APPROACH TO WOUND EVALUATION

Question 1

HPI

Answer 1

Location
Age (of wound)
Mechanism: shear, blunt, crush, bite, puncture
Contamination risk
Foreign Body Sensation
Foreign Body Type

Question 2

Associated Symptoms

Answer 2

r/o
Paresthesias
Muscle Weakness

Question 3

Contamination risk factors

Answer 3

location of injury (perineum, axilla, interdigit web space)
wound care prior to ED
time elapsed until initial cleaning and ED presentation
time elapsed until ED presentation
object that caused injury

Question 4

Impaired Wound Healing Risk Factors

Answer 4

Extreme of Age
Diabetes
Chr Renal Failure
Cardiac Disease
Peripheral vascular disease
Obesity
Malnutrition
Immunosuppression
Radiation
Tobacco Use

Question 5

Allergies

Answer 5

Latex
Anesthetic
Antibiotics

Question 6

Immunization

Answer 6

Tetanus Status

Question 7

Social Hx

Answer 7

Hand Dominance
Occupation
Tobacco Use

Question 8

Elements of wound examination

Answer 8

Adequate lighting
Tourniquets or epinephrine
Reposition joint or extremity in the position of injury

Question 9

When to provide local or regional anesthetic

Answer 9

After vascular and sensory exam
Prior to motor exam

Question 10

High-pressure Irrigation Technique

Answer 10

NS
30 or 10 cc(?) syringe
18 gauge needle

Question 11

Definition of High Pressure Irrigation

Answer 11

7 psi

Question 12

Amount of irrigation per wound length of clean appearing wounds

Answer 12

25 - 100 ml / cm

Question 13

Skin disinfection: agent and technique

Answer 13

Povidone-iodine or chlorhexidine

Do not comtaminate wound

Apply to wound edges and outward

Question 14

4 Hemostasis techiques

Answer 14

Direct pressure
Xylocaine + epinephrine
Small vessel clamp
Tourniquet

Question 15

Risk factors for foreign body

Answer 15

Head or foot wounds
MVA
Puncture wounds

Question 16

Clinical Features of foreign bodies

Answer 16

Foreign body sensation
Point tenderness
Increased pain with range of motion

Question 17

LR of a foreign body with the sensation of foreign body

Answer 17

+2.5

Question 18

Hair Removal techniques

Answer 18

1 - 2 mm above skin with scissors
NO SHAVING

Question 19

Debridement: indications

Answer 19

Narrow base
Irregular devitalized edges
Lack capillary refill

Question 20

Indications for prophylactic antibiotics and antibiotic type

Answer 20

Human bites to the hands and feet
Mammalian bites to the hand
Clavulin

Question 21

2 Wounds with increased risk of pseudomonas

Answer 21

Fresh water contamination
Puncture wounds through athletic shoes

Question 22

Major inorganic soil compenent responsible for infection

Answer 22

Clay

Question 23

Number of days for primary closure delay with high risk wounds

Answer 23

4 days

Question 24

Risk factors for infection

Answer 24

Bacterial colonization
Vascular supply

Question 25

Body parts with higher risk of infection (high bacterial colonization)

Answer 25

Axilla
Perineum
Toe Webs
Intertriginous areas

Question 26

% risk of post ED closure of head and neck, upper extremity, lower extremity

Answer 26

Head and Neck: 1%
Upper Extremity: 4 %
Lower Extrrmity: 7%