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Anaesthetics, ED and Plastics > Wounds > Flashcards

Flashcards in Wounds Deck (29)
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1

What makes up epidermis

Stratified squamous keratinised epithelium

Melanocytes - produce melatonin responsible for skin colour + protect against UV

2

What makes up dermis

Connective tissue responsible for strength / elasticity
95% of thickness
Contains rich vascular plexus

3

What is beneath dermis

Subcutaneous tissue
Fascia
Muscle
Penetrating vessels contributing to dermal plexus

4

What is important in Hx of a wound

What caused it?
How long for?
When did it occur?
Where did it occur? - clean or contaminated
Any chance of FB?
Tetanus status
PMH of anything that would affect healing - DM / steroid / anti-coagulant
Any allergies
Previous experience with LA

5

How do you examine wound and what for

Site, depth and length
Check for damage to deeper structures (may need exploration under GA)
- Check sensation
- Signs of nerve / vascular damage
Any FB
Any other injuries

6

What are types of wound - acute

Bruise
Abrasion
Laceration
Incised wound
De-gloving
Avulsion
Crush
Puncture
Haematoma

7

What are chronic wounds

Ulcers
Sinuses
Fistula

8

Bruise

Area of injury leading to escape of block
Initially black and changes colour due to breakdown of Hb

9

Abrasion

Graze caused by rubbing or scraping
Can be heavily contaminated

10

Laceration

Tear of tissue 2 to trauma
Leads to irregular edge with compromised blood supply

11

Incision

Sharp object
Clean well defined age with viable vascularity

12

De-gloving

Laceration where skin is sheared from underlying fascia
Can lead to skin ischaemia

13

Avulsion

Tearing or forcible separation of structure from origin

14

Crush

Tissue damage from compression

15

Puncture

Penetration usually due to sharp object
Risk of infection as extends into SC

16

Haematoma

Accumulation of blood in a tissue, organ or space
Can compress underlying structures

17

Ulcer

Discontinuity of epithelial surface
Can be associated with infection or inflammation

18

Sinuses

Blind track lined by granulation tissue from epithelial surface to surrounding tissue

19

Fistula

Abnormal connection between two epithelial surfaces e.g. gut or skin

20

What are wounds

Clean
Contaminated

21

What are clean wounds

Surgical created or incised
Well defined edges
No contamination

22

How can clean wounds be closed

Primary intention

23

What are contaminated wounds

Laceration / crush / avulsion / de-gloving
Contain foreign material or large amounts of revitalised tissue
Any bite
Any wound >6 hours

24

How do you close

NOT safe by primary

25

What is a tetanus prone wound

Any significant devitalised tissue
Any puncture
Wounds requiring surgery but delayed >6 hours
Contact with soil / manure
Contact with FB
Any open fracture
Evidence of sepsis
Frost bite injury

26

How do you Rx

500g tetanus Ig + muscle relaxant
Vaccination if not had full 5 vaccine

27

What do you do if not tetanus proned wound

Look at immunisation history
If had all 5 = no Rx
If not fully vaccinated = give vaccine and inform GP

28

If a wound is highly contaminated what is required

Clean prior to Rx
May need to clean with LA or in theatre
Irrigation

29

If risk of foreign body

Explore wound
X-ray before closing
May need USS if wood / plastic as won't show up