Wound Em

Front 1

Discuss the epidemiology of the frequency of wounds in the ED

Back 1

7% of all ED visits

Front 2

Discuss locations where majority of wounds occur

Back 2

face, scalp, fingers and hands

Front 3

What is most likey to cause a shear wound

Back 3

sharp object that cuts thru skin

Front 4

WOUND MGT: EM

Back 4

WOUND MGT: EM

Front 5

Name the 3 most common MOI of wounds

Back 5

blunt, crush, shear

Front 6

Explain why everting (turning inside out) the edgesis important to do when performing a wound closure

Back 6

best cosmetic outcome. matching each layer with counterpart on opposite side ensurs eversion of edges minimizing tension on wound. As swelling subsides wound will flatten, becoming flush with surrounding skin surface. Inadvertent inversion of the wound edges may result in an unsightly depressed scar

Front 7

Explain the difference between a hypertrophic scar and a keloid

Back 7

scars: excess collagen confined to original boundaries of wound due to tissue tension. Keloid: grow beyond original wound boundaries

Front 8

Briefly describe what is meant by primary closure (intention)

Back 8

wound immediately closed. main advantage is ↓healing time. may ↓ bleeding and discomfort often associated with open wounds

Front 9

Briefly describe what is meant by secondary closure (intention)

Back 9

wound left open & allowed to close on own, good for contaminated or infected wounds. relatively slow, uncomfortable & leaves larger scar than primary closure

Front 10

Identify the risk factors and PE findings that suggest an increased risk for wound infection

Back 10

risk of infection based on bacterial population & vascular bl supply. highly vascular areas lower risk for infection. ↓ on body increases risk

Front 11

Explain how to assess neurological function and vascular injury prior to wound closure

Back 11

Prior to anesthetic assess sensory, motor & vascular: distal sensory & motor fxn, distal pulses, capillary refill. Isolate for tendon fxn when possible

Front 12

Describe what suggest a foreign body (FB) in a wound and how it can be detected

Back 12

FB sensation, point tenderness, or ↑ px w/ROM. Visual inspection to full depth is most important method for detecting FB. Imaging modalities: XR, US, CT, MRI

Front 13

Discuss techniques used to remove foreign bodies (FB) at the bedside

Back 13

Depends on what country they are from.

Front 14

When is XR good for detecting foreign bodies

Back 14

metal, glass, gravel, teeth, and bone layer >1mm

Front 15

Whan is CT good for detecting foreign bodies

Back 15

plastic, wood, other organic materials

Front 16

Discuss the various methods of achieving hemostasis

Back 16

control bleeding by compression, elevation chemicals (epi, etc.) bipolar electrocautery, tourniquet

Front 17

Explain when and how to use a blood pressure cuff as a tourniquet and the risk involved

Back 17

inflate above pt's systolic pressure. elevate extremity to reduce venous blood volume prior to cuff inflation is useful

Front 18

Explain what is done with wounds in hairy areas and how hair is removed

Back 18

clip 1-2 mm above skin w/scissors. Shaving area damages hair follicle allowing bacteria & associated w/infection

Front 19

Know when and when not to remove hair

Back 19

Hair should never be removed from eyebrows. Hair may provide good landmarks for alignment of wound edges during suturing

Front 20

Explain the importance of wound irrigation and how it's done

Back 20

reducing risk of wound infection. Because of discomfort local anesthetic usually prior to irrigation.
Due to splashing, universal precautions, sheilds etc. should be maintained.

Front 21

Discuss the importance of wound debridement and identify which wounds should be debrided

Back 21

removes foreign matter, bacteria, devitalized tissue, & also creates clean edge easier to repair. Goal of debridement is to reestablish margin of normal tissue at wound edge.

Front 22

Identify the types of wounds that are considered at risk for tetanus infection

Back 22

lacerations, punture wounds, stretch injuries, compression or crush injuries, bites

Front 23

Explain why a puncture wound thru a shoe can be dangerous

Back 23

Any injury to the lower extremity (especially the foot) jeopardizes the ability to walk.Sneakers and tennis shoes offer little protection from nail punctures of the plantar surface of the foot.

Front 24

Identify most frequent pathogen responsible for infection with a punture wound thru a shoe

Back 24

Pseudomonas bacteria (which contaminates the soles of tennis shoes)

Front 25

Identify the types of puncture wounds that are increased risk for infection

Back 25

penetration thru shoe, dog bites, cat bites, cat claws, adult human bites

Front 26

Explain general treatment of uncomplicated puncture wounds less than 6 hours old

Back 26

wound cleansing and tetanus prophylaxis as indicated

Front 27

Explain general treatment of puncture wounds in pt's with peripheral vascular disease, DM or immune compromised

Back 27

associated w/increased incidence of infection and may benefit from abx

Front 28

Explain general treatment of puncture wounds into plantar surfaces

Back 28

abx, high oral bioavailability of flouroquinolones good.

Front 29

Discuss the complications of local cellulitis, how it presents and how it's treated

Back 29

localized inflammation of dermis surrounding wound Ø significant drainage
develop 1-4 d. limit wt bearing on affected foot, antimicrobial coverage directed @ gram+ organisms, especially S. aureus

Front 30

Discuss the complications of abscesses, how it presents and how it's treated

Back 30

swelling, fluctuance, local drainage. I&D w/exploration for retained FB

Front 31

Discuss the typical presentation of osteomyelitis

Back 31

acute w/local sxs & systemic toxicity or indolent w/insidious onset of vague px over site, progressing to local tenderness. Fever absent 1/3. Abscess late & unusual. Draining sinus tracts in chronic infection or infection of FB implants

Front 32

Discuss the risk factors with osteomyelitis

Back 32

Trauma, ischemia, and foreign bodies enhance the susceptibility of bone to microbial invasion by exposing sites to which bacteria can bind

Front 33

Discuss the evaluation for osteomyelitis

Back 33

Routine labs limited value, leukocyte count often elevated in acute disease but may be normal in chronic infection. erythrocyte sed rate elevated in most pts

Front 34

Discuss the treatment for osteomyelitis

Back 34

systemic abx + surgery to drain abscesses/debridement of necrotic tissue. Pts w/acute osteomyelitis should be hospitalized for IV abx

Front 35

Explain how high-pressure injection injuries typically present

Back 35

Most injuries occur in nondominant hand. may initially cause little px, Within hrs, px becomes severe, evidence of ischemia or widespread inflammation is manifest

Front 36

Define high-pressure injection injuries

Back 36

caused by industrial equipment designed to force paint, grease, or other liquids through a small-diameter nozzle at pressures several times higher than that required to penetrate intact skin.

Front 37

Explain why high-pressure injection injuries are so serious

Back 37

delays in initial management increase the risk of amputation or disability

Front 38

How would you treat high-pressure injection injuries

Back 38

agressive px mgt, prophylactic abx, radiographs, early surgical debridement specialist consult

Front 39

Are digital nerve blocks acceptable tx as px mgt for pt's with high pressure injection injuries

Back 39

NO! digital nerve blocks should be avoided

Front 40

Identify most common cause of human bites, pathogens and in whom they most frequetnly occur

Back 40

most common young males on hand when striking opponent's tooth with clenched fist. paths: streptococcus anginosus, S. aureus, E. corrodens.

Front 41

Identify the organism(s) most frequently isolated as the cause of osteomyelitis

Back 41

S aureus is the primary agent of osteomyelitis in 60–70% of cases (90% in children). S aureus causes the infection after hematogenous spread or following direct inoculation

Front 42

Identify the organism(s) most frequently isolated as the cause of septic arthritis

Back 42

Staphylococcus

Front 43

Identify the organism(s) most frequently isolated as the cause of abscesses in the hand

Back 43

Staphylococcus & Streptococcus routinely colonize skin. These bacteria most frequently isolated from hand infections. abscesses 2* to FB, S. aureus most common

Front 44

Discuss treatment of human bites

Back 44

aerobic/anaerobic cultures, exam, irrigation, cleansing, XR,

Front 45

Discuss treatment of fresh closed fist injury

Back 45

inspection under anesthesia, XR. If no laceration of extensor, tendon or joint capsule: irrigate, leave open, immobilize in bulky dressing, elevate 24h, reeval 1-2days

Front 46

Discuss treatment of non closed fist injuries to the hand

Back 46

left open afeter examination and irrigation

Front 47

Discuss treatment to wounds to areas other than the hand

Back 47

primary closure after copious irrigation and judicious limited debridement

Front 48

Discuss when prophylactic use of antibiotics is appropriate for wounds

Back 48

all human bites on hands, bites to other locations in high-risk pts such as asplenia, DM, immune deficiency

Front 49

Identify the age group most commonly bitten and the area most likely involved

Back 49

School-age children (5-14) sustain the majority of reported animal bites. The most frequently reported sites of animal bites include the hands (48-59%) arms (16-26%) legs (15%) and face (8-30%)

Front 50

List the animals considered at risk for rabies

Back 50

In general, skunks, raccoons, bats, foxes, and most carnivores should be considered as high risk for rabies and postexposure immunoprophylaxis should be initiated

Front 51

List the animals whose bites often involve fractures, discuss this importance when treating a patient with these types of wounds

Back 51

Bites from animals known to have strong jaws, such as pit bulls, mastiffs, tigers, and cougars, should be assumed to produce fractures until proven otherwise by XR

Front 52

Identify the 3 most liekly aerobes involved in dog bite infections and how they can be identified by time of infection presentation

Back 52

S.Aureus, pasteurella multocida, S.intermedius. also likely to contain anaerobes, streptococcal, and staphylococcal species

Front 53

Explain the basic treatment for dog bites

Back 53

XR, culture, irrigate. Closure not recommended for wounds >8-12h, puncture, hand lacerations, or high-risk wounds. Bite wounds on face considered for closure >8-12hrs

Front 54

Discuss why a moist environment is important for early wound repair and how this is best achieved

Back 54

increases rate of reepithelialization and occluded wounds heal faster than those exposed to air

Front 55

List the reasons for using a wound dressing

Back 55

absorbs exudate, protection, cosmetic, prevention suture removal, soft split, pt's expectation of dressing

Front 56

Explain the layers of a basic wound dressing

Back 56

nonadherent layer adjacent to wound, guaze sponges to absorb exudate, wrap to hold 2 layers, tape or elastic bandage to secure entire pkg

Front 57

When should sutures or staples be removed from face

Back 57

3-5 days

Front 58

When should sutures or staples be removed from scalp

Back 58

7 days

Front 59

When should sutures or staples be removed from chest

Back 59

8-10 days

Front 60

When should sutures or staples be removed from back

Back 60

10-14 days

Front 61

When should sutures or staples be removed from forearm

Back 61

10-14 days

Front 62

When should sutures or staples be removed from fingers

Back 62

8-10 days

Front 63

When should sutures or staples be removed from hand

Back 63

8-10 days

Front 64

When should sutures or staples be removed from lower extremity

Back 64

8-12 days

Front 65

When should sutures or staples be removed from foot

Back 65

8-12 days

Front 66

List washing and grooming instructions for sutured scalp, face or neck

Back 66

can be washed after 8 to 24h after closure without any increased risk of infection or impairment of healing. Immersion or soaking should be avoided

Front 67

List washing andgrooming instructions for other sutured areas from head

Back 67

12-24 hours after repair. Do not immerse in water. Dry promptly after washing

Front 68

List washing and grooming instructions for stapled wounds

Back 68

12-24 hours after repair. Do not immerse in water. Dry promptly after washing.

Front 69

List washing and grooming instructions for taped wounds

Back 69

should not be moistened or washed.

Front 70

List washing and grooming instructions for wounds closed with adhesive (dermabond)

Back 70

may be very gently cleaned after 24 h, but immersion should be prohibited