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Clin Specialties > EMed - Wound Care > Flashcards

EMed - Wound Care Flashcards

1
Q

Initial ? to ask for knife lac

A

Orientation of hand when cutting (don’t want tendon to move out of view)

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2
Q

Animals of concern for rabies

A
  • bats/raccoons/wild

- squirrel/rat carry but don’t transmit rabies

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3
Q

MC avulsion

A

tip of finger

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4
Q

Best way to assess nerve damage in fingertip

A

2 point discrimination (eval both hands d/t person-to-person evaluation)

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5
Q

Assess tendon lac using this technique

A

Strength (motor function works even when tendon nearly cut thru)
Anesthesia before motor assessment

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6
Q

Imaging for organic foreign body

A

US

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7
Q

Initial epithealizialization for wound in how long?

A

24-48h

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8
Q

how long do you have to close LE wound

A

8h

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9
Q

how long do you have to close UE wound (not face)

A

12h

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10
Q

what % of max tensile strength does would have at 2 weeks?

A

5%

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11
Q

for delayed closure, how long to wait and debride again after initial packing w/ saline gauze?

A

72-96h

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12
Q

why interrupted stitches (as opposed to running) in ER?

A

ability to partially open if becomes infected

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13
Q

wound oriented how has highest tension?

A

> 45 degrees from Langhen line

Scars worse

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14
Q

Layer where suture can be held

A

Epidermis/percutaneous
Hypo/thenar fascia on hand
Sphinter + frontalis muscle of face
Tendon (consult ortho)

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15
Q

Consideration when injecting lido to minimize pain

A

small gage needle and small syringe, even if you have to use multiple syringes

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16
Q

Agents to clean wound

A

Saline irrigation @ 6PSI (anesthesia first)

No: betadine, iodine, EtOH, chlorhexidine, peroxide (cytotoxic!)

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17
Q

Options for hemostasis

A

Direct pressure

Epi only above neck

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18
Q

Skin reactivity of suture

A

silk/gut > braided/monofilament

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19
Q

Infection risk of suture

A

braided > monofilament > silk/gut

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20
Q

Face suture

A

6o or 7o

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21
Q

Low tension suture

A

5o

22
Q

high tension/scalp suture

A

4o

23
Q

where is eversion during sutures desirable?

A

everywhere but face (face has low tension)

24
Q

Contaminated wound - what suture material to avoid?

A

gut/silk d/t high reactivity

25
Q

subdermal suture primary used to

A

reduce tension of wound

26
Q

intradermal suture - where is knot

A

below dermis

27
Q

mattress suture used to

A

avoid inversion of redundant tissue

28
Q

vertical mattress stitch - where on body

A

knee, large joint

need space to do far/far near/near

29
Q

horizontal mattress stitch - where on body

A

fingers/hands/soles (less real estate)

30
Q

mattress stitch - which is more superficial, near or far

A

near

31
Q

MC mistake w/ mattress stitch

A

putting nears/fars too close

results in over-eversion

32
Q

which needs local anesthesia - suture, strips, glue, staples?

A

all

33
Q

“loose closure” - what is it and why?

A

closed wound w/ sutures farther apart

allows for drainage

34
Q

can you combine staple/suture or mattress/interrupt sutures on same wound

A

yes

35
Q

indication for steri-strips?

A

early removal of stitches (i.e., when scar minimization desired)
thin, fragile skin (vertically oriented to skin, then stitch through the strips to provide support)

NOT contaminated wounds (bites, etc)

36
Q

indication for dermabond?

A

low tension wound that needs single layer of closure; or on top of intradermal

37
Q

approach for stitches on oral mucosa?

A

modified intradermal w/ knot below (avoids pt biting the knot)

38
Q

oral abx in wound needed?

A

open bone, cartilidge, joint
tendon lac
thru + thru lip
cat bites

39
Q

oral abx for wound should be considered (but not absolute)

A 
highly contaminated
high risk pt
foot puncture (psuedomonas)
pretibial lac
dog/human bites
40
Q

instruction for pt applying abx ointment to wound

A

apply like lotion (rub in) - don’t want wound too dry or too wet

41
Q

how to approach tetanus in pt w/ incomplete vax or no hx vax

A

Tetanus immunoglobulin, and start vax series w/ Tdap

42
Q

when is tdap indicated post-wound

A

age 19+ w/ >7 years since last vax

43
Q

remove facial stitches after how long

A

3-5d

44
Q

remove scalp stitches after how long

A

7d

45
Q

remove torso/UE stitches after how long

A

7-10d

46
Q

remove LE stitches after how long

A

8-14d

47
Q

imaging consideration in bites

A

x-ray (foreign bodies, cat teeth can break, etc)

48
Q

rabies ppx consists of

A

rabies immunoglobulin @ site of bite

4-series vax at different site than bite

49
Q

when to consider delayed primary closure

A

extreme wound >8h, high-risk features

50
Q

when to consider loose stitches

A

<8h w/ wounds amenable to irrigation

Clin Specialties (8 decks)

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