EMed - Wound Care

Question 1

Initial ? to ask for knife lac

Answer 1

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

Question 2

Animals of concern for rabies

Answer 2

• bats/raccoons/wild

- squirrel/rat carry but don’t transmit rabies

Question 3

MC avulsion

Answer 3

tip of finger

Question 4

Best way to assess nerve damage in fingertip

Answer 4

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

Question 5

Assess tendon lac using this technique

Answer 5

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

Question 6

Imaging for organic foreign body

Answer 6

US

Question 7

Initial epithealizialization for wound in how long?

Answer 7

24-48h

Question 8

how long do you have to close LE wound

Answer 8

8h

Question 9

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

Answer 9

12h

Question 10

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

Answer 10

5%

Question 11

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

Answer 11

72-96h

Question 12

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

Answer 12

ability to partially open if becomes infected

Question 13

wound oriented how has highest tension?

Answer 13

> 45 degrees from Langhen line

Scars worse

Question 14

Layer where suture can be held

Answer 14

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

Question 15

Consideration when injecting lido to minimize pain

Answer 15

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

Question 16

Agents to clean wound

Answer 16

Saline irrigation @ 6PSI (anesthesia first)

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

Question 17

Options for hemostasis

Answer 17

Direct pressure

Epi only above neck

Question 18

Skin reactivity of suture

Answer 18

silk/gut > braided/monofilament

Question 19

Infection risk of suture

Answer 19

braided > monofilament > silk/gut

Question 20

Face suture

Answer 20

6o or 7o

Question 21

Low tension suture

Answer 21

5o

Question 22

high tension/scalp suture

Answer 22

4o

Question 23

where is eversion during sutures desirable?

Answer 23

everywhere but face (face has low tension)

Question 24

Contaminated wound - what suture material to avoid?

Answer 24

gut/silk d/t high reactivity

Question 25

subdermal suture primary used to

Answer 25

reduce tension of wound

Question 26

intradermal suture - where is knot

Answer 26

below dermis

Question 27

mattress suture used to

Answer 27

avoid inversion of redundant tissue

Question 28

vertical mattress stitch - where on body

Answer 28

knee, large joint | need space to do far/far near/near

Question 29

horizontal mattress stitch - where on body

Answer 29

fingers/hands/soles (less real estate)

Question 30

mattress stitch - which is more superficial, near or far

Answer 30

near

Question 31

MC mistake w/ mattress stitch

Answer 31

putting nears/fars too close | results in over-eversion

Question 32

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

Answer 32

all

Question 33

"loose closure" - what is it and why?

Answer 33

closed wound w/ sutures farther apart | allows for drainage

Question 34

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

Answer 34

yes

Question 35

indication for steri-strips?

Answer 35

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)

Question 36

indication for dermabond?

Answer 36

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

Question 37

approach for stitches on oral mucosa?

Answer 37

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

Question 38

oral abx in wound needed?

Answer 38

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

Question 39

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

Answer 39

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

Question 40

instruction for pt applying abx ointment to wound

Answer 40

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

Question 41

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

Answer 41

Tetanus immunoglobulin, and start vax series w/ Tdap

Question 42

when is tdap indicated post-wound

Answer 42

age 19+ w/ >7 years since last vax

Question 43

remove facial stitches after how long

Answer 43

3-5d

Question 44

remove scalp stitches after how long

Answer 44

7d

Question 45

remove torso/UE stitches after how long

Answer 45

7-10d

Question 46

remove LE stitches after how long

Answer 46

8-14d

Question 47

imaging consideration in bites

Answer 47

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

Question 48

rabies ppx consists of

Answer 48

rabies immunoglobulin @ site of bite | 4-series vax at different site than bite

Question 49

when to consider delayed primary closure

Answer 49

extreme wound >8h, high-risk features

Question 50

when to consider loose stitches

Answer 50

<8h w/ wounds amenable to irrigation