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Emed > #2: Wound Care > Flashcards

#2: Wound Care Flashcards

1
Q

When doing wound assessment what 2 things are you checking for
- which is done 1st

A

Wound Assessment

  1. check for nerve injury (1st)
  2. check for motor deficit
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2
Q

Wound Assessment: FBs

  1. what are most detected w/
  2. what is other test used, more sensitive for organic matter
A

Wound Assessment: FBs

  1. most detected w/ XR
  2. CT = more sensitive for organic matter
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3
Q

Types of Wounds

  1. which is very contaminated and a/w delayed closure
  2. which is a/w tissue necrosis, hemorrhage, impaired ability to heal, compartment syndrome)
A

Types of Wounds

  1. Bite = very contaminated and a/w delayed closure
  2. Crush = a/w tissue necrosis, hemorrhage, impaired ability to heal, compartment syndrome)
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4
Q

Types of Wound Healing*

  1. wound closed at/near time of injury
  2. wound closes naturally
  3. wound prepped in OR –> brought back later for primary repair (2 names)
A

Types of Wound Healing*

  1. wound closed at/near time of injury = Primary intention
  2. wound closes naturally = Secondary intention
  3. wound prepped in OR –> brought back later for primary repair = Tertiary/Delayed Primary
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5
Q

Golden Period of Wound Closure

  1. time frame bacteria need to proliferate/produce infxn
  2. after how many hrs do bacterial counts rise exponentially
  3. what types of wound at incr risk of delayed/complicated healing
A

Golden Period of Wound Closure

  1. bacteria need 3-5 hrs to proliferate/produce infxn
  2. after 8 hrs bacterial counts rise exponentially
  3. untidy wounds = incr risk of delayed/complicated healing
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6
Q

Primary Intention/Closure Recommendations

  1. for Face
  2. for UE
  3. for LE
A

Primary Intention/Closure Time Frame

  1. for Face < 24 hrs
  2. for UE < 12 hrs
  3. for LE < 8 hrs
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7
Q

Delayed Primary Closure (Tertiary)

  1. when should this type of healing be done (2)
  2. after how many hrs –> consider this
A

Delayed Primary Closure (Tertiary)

  1. when high bacterial load, delayed access to care
  2. after 96 hrs –> consider this
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8
Q

Procedure for Delayed Primary Closure (Tertiary)

  1. clean and ____ the devitalized tissue
  2. Apply ____ and cover wound
  3. after 72-96 hrs –> what to do (4 things)
A

Procedure for Delayed Primary Closure (Tertiary)

  1. clean and debride the devitalized tissue
  2. Apply damp saline gauze and cover wound
  3. after 72-96 hrs –>
    - irrigate
    - debride
    - undermine
    - close wound
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9
Q

Wound Closure: Tension

  • wounds along what –> lower tension and less scaring
  • at what orientation = greater tension
A

Wound Closure: Tension

  • wounds along LANGER LINE –> lower tension and less scaring
  • > 45 degrees from them = higher tension/scarring risk
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10
Q

Wound Closure: High Tension Wounds

  1. need looser or tighter closure
  2. on face what needs to be done to help decr tension
A

Wound Closure: High Tension Wounds

  1. need Tighter closure
  2. on face–> multilayered closure –> decr tension
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11
Q

Other Methods of Wound Closure than Sutures

  1. what part of body are staples used for
  2. what method has low tensile strength, high dehiscence rate; used w/ subcuticular sutures, after staple/sutures removed, delayed wound closure, low tension frail skin tears
  3. what method is for simple low tension, self approx wounds on face
A

Other Methods of Wound Closure than Sutures

  1. Staples = scalp
  2. what method has low tensile strength, high dehiscence rate; used w/ subcuticular sutures, after staple/sutures removed, delayed wound closure, low tension frail skin tears = steri strips
  3. what method is for simple low tension, self approx wounds on face = Tissue Adhesive
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12
Q

Anesthesia: Local

  1. Most ___ and ____ type
  2. where do you inject
  3. speed of inject and why
  4. systemic abs –> what 2 organ system toxicity
A

Anesthesia: Local

  1. Most direct and reliable type
  2. inject w/in wound edges
  3. slow injection –> decr pain
  4. systemic abs –> CV and CNS toxicity
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13
Q

Anesthesia: Regional/Nerve Block

  1. used when wounds otherwise need _____
  2. wounds where need to avoid
  3. used when local would be painful (location?)
A

Anesthesia: Regional/Nerve Block

  1. used when wounds otherwise need lot of anesthesia
  2. wounds where need to avoid tissue distortion (lip, digits)
  3. used when local would be painful (plantar foot)
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14
Q

Anesthesia: Regional/Nerve Block CIs

  1. what areas can Epi NOT be used in
  2. what pts pop can Bupivicaine NOT be used in
  3. what med can pts NOT be on if using Epi
A

Anesthesia: Regional/Nerve Block CIs

  1. areas Epi NOT used in = fingers, nose, penis, toes
  2. Bupivicaine can NOT be used in pregnancy
  3. pts can NOT be on propanolol if use Epi
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15
Q
  1. areas w/ low blood flow or blanching
  2. infected wounds
  3. signif CVD or vascular dz

CIs to what type of Regional Anesthetic

A

Other CIs for Epi

  1. areas w/ low blood flow or blanching
  2. infected wounds
  3. signif CVD or vascular dz
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16
Q

Anesthesia: Topical (Lido, Epi, Tetracaine)

  1. used in what types of wounds in kids
  2. soak dause pad and place directly on wound for ___
  3. dont use over _____ or areas w/ ________
A

Anesthesia: Topical (Lido, Epi, Tetracaine)

  1. used in small wounds in kids
  2. soak dause pad and place directly on wound for 20 min
  3. dont use over mucous mem or areas w/ end arterial circulation
17
Q

Aseptic Technique Sterile Field

  1. what is margin need on all sides
  2. areas where suture tail may land must be covered in what
A

Aseptic Technique Sterile Field

  1. need 1 inch margin on all sides
  2. areas where suture tail may land must be covered in sterile drape
  • field must be dry
18
Q

Instruments

  1. which do you use tripod grip, distal phalanx of thumb and 3rd/4th finger
  2. which do you hold like pencil and has teeth
  3. which do you use tripod grip, cut at tips and 45 degrees to avoid cutting out knots

Options: Webster needle Driver, Adson Forceps, Iris Scissors

A

Instruments

  1. which do you use tripod grip, distal phalanx of thumb and 3rd/4th finger = Webster needle Driver
  2. which do you hold like pencil and has teeth = Adson Forceps
  3. which do you use tripod grip, cut at tips and 45
    degrees to avoid cutting out knots =Iris Scissors
19
Q

Wound Care Steps #1 Wound Prep w/ Hair Removal

  1. why are hair follicles removed
  2. why are eyebrows not removed (2)
  3. what is used to matt down hair
  4. shaving recommended as method?
A

Wound Prep: Hair Removal

  1. why are hair follicles removed b/c source of infxn
  2. why are eyebrows not removed
    - may not grow back
    - need to maintain landmarks
  3. Bacitracin used to matt down hair
  4. shaving is NOT recommended
20
Q

Wound Care Steps #2: Wound Debridement

  1. avoid debriding what 3 things
  2. what 2 tpyes of tissue should be removed
  3. when is the only time total excision is approp
A

Wound Care Steps #2: Wound Debridement

  1. avoid debriding: landmarks, areas needing plastic reconstruction, high tension area
  2. Remove devitalized and adipose tissue
  3. only time total excision is approp= no specialized structures involved
21
Q

Wound Care Steps #3: Wound Cleaning

  1. What type of mechanical irrigation is best
  2. 2 types of wound cleansing preps used
A

Wound Care Steps #3: Wound Cleaning

  1. high pressure mechanical irrigation w/NS is best
  2. 2 types of wound cleansing preps used
    - Providone
    - Poloxamer/ShurClens
22
Q

Wound Care Steps #3: Wound Irrigation

  1. When should irrigation of wound before performed
  2. what is the benefit of it
  3. two things used for wound irrigation
  4. what types of wounds can tap water be used as irrigation (3 criteria)
A

Wound Care Steps #3: Wound Irrigation

  1. irrigation performed AFTER anesthesia
  2. benefit = decr infxn rates
  3. two things used for wound irrigation
    - NS
    - 5-8 PSI
  4. Tap water irrigation
    - clean, non-contaminated, highly vascularized wounds
23
Q

Wound Care Steps #3: Hemostasis

  • 5 options for it
A

Wound Care Steps #3: Hemostasis

  1. direct pressure
  2. Epi
  3. Digital tourniquet
  4. ligation of blood vessel
  5. inflated BP cuff
24
Q

Suture Info

  1. Size: more O’s mean what
  2. what do sutures provoke
    (why dont use highly reactive sutures (gut/silk) in contaminated wounds)
  3. strength: only slightly higher than ____
A

Suture Info

  1. Size: more O’s mean smaller (7.0 smaller than 2.0)
  2. Sutures provoke inflam resp –> dont use highly reactive sutures (gut/silk) in contaminated wounds
  3. strength: only slightly higher than skin
25
Q

Types of Suture Material

  1. 4 types of non-absorable
  2. 3 types of Absorbable
  3. what type incr risk of infxn but has secure knotting
  4. what has lower infxn risk but less secure knotting
A

Types of Suture Material

  1. 4 types of non-absorable
    - ethilon
    - prolene
    - silk
    - Nurolon
  2. 3 types of Absorbable
    - Vicryl
    - PDS
    - Gut
  3. Braided = incr risk of infxn but has secure knotting
  4. Monofilament = lower infxn risk but less secure knotting
26
Q

Tool for Suturing: Needles

  1. which way do you cut for conventional needles
  2. which way do you cut for reverse cutting needles
A

Tool for Suturing: Needles

  1. conventional needles –> cut TOWARD wound edge
  2. reverse cutting needles –> cut AWAY from wound edge

Emed (10 decks)

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