48 - wound care

Question 1

what to do for laceration

Answer 1

1. Hx and Phx
2. clean
3. close
4. analgesia
5. dress
6. discharge instruction

Question 2

4 factors that increase likelihood of infection

Answer 2

1. type of injury
   - crush, deep, contaminated
2. location
   - lower extremity more common
3. time of presentation
4. med Hx
   - diabetes, immunocompromised

Question 3

3 keys to good Phx

Answer 3

1. lighting
2. analgesia
3. hemostasis

Question 4

what to look for

Answer 4

1. deep structures
2. distal neuro
3. vascular
4. motor

Question 5

main method of analgesia

Answer 5

lidocaine with or without epi

Question 6

4 regions not to use epi

Answer 6

fingers, nose, penis, toes

Question 7

2 topical anesthetics

Answer 7

1. LET - lido, epi, tetracaine

2. EMLA - mix

Question 8

methods of cleansing

Answer 8

• clip hair down
• vaseline hair
• chlorhexidane
• irrigation at 7psi or more

Question 9

3 times of closure

Answer 9

primary - 8-12 hours, 24 for face
secondary - leave open and allow to heal
- for late or infected
delayed - leave open for 4-5 days, then close

Question 10

4 main methods to close

Answer 10

1. suture
2. staples
3. tapes
4. adhesives

Question 11

size of suture and time for face, scalp, limb, trunk, joint

Answer 11

face 5-0 or 6-0, 5 days
scalp 4-0, 7-10
limb 4-0, 10-14
trunk 4-0 or 3-0, 7-14
joint 4-0 or 3-0, 14

Question 12

when to prescribe Abx

Answer 12

not normally

• immunocompromised
• crush
• joints
• mammal bites

Question 13

who needs tetanus

Answer 13

10 yrs - yes

incomplete - YES

Question 14

2 types of dressing

Answer 14

1. transparent cover

2. absorpative foam if expect more juices

Question 15

main discharge instructions (4)

Answer 15

1. cleansing
2. timing of suture removal
3. signs of infection
4. expected cosmetic results

Question 16

how long to leave on dressing

Answer 16

24 hours

Question 17

how to cleanse

Answer 17

soap and water