Chapter 8

Question 1

contrast control of a small bleeder with large bleeders

Answer 1

small bleeder
 - wait for it to stop in its own
- apply pressure with sterile gause
- cauterize, clamp with hemostat
large bleeder
- clamp with hemostat and tie off with dissolvable suture 
- cauterize by touching hyfrecator tip to hempstat
- tie off with figure of eight suture

Question 2

what are the other steps in the laceration evaluation and treatment

Answer 2

• stop the bleeding
• assess for contamination
• check: flexion/extension
• R/O fractures
• inject anesthesia - no epi
• clean and debride,
• culture if infx risk
• close and bandage

Question 3

what is quikclot, when should it be concidered

Answer 3

only use when direct pressure isn’t working, you are really far from medical help, must still get to ER

• gauzy wounds filled with kaolin, that activates blood coagulation.
• it must contact bleeding vessel to work

Question 4

what is surgigel, when should you use it

Answer 4

absorbable hemostat that is albos bactericidal against G- and G+. plant bases
- only use with ther convential methose for small stff
NOT for hemorrhage from large arteries.
not for closed contaminated
removed when bleeding stops.

Question 5

contrast treatment of skin loss up to 1 sqcm on finger verses larger wound or avulstion on finger tip

Answer 5

small skin loss- dressing changed regularly
larger wounds - refer to plastic surteon
nail bed damage = plastic surgeon

Question 6

concerns about a palm wound

Answer 6

assess carefully - easy for nerve involvement and tendons

Question 7

tetanus admin guidlines

Answer 7

Determine tetanus status, if not sure if had booster withing 10 years give tetanus toxoid
- less than two tetanus toxoid in life and lots of contamination the give toxoid and immune globulin

Question 8

controllable issues that affect wound healing

Answer 8

Be gentle with tissures
clean tissues well
spint/cast near joints to help prevent dehissence

Question 9

uncontrollable issues that affect wound healing

Answer 9

• mech of injury
• location
• age and race
• patients healing ability/healthy
• patients nutritional status
• patients tendency to scar

Question 10

what should be done to wound side prior to applying anesthesia?

Answer 10

asses wound site

• tissue damage
• contamination
• underlying nerve, tendon, muscle and boney damage

Question 11

how should anesthetic ususally be administered in relation to wound?

Answer 11

• inject from inside or senter of laceration out through side of wound into tissue = less painfull (not through skin surface)
• don’t do this if its really contaminated

Question 12

what should be done with human bite wounds

Answer 12

they are contaminated and ususally left open for a while to watch for infection.
all wounds are concicered contaminted

Question 13

what is wound tattooing and how is it prevented

Answer 13

• embedded foreign material that heals inside wound

- clean it, remove material with needle or forceps,

Question 14

what is the point of trimming a wound edge

Answer 14

wound opening wider at base than surface to help evert edges

Question 15

how can excessive scar formation be minimized

Answer 15

through gentle handeling and careful cleaning of injured tissue

Question 16

is there a golden period of 12 -24 hours after which you cant close wound

Answer 16

not anymore

Question 17

what three types of wounds cant usually be sufficiently closed by steristrips and glue

Answer 17

1- laceration into the deeper dermal layers and sub Q
2 - wounds missing tissue
3 - wounds with increased wound tension

Question 18

name the 7 wound closure technique basics

Answer 18

1 - handle tissures gently
2 - ensure hemostasis
3 - use fine a suture as feasible
4 - needle at 90 degress
5 - evert wound edges
6- keep skin edges relaxed but opposed
7 - remove sutures early to avoid scarring

Question 19

what are the closure options for cleaned vs. contaminated/dirty wounds

Answer 19

clean
- small primary
- large: undermine if necessary and suture or allow to heal by secondary intention, or refer to specialist
dirty
- secondary closure
- large - delayed primary closure , little additional risk of infection

Question 20

should a drain be inserted into a traumatic laceration

Answer 20

routine traumatic laceration ; no drain

suspect future infection : concider draining

Question 21

suture removal techniques

Answer 21

grasp knot, move enough so you can see,
cut suture,
pull freed knot across suture line.

Question 22

trmoval times for sutures

Answer 22

face/ 3-5
scalp - 5-7
extremity 6-14
abdomen chest and back = 6-12

Question 23

when would you use a three point corner stitich

Answer 23

lacerations and plastic surgery procedures