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70 Cards in this Set

  • Front
  • Back
Discuss the epidemiology of the frequency of wounds in the ED
7% of all ED visits
Discuss locations where majority of wounds occur
face, scalp, fingers and hands
What is most likey to cause a shear wound
sharp object that cuts thru skin
Name the 3 most common MOI of wounds
blunt, crush, shear
Explain why everting (turning inside out) the edgesis important to do when performing a wound closure
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
Explain the difference between a hypertrophic scar and a keloid
scars: excess collagen confined to original boundaries of wound due to tissue tension. Keloid: grow beyond original wound boundaries
Briefly describe what is meant by primary closure (intention)
wound immediately closed. main advantage is ↓healing time. may ↓ bleeding and discomfort often associated with open wounds
Briefly describe what is meant by secondary closure (intention)
wound left open & allowed to close on own, good for contaminated or infected wounds. relatively slow, uncomfortable & leaves larger scar than primary closure
Identify the risk factors and PE findings that suggest an increased risk for wound infection
risk of infection based on bacterial population & vascular bl supply. highly vascular areas lower risk for infection. ↓ on body increases risk
Explain how to assess neurological function and vascular injury prior to wound closure
Prior to anesthetic assess sensory, motor & vascular: distal sensory & motor fxn, distal pulses, capillary refill. Isolate for tendon fxn when possible
Describe what suggest a foreign body (FB) in a wound and how it can be detected
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
Discuss techniques used to remove foreign bodies (FB) at the bedside
Depends on what country they are from.
When is XR good for detecting foreign bodies
metal, glass, gravel, teeth, and bone layer >1mm
Whan is CT good for detecting foreign bodies
plastic, wood, other organic materials
Discuss the various methods of achieving hemostasis
control bleeding by compression, elevation chemicals (epi, etc.) bipolar electrocautery, tourniquet
Explain when and how to use a blood pressure cuff as a tourniquet and the risk involved
inflate above pt's systolic pressure. elevate extremity to reduce venous blood volume prior to cuff inflation is useful
Explain what is done with wounds in hairy areas and how hair is removed
clip 1-2 mm above skin w/scissors. Shaving area damages hair follicle allowing bacteria & associated w/infection
Know when and when not to remove hair
Hair should never be removed from eyebrows. Hair may provide good landmarks for alignment of wound edges during suturing
Explain the importance of wound irrigation and how it's done
reducing risk of wound infection. Because of discomfort local anesthetic usually prior to irrigation.
Due to splashing, universal precautions, sheilds etc. should be maintained.
Discuss the importance of wound debridement and identify which wounds should be debrided
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.
Identify the types of wounds that are considered at risk for tetanus infection
lacerations, punture wounds, stretch injuries, compression or crush injuries, bites
Explain why a puncture wound thru a shoe can be dangerous
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.
Identify most frequent pathogen responsible for infection with a punture wound thru a shoe
Pseudomonas bacteria (which contaminates the soles of tennis shoes)
Identify the types of puncture wounds that are increased risk for infection
penetration thru shoe, dog bites, cat bites, cat claws, adult human bites
Explain general treatment of uncomplicated puncture wounds less than 6 hours old
wound cleansing and tetanus prophylaxis as indicated
Explain general treatment of puncture wounds in pt's with peripheral vascular disease, DM or immune compromised
associated w/increased incidence of infection and may benefit from abx
Explain general treatment of puncture wounds into plantar surfaces
abx, high oral bioavailability of flouroquinolones good.
Discuss the complications of local cellulitis, how it presents and how it's treated
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
Discuss the complications of abscesses, how it presents and how it's treated
swelling, fluctuance, local drainage. I&D w/exploration for retained FB
Discuss the typical presentation of osteomyelitis
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
Discuss the risk factors with osteomyelitis
Trauma, ischemia, and foreign bodies enhance the susceptibility of bone to microbial invasion by exposing sites to which bacteria can bind
Discuss the evaluation for osteomyelitis
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
Discuss the treatment for osteomyelitis
systemic abx + surgery to drain abscesses/debridement of necrotic tissue. Pts w/acute osteomyelitis should be hospitalized for IV abx
Explain how high-pressure injection injuries typically present
Most injuries occur in nondominant hand. may initially cause little px, Within hrs, px becomes severe, evidence of ischemia or widespread inflammation is manifest
Define high-pressure injection injuries
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.
Explain why high-pressure injection injuries are so serious
delays in initial management increase the risk of amputation or disability
How would you treat high-pressure injection injuries
agressive px mgt, prophylactic abx, radiographs, early surgical debridement specialist consult
Are digital nerve blocks acceptable tx as px mgt for pt's with high pressure injection injuries
NO! digital nerve blocks should be avoided
Identify most common cause of human bites, pathogens and in whom they most frequetnly occur
most common young males on hand when striking opponent's tooth with clenched fist. paths: streptococcus anginosus, S. aureus, E. corrodens.
Identify the organism(s) most frequently isolated as the cause of osteomyelitis
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
Identify the organism(s) most frequently isolated as the cause of septic arthritis
Identify the organism(s) most frequently isolated as the cause of abscesses in the hand
Staphylococcus & Streptococcus routinely colonize skin. These bacteria most frequently isolated from hand infections. abscesses 2* to FB, S. aureus most common
Discuss treatment of human bites
aerobic/anaerobic cultures, exam, irrigation, cleansing, XR,
Discuss treatment of fresh closed fist injury
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
Discuss treatment of non closed fist injuries to the hand
left open afeter examination and irrigation
Discuss treatment to wounds to areas other than the hand
primary closure after copious irrigation and judicious limited debridement
Discuss when prophylactic use of antibiotics is appropriate for wounds
all human bites on hands, bites to other locations in high-risk pts such as asplenia, DM, immune deficiency
Identify the age group most commonly bitten and the area most likely involved
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%)
List the animals considered at risk for rabies
In general, skunks, raccoons, bats, foxes, and most carnivores should be considered as high risk for rabies and postexposure immunoprophylaxis should be initiated
List the animals whose bites often involve fractures, discuss this importance when treating a patient with these types of wounds
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
Identify the 3 most liekly aerobes involved in dog bite infections and how they can be identified by time of infection presentation
S.Aureus, pasteurella multocida, S.intermedius. also likely to contain anaerobes, streptococcal, and staphylococcal species
Explain the basic treatment for dog bites
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
Discuss why a moist environment is important for early wound repair and how this is best achieved
increases rate of reepithelialization and occluded wounds heal faster than those exposed to air
List the reasons for using a wound dressing
absorbs exudate, protection, cosmetic, prevention suture removal, soft split, pt's expectation of dressing
Explain the layers of a basic wound dressing
nonadherent layer adjacent to wound, guaze sponges to absorb exudate, wrap to hold 2 layers, tape or elastic bandage to secure entire pkg
When should sutures or staples be removed from face
3-5 days
When should sutures or staples be removed from scalp
7 days
When should sutures or staples be removed from chest
8-10 days
When should sutures or staples be removed from back
10-14 days
When should sutures or staples be removed from forearm
10-14 days
When should sutures or staples be removed from fingers
8-10 days
When should sutures or staples be removed from hand
8-10 days
When should sutures or staples be removed from lower extremity
8-12 days
When should sutures or staples be removed from foot
8-12 days
List washing and grooming instructions for sutured scalp, face or neck
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
List washing andgrooming instructions for other sutured areas from head
12-24 hours after repair. Do not immerse in water. Dry promptly after washing
List washing and grooming instructions for stapled wounds
12-24 hours after repair. Do not immerse in water. Dry promptly after washing.
List washing and grooming instructions for taped wounds
should not be moistened or washed.
List washing and grooming instructions for wounds closed with adhesive (dermabond)
may be very gently cleaned after 24 h, but immersion should be prohibited