CHAPTER 40: Wound Preparation

Question 1

TRUE or FALSE?

All traumatic lacerations are contaminated to some degree

Answer 1

TRUE

All traumatic lacerations are contaminated to some degree; however, the level of contamination differs based on etiology, wound location, and time of injury.

Question 2

Includes all of the steps required prior to wound closure aimed at reducing the risk of infection, optimizing cosmetic outcome, and minimizing patient pain and discomfort

Answer 2

Wound preparation

Question 3

TRUE or FALSE?

Full sterile technique significantly reduce wound infection rates after laceration repair in the ED setting

Answer 3

FALSE

Although routinely practiced in other settings (e.g., the operating room), full sterile technique (mask, cap, gown, and gloves) apparently does not reduce wound infection rates after laceration repair in the ED setting.

Use of sterile gloves for laceration repair or outpatient surgical procedures does not reduce infection rates compared to clean, nonsterile gloves.

Question 4

TRUE or FALSE?

Chlorhexidine is a better antiseptic agent than povidone iodine

Answer 4

TRUE

Chlorhexidine is likely a better antiseptic agent
Preoperative chlorhexidine antisepsis was associated with a lower incidence of surgical site infections

Question 5

The antiseptic should also be allowed to dry for —?— minutes for maximal efficacy

Answer 5

2 to 3 minutes

Question 6

The specific choice of anesthetic and route of administration (local or regional) is determined by —?—

Answer 6

Wound size, Location, & Patient condition

Question 7

TRUE or FALSE?

Hair removal prior to wound repair does not reduce the incidence of infection and is not necessary before wound repair.

Answer 7

TRUE

Hair removal prior to wound repair does not reduce the incidence of infection and is not necessary before wound repair. However, removal of the hair may facilitate wound evaluation and closure, especially with long hair.

Question 8

Hemostatic agent that has no intrinsic hemostatic properties and works by the pressure it exerts as it expands

Answer 8

Denatured gelatin [Gelfoam®]

Question 9

Hemostatic agent made of sponge reacts with blood, forming an artificial clot

Answer 9

Cellulose derivative [Oxycel®] OR a Collagen [Actifoam®]

Question 10

Hemostatic agent impregnated in polyester/rayon gauze pads and rolls which initiates the closing process by acti-vating factor XII of the coagulation cascade

Answer 10

Kaolin [QuickClot®]

Question 11

Commercially available impregnated in polyester/rayon gauze pads and rolls compressed directly onto a bleeding wound and achieve hemostasis typically in —?— minutes in clinical studies.

Answer 11

5 minutes

Question 12

A drug that can be applied directly to a bleeding wound by saturating a gauze pad, powder or paste

Answer 12

Tranexamic acid

Question 13

Proximal tourniquet used as a temporizing measure in excessive bleeding should not be left on more than —?— minutes

Answer 13

not be left on more than 30 minutes

Question 14

Sutures from the wound edges that can control continued bleeding

Answer 14

Horizontal mattress suture OR Figure-of-eight suture

Question 15

High-pressure irrigation is generally defined as pressures greater than —?— pounds per square inch

Answer 15

greater than 7 pounds per square inch (or 48 kPa)

Question 16

TRUE or FALSE?

High-pressure irrigation should be limited to heavily contaminated wounds

Answer 16

TRUE

High-pressure irrigation has the potential to cause further tissue trauma and distortion of the tissues, complicating meticulous wound closure, and exposes the provider to bloodborne splatter.

Question 17

TRUE or FALSE?

Normal saline is better in reducing wound infection in traumatic lacerations.

Answer 17

FALSE

Tap water is as effective as normal saline in reducing wound infection in both children and adults with traumatic lacerations.

Question 18

Is a tenet of infection control in wound management

Answer 18

Hand washing prior to patient contact