#2: Wound Care

Question 1

When doing wound assessment what 2 things are you checking for
- which is done 1st

Answer 1

Wound Assessment

1. check for nerve injury (1st)
2. check for motor deficit

Question 2

Wound Assessment: FBs

1. what are most detected w/
2. what is other test used, more sensitive for organic matter

Answer 2

Wound Assessment: FBs

1. most detected w/ XR
2. CT = more sensitive for organic matter

Question 3

Types of Wounds

1. which is very contaminated and a/w delayed closure
2. which is a/w tissue necrosis, hemorrhage, impaired ability to heal, compartment syndrome)

Answer 3

Types of Wounds

1. Bite = very contaminated and a/w delayed closure
2. Crush = a/w tissue necrosis, hemorrhage, impaired ability to heal, compartment syndrome)

Question 4

Types of Wound Healing*

1. wound closed at/near time of injury
2. wound closes naturally
3. wound prepped in OR –> brought back later for primary repair (2 names)

Answer 4

Types of Wound Healing*

1. wound closed at/near time of injury = Primary intention
2. wound closes naturally = Secondary intention
3. wound prepped in OR –> brought back later for primary repair = Tertiary/Delayed Primary

Question 5

Golden Period of Wound Closure

1. time frame bacteria need to proliferate/produce infxn
2. after how many hrs do bacterial counts rise exponentially
3. what types of wound at incr risk of delayed/complicated healing

Answer 5

Golden Period of Wound Closure

1. bacteria need 3-5 hrs to proliferate/produce infxn
2. after 8 hrs bacterial counts rise exponentially
3. untidy wounds = incr risk of delayed/complicated healing

Question 6

Primary Intention/Closure Recommendations

1. for Face
2. for UE
3. for LE

Answer 6

Primary Intention/Closure Time Frame

1. for Face < 24 hrs
2. for UE < 12 hrs
3. for LE < 8 hrs

Question 7

Delayed Primary Closure (Tertiary)

1. when should this type of healing be done (2)
2. after how many hrs –> consider this

Answer 7

Delayed Primary Closure (Tertiary)

1. when high bacterial load, delayed access to care
2. after 96 hrs –> consider this

Question 8

Procedure for Delayed Primary Closure (Tertiary)

1. clean and ____ the devitalized tissue
2. Apply ____ and cover wound
3. after 72-96 hrs –> what to do (4 things)

Answer 8

Procedure for Delayed Primary Closure (Tertiary)

1. clean and debride the devitalized tissue
2. Apply damp saline gauze and cover wound
3. after 72-96 hrs –>
   - irrigate
   - debride
   - undermine
   - close wound

Question 9

Wound Closure: Tension

• wounds along what –> lower tension and less scaring
• at what orientation = greater tension

Answer 9

Wound Closure: Tension

• wounds along LANGER LINE –> lower tension and less scaring
• > 45 degrees from them = higher tension/scarring risk

Question 10

Wound Closure: High Tension Wounds

1. need looser or tighter closure
2. on face what needs to be done to help decr tension

Answer 10

Wound Closure: High Tension Wounds

1. need Tighter closure
2. on face–> multilayered closure –> decr tension

Question 11

Other Methods of Wound Closure than Sutures

1. what part of body are staples used for
2. what method has low tensile strength, high dehiscence rate; used w/ subcuticular sutures, after staple/sutures removed, delayed wound closure, low tension frail skin tears
3. what method is for simple low tension, self approx wounds on face

Answer 11

Other Methods of Wound Closure than Sutures

1. Staples = scalp
2. what method has low tensile strength, high dehiscence rate; used w/ subcuticular sutures, after staple/sutures removed, delayed wound closure, low tension frail skin tears = steri strips
3. what method is for simple low tension, self approx wounds on face = Tissue Adhesive

Question 12

Anesthesia: Local

1. Most ___ and ____ type
2. where do you inject
3. speed of inject and why
4. systemic abs –> what 2 organ system toxicity

Answer 12

Anesthesia: Local

1. Most direct and reliable type
2. inject w/in wound edges
3. slow injection –> decr pain
4. systemic abs –> CV and CNS toxicity

Question 13

Anesthesia: Regional/Nerve Block

1. used when wounds otherwise need _____
2. wounds where need to avoid
3. used when local would be painful (location?)

Answer 13

Anesthesia: Regional/Nerve Block

1. used when wounds otherwise need lot of anesthesia
2. wounds where need to avoid tissue distortion (lip, digits)
3. used when local would be painful (plantar foot)

Question 14

Anesthesia: Regional/Nerve Block CIs

1. what areas can Epi NOT be used in
2. what pts pop can Bupivicaine NOT be used in
3. what med can pts NOT be on if using Epi

Answer 14

Anesthesia: Regional/Nerve Block CIs

1. areas Epi NOT used in = fingers, nose, penis, toes
2. Bupivicaine can NOT be used in pregnancy
3. pts can NOT be on propanolol if use Epi

Question 15

1. areas w/ low blood flow or blanching
2. infected wounds
3. signif CVD or vascular dz

CIs to what type of Regional Anesthetic

Answer 15

Other CIs for Epi

1. areas w/ low blood flow or blanching
2. infected wounds
3. signif CVD or vascular dz

Question 16

Anesthesia: Topical (Lido, Epi, Tetracaine)

1. used in what types of wounds in kids
2. soak dause pad and place directly on wound for ___
3. dont use over _____ or areas w/ ________

Answer 16

Anesthesia: Topical (Lido, Epi, Tetracaine)

1. used in small wounds in kids
2. soak dause pad and place directly on wound for 20 min
3. dont use over mucous mem or areas w/ end arterial circulation

Question 17

Aseptic Technique Sterile Field

1. what is margin need on all sides
2. areas where suture tail may land must be covered in what

Answer 17

Aseptic Technique Sterile Field

1. need 1 inch margin on all sides
2. areas where suture tail may land must be covered in sterile drape

• field must be dry

Question 18

Instruments

1. which do you use tripod grip, distal phalanx of thumb and 3rd/4th finger
2. which do you hold like pencil and has teeth
3. which do you use tripod grip, cut at tips and 45 degrees to avoid cutting out knots

Options: Webster needle Driver, Adson Forceps, Iris Scissors

Answer 18

Instruments

1. which do you use tripod grip, distal phalanx of thumb and 3rd/4th finger = Webster needle Driver
2. which do you hold like pencil and has teeth = Adson Forceps
3. which do you use tripod grip, cut at tips and 45
   degrees to avoid cutting out knots =Iris Scissors

Question 19

Wound Care Steps #1 Wound Prep w/ Hair Removal

1. why are hair follicles removed
2. why are eyebrows not removed (2)
3. what is used to matt down hair
4. shaving recommended as method?

Answer 19

Wound Prep: Hair Removal

1. why are hair follicles removed b/c source of infxn
2. why are eyebrows not removed
   - may not grow back
   - need to maintain landmarks
3. Bacitracin used to matt down hair
4. shaving is NOT recommended

Question 20

Wound Care Steps #2: Wound Debridement

1. avoid debriding what 3 things
2. what 2 tpyes of tissue should be removed
3. when is the only time total excision is approp

Answer 20

Wound Care Steps #2: Wound Debridement

1. avoid debriding: landmarks, areas needing plastic reconstruction, high tension area
2. Remove devitalized and adipose tissue
3. only time total excision is approp= no specialized structures involved

Question 21

Wound Care Steps #3: Wound Cleaning

1. What type of mechanical irrigation is best
2. 2 types of wound cleansing preps used

Answer 21

Wound Care Steps #3: Wound Cleaning

1. high pressure mechanical irrigation w/NS is best
2. 2 types of wound cleansing preps used
   - Providone
   - Poloxamer/ShurClens

Question 22

Wound Care Steps #3: Wound Irrigation

1. When should irrigation of wound before performed
2. what is the benefit of it
3. two things used for wound irrigation
4. what types of wounds can tap water be used as irrigation (3 criteria)

Answer 22

Wound Care Steps #3: Wound Irrigation

1. irrigation performed AFTER anesthesia
2. benefit = decr infxn rates
3. two things used for wound irrigation
   - NS
   - 5-8 PSI
4. Tap water irrigation
   - clean, non-contaminated, highly vascularized wounds

Question 23

Wound Care Steps #3: Hemostasis

• 5 options for it

Answer 23

Wound Care Steps #3: Hemostasis

1. direct pressure
2. Epi
3. Digital tourniquet
4. ligation of blood vessel
5. inflated BP cuff

Question 24

Suture Info

1. Size: more O’s mean what
2. what do sutures provoke
   (why dont use highly reactive sutures (gut/silk) in contaminated wounds)
3. strength: only slightly higher than ____

Answer 24

Suture Info

1. Size: more O’s mean smaller (7.0 smaller than 2.0)
2. Sutures provoke inflam resp –> dont use highly reactive sutures (gut/silk) in contaminated wounds
3. strength: only slightly higher than skin

Question 25

Types of Suture Material 1. 4 types of non-absorable 2. 3 types of Absorbable 3. what type incr risk of infxn but has secure knotting 4. what has lower infxn risk but less secure knotting

Answer 25

Types of Suture Material 1. 4 types of non-absorable - ethilon - prolene - silk - Nurolon 2. 3 types of Absorbable - Vicryl - PDS - Gut 3. Braided = incr risk of infxn but has secure knotting 4. Monofilament = lower infxn risk but less secure knotting

Question 26

Tool for Suturing: Needles 1. which way do you cut for conventional needles 2. which way do you cut for reverse cutting needles

Answer 26

Tool for Suturing: Needles 1. conventional needles --> cut TOWARD wound edge 2. reverse cutting needles --> cut AWAY from wound edge