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Patient Evaluation > Exam 3 - Suturing > Flashcards

Exam 3 - Suturing Flashcards

1
Q

Patients presenting to the ED for wounds average age and gender

A

74% males, 23

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2
Q

Most common location for wounds

A

51% face & scalp
34% arms
13% legs

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3
Q

what is the most common complication for wounds

A

infection ~5%, increased chance with bite wounds, LE and FB

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4
Q

Goals of wound care

A 
Hemostasis
Anesthesia
Wound irrigation
Wound exploration
Removal infected/bad tissue
Tissue preservation
Closure tension
Deep sutures
Tissue Handling
Wound infection
Dressing
F/U
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5
Q

Examples of topical anesthesia

A

benzocaine
cocaine
tetracaine
Lidocaine

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6
Q

what is the only topical anesthesia that vasoconstricts?

A

cocaine - nose

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7
Q

what are examples of direct infiltration anesthesia?

A

Lidocaine (Xylocaine) 1-2% w/ or w/o epi
Mepivacaine
Tetracaine

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8
Q

what type of anesthetic is best used on the face

A

topical anesthesia

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9
Q

what is used for lacerations of 5cm of less?

A

topical anesthesia

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10
Q

Where do you not use topical anesthesia ?

A

mucous membranes or conjunctivae

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11
Q

what is good about acid and bad about base’s in injectable local anesthesia ?

A

acid prolongs shelf life but has a burning sensation

base reduces acidity and shelf life and epi but it does not sting

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12
Q

what is epinephrine and what does it do?

A

vasoconstrictor and it decreased blood flowing systemic absorption, it also extends duration of action and shortens onset time so you numb faster

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13
Q

where do you not used epi?

A

terminal capillary flow like tips of finger and toes, tip of nose and pinna of ear

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14
Q

Where do you inject local anesthesia for immediate onset?

A

junction of dermis and subcutaneous fat /painless/short duration (30-60 min)

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15
Q

where do you inject local anesthesia for slower onset?

A

digital nerve blocks cause nerve is bigger but it lasts longer ( 1-2 hrs)

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16
Q

where do you inject for direct infiltration of a wound?

A

junction of the dermis and subcutaneous fat

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17
Q

where do you inject for local infiltration into INTACT skin?

A

dermis-subcutaneous junction

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18
Q

what technique for anesthesia is used for large areas and for grossly contaminated wounds?

A

field block (make a square around the wound)

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19
Q

What technique is used for procedures distal to the mid proximal phalanx?

A

digital block (epidermis then advance to bone) - 4 total injections - DISTAL TO THE WEB SPACE IN THE MIDDLE OF THE DIGIT

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20
Q

how long can clean wound be open for?

A

6-8 hrs

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21
Q

wound on the face or scalp can be closed for up to 24 hrs why?

A

cause the face is very vascular

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22
Q

contraindications to wound closure:

A 
increased risk of infection
disruption of nerve, art. tendons
FB
punctured wound - drives bacteria deep
high pressure wound
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23
Q

clean wound

A

surgery ( aseptic technique)

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24
Q

clean-contaminated wound

A

like aseptic during surgery but it involves the GI, GU or respiratory tract

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25
Q

contaminated wound

A

traumatic wound with gross spillage

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26
Q

infected wound

A

like an abscess

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27
Q

Primary intention for wound closure

A

all layers closed - minimum scarring

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28
Q

Secondary intention for wound closure

A

deep layers closed, superficial layers granulate form inside to out - wide scar

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29
Q

Third intention for wound closure

A

deep layers closed, reassess at day 4-5 for infection. If no infection then superficial layers are closed - usually with contaminated wound (primary delayed intention)

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30
Q

where do you use absorbable sutures?

A

mucosal areas, intradermal
Dexon and Vicryl
Surgical gut - plain or chromic

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31
Q

where do you used non-abosrobale suture material?

A

superficial layers

Silk
Nylon
Prolene ( blue)
Stainless steel wiring

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32
Q

Monofilament

A

weaker but pass easier and less chance of infection

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33
Q

Multifilament

A

more flexible and stronger but increased risk of infection

34
Q

Higher number of zeros equals

A

= smaller diameter

35
Q

Face suture size

A

5-0 to 6-0 (56)

36
Q

Scalp suture size

A

3-0 to 5-0 (35)

37
Q

Chest suture size

A

3-0 to 4-0 (34)

38
Q

Back suture size

A

34

39
Q

abdomen suture size

A

34

40
Q

extremity suture size

A

45

41
Q

joint suture size

A

34

42
Q

oral suture size

A

35 - absorbable

43
Q

suture instruments are

A

needle driver
skin forceps - with or w/o teeth
suture scissors

44
Q

instrument tie

A

2 wraps around needle driver for first knot, then single wraps

45
Q

what is the most frequently used suture type used to stitch and close lacerations?

A

simple interrupted - enter at 90 degrees to skin - start half way point

46
Q

How do you correct dog ears and what are they?

A

they are asymmetrical end of wound after sticking and to fix them you make an incision at 45 degree angle and excise the triangle

47
Q

What type of suture do you not used on dirty wounds and can cause tenosynovitis and can leaved “railroad tracks”?

A

continuous, running, baseball suture ( this method is quick)

48
Q

what suture type is used for deep wounds to eliminate dead space within the wound?

A

vertical mattress ( far/far-near/near)

49
Q

what is the second most commonly used stitch?

A

vertical mattress

50
Q

what stitch lies perpendicular to the skin plane?

A

vertical mattress

51
Q

what suture type lies parallel to the skin plane?

A

horizontal mattress

52
Q

What suture type is used for flap-wounds - tip repair

A

horizontal mattress

53
Q

what suture type adds strength in fascial closure and is also used in calloused skin like palms and soles?

A

horizontal mattress

54
Q

what suture type is used for surgical incisions or very clean wounds?

A

running subcuticular - for face and better cosmetic results (not used for tension wounds)

55
Q

running subcuticular stitch require a __________ suture?

A

absorbable

56
Q

equally passes through dermal wound edges in horizontal plane?

A

running subcuticular

57
Q

initial and final knot is buried

A

running subcuticular

58
Q

used for long linear laceration of the scalp , trunk and extremities, NOT FOR FACE HANDS OR OVER A JOINT?

A

skin staples

59
Q

used for face trunk and limbs and is quick and painless

A

skin adhesives

60
Q

what is painted over wound edges 3x with 30 sec of drying time in between?

A

skin adhesives

61
Q

how long does it take for skin adhesives to get to full strength?

A

2.5 minutes ( starts to slough of in 5-10 days)

62
Q

what do you add first before stern strips?

A

benzoin, aids adhesion

63
Q

cate bites ABS and bacteria?

A

Augmentin / Pasteurella multocida

64
Q

When do you want to consider ABS?

A 
12 hrs old wounds
Human or animal bite
crush wounds
contaminated wounds
wound in avascular area
severe paronychia
severe felon
IS patients
if pt has heart disease
65
Q

how long before you remove sutures of the scalp?

A

6-8 days

66
Q

how long before you remove sutures of the face?

A

4-5 days

67
Q

how long before you remove sutures of the ear?

A

4-5days

68
Q

how long before you remove sutures of the chest/abdomen?

A

8-10 days

69
Q

how long before you remove sutures of the back?

A

12-14 days

70
Q

how long before you remove sutures of the arm/leg?

A

8-10 days

71
Q

how long before you remove sutures of the hand?

A

8-10 days

72
Q

how long before you remove sutures of the fingertip?

A

8-12 days

73
Q

how long before you remove sutures of the foot?

A

12-14 days

74
Q

During suture removal

A

use sterile instruments and avoid dragging contaminated suture through the patients body

75
Q

when do you not want to perform a punch biopsy?

A

if the lesion can be easily excised

76
Q

how large much a lesion be to do an elliptical excision to avoid dog ears?

A

8mm or larger

77
Q

Punch Biopsy extends to which layer of the skin?

A

subcutaneous fat

78
Q

use tip of blade for corner of the ellipse and belly of the blade for the rest?

A

excisional biopsy (30 degrees)

79
Q

where do you not want to I & D furuncles ?

A

on central face

80
Q

I & D uses a ___________ to anesthetize the area

A

field block (5-10 min)

81
Q

Iodoform gauze

A

prevents incision from healing over and allows drainage of abscess, replace 12-24 hrs and it heals from inside out

82
Q

patient education on wound healing time :

A

suture removed, wound still weak

several months to a year for final scar appearance

scar revision may be possible at a later date

all wounds leave a scar

Patient Evaluation (29 decks)

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