Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Surgery (bpa) > ED Surgical Wounds > Flashcards

ED Surgical Wounds Flashcards

1
Q

Wound healing stages

A

Inflammatory: 0-3d
Epithelialization: 2-5d
Proliferative/Fibroplasia: 4-24d
Maturation: 24d-1y

Collagen remodels and scars revise for up to 1 year after injury*

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Primary Union

A
  • closure of wound edges w/sutures, staples, or adhesives
  • best if w/in 6hr of injury*
  • longer delay acceptable if good vascular supply and wound not grossly contaminated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Secondary Union (Secondary Intention)

A
  • granulates from bottom to top

- used in older, contaminated or puncture wounds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Delayed primary union

A
  • delayed suture closure after 3-5d

- contaminated or old wound that may have cosmetic or functional importance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Approach to wound care, general

A

Brief wound assessment

  • control bleeding w/pressure and elevation prn
  • protect wound w/sterile dressing until ready to eval
Xray if indicated
Tissue anesthesia
Wound cleansing
Full tissue eval 
Wound repair 
Adjuncts, discharge
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Wound Care PE

A
  • measure size, depth of wound
  • identify base of wound and probe for foreign bodies
  • neurovascular status distal to wound: 2-point discrimination
  • test tendon function and ROM if joint involved
  • brief neurologic exam w/head lac
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Indications for wound radiography

A
  • suspected foreign body
  • intoxicated/AMS pt w/wounds of unknown origin/duration
  • patients returning to ED w/infected wounds
  • suspected underlying fracture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Wound anesthesia types

A
  1. local infiltration
    - lidocaine
    - bupivacaine
  2. regional: nerve block
    - fingers most common, then toes
    - lidocaine or bupivacaine
  3. topical
    - LAT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Anesthesia additives

A
  1. epinephrine
    - C.I. fingers, toes, ears, tip of nose, penis
    - effects: prolongs duration of anesthesia, increases pain, limits bleeding
  2. sodium bicarbonate [mix 1mL to 10mL of lidocaine]
    - C.I. use only w/lidocaine, not bupivacaine
    - effects: diminishes pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Lidocaine

A

Max adult dose = 30cc (300mg) of 1% solution

Warn pt it will sting

Neuro sxs if toxic:

  • circumoral or tongue numbness
  • metallic taste
  • lightheadedness
  • disorientation
  • drowsiness
  • seizure
  • CV or respiratory collapse

Methods to decrease pain of injection:

  • slow infiltrate wound
  • add bicarb

Infiltrate through wound margins, not through intact skin, unless grossly contaminated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Digital block fingers - regional anesthesia

A
  • 27G needle w/1-2mL Lidocaine or Bupivacaine dorsally on either side of finger just proximal to web space or palmar for fingers 2-4
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

LAT Anesthesia

A

Lidocaine / adrenaline / tetracaine

Advantages: increased tolerance over injection

Indication: facial lac in children or developmentally disabled

Risk:

  • incomplete anesthesia
  • avoid getting into mucus membrane
  • takes 20-30min

How:

  • soak cotton ball/gauze w/LAT
  • place over laceration w/occlusive dressing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Wound tourniquetes

A

common:
- finger tourniquet
- BP cuff
- penrose drains

advantages:
- hemostasis
- dry field

risks:
- ischemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Absorbable (internal) sutures

A

degrade in tissue

vicryl*
chromic gut
cat gut
PDS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Nonabsorbable (external)

A

do not degrade

nylon*
prolene*
silk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Suture size

A
  1. 0 - cosmetic face
  2. 0 - face, extremity
  3. 0/3.0 - thigh, back, scalp, nails
  4. 0/1.0 - deep fascia
17
Q

Staple wound closure

A

Advantage:

  • speed
  • decreased risk of infection
  • increased wound eversion

Indications:
- high tension areas of scalp and extremities (knee)

Risks/disadvantage

  • cost
  • decreased precision
  • cosmesis
18
Q

Steri-strip wound closure

A

Can reinforce or be used alone

Indications:

  • superficial, straight, low tension lac
  • skin tears in elderly

Advantages:
- painless, easy application

Disadvantage:

  • poor eversion
  • adhesion, wound approximation

Tips: Benzoin or Mastisol aids adhesion

19
Q

Dermabond wound closure

A

Cyanoacrylate or “super glue”

Indications:

  • low tension area (face)
  • avoid mouth, hair, eyes, mucus membrane

Benefits:

  • quick, painless
  • no suture/staple removal

How to:

  • need dry field, won’t work in grossly bloody wound
  • 2+ applications
  • NO topical abx/lubricants afterward
20
Q

Scalp lacerations

A

Abundant blood supply = increased bleeding risk

Anesthesia: lidocaine, bupivacaine w/epinephrine

Suture ligate arterial bleeders prn

21
Q

General facial lacerations

A

Sutures close together to limit scarring

Use subcutaneous sutures prn to reduce tension

Remove sutures earlier (5d) than other areas

Avoid debridement

Align vermillion border very carefully*

22
Q

MC ED skin closure technique

A

Simple interrupted

23
Q

Vertical mattress suture

A

Excellent wound edge eversion for neck and thigh or as a holding suture

24
Q

Horizontal mattress suture

A

Good for gaping or high-tension areas with little SQ tissue, such as the shin

25
Q

Continuous running technique

A

Benefit: speed
Indication: long linear extremity or trunk wounds
Precautions: wounds with increased infection risk

26
Q

SQ Sutures - layered closure

A

Benefits

  • reduce wound tension
  • close dead space where fluid collections develop

Avoid in grossly contaminated wounds

Layer is placed in the dermis

Avoid suturing other subcuticular tissues (fat/muscle)

  • won’t hold stitches well
  • increased infection risk
27
Q

Wounds and abx

A

MC organism:

  1. Staph aureus (uncomplicated)
  2. Streptococcus

Inpatient: Cefazolin IV/IM 1g in ED

Outpatient: Cephalexin, Cefadroxil, or Dicloxacillin x 3-5d to prevent unless known MRSA

28
Q

Dressings

A

Function: protect, absorb

Triple antibiotic is beneficial

3 layer = MC

  • nonabsorbent contact layer e.g. Telfa or petroleum gauze
  • absorbent layer - gauze
  • outer wrap - Kerlex
29
Q

Increased risk of tetanus

A 
Wound > 6hr old
Depth > 1cm
MOA: missile, crush, burn or frostbite
Devitalized tissue present
Contaminants (dirt, saliva) present

Admin tetanus toxoid-containing vaccine for wound management when >5y have passed since last tetanus toxoid-containing dose

If indicated for person >11y, Tdap is preferred for those whose history is unknown or have not prior received

Tdap for pregnancy

Nonpregnant w/previous Tdap - either Td or Tdap may be used

30
Q

Initial severe burn evaluation

A

Primary Survey

  1. Airway and c-spine
    - recognize impending airway compromise
    - consider CO poisoning in structural fires
  2. Breathing and ventilation
    - chest/lung inspection, palpation, percussion, auscultation
    - mask O2 liberally
  3. Circulation
    - auscultate heart and assess perfusion
    - find appropriate peripheral or central vascular access
  4. Disability
    - GCS
  5. Exposure
    - remove clothing and keep warm

Adjuncts:
- chest radiograph and other Xray

Labs:

  • ABG
  • carboxyhemoglobin
  • CBC, BMP
  • Urine myoglobin

Begin fluid resuscitation

31
Q

ABA Burn Center Transfer Criteria

A
  1. Partial thickness burn greater than 10%
  2. Involving face, hands, feet, genitalia, perineum, or major joints
  3. Third degree in any age group
  4. Electrical burns, including lightning injury
  5. Chemical burns
  6. Inhalation injury
  7. Burn injury in pt w/preexisting medical disorders that could complicate mgmt, prolong recovery, or affect mortality
  8. Concomitant trauma (such as fractures) in which the burn injury poses the greatest risk of morbidity or mortality
  9. Burned child in hospital w/out qualified personnel or equipment for care of children
  10. Pt requiring special social, emotional, or rehab intervention
32
Q

Minor burn treatment

A
  1. Immediate cooling
    - decreases burn depth if applied within 1hr
    - use cool water, not ice
  2. Analgesia
    - NSAIDs*
    - opioids if severe pain
  3. Elevate extremity
  4. Cleanse with mild soap and water
    - irrigate
    - leave blisters intact unless tense and large
  5. Apply burn ointment
    - Silvadene** or triple antibiotic
  6. Non-adherent dressing
  7. Tetanus prophylaxis
  8. Dressing change BID
  9. Wound recheck 24-48hr
    - debride prn
    - low threshold for abx if suspicious at f/u

Surgery (bpa) (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions