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SU-18 ER > Wound Care > Flashcards

Wound Care Flashcards

(69 cards)

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1
Q

layers of the skin

A
  1. epidermis
  2. dermis
  3. superficial fascia
  4. deep fascia
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2
Q

epidermis

A

cutaneous layer

few cell layers thick

undifferentiated from dermis

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3
Q

dermis

A

layer used to approximate for closure

easily ID

replaced by scar tissue

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4
Q

superficial fascia

A

subcutaneous layer

loose CT, fat, nerves

can be liberally debrided, susceptible to infection

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5
Q

deep fascia

A

thick, dense, fibrous off white sheath

supports and protects the muscle

requires closure

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6
Q

injury and tension line

A

laceration parallel to tension lines heal better than lacerations perpendicular

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7
Q

types of injury list

A
  1. shearing injury
  2. tension injury
  3. compression injury
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8
Q

shearing injury

A

sharp objects

little energy transfer

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9
Q

tension injury

A

higher energy transfer
potential devitalized tissue
higher risk of infection

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10
Q

compression injury

A

significant risk of devitalization

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11
Q

what to consider when deciding sedation or anesthesia

A

procedural complexity
duration
pt population

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12
Q

conscious sedation agents

A

ketamine
propofol

ketamine + propofol

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13
Q

considerations for LOCAL anesthetics

A
  1. location
  2. onset of action
  3. duration of action
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14
Q

location for local anesthetics

avoid lidocaine where?

A

in combination with epinephrine when

fingers, nose, lips, toes, anything that grows

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15
Q

when do you use bupivicaine 0.5%

A

nerve blocks

aka marcaine, sensorcaine

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16
Q

esters list

A

cocaine
benzocaine
tetracaine
Procaine (Novocaine)

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17
Q

Amides list

A

Bupivicaine (95% protein bound)
Mepivicaine (78% protein bound)
Lidocaine (64% protein bound0

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18
Q

lidocaine MOA

A

prevents sodium influx across nerve membrane = decreased polarization = inadequate formation of AP = no nerve impulse

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19
Q

lidocaine

A

immediate onset of action

MC used

epi extends duration of action

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20
Q

anesthetic buffering

A

mix 1 mL bicarb per 9 Ml 1% lidocaine

reduces time to onset and increases intensity

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21
Q

small needles

A

reduce the speed of injection

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22
Q

topical anesthesia combos

A

TAC (Tetracaine, epinephrine, cocaine)

LAT (lidocaine, epinephrine, tetracaine)

pediatric pts

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23
Q

direct wound infiltration

A

inject plane just below dermis at jxn with superficial fascia

MC approach

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24
Q

list of nerve blocks (5)

A
  1. supraorbital n.
  2. infraorbital n.
  3. mental n.
  4. digital n.
  5. auricular block

should all be done with Marcaine

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25
supraorbital block
forehead block parallel margin infiltration in continuous track at brow level
26
infraorbital
intra or extra orally intraoral is less painful (insert needle from maxillary banana to infraorbital foramen) 1-3 cc
27
mental block
insert needle at gingival buccal margin inferior to second bicuspid extend to mental nerve foramen midway between up and low margin of mandible
28
Digital nerve block and epi
DO NOT use vasoconstrictors bc it can cause tissue extravasation (ischemia and scarring) if you do - Phentolamine
29
digital nerve
all 4 digits go in and numb right around bone
30
best strategy for repairing wound to external ear
auricular n. block parallel margin, 2-3 mL of anesthesia do not use lidocaine + epi inject below dermis at subQ jxn
31
components of wound prep
``` personal precautions anesthesia foreign material wound soaking wound periphery cleansing irrigation ```
32
foreign material
all should be considered harmful MC reason for malpractice suit
33
irrigation
irrigate until no visible contaminate around wound NS is MC used
34
3 categories of wound closure
primary closure secondary closure tertiary closure
35
primary intention
clean wounds must be repaired within 6-8 hrs of injury ( < 24 hrs on face)
36
secondary intention
wounds >8 hrs old (>24 hrs on face) abscess, punctures, bites NOT closed with suture but allowed to heal gradually by granulation of re-epithelialization
37
tertiary intention
clean, debrided, observe wound 4-5 days then come back and close again grossly contaminated wound with vital tissue
38
wound exploration
should be done whenever there is minor possibility of FB XR before explore if glass, gravel, metallic FB suspected I.e. tooth fracture - XR to see fragment
39
how to get hemostasis
``` direct pressure (most effective) vasoconstrictor gelfoam direct clamping cautery tourniquets ``` ** NO BLIND CLAMPING
40
active bleeding and wound care
hemostasis prior to closure is idea bc active bleeding limits exportation and visualization can cause hematoma formation
41
tourniquets time
can only be on 30 min max in large extremities (20 min max in digit)
42
common instruments in suture kit
``` needle holder forceps/skin hooks scissors hemostats scalpel/blade ```
43
needle driver
hold like a pencil rings are designed to be used for closing and release
44
forceps
used to grasp fascia incorrect use may cause crushing injury to dermis and epidermis can be used as skin hook
45
functions of hemostat
1. clamp small blood vessels for hemorrhage control 2. grasp and secure undermining and deriding wound 3. expose, explore, visualize deeper area of wound
46
scapel sizes
numer 11 blade number 10 blade number 15 blade
47
numer 11 blade
I and D of superficial abscess removing small sutures
48
number 10 blade
used for cutting skin | helpful for extending wounds during revision
49
number 15 blade
versatile | precise depribement and wound revision
50
simple excision
wound edge revision minimal excision of macerated and devitalized tissue
51
full wound excision
involved more extensive excision of devitalized and contaminated epidermal, dermal, subQ tissues must score the epidermis, dermis reserved for wounds when skin is not viable but must have tissue redundancy lenticular (length:width = 3:1)
52
considerations in selecting suture material
tensile strength knot security pliability ability to resist infection
53
classes of suture material
1. non absorbable (primary surface skin closure) | 2. absorbable (dead space in lg wound, reduce closure tension)
54
non absorbable suture material (monofilament)
nylon, polypropylene (ethylene, proline) MC suture material for percutaneous dermal layer closure less tissue reactive, strong, able to resist infection greater material memory = knot loosen if not secure
55
common absorbable suture material
vicryl chromic gut monocole
56
vicyrl
MC used absorbable buried subQ suture, oral mucosa, perennial area braided threat
57
chromic gut used where
MC oral, perennial and scrotal tissue mucosal closure
58
monocle
new reduced hypertrophic scar formation monofillamnet
59
location and suture size scalp
4-0 ethilon or proline
60
location and suture size face
6-0 proline ethilon
61
trunk location and suture size
4-0 ethilon
62
extremities location and suture size
4-0 ethilon
63
digits location and suture size
5-0 proline, ethylene
64
sutures last
7-10 days then removed 5 days if in face
65
types of needles
1. reverse cutting | 2. tapered
66
reverse cutting needles
wound and laceration repair more sharp less traumatic code P designation
67
tapered needle
less expensive less sharp code C or FS
68
undermining
used to reduce tension in wound releases dermis and superficial fascia from deeper attachment can be done by hemostats or scissors distance should be = to gap of wound
69
where MC undermining use
where skin is under great deal of natural tension scalp, forehead, lower legs

SU-18 ER (11 decks)

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