Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
56 Cards in this Set
- Front
- Back
- 3rd side (hint)
|
Frequency of traumatic wounds in the ED
|
7% of all ED visits.
|
|
|
|
Where are most wounds located?
|
The face
scalp fingers and hands most common Lacerations on children head linear shorter less contaminated and more often due to blunt trauma |
|
|
|
More susceptible to infection than wounds resulting from shear forces
because they tend to cause greater tissue devitalization. |
Crush injuries
|
|
|
|
May not result in lacerations;
instead they may disrupt vessels leading to ecchymosis or hematoma formation Some hematomas spontaneously resorb Those that remain encapsulated usually require aspiration or incision. |
Low energy impact injuries
|
|
|
|
The differences between a
Hypertrophic Scar & Keloid. Keloids are more prevalent in ------- & ------- ethnicities. |
Keloids grow beyond the original wound boundaries
Hypertrophic Scars stay w\in Original Wound Boundaries Keloids are more prevalent in Asian and Black patients. |
|
|
|
Particularly well suited for
highly contaminated or infected wounds as well as in patients at high risk of infection |
Secondary closure
(intention) |
|
|
|
Wound is immediately closed by
approximating the edges main advantage is reduction of healing time in comparison to other closure methods |
Primary closure
(intention) |
|
|
|
The most important method for detecting
FB {Foriegn Bodies} |
Visual wound inspection
down the full depth & along the full course of wound |
|
|
|
Methods of achieving hemostasis: in lacerations
can be used in situations where vessels are not visualized → may leave non-viable tissue by impairing blood flow |
Specially designed
clips figure-of-8 horizontal mattress suture |
|
|
|
Used for hemostasis in blood vessels smaller than 2 mm diameter
|
Bipolar electrocautery
|
|
|
|
The simplest tourniquet to use in the ED and is placed proximal to the wound
may compress and damage underlying blood vessels and nerves resulting in a reduction in tissue viability |
BP cuff
|
|
|
|
What is done with wounds in hairy areas
how hair is removed. |
Hair removal accomplished by using scissors
(hair clipped to 1-2 mm above the skin) alternative method would be to use saline of ointment to allow hair to be parted away from wound edges |
|
|
|
What are two exceptions to hair removal for wounds?
|
Scalp and eyebrows
|
|
|
|
Name That Rx?
-Slow onset -Higher toxicity -Longer duration -Usually used for longer procedures |
Bupivacaine
(Marcaine) |
|
|
|
Name That Rx?
-Rapid onset -Intermediate toxicity -Intermediate duration |
Mepivacaine
|
|
|
|
Name That Rx?
-Rapid Onset -Lower cardiac toxicity than Lido or Bupivacaine -Intermediate Duration |
Prilocaine
|
|
|
|
Name That Rx?
Slow onset Little Tox #1 used Rx Short Plasma half-life & long duration #1 used spinal anesthesia topical anesthetic for: Eye Mucous membranes & Skin |
Tetracaine
|
|
|
|
Can be used when a person with true allergies to local anesthetics
|
Diphenhydramine and benzyl alcohol
|
|
|
|
Parts of the body that should not be infiltrated with epinephrine.
|
End organs including fingers
toes and tip of nose ears and penis but practice has been challenged regarding the use of epinephrine mixed with local anesthetics for digital nerve blocks. |
|
|
|
It removes foreign matter
bacteria and devitalized tissue creates a clean wound edge that is easier to repair. Should always be used if nonviable tissue is present. |
Wound debridement
|
|
|
|
What is the only situation which a tetanus booster is needed if the patient has had more than three doses ?
|
Longer than 10 years since last
or contaminated wound longer than 5 years since last |
|
|
|
What tetanus booster is not given with a clean minor wound
pt Hx of less than three or unknown doses? |
Tetanus immune globulin
|
|
|
|
The main offender in puncture wounds
Puncture wounds are especially dangerous because the puncture object penetrates deep into the tissues and is followed by rapid closure, . What BUG? Gram Pos or Neg? |
Staphylococcus aureus
(gram +) |
|
|
|
Can produce
septic arthritis while penetration of cartilage periosteum and bone can lead to osteomyelitis. |
Puncture wounds
over joints |
|
|
|
Plantar puncture wounds
through athletic shoes with debris occurring outdoors long objects with deeper penetration and host factors inhibiting wound healing |
Puncture wounds that are at increased risk for infection
|
|
|
|
When to use Abx for puncture wounds
|
Vascular Dz
DM or immune compromised located in forefoot through athletic shoes |
|
|
|
What Abx?
to use for puncture wound through an athletic shoe What bug does it cover? |
Pseudomonas
coverage needed so Fluoroquinolones |
|
|
|
Generally caused by
streptococcal and staphylococcal skin flora and Usually respond to a 7-10 day course of a first-generation CEPHALOSPORIN. |
Cellulitis
|
|
|
|
Usually associated with a retained foreign body
Tender warm fluctuant mass is palpable at the site of injury. |
Abscess:
analgesia antibiotics Routine follow-up within 48 hours is recommended. |
|
|
|
What is the dx and tx for Redness or
swelling at site remote from puncture site? 2 things |
Deeper spreading infection
parenteral Abx and surgical referral |
|
|
|
Nondominant hand of an operator using a high-pressure gun
Evidence of ischemia or wide spread inflammation Delays in initial management increase the risk of amputation or disability What is tx? |
Pain management
Abx against skin flora surgical debridement to avoid amputation Consult hand specialist |
|
|
|
what type of wound or injury do these come from?
What Bug? Possible complications are localized cellulitis lymphangitis abcess tenosynovitis septic arthritis osteomyelitis all from polymicrobial infection |
Human bites
Most frequent isolate is strep viridans |
|
|
|
What are the sites of frequent occurrence in human bites?
|
Closed fist injuries
|
|
|
|
Organism(s) most frequently isolated as the cause of osteomyelitis
septic arthritis and abscesses in the hand. |
Eikenella corrodens
|
|
|
|
Subsequent tenosynovitis and Pyarthrosis generally require operative management and intravenous antibiotics.
|
Fresh closed fist injury
|
|
|
|
Can cause local infection following a human bite or
contact with infected saliva Results in a coalescence of pustules typically on the distal phalanx Incision and drainage are contraindicated |
Herpes simplex virus
|
|
|
|
Recommended Rx Abx for treatment and prophylaxis following all but the most trivial human bites.
|
Amoxicillin-clavulanate
|
|
|
|
Bats
skunks raccoons and foxes All carnivores and omnivores can transmit |
Animals considered at risk for rabies
|
|
|
|
Have a 60 to 80 % chance that will become infected.
|
Cat bites
|
|
|
|
Pasturella multocida
likely involved in what type of bite? |
Cat bites
Dog bites |
|
|
|
What is a prudent approach to treating cat bites?
|
Treat all with Abx
|
|
|
|
What environmental consideration increases the rate of re-epithelialization?
|
Maintaining a warm
moist environment |
|
|
|
The use of commercial dressings and topical antibiotics help maintain
|
A moist environment.
|
|
|
|
suture removal guide
Body surface how many groups? __ List groups ___ |
9 body surface groups
-Face -Scalp -Chest -Hand -Lower Extremities -Foot -Back -Forearm - Joint Surfaces Arm - Joint Surfaces Leg |
|
|
|
The layers of a basic wound dressing
|
Non-adherent base
Gauze sponge covering--like 2x2 or bigger to absorb exudate Gauze wrap--to hold everything on and tape |
|
|
|
Remove Dressing to check for Infection?
When should the patient with a sutured or stapled wound remove the dressing to check for infection? |
24 to 48
hours |
|
|
|
Time Parameters
for Suture Removal = # Days ?, h+ = How many in that grouping of days? |
3-5 Days (?ct)
7 Days (?ct) 8-10 Days (?ct) 8-12 Days (?ct) 10-12 Days (?ct) 10-14 Days (?ct) |
3-5 Days (1ct)
7 Days (1ct) 8-10 Days (2ct) 8-12 Days (1ct) 10-12 Days (2ct) 10-14 Days (3ct) |
|
|
face
When should sutures or staples be removed when they are used on the face |
3-5 days
|
|
|
|
scalp
When should sutures or staples be removed when they are used on the scalp |
7 days
|
|
|
|
chest
When should sutures or staples be removed when they are used on the chest |
8-10 days
|
|
|
|
hand
When should sutures or staples be removed when they are used on the hand |
8-10 days
|
|
|
|
foot
When should sutures or staples be removed when they are used on the foot |
10-12 days
|
|
|
|
lower extremities
When should sutures or staples be removed when they are used on the lower extremities |
8-12 days
|
|
|
|
on the back
When should sutures or staples be removed when they are used on the back |
10-14 days
|
|
|
|
forearm
When should sutures or staples be removed when they are used on the forearm |
10-14 days
|
|
|
|
Arm or Leg
Joint Surfaces When should sutures or staples be removed when they are used on the arm or leg joint surface |
10-14 days
|
|
