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48 Cards in this Set
- Front
- Back
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What history questions do you ask for someone who presents with a wound
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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 |
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What are you concerned about with a penetrating injury
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any underlying damage? (because often will look good on the outside)
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What are you concerned about with a blunt trauma
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underlying structures
internal bleeding broken bones flap integrity |
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what are you concerned about with crush injuries
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degloving
fracture high risk |
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what are you concerned about with puncture
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"worse than it looks!"
foreign body - through clothing or shoes tetanus pseudomonas - esp if through shoe |
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what are you concerned about with bites
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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 |
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What if a dog bite is to the face? how is it managed
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refer to plastics
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What if a human bite is to the hand?
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refer to hand specialist b/c of risk of tendon infection
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How do you determine if there is a tendon infection
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won't open and close their hand
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what are you concerned about with abrasions
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contamination - find out how they got it
how big is it |
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what is an avulsion and what are the 2 types
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missing skin
1. partial - flap 2. full - hole |
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what are you concerned about with avulsions
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PARTIAL - is the flap healthy/well perfused
FULL - bone protrusion |
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What is the concern with decreased blood flow to flaps
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will lose it to necrosis
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What are the 3 types of lacerations
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1. incisional - leaves a clean edge
2. flap-like 3. stellate |
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what are you concerned about with stellate laceration
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assess for other injuries
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What meds increase healing time?
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corticosteroids
NSAIDS Penicillimine Cochicine Anticoags Antineoplastics |
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Aspects of past medical hx that increases healing time
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increased age
immunocompromised acute uremia hypoxia PVD DM Alcoholism Ehlers-Danlos severe anemia |
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Safe time to closure:
Face / neck / scalp |
12-24hr
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Safe time to closure:
Upper extremities |
8-12hr
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Safe time to closure:
Lower extremities/trunk |
6-8hr
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What are the aspects of the PE that are important for the wound
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type of skin injury
size of wound Neuro Musc exam Vascular exam Wound assessment |
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How do you differentiate Partial from Full Burns
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Partial - blistering, but healthy & intact dermis
Full - change to the dermal layer, true Full is white and leathery |
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What do you worry about with a circumferential burn - what are the signs
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compartment syndrome
- horrible pain - decreased circulation below - skin tightness |
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How are perineal burns managed
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Always to ED
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Which is more painful: 2nd or 3rd degree burns
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2nd
b/c 3rd degree is past nerve endings |
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What are neuromuscular assessments you consider with a wound
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sharp vs. dull
2 pt discrimination Strength ROM - isolating joints |
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2 parts of wound prep
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anesthesia
wound cleaning |
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when do you never use epinephrine as anesthetic
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where there is only blood flow in only 1 direction
nose ears fingers penises |
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What are the techniques to decrease discomf with anesthetic infiltration
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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 |
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what part of the skin do you inject into
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dermis
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why do you use epinephrine
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improves hemostasis
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what do you clean with
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around the wound with betadine (or peroxide)
irrigate with water or NS |
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How do you manage wounds that you cannot fully debride
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send to OR
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How do you prevent "tatooing"
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make sure to fully irrigate and get all of the contamination out
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How do you treat an abrasion
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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) |
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What are the important aspects of using Silvadine
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cannot use on the face - use bacitracin or erytromycin
Cannot use if sulfa probs - use bacitracin instead |
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what do you use on the wound if it is near the eye?
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erythromycin
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what do you use on the wound if it is on the face
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bacitracin or erytromycin
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how do you manage treatment of avulsions if there is a flap
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sew it down!
monitor carefully tell the patient that it likely will not heal |
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how do you manage puncture wounds
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Consider antibiotics b/c high risk of infection
IRRIGATE - a lot Consider core incision - thoroughly cleans it out |
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What infectious processes do you consider with a puncture wound and how do you treat?
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tetanus -- immunization
pseudomonas (shoe) staph and strep vibrio -- bay exposure --> add Cipro General treatment is with Keflex and Bactrim |
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How do you manage a bite?
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Cats - augmentin (or doxycyline)
NEVER: suture / ointment |
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What is the importance of tension lines
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stress on the sutures and risk for reopening
want to consider when suturing to decrease scarring |
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when do you shave eyebrows
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NEVER
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When do you use only absorbable sutures
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nail beds
oral mucosa scrotal or vaginal repair subcutaneous deep closure |
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when do you use regular (nonabsorb.) sutures
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skin
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what type of sutures are used
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synthetic
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When are sutures removed from various locations (which are soonest/latest)
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Face - 3-5days
Scalp - 7days Chest - 8-10days High tension area - 10-14days (joints, hands) Back - 10-14days |
