Flashcards in Laceration & Wound Care Deck (109)
order of wound healing
platelets release factors
capillary permeability increases to allow WBCs to migrate & eliminate debris/bacteria
monocyes become macrophages
release chemotactic substances
trigger fibroblast replication and neovascularization
principle structural protein of most body tissue
needed for tissue repair
fibroblasts make and deposit collagen within 48 hrs peaks at DAY 7
young collagen is disorganized
greatest mass at 3 weeks, continues to remodel over 6-12 months
wound contraction phase
movement of whole thickness skin towards the center of the defect
AT TIME OF INJURY: wound edges retract & pulls away, increasing defect size, tension lines will make traction, any laceration PERPENDICULAR to those lines are under greater tension and result in larger scars
3-4 DAYS LATER: wound size shrinks, edges move towards the center, process INDEPENDENT of epithelization, presence of collagen is NOT needed either
epithelial cells migrating across the wound
starts near the edges within HOURS
any eschar/debris will DELAY process
if wound is properly cleaned/debrided, process will occur at a max rate
for any SURGICAL wound: epithelial cells bridge to the wound by 48 hours, begin to grow down and corm the classic epidermis within 5 days
which type of wound has the greatest surface area, jagged or smooth?
jagged, distributes the tension creating less tension per unit of strength
stitching the wound
when should primary intent be done?
simple, relatively clean wounds
methods of primary intent
stitch, staples, commercial adhesive, steri-strips
letting the body heal itself
when should secondary intent be done?
infected wounds, ulcerations, abscesses, abrasions, animal/human bites
purpose of secondary intent
allows skin to heal via granulation tissue and epithelization
watch, wait, and eventually stitch it up
when should tertiary intent be done?
special wounds that are too contaminated from soil, feces, saliva
method of tertiary intent
clean, debride, observe for 4-5 days and close how you would like
onset of lidocaine
duration of lidocaine
info about lidocaine
MOST commonly used anaesthetic
1% lido comes in a 10 mg/mL bottle
what can you mix lidocaine with?
why would you want to mix lidocaine with epinephrine?
results in vasoconstriction a nd prolongs effect for 2-6 hours BUT will delay healing and lower resistence to infection
old thought about epi
avoid in extremities, but studies show now that judicious use is okay
onset of bupivacaine
duration of bupivacaine
info about bupivacaine
equal quality to lidocaine
great for nerve blocks
what can you do it a patient complains the anaesthetic stings?
add bicarb to lidocaine
will adding bicarb to lidocaine impair the anaesthesia?
how much bicarb should be added to lidocaine?
1 mL to a 10 mL bottle of lidocaine
how much bicarb should be added to bupivacaine?
0.1 mL to a 10 mL bottle of bupivacaine