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56 Cards in this Set

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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