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Med Procedures - Quiz 3 > I&D, Subungual Hematomas, Ticks, Etc. > Flashcards

I&D, Subungual Hematomas, Ticks, Etc. Flashcards

1
Q

What is essential if hands are contaminated?

A

Hand washing

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2
Q

What is sufficient if hands are NOT contaminated?

A

Alcohol based sanitizer

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3
Q

When is alcohol based sanitizer sufficient to clean hands?

A

When hands are NOT contaminated

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4
Q

What do alcohol based sanitizers not cover?

A

C. diff or Vanco-resistant enterococcal infections

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5
Q

Define abscess

A

A swollen area within the body tissue containing an accumulation of pus that is not resolving spontaneously

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6
Q

Community MRSA tends to have more ____ involvement

A

Cutaneous

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7
Q

Healthcare MRSA tends to have ____ involvement

A

Bloodstream, PNA, surgical site

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8
Q

MC causes of abscesses

A

Foreign bodies

Puncture wounds

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9
Q

Who is at most risk of MRSA?

A
  • IVDA
  • Poor dental hygiene
  • Contact sports
  • Incarceration
  • Communities w/high prevalence
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10
Q

MC pathogens of abscesses

A
  • MRSA
  • MSSA
  • Streptococcus
  • Other
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11
Q

What types of patients offer a damaging agent easier access to form an abscess?

A
  • Skin of obese, debilitated, elderly
  • Diabetics (elevated glycemic state)
  • Immunocompromised
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12
Q

Where do abscesses arise from?

A

Dermal layer and spread lower (to SC fat, muscle and deeper structures)

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13
Q

What is the point/head of an abscess?

A

Thinnest area

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14
Q

PE findings of an abscess

A
  • Pain
  • Edema
  • Induration
  • Fluctuance
  • Surrounding cellulitis
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15
Q

Contraindications to I&D

A
  • Furuncles on face

- Rectal or genital abscesses

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16
Q

When does an abscess warrant caution?

A
  • Abscess from IVDA (“shooters abscess”)
  • Purple bluish appearing induration (suggests vascular)
  • If a known close proximity to major vessel
  • Breast abscess (non lactating female) NOT in subareolar area is rare and should be investigated further
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17
Q

What areas are close to major vessels and should warrant caution for an abscess I&D?

A
  1. Peritonsillar/retropharyngeal
  2. Anterior triangle of neck
  3. Supraclavicular fossa
  4. Deep axilla
  5. Antecubital space
  6. Groin
  7. Popliteal fossa
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18
Q

Treatment of simple/small abscess

A
  • Warm compress to allow spontaneous drainage
  • Abx NOT necessary once draining
  • If it enlarges, it can encapsulate which will render abx ineffective
  • I&D, wound culture
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19
Q

When are abx warranted after I&D?

A

If local cellulitis present

20
Q

Where should you incise during an I&D?

A

Along Langer lines

21
Q

What should an I&D abscess be packed with?

A

Iodoform gauze

22
Q

Healing of an I&D abscess progresses in what way?

A

Inside out - so pack it well and full enough

23
Q

If abscess needs longer time to heal, what can be done during I&D?

A

Use criss cross (cruciate) incision

24
Q

Aftercare of an abscess I&D

A
  • Pain control
  • Schedule FU
  • Apply warm wet compresses
  • Non adherent bulky dressing w/daily changes
  • Immobilize cellulitis
  • RICE
  • Abx are guided by wound cultures and risks
  • Refer to surgeon when appropriate
25
Q

Common site of ingrown toenail

A

Medial or lateral great nails

26
Q

MC cause of ingrown toenail

A

Improper fitting shoes or trimming of nails

27
Q

Relative contraindications of treating ingrown toenail

A
  • Bleeding issues
  • CAINE allergies
  • PVD
  • Pregnancy (phenol to ablate matrix is contraindicated)
28
Q

What is onychogryposis?

A

Congenital curved toenail causing increased risk of ingrown toenail

29
Q

Complications of ingrown toenail

A
  • Infection

- Nail will regrow if not ablated properly using cautery or 10% phenol

30
Q

Follow up care of ingrown toenail

A
  • Elevation 24-36 hrs w/gradual return to walking
  • OTC pain control
  • Dressing changes in 24 hrs
  • Soak toe in warm water twice daily for several days after first dressing change
31
Q

What may occur if pressure of a subungual hematoma is not relieved?

A

Damage to nail matrix and germinal layer

32
Q

Contraindications to subungual hematoma drainage

A
  • Crushed or fractured nails
  • Tuft fracture
  • Suspicious lesion under nail
  • Pt wearing acrylic nails
  • Over 50% of nail could indicate nail bed laceration (controversy over whether to remove or not)
33
Q

Complications of subungual hematoma

A
  • Nail deformity
  • Infection
  • Cautery can cause burn to nail bed (if not used properly)
  • Numbness (RARE)
34
Q

How to grasp tick during removal?

A
  • Grasp at skin level tugging up steadily
  • DO NOT TWIST
  • Do not grab tick by body or could expel the contents into patient
35
Q

What of the tick will transmit disease?

A

Head NOT mandible - if the mandible is imbedded it can stay in, it won’t transmit disease

36
Q

Treatment for early Lyme disease

A

Doxy

37
Q

How should a fish hook wound be prepped for removal?

A
  • Cleanse hook and puncture wound with povidone-iodine or another abx solution
  • Provide tetanus prophylaxis as needed
38
Q

How should superficial fish hook removal be attempted?

A

“Retrograde” technique - push hook back along entrance while applying gentle downward pressure on shank

39
Q

How should a fish hook be removed if it cannot be taken out using retrograde technique?

A

18 gauge needle inserted into puncture hole and used as a mini scalpel blade - manipulate hook into a position so you can cut the bands of connective tissue caught over barb and release it

40
Q

How should deeply imbedded fish hooks be removed?

A
  • “Needling” the hook
  • # 18 or 20 hypodermic needle through wound alongside hook
  • Blindly slide needle opening over barb of hook and lock 2 together
  • With barb covered, remove hook and needle as 1 unit
41
Q

What does “needling” a fish hook for removal require?

A

Greater skill but allows you to work on an unstable skin surface like finger or ear

42
Q

When unable to try other techniques including “needling”, how can fish hooks be removed?

A

“Push through” maneuver - then cut off tip of hook and remove shaft

43
Q

How to remove a multifaceted (treble) hook?

A

Cover free hooks with corks or use a pin cutter to remove free hooks

44
Q

DON’Ts of fish hook removal

A
  • Do not try to remove multifaceted hook w/o first covering free hooks or removing them
  • Do not attempt “string” technique if hook is near patient’s eye
  • Do not routinely prescribe proph abx (infection is rare)
45
Q

Prophylactic abx for fish hook removal?

A

Do NOT routinely prescribe - even hooks contaminated by fish rarely cause secondary infection

Med Procedures - Quiz 3 (4 decks)

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