general

Question 1

List 5 stages of wound healing.

Answer 1

1. Coagulation
   2. Inflammation
   3. Collagen metabolism – 48 hours post injury
   4. Wound contraction – 3 – 4 days after injury
   5. Epithelialization – in a repaired laceration it starts to occur at 48h

Question 2

List wound associated risk factors for wound morbidity and infection.

Answer 2

- HISTORY:
		o Wound greater than 8-12h old
		o Blunt/Crush mechanisms
		o High velocity missile injuries (long guns or military)
	- PHYSICAL EXAM
		o Location (Legs and thigh, then arms, feet, chest, back, face, scalp)
		o Contamination
	- REPAIR:
		o Anes with epinephrine
		o Subcutaneous sutures
Sutures > Staples > Tape

Question 3

Which class of local anesthetics causes most of the allergies?

Answer 3

• Amides mnemonic (2 “i”s in the name like “lidocaine”)

Question 4

List wound irrigation options.

Answer 4

• NS or tap water
  
  • High pressure i.e. 35cc syringe and 18Ga needle results in 7 – 8psi
  • > 7 psi removes bacteria

Question 5

What are the indications for delayed primary closure?

Answer 5

· Infected wound
· Heavily contaminated wounds – soil, feces, saliva
· Wounds associated with extensive tissue damage – eg missle injuries
· Some bite wounds – especially human
· Lacerations to the bottom of feet

Question 6

List 10 indications for prophylactic antibiotics for lacerations.

Answer 6

• Gross contamination
  
  • Severe crush injuries
  • Immunocompromised
  • Through and through intra-oral
  • Cat bites
  • Some dog bites
  • Some human bites
  • Some puncture injuries to the foot - cipro
  • Open fractures
    Exposed tendons or joints

Question 7

List bacteria associated with cat bites.

Answer 7

• Staphylococcus
  
  • Streptococcus
    Pasteurella multoceda

Question 8

List indications for prophylactic antibiotics for hand lacerations/wounds.

Answer 8

• Mammalian bites
• Exposed bone
• > 12 hours
• Comorbidities affecting healing (diabetes, renal disease, PVD)

Question 9

What are 2 sequelae of intraocular foreign bodies

Answer 9

1. endopthalmitis

2. siderosis bulbi (if metal)

Question 10

List substances use to kill or immobilize insects in the ear canal.

Answer 10

• Lidocaine 10% spray
• Lidocaine liquid
• Lidocaine gel 2%
• Mineral oil with 2% or 4% lidocaine
• Alcohol

Question 11

How does a coin tend to orient of the AP xray when lodges in the trachea or in the esophagus?

Answer 11

• Saggital orientation: Suggests tracheal position

Coronal orientation: Suggests esophageal position

Question 12

List the three constriction points of the esophagus (prone to FB impaction).

Answer 12

1. Proximal at cricopharyngeal muscle and thoracic inlet (X-ray: clavicular level)
   
   2. Midesophagus at level of aortic arch and carina
   3. Distal esophagus just proximal to esophogastric junction (X-ray: 2 – 4 vertebral bodies cephalad to stomach bubble)

Question 13

Why are button disc batteries bad?

What is their management?

Answer 13

• Pressure
• Electrical current
• Corrosive leaks (potassium – liquefaction necrosis)
• Heavy metal poisoning (Mercury)

If in esophagus: remove
If in stomach:

Question 14

What pharmacologic agents can be used to attempt esophageal relaxation and impacted food bolus migration distally into the stomach?

Answer 14

• Carbonated beverage (not if they have chest pain which can be a sign of perforation)
• Glucagon 0.5 – 2mg IV (slowly)
• Nitroglycerine or nifedipine
• GI

Question 15

List factors that affect a FB in the stomach’s ability to pass spontaneously?

Answer 15

• Shape i.e. sharp objects more likely to become impacted
• Size:
  o Width > 2cm (unlikely to pass pylorus)
  o Length > 6cm (unlikely to clear duodenal sweep)

Question 16

List factors that affect the type and intensity of tissue reaction to a foreign body.

Answer 16

- Chemical composition
	o Inert: glass, metal, plastics
	o Reactive: vegetable matter (wood, thorns, spines)
- Physical form
	o Less inflammation: smooth, nonporous
	o Greater inflammation: rough, porous

Question 17

List physical exam findings suggestive of retained foreign body.

Answer 17

• Discoloration
• Visible mass
• Palpaple mass
• Sharp-well localized pain with palpation
• Limited passive ROM of a joint
• Chronic draining sinus
• Chronic granulomatous reaction
• Sterile abscess

Question 18

What is a potential delayed sequelae of bullets left in situ?

Answer 18

• Migration and embolization

Question 19

List 5 techniques for removal of a fish hook.

Answer 19

1. Simple retrograde
   
   2. String-pull
   3. Needle-cover
   4. Advance-and-cut
      Incision