Wounds etc.

Question 1

Examples of nonabsorbable suture

Answer 1

PTFE
Nylon
Polyester
Polypropulene
Silk
Stainless steel

Question 2

examples of absorbable suture

Answer 2

catgut
polyglycolic (dexon)
Polyglactin (vicryl)
poligleacaprone (monocryl)

Question 3

suture removal times for body parts

Answer 3

Face and neck: 3 to 5 days
Scalp and body: 5 to 7
Extremities: 7 to 12 days

Question 4

What are the areas of the body or situations that require special attention and or hospitalization?

Answer 4

• Partial thickness greater than 20% body
• Burns of face, hands, feet, genitalia, major joints.
• 3rd degree burns
• Electrical burns
• Chemical burns
• Inhalation injury

Question 5

Clinical features that are suspicious for child abuse?

Answer 5

• delay seeking medical advise
• burn in shape of object
• sharp demarcated boarder, bilateral
• cigarette burns

Question 6

Ratings of hypothermia, 3 levels?

Core body temp below?

Answer 6

Mild: 32-35 Celsius 35 = 95 F
Moderate: 28-31.9 C
Severe: <28

Question 7

Dysbarism?

Answer 7

Decompression sickness, arterial gas embolism, barotrauma

Question 8

Decompression sickness
Path
Sx
Tx

Answer 8

Nitrogen bubbles in tissues during ascent
Type 1: Deep aching pain in large joints (bends).
Type 2: Cardiorespiratory
Type 3: arterial gas embolism: air in the interstitial space or pulmonary veins
Tx: 100% O2, Iv fluids, possibly hyperbaric chamber.

Question 9

Acute mountain sickness
Sx:
Tx:

Answer 9

Sx: HA with GI disturbance, dizziness, fatigue or sleep disturbance
Tx: Decent is definitive treatment
- Rest, supplemental O2, NSAIDs, antiemetic
- Dexamethasone for moderate or severe cases only

Question 10

High altitude pulmonary edema
Sx:
Tx:

Answer 10

Rapid ascent above 8000ft.
Most lethal of all altitude sickness
Sx: dry cough, decrease exercise perf,
- late: dyspnea at rest, productive cough, pink frothy sputum
- later: AMS, coma
Tx: O2 and decent best treatment, Nifedipine

Question 11

Burn assessments regarding surface area?

Answer 11

Rule of nines: Each area represents 9%
- head, anterior chest, anterior abdomen, each arm, anterior each leg, posterior each leg.

Can use palmar method: size of patients palm represents 1% of their body surface area.

Question 12

Define first degree burns
Pres
w/u
tx:

Answer 12

Superficial, epidermis
Presentation: erythema only, no blistering
w/u: consider cause of burn
Tx: irrigate w/ NS, non-adherent dressing, topical abx, elevate, NSAIDs, OP follow up
- No systemic abx unless signs of infection then keflex

Question 13

Define 2nd - 4th degree burns
Pres
w/u
tx:

Answer 13

2nd: Partial thickness, epidermis and dermis = erythema plus blisters
3rd: Full thickness, subQ = pink, white or brown, skin appears smooth and leathery, painless
4th: Burns to muscle and bone = eschar, “deep burn necrosis”
W/u: survey for immediate life threats
- Calculate TBSA
- ABG, carboxy-hgb, CBC, electro, ect.
- CXR
Tx: ABCs!, IV fluids, wounds etc.

Question 14

Burn severity scale

Answer 14

Mild: < 10% body, <5% child or elderly
Moderate: 10-20%, 1/2 for kids, elders
Major: >20% partial thickness burns or 3rd degree or specific types or locations of burns

Question 15

Complications from burns?

Answer 15

Fluid, electrolyte, protein loss…
Infection
Airway compromise
Circumferential burns: compartment syndrome

Question 16

Black widow spider bite
S/s
Tx

Answer 16

Pain can spread to entire extremity, erythema in 20-60 minutes, target lesion 1-2cm, muscle cramping of large muscle groups, severe ABDOMINAL wall cramping
Tx: latrodectus antivenom, opioids, benzos

Question 17

Bee and wasp stings
complications
indications for admission

Answer 17

comp: severe local reaction
- anaphylaxis (usually within 15 minutes, no longer than 6 hours from sting)
- Delayed reaction: Serum sickness like symptoms; 5-14 days,
- Greater than 100 stings or significant comorbidities = hospital admission

Question 18

Cat and dog bites:
Pathogens
Tx:

Answer 18

Cat bites: pasturella
Cat scratch: bartonella
Tx: Augmentin, do not close wound

Question 19

Human bites tx:

Answer 19

Augmentin for all bites