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22 Cards in this Set
- Front
- Back
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Factors affecting wound healing
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Age
DM CRF obestity alcoholism/malnutrition immunosuppression, including steroid use predisposition to keloids |
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pearls for wound evaluation
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well, lit bloodless field
can use turnoquet/BP cuff (only for 30-60 min) if needed eval tendons through full ROM r/o- bone/joint involvement, FB, NV injury |
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handing of amputated digits
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wrap in protective saline-soaked dressingseal in water-proof bag, then place on ice
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types of local anesthetics
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esters (procaine, cocaine, benzocaine, tetracaine)
amides (lidocaine, bupivicaine) **amides cause less sensitivitly/allergic rxns |
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lidocaine (Xylocaine)
safe dose, onset, duration |
safe dose- 4.5 mg/kg
**30 cc of 1%, 50 cc of 1% with Epi (70 kg) onset- 2-5 minutes duration- 1-2 hours |
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Bupivicaine (Marcaine)
Safe dose, onset, duration |
safe dose- 2 mg/kg
**40 cc of 0.25%,60 cc of 0.25% with Epi onset- up to 5 minutes duration- 2-8 hours ** not approved in kids <12 |
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Foreign bodies visible on X-ray
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metal
bone teeth graphite glass (>2mm)gravel/sand certain plastics some wood |
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irrigation pearles
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low pressure irrigation- removes particulate matter; DOES NOT remove bacteria
Efficacy is correlated with psi weigh benefits of irrigation with risk of tissue destruction/edema |
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wound drains
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only indicated for drainage of harmful collections of blood or pus
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primary closure
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immediate closure
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secondary closure
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wound left open, allowed to close on it's own-suitable for hihgly contaminated or infected wounds
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delayed primary closure (tertiary closure)
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wound closed after being left open for 3-5 days
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time to wound closure
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facial laterations heal well regardless of time to closure
trunk/extremity exhibit lower rates of healing if closed > 19 hours for time to injury |
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deep suture pitfalls
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Can damage deep structures
not to be used in the hand increase rate of infection in contaminated wounds or when placed into adipose tissue |
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Tissue adhesive
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cyanoacylae polymers
least reactive = octylcyanoacrylate (Dermabond) wound needs to be cleaned, explored and prepped will slogh in 5-10 days (can be accelerated with pet jelly, H20 or antibiotic ointment if needed |
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Bite wounds- pearles
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may be more extensive than they appear
human or cat bites should not be closed ; dog bite closure is controversial |
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plantar pucture wounds
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infections (typically Staph or pseudomonas)
can lead to disability or amputation consider enlarging the wound for adequate exploration irrigation alone and or blind probing likely not helpful prophylactic abx controversialneed wound check in 2-3 days |
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facial lacs- pearles
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non-gaping lacs don't benefit from layered closure
excessive irrigation may be harmful; weigh r vs b -re-approximate key structures first eyebrow/vermillion/forehead or nasolabial crease keep tension lines in mind |
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through and through lip lacs
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r/o embeded teeth
close oral mucosal layer 1st (4.0 or 5.0 absorbable), then RE-IRRIGATE close muscle 2nd close skin 3rd Abx, soft diet, post-meal oral rinses |
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Ear lacs
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consider field block
cartilage must be covered completely drain hematomas/ compressive dressing a must (necrosis will lead to califlour ear) prophylactic abx if cartilage exposed |
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eye lid lacs
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exclude injury to lacrimal ducts or tarsal plate (requires optho c/s)
ptosis or bulging of sub cu fat suggests tarsal plate violation |
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post repair wound care
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keep moist/dressed for 24-48 hrs (until epithethilialized)
consider abx for heavily contaminated wounds/pts at risk elevate to prevent edema splint if area of tension tetanus!! limit sun exposure for 6-12 months |
