Flashcards in Week 3 - Lacerations Deck (22)
What are the top 6 history questions one should ask?
1. When injury occurred
2. Cause of injury
3. Where injury occurred
4. Other injuries
6. Other health problems
What are the top 7 wound complications?
2. Irregular closure
3. Dehiscence - wound ruptures along surgical suture
4. Contact dermatitis
5. Suture reaction
6. Keloid formation
In examining a wound what are the top 8 physical exam components?
2. Edges (of wound & tissue loss)
4. Nerve Injury
5. Tendon injury
6. Foreign body
What are the top 7 methods of closing a wound?
1. Nonabsorbable sutures
5. Absorbable suture
6. Secondary closure - doing nothing, wound is allowed to granulate and is packed
7. . .?
What should you do to a bleeding wound?
Apply pressure to stop bleeding
Why can injury to a local artery be dangerous for a distal limb?
Can cause compartmentalization and loss of muscle - ex: ulnar artery laceration
What can punching someone in the face cause?
Wound over the knuckle that gets infected - it's the worst type of infection that you can have - don't want mouth flora entering the bursa/sheath space
What do people with open fractures need?
Realignment and antibiotics
What are langers lines?
Lines of skin tension that surgeons try to cut along to prevent scarring
What bites are the worst?
Human, then cat (you want a wound wider than it is deep), then dog -due to bacteria
What should you remember when giving local anesthesia injections?
Be generous but giving too much can distort wound edges, making closure more difficult and some areas of skin do not allow for much injection (nose, ear)
What anethesia is most likely to cause an allergic reaction?
Procainamide - an ester
What is Lidocaine?
An anesthesia that is an amide
What is Bupivacaine and mepivacaine?
Longer acting anesthetics are used often with dental pain
Why should you be careful with epinephrine?
It decreases bleeding but be cautious using at distal points of the body - like nose or finger - you could potentially completely cut off the blood supply
How should you give an injection?
-Use a needle smaller than 25, inject slowly, buffer with sodium bicarbonate and inject through the sides of the wound edges into adjacent tissue
How do you do a digital nerve block?
Inject on both sides of the finger and top
When you prepare/clean a wound, what should you keep in mind?
-The more volume you use, the cleaner the wound
-Any clean solution can be used bc volume and pressure are more important to creating a clean wound
-Irrigate with moderate pressure
-Do NOT use Hydrogen peroxide
-Always dilute betadine
When should you avoid using Tissue Adhesive?
Bites, mucosal surfaces, high moisture areas, areas of skin tension (avoid any ointments or fluids)
What is the timeline for wound healing after suturing?
Epithelialization -sealing of wound edges by 24 hours
-Peak collagen formation by 7 days
-Wound tensile strength 20% of full by 3 weeks, 60% of full by 4 months -- never exceeds 80%
Mature scar = 6-12 months
What is dehiscence? How is it caused?
Reopening of a wound, sutured wound or surgical wound.
It can be caused by sutures being removed too soon or too much wound tension.