PRINCIPLES OF WOUND CARE

Question 1

Name some basic components of aseptic technique

Answer 1

hygiene
use of PPE
use of sterile feild
opening and introducing packets w/out contamination
not touching non sterile items

Question 2

3 components of a well managed wound

Answer 2

well vascularized (not dead or foreign stuff)-debrided
clean (sterile fluid)-irrigation
moist- dressed w/ impregnated layer, then dry layer

Question 3

define a clean wound and its TX

Answer 3

Uninfected, operative wound, no infl., no Resp/GI/GU. Primarily closed, no abx.

Question 4

define a clean-contaminated wound and its TX

Answer 4

Operative wound Rsp/GI/GU inv. in cntrld cndtns, debride, irrig, 1rst clos, Cefazolin/Cefotetan

Question 5

define a contaminated wound and its TX

Answer 5

Trauma (exp. To FB), GI spillage, infl. Encountered. Debride, irrig, 2nd clos. Cefazolin/ofloxacin

Question 6

define a dirty-infected wound

Answer 6

Old traumatic wounds, active infection. Debride, irrig, 2nd clos, Augmentin.

Question 7

when is primary closure indicated?

Answer 7

• Primary: clean wound, deep enough to leave excess scar if not closed, suture->hairline scar

Question 8

When is secondary closure indicated?

Answer 8

gaping, irregular wound, dirty >18hrs-

Question 9

When is tertiary closure indicated?

Answer 9

wound that is greater than 18 hours. This is a judgement call for wounds that may be infected, but would ideally be closed for cosmetic or functional purposes. clean and debride, allow granulation and reassess in 4-5 days.

Question 10

When is closure contraindicated

Answer 10

never close infected wounds: FB, contam, puncture, crush, abscess, sig. delay

Question 11

what is stronger: synthetic or organic suture?

Answer 11

synthetic

Question 12

what is more reactive: synthetic or organic suture?

Answer 12

organic

Question 13

what has more tensile strength and is bigger: 1.0 or 10.0?

Answer 13

1.0

Question 14

What size suture would you use on eyelids/face/penis?

Answer 14

7.0/6.0

Question 15

What size suture would you use on low tension areas like parts of scalp, oral mucosa, abdomen or hand?

Answer 15

5.0

Question 16

what size suture would you use on high tension parts of the scalp, the chest or foot?

Answer 16

4.0

Question 17

what size suture would be appropriate for foot skin, deep in the abdomen or the back?

Answer 17

3.0

Question 18

what size suture is used for chest tubes and GI tubes?

Answer 18

2.0

Question 19

Name a strong and low reactive absorbable suture

Answer 19

PDS or Vicryl

Question 20

Name a weak and high reactive absorbable suture

Answer 20

Gut type sutures (used in face and mouth)

Question 21

Name a strong and low reactive non absorbable suture

Answer 21

Prolene or Nylon

Question 22

Name a weak and high reactive non absorbable suture

Answer 22

silk

Question 23

You just sutured a patient’s cheek, when can she have the sutures removed?

Answer 23

3-5 days

Question 24

You just sutured a hand laceration, when can your patient have the sutures removed?

Answer 24

7-10 days arms/scalp, 10-14 hands,trunk,legs and 14-21 for palms and soles.

Question 25

Your patient has to have surgical repair of his wrist what sort of anesthesia will block his entire arm? What are the minimum/ max times for this sort of anesthesia?

Answer 25

regional/bier block | min 30 minutes max 1.5-2 hours

Question 26

Your patient comes in with a giant abscess on his back and asks for anesthesia before your I&D. What's a good option?

Answer 26

Local injection

Question 27

How does lidocaine toxicity present?

Answer 27

``` metallic taste tinnitus lip tingling agitation seizure arrythmia urticaria anaphylaxis ```

Question 28

Your patient has a laceration on her index finger, what is a good option for anesthesia before you debride?

Answer 28

Digital block

Question 29

Your lidocaine says 1% on it what does this mean?

Answer 29

The concentration is based on kilograms per 100mL. 1% is 10mg/ml.

Question 30

What is the max dose for lidocaine 1%? w/ epi? How long does it last?

Answer 30

4mg/kg or 300mg or 30mL 7mg/kg or 500mg or 50 mL lasts 1-2 hours 3 w/ epi Same for mepivicaine

Question 31

When is mepivicaine contraindicated?

Answer 31

pregnancy

Question 32

What is the max dose for bupivicaine .25%?w/ epi? How long does it last?

Answer 32

2mg/kg=>175mg/70cc, 3mg/kg=> 225mg/90cc . 4-8 hours

Question 33

How long does topical EMLA need to be on to provide anesthesia to your kiddo before he gets a needle stick?

Answer 33

1 hour lasts up to 4 don't use on broken skin.

Question 34

How long do lido, bupivicaine and mepivicaine take to start providing anesthesia?

Answer 34

about 5 minutes

Question 35

Name some examples of anaerobic infections

Answer 35

anaerobes displaced from GI or soil where they don't belong.... - dead/dying tissue - pneumonia - oral or pelvic infections

Question 36

What ABX work for anaerobic infections

Answer 36

metronidazole clindamycin G2 ceph like cefoxitin w/ anaerobic coverage

Question 37

Name some examples of G- infections

Answer 37

E. coli (UTI) Klebsiela/Pseudomonas (Pneumonia, bloodstream) N. Gonn (STD)

Question 38

What ABX work for G- infections

Answer 38

- Fluoroquinalones (Cipro/levo) - TSM - Aminoglycoside (gentamycin) - 3rd Gen Ceph (ceftazadine, ceftriaxone)

Question 39

Name some examples of G+ infections

Answer 39

- Staph(abscess and soft tissue, pneumo, etc), - strep (pneumo, URI, soft tissue) - enterococcus (UTI, diverticulitis, blood, intra abd.) - listeria (flu-like) - clostridium (enteritis C. perf, gas gangrene Cperf., diahrrea for C. diff)

Question 40

What ABX work for G+ infections

Answer 40

HAMRSA: Vanc, CAMRSA: TMS. PCN’s, Ceph (1/2), Carbapenim, Macrolides, Tetracyclines

Question 41

Name 3 infections that affect the epidermis

Answer 41

erysipelas impetigo folliculitis

Question 42

Name two infections that affect the dermis

Answer 42

furuncle | carbuncle

Question 43

What infection exists b/t dermis and subQ

Answer 43

cellulitis

Question 44

what infection invades subQ and fascia

Answer 44

necrotizing fasciitis

Question 45

What infection invades muscle

Answer 45

gas gangrene

Question 46

DOC for impetigo, ulcer or lac?

Answer 46

mupirocin/ bactroban

Question 47

TX for simple abscess

Answer 47

I&D no ABX

Question 48

Complicated abscess/boil (cellulitis, const. sx, immunosup., area diff. to drain)

Answer 48

I&D Oral/IV Vanc/Linezolid/Clinda

Question 49

Non purulent (strep) cellulitis outpatient

Answer 49

Clinda/tms or doxy+cephalexin/b-lactam

Question 50

Purulent (staph) cellulitis outpatient

Answer 50

Clinda/TMS/Doxy/Linezolid