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Flashcards in Chapter 8 Deck (23)
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1
Q

contrast control of a small bleeder with large bleeders

A
small bleeder
 - wait for it to stop in its own
- apply pressure with sterile gause
- cauterize, clamp with hemostat
large bleeder
- clamp with hemostat and tie off with dissolvable suture 
- cauterize by touching hyfrecator tip to hempstat
- tie off with figure of eight suture
2
Q

what are the other steps in the laceration evaluation and treatment

A
  • stop the bleeding
  • assess for contamination
  • check: flexion/extension
  • R/O fractures
  • inject anesthesia - no epi
  • clean and debride,
  • culture if infx risk
  • close and bandage
3
Q

what is quikclot, when should it be concidered

A

only use when direct pressure isn’t working, you are really far from medical help, must still get to ER

  • gauzy wounds filled with kaolin, that activates blood coagulation.
  • it must contact bleeding vessel to work
4
Q

what is surgigel, when should you use it

A

absorbable hemostat that is albos bactericidal against G- and G+. plant bases
- only use with ther convential methose for small stff
NOT for hemorrhage from large arteries.
not for closed contaminated
removed when bleeding stops.

5
Q

contrast treatment of skin loss up to 1 sqcm on finger verses larger wound or avulstion on finger tip

A

small skin loss- dressing changed regularly
larger wounds - refer to plastic surteon
nail bed damage = plastic surgeon

6
Q

concerns about a palm wound

A

assess carefully - easy for nerve involvement and tendons

7
Q

tetanus admin guidlines

A

Determine tetanus status, if not sure if had booster withing 10 years give tetanus toxoid
- less than two tetanus toxoid in life and lots of contamination the give toxoid and immune globulin

8
Q

controllable issues that affect wound healing

A

Be gentle with tissures
clean tissues well
spint/cast near joints to help prevent dehissence

9
Q

uncontrollable issues that affect wound healing

A
  • mech of injury
  • location
  • age and race
  • patients healing ability/healthy
  • patients nutritional status
  • patients tendency to scar
10
Q

what should be done to wound side prior to applying anesthesia?

A

asses wound site

  • tissue damage
  • contamination
  • underlying nerve, tendon, muscle and boney damage
11
Q

how should anesthetic ususally be administered in relation to wound?

A
  • inject from inside or senter of laceration out through side of wound into tissue = less painfull (not through skin surface)
  • don’t do this if its really contaminated
12
Q

what should be done with human bite wounds

A

they are contaminated and ususally left open for a while to watch for infection.
all wounds are concicered contaminted

13
Q

what is wound tattooing and how is it prevented

A
  • embedded foreign material that heals inside wound

- clean it, remove material with needle or forceps,

14
Q

what is the point of trimming a wound edge

A

wound opening wider at base than surface to help evert edges

15
Q

how can excessive scar formation be minimized

A

through gentle handeling and careful cleaning of injured tissue

16
Q

is there a golden period of 12 -24 hours after which you cant close wound

A

not anymore

17
Q

what three types of wounds cant usually be sufficiently closed by steristrips and glue

A

1- laceration into the deeper dermal layers and sub Q
2 - wounds missing tissue
3 - wounds with increased wound tension

18
Q

name the 7 wound closure technique basics

A
1 - handle tissures gently
2 - ensure hemostasis
3 - use fine a suture as feasible
4 - needle at 90 degress
5 - evert wound edges
6- keep skin edges relaxed but opposed
7 - remove sutures early to avoid scarring
19
Q

what are the closure options for cleaned vs. contaminated/dirty wounds

A

clean
- small primary
- large: undermine if necessary and suture or allow to heal by secondary intention, or refer to specialist
dirty
- secondary closure
- large - delayed primary closure , little additional risk of infection

20
Q

should a drain be inserted into a traumatic laceration

A

routine traumatic laceration ; no drain

suspect future infection : concider draining

21
Q

suture removal techniques

A

grasp knot, move enough so you can see,
cut suture,
pull freed knot across suture line.

22
Q

trmoval times for sutures

A

face/ 3-5
scalp - 5-7
extremity 6-14
abdomen chest and back = 6-12

23
Q

when would you use a three point corner stitich

A

lacerations and plastic surgery procedures