Laceration & Wound Care Flashcards Preview

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Flashcards in Laceration & Wound Care Deck (109)
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1

order of wound healing

-coagulation
-inflammation
-collagen metabolism
-wound contraction
-epithelization

2

coagulation phase

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

3

inflammation phase

monocyes become macrophages
release chemotactic substances
trigger fibroblast replication and neovascularization

4

collagen phase

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

5

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

6

epithelization phase

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

7

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

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

8

primary intent

stitching the wound

9

when should primary intent be done?

simple, relatively clean wounds

10

methods of primary intent

stitch, staples, commercial adhesive, steri-strips

11

secondary intent

letting the body heal itself

12

when should secondary intent be done?

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

13

purpose of secondary intent

allows skin to heal via granulation tissue and epithelization

14

tertiary intent

watch, wait, and eventually stitch it up

15

when should tertiary intent be done?

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

16

method of tertiary intent

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

17

onset of lidocaine

minutes

18

duration of lidocaine

30-60 minutes

19

info about lidocaine

MOST commonly used anaesthetic
1% lido comes in a 10 mg/mL bottle

20

what can you mix lidocaine with?

epinephrine

21

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

22

old thought about epi

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

23

onset of bupivacaine

minutes

24

duration of bupivacaine

4-6 hours

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