diseases service

  • Substantial progression of infection a concern for necrotising fasciitis

  • Suggested addition of vancomycin and clindamycin

14:13Vancomycin (1 g intravenously)
14:32Clindamycin (600 mg intravenously)
14:48

  • Patient reassessed by plastic surgery service

  • Substantially worsened appearance

  • Decision made to take to operating room

16:07Surgery begins for incision and drainage of infection
17:14Clindamycin (600 mg intravenously)
21:06

  • Wounds reassessed by plastic surgery service

  • Erythema markedly reduced from last marking

  • Minimal tenderness

  • No purulence or malodour from wounds

Postinjury day two
03:21Vancomycin (1 g intravenously)
06:30Clindamycin (600 mg intravenously)
09:00Ceftriaxone (2 g intravenously)
13:53Clindamycin (600 mg intravenously)
15:44Vancomycin (1 g intravenously)
18:00Penicillin G (4 million units intravenously)
22:15Clindamycin (600 mg intravenously)
23:28Penicillin G (4 million units intravenously)