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Laceration & Wound Care Flashcards

(109 cards)

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1
Q

order of wound healing

A
  • coagulation
  • inflammation
  • collagen metabolism
  • wound contraction
  • epithelization
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2
Q

coagulation phase

A

platelets release factors

capillary permeability increases to allow WBCs to migrate & eliminate debris/bacteria

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3
Q

inflammation phase

A

monocyes become macrophages
release chemotactic substances
trigger fibroblast replication and neovascularization

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4
Q

collagen phase

A

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

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5
Q

wound contraction phase

A

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

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6
Q

epithelization phase

A

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

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7
Q

which type of wound has the greatest surface area, jagged or smooth?

A

jagged, distributes the tension creating less tension per unit of strength

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8
Q

primary intent

A

stitching the wound

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9
Q

when should primary intent be done?

A

simple, relatively clean wounds

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10
Q

methods of primary intent

A

stitch, staples, commercial adhesive, steri-strips

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11
Q

secondary intent

A

letting the body heal itself

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12
Q

when should secondary intent be done?

A

infected wounds, ulcerations, abscesses, abrasions, animal/human bites

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13
Q

purpose of secondary intent

A

allows skin to heal via granulation tissue and epithelization

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14
Q

tertiary intent

A

watch, wait, and eventually stitch it up

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15
Q

when should tertiary intent be done?

A

special wounds that are too contaminated from soil, feces, saliva

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16
Q

method of tertiary intent

A

clean, debride, observe for 4-5 days and close how you would like

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17
Q

onset of lidocaine

A

minutes

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18
Q

duration of lidocaine

A

30-60 minutes

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19
Q

info about lidocaine

A

MOST commonly used anaesthetic

1% lido comes in a 10 mg/mL bottle

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20
Q

what can you mix lidocaine with?

A

epinephrine

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21
Q

why would you want to mix lidocaine with epinephrine?

A

results in vasoconstriction a nd prolongs effect for 2-6 hours BUT will delay healing and lower resistence to infection

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22
Q

old thought about epi

A

avoid in extremities, but studies show now that judicious use is okay

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23
Q

onset of bupivacaine

A

minutes

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24
Q

duration of bupivacaine

A

4-6 hours

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25
info about bupivacaine
equal quality to lidocaine | great for nerve blocks
26
what can you do it a patient complains the anaesthetic stings?
add bicarb to lidocaine
27
will adding bicarb to lidocaine impair the anaesthesia?
NOPE
28
how much bicarb should be added to lidocaine?
1 mL to a 10 mL bottle of lidocaine
29
how much bicarb should be added to bupivacaine?
0.1 mL to a 10 mL bottle of bupivacaine
30
what is TAC?
tetracaine/adrenaline/cocaine
31
how is TAC used?
soak cotton ball with solution, place on wound for 10-20 min
32
pros of TAC
similar effectiveness to lidocaine anatomy undisturbed pt acceptance increases
33
cons of TAC
infection rate increased if wound contaminated | avoid mucous membrane woudns
34
what is LET
lidocaine/epinephrine/tetracaine
35
pros of LET
similar properties to TAC, but avoids the complications with cocaine
36
what is EMLA
cream of local anaesthetic
37
cons of EMLA
takes about 1 hour to numb the area | usefulness varies
38
anaesthesia containing esters
procaine tetracaine benzocaine
39
anaesthesia containing amidea
lidocaine | bupivavaine
40
what size needle lessens the pain of injection?
smaller, but at the cost of speed of the injection
41
is there a concern for seeding bacteria deeper when injecting anaesthesia?
NOPE
42
when should you do a field block?
when want to avoid injecting through a highly contaminated area less needle sticks
43
when should you do a nerve block?
situations where you can distort anatomy with anaesthesia injection pain relief with the best cosmesis
44
what is the biggest concern with nerve blocks?
face and fingers
45
what microbes does betadine cover?
gram positive & negative, fungi and some viruses
46
what microbes does chlorhexidine cover?
less effective against gram negatives
47
what is debridement?
removal of foreign material and devitalized tissue from the wound
48
what is more effective in cleaning wounds, NS or tap water?
EQUAL
49
should you use iodine to clean a wound?
not unless its 1% solution (usually comes in 10%)
50
what pressure does irrigation need to be to decrease infection and bacteria?
>7 PSI
51
should you soak or scrub a wound?
NO! unless its road rash, then scrub the crap out of it
52
which is better at irrigation, high pressure irrigation or water pick?
water pick is more pressure, but can damage tissues
53
what is post-traumatic tattooing?
when a person has road rash that was not properly scrubbed so now there are imbedded particles pigmenting the skin
54
4 Cs of viability
coloc, consistency, contractility, capillary ooze
55
should you shave hair?
NEVER!
56
non-absorbable sutures
nylon, prolene and silk
57
importance of nylon sutures
black, good to stitch, tie well, little tissue reactivity
58
importance of prolene sutures
blue, doesn't tie well, good for hairy areas
59
importance of silk sutures
technically will slowly degrade, greatest tissue reactivity and not typically used anymore
60
absorbable sutures
gut, chromic gut, dexon, vicryl, PDS
61
how long will to take for absorbable sutures to biograde?
2-6 weeks
62
when is it best to use absorbable sutures?
layered closure
63
importance of gut sutures
from cows/sheep submucosa, varied knot tie holding
64
importance of chromic gut sutures
gut with chromium salts, doubles life of the suture
65
importance of dexon/vicryl/PDS sutures
synthetic, minimal tissue reaction, worse knot holding
66
which numbers are for smaller sized stitches?
higher number therefore, smaller numbers are for larger stitches
67
how do you determine the size of the stitch you should use?
location, tension, cosmesis
68
size of stitch for the face
5-0/6-0
69
size of stitch for the scalp and joint surfaces
3-0/4-0
70
size of stitch for trunk
4-0/5-0
71
shape of stitch needles
tapered,cutting and reverse cutting
72
when should tapered needles be used?
in the OR on delicate tissue
73
when should cutting needles be used
MOST common, 3 edges
74
when should reverse cutting be used?
tough skin and ligaments
75
if you need to take big bites, what size needle should you use?
bigger needle
76
if you need to stitch more delicate tissue, what size needle should you use?
smaller needle
77
rule of 5s for simple interrupted sutures
sutures placed 5 mm from wound edge, 5 mm apart
78
what is the goal for the edge of sutures?
evert! wounds will flatten as they heal
79
whats so special about a lac on the vermillion border?
regardless of the wound, repair border first, cosmesis first NYLON (or another non-absorbable) for skin VICRYL (or some absorbable) for the lip itself
80
whats so special about an eye lac?
lid lacs NOT involving the edges are okay to repair | anything involving the medial or lateral canthus/lid margain needs an ophthamologist
81
how do you handle a flap lac?
B-C | | A D A and D tied together
82
when would you use a vertical mattress suture?
larger wound
83
what's the issue with vertical mattress sutures?
risk of dehiscence
84
when would you use a horizontal mattress suture?
larger wounds or unequal skin flaps
85
when would you use a figure 8 stitch?
bleeding vessels and varicose veins
86
what is dermabond?
synthetic adhesive that polymerize on contact in an exothermal reaction to form a strong wound closure bond
87
how long until dermabond sloughs off?
7-10 days
88
can dermabond get wet?
yes
89
pros of dermabond
fast, cheap, east, low skill level
90
cons of dermabond
water exposure breaks it down, low tensile strength, ?cosmesis
91
how to apply dermabond
clean and irrigate, approximate the edges or have an assistant hold, squeeze tube and roll on, no need to "paint it", apply one layer, wait and apply another, MUST be dry or bloodless, tegaderm or vaseline to help create borders
92
uses of steri-strips
close primary wound, reinforce repairs or after suture removal
93
tools needed to apply steristrips
steri-strip, benzion, suture removal kit and TWO sets of gloves
94
how long to steri-strips last?
usually a few days, more water exposure will decrease duration
95
steps to apply steristrips
apply benzion to the skin around the wound, open the steri-strips, cut to length, grab the steri-strips with the forceps, for a primary closure, have an assistant approximate the wound edges and apply the steri-strips still using the forceps
96
when are staples used?
usually surgery or in the ER for scalp lacs
97
what should you do when removing sutures?
COUNT THEM and make sure it's the same amount that went in
98
which part of the staple remover goes under the staple?
ALWAYS the two teeth side
99
what stitch is the most important?
the first one
100
who gets a tetanus shot?
>6 hrs old, >1 cm deep, stellate/avulsion configuration, devitalized tissue, contaminated with soil/feces/saliva, from a missle, puncture or crush, associated with a burn or frostbite
101
if the lac was non-tetanus prone and they have a shot within 10 years, do they need another?
no
102
if the lac was tetanus prone and they had a shot within 5 years, do they need another?
nah
103
if the patient has no history of a tetanus shot and they get any lac, do they need a shot?
YES
104
if someone had a face lac, how long do you have to give the tetanus shot?
24 hours
105
if someone has a lac anywhere but the face, how long until they get the tetanus shot?
18 hours
106
how long until removal of face stitches?
4-5 days
107
how long until removal of scalp stitches?
6-8 days
108
how long until removal of trunk stitches?
8-10 days
109
how long until removal of extremity stitches?
8-10 days

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