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48 Cards in this Set

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What history questions do you ask for someone who presents with a wound
1. mechanism of injury
2. time since injury
3. neuro-musc symptoms
4. foreign body risk
5. PMHx
6. Medications (increase healing time)
7. Tetanus immunization
What are you concerned about with a penetrating injury
any underlying damage? (because often will look good on the outside)
What are you concerned about with a blunt trauma
underlying structures
internal bleeding
broken bones
flap integrity
what are you concerned about with crush injuries
degloving
fracture high risk
what are you concerned about with puncture
"worse than it looks!"

foreign body - through clothing or shoes
tetanus
pseudomonas - esp if through shoe
what are you concerned about with bites
consider broken bones with dogs

dogs --> ripping injuries / muscle damage

note: cat bites are punctures and therefore highly infectable

human bites are extremely dangerous - bites on hand the worst
What if a dog bite is to the face? how is it managed
refer to plastics
What if a human bite is to the hand?
refer to hand specialist b/c of risk of tendon infection
How do you determine if there is a tendon infection
won't open and close their hand
what are you concerned about with abrasions
contamination - find out how they got it
how big is it
what is an avulsion and what are the 2 types
missing skin
1. partial - flap
2. full - hole
what are you concerned about with avulsions
PARTIAL - is the flap healthy/well perfused

FULL - bone protrusion
What is the concern with decreased blood flow to flaps
will lose it to necrosis
What are the 3 types of lacerations
1. incisional - leaves a clean edge
2. flap-like
3. stellate
what are you concerned about with stellate laceration
assess for other injuries
What meds increase healing time?
corticosteroids
NSAIDS
Penicillimine
Cochicine
Anticoags
Antineoplastics
Aspects of past medical hx that increases healing time
increased age
immunocompromised
acute uremia
hypoxia
PVD
DM
Alcoholism
Ehlers-Danlos
severe anemia
Safe time to closure:
Face / neck / scalp
12-24hr
Safe time to closure:
Upper extremities
8-12hr
Safe time to closure:
Lower extremities/trunk
6-8hr
What are the aspects of the PE that are important for the wound
type of skin injury
size of wound
Neuro Musc exam
Vascular exam
Wound assessment
How do you differentiate Partial from Full Burns
Partial - blistering, but healthy & intact dermis

Full - change to the dermal layer, true Full is white and leathery
What do you worry about with a circumferential burn - what are the signs
compartment syndrome
- horrible pain
- decreased circulation below
- skin tightness
How are perineal burns managed
Always to ED
Which is more painful: 2nd or 3rd degree burns
2nd

b/c 3rd degree is past nerve endings
What are neuromuscular assessments you consider with a wound
sharp vs. dull
2 pt discrimination
Strength
ROM - isolating joints
2 parts of wound prep
anesthesia
wound cleaning
when do you never use epinephrine as anesthetic
where there is only blood flow in only 1 direction
nose
ears
fingers
penises
What are the techniques to decrease discomf with anesthetic infiltration
warm to body temp
buffer lidocaine w/ Na Bicab
(1cc bicarb: 10cc lidocaine)
inject slowly
use smallest needle (25/27)

also: go through area you've already injected
what part of the skin do you inject into
dermis
why do you use epinephrine
improves hemostasis
what do you clean with
around the wound with betadine (or peroxide)
irrigate with water or NS
How do you manage wounds that you cannot fully debride
send to OR
How do you prevent "tatooing"
make sure to fully irrigate and get all of the contamination out
How do you treat an abrasion
treat like a burn if extensive - use silvadene
1. clean: use betadine solution and NS irrigation
2. Have pt soak TID with soap/water
3. keep moist with abx ointment (bacitracin, not neosporin - silvadine if extensive)
What are the important aspects of using Silvadine
cannot use on the face - use bacitracin or erytromycin
Cannot use if sulfa probs - use bacitracin instead
what do you use on the wound if it is near the eye?
erythromycin
what do you use on the wound if it is on the face
bacitracin or erytromycin
how do you manage treatment of avulsions if there is a flap
sew it down!
monitor carefully
tell the patient that it likely will not heal
how do you manage puncture wounds
Consider antibiotics b/c high risk of infection
IRRIGATE - a lot
Consider core incision - thoroughly cleans it out
What infectious processes do you consider with a puncture wound and how do you treat?
tetanus -- immunization
pseudomonas (shoe)
staph and strep
vibrio -- bay exposure --> add Cipro

General treatment is with Keflex and Bactrim
How do you manage a bite?
Cats - augmentin (or doxycyline)

NEVER: suture / ointment
What is the importance of tension lines
stress on the sutures and risk for reopening

want to consider when suturing to decrease scarring
when do you shave eyebrows
NEVER
When do you use only absorbable sutures
nail beds
oral mucosa
scrotal or vaginal repair
subcutaneous deep closure
when do you use regular (nonabsorb.) sutures
skin
what type of sutures are used
synthetic
When are sutures removed from various locations (which are soonest/latest)
Face - 3-5days
Scalp - 7days
Chest - 8-10days
High tension area - 10-14days (joints, hands)
Back - 10-14days