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Clinical Skills > Laceration & Wound Care > Flashcards

Laceration & Wound Care Flashcards

1
Q

order of wound healing

A
  • coagulation
  • inflammation
  • collagen metabolism
  • wound contraction
  • epithelization
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2
Q

coagulation phase

A

platelets release factors

capillary permeability increases to allow WBCs to migrate & eliminate debris/bacteria

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3
Q

inflammation phase

A

monocyes become macrophages
release chemotactic substances
trigger fibroblast replication and neovascularization

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4
Q

collagen phase

A

principle structural protein of most body tissue
needed for tissue repair
fibroblasts make and deposit collagen within 48 hrs peaks at DAY 7
young collagen is disorganized
greatest mass at 3 weeks, continues to remodel over 6-12 months

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5
Q

wound contraction phase

A

movement of whole thickness skin towards the center of the defect
AT TIME OF INJURY: wound edges retract & pulls away, increasing defect size, tension lines will make traction, any laceration PERPENDICULAR to those lines are under greater tension and result in larger scars
3-4 DAYS LATER: wound size shrinks, edges move towards the center, process INDEPENDENT of epithelization, presence of collagen is NOT needed either

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6
Q

epithelization phase

A

epithelial cells migrating across the wound
starts near the edges within HOURS
any eschar/debris will DELAY process
if wound is properly cleaned/debrided, process will occur at a max rate
for any SURGICAL wound: epithelial cells bridge to the wound by 48 hours, begin to grow down and corm the classic epidermis within 5 days

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7
Q

which type of wound has the greatest surface area, jagged or smooth?

A

jagged, distributes the tension creating less tension per unit of strength

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8
Q

primary intent

A

stitching the wound

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9
Q

when should primary intent be done?

A

simple, relatively clean wounds

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10
Q

methods of primary intent

A

stitch, staples, commercial adhesive, steri-strips

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11
Q

secondary intent

A

letting the body heal itself

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12
Q

when should secondary intent be done?

A

infected wounds, ulcerations, abscesses, abrasions, animal/human bites

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13
Q

purpose of secondary intent

A

allows skin to heal via granulation tissue and epithelization

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14
Q

tertiary intent

A

watch, wait, and eventually stitch it up

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15
Q

when should tertiary intent be done?

A

special wounds that are too contaminated from soil, feces, saliva

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16
Q

method of tertiary intent

A

clean, debride, observe for 4-5 days and close how you would like

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17
Q

onset of lidocaine

A

minutes

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18
Q

duration of lidocaine

A

30-60 minutes

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19
Q

info about lidocaine

A

MOST commonly used anaesthetic

1% lido comes in a 10 mg/mL bottle

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20
Q

what can you mix lidocaine with?

A

epinephrine

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21
Q

why would you want to mix lidocaine with epinephrine?

A

results in vasoconstriction a nd prolongs effect for 2-6 hours BUT will delay healing and lower resistence to infection

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22
Q

old thought about epi

A

avoid in extremities, but studies show now that judicious use is okay

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23
Q

onset of bupivacaine

A

minutes

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24
Q

duration of bupivacaine

A

4-6 hours

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25
Q

info about bupivacaine

A

equal quality to lidocaine

great for nerve blocks

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26
Q

what can you do it a patient complains the anaesthetic stings?

A

add bicarb to lidocaine

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27
Q

will adding bicarb to lidocaine impair the anaesthesia?

A

NOPE

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28
Q

how much bicarb should be added to lidocaine?

A

1 mL to a 10 mL bottle of lidocaine

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29
Q

how much bicarb should be added to bupivacaine?

A

0.1 mL to a 10 mL bottle of bupivacaine

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30
Q

what is TAC?

A

tetracaine/adrenaline/cocaine

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31
Q

how is TAC used?

A

soak cotton ball with solution, place on wound for 10-20 min

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32
Q

pros of TAC

A

similar effectiveness to lidocaine
anatomy undisturbed
pt acceptance increases

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33
Q

cons of TAC

A

infection rate increased if wound contaminated

avoid mucous membrane woudns

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34
Q

what is LET

A

lidocaine/epinephrine/tetracaine

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35
Q

pros of LET

A

similar properties to TAC, but avoids the complications with cocaine

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36
Q

what is EMLA

A

cream of local anaesthetic

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37
Q

cons of EMLA

A

takes about 1 hour to numb the area

usefulness varies

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38
Q

anaesthesia containing esters

A

procaine
tetracaine
benzocaine

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39
Q

anaesthesia containing amidea

A

lidocaine

bupivavaine

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40
Q

what size needle lessens the pain of injection?

A

smaller, but at the cost of speed of the injection

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41
Q

is there a concern for seeding bacteria deeper when injecting anaesthesia?

A

NOPE

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42
Q

when should you do a field block?

A

when want to avoid injecting through a highly contaminated area
less needle sticks

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43
Q

when should you do a nerve block?

A

situations where you can distort anatomy with anaesthesia injection
pain relief with the best cosmesis

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44
Q

what is the biggest concern with nerve blocks?

A

face and fingers

45
Q

what microbes does betadine cover?

A

gram positive & negative, fungi and some viruses

46
Q

what microbes does chlorhexidine cover?

A

less effective against gram negatives

47
Q

what is debridement?

A

removal of foreign material and devitalized tissue from the wound

48
Q

what is more effective in cleaning wounds, NS or tap water?

A

EQUAL

49
Q

should you use iodine to clean a wound?

A

not unless its 1% solution (usually comes in 10%)

50
Q

what pressure does irrigation need to be to decrease infection and bacteria?

A

> 7 PSI

51
Q

should you soak or scrub a wound?

A

NO! unless its road rash, then scrub the crap out of it

52
Q

which is better at irrigation, high pressure irrigation or water pick?

A

water pick is more pressure, but can damage tissues

53
Q

what is post-traumatic tattooing?

A

when a person has road rash that was not properly scrubbed so now there are imbedded particles pigmenting the skin

54
Q

4 Cs of viability

A

coloc, consistency, contractility, capillary ooze

55
Q

should you shave hair?

A

NEVER!

56
Q

non-absorbable sutures

A

nylon, prolene and silk

57
Q

importance of nylon sutures

A

black, good to stitch, tie well, little tissue reactivity

58
Q

importance of prolene sutures

A

blue, doesn’t tie well, good for hairy areas

59
Q

importance of silk sutures

A

technically will slowly degrade, greatest tissue reactivity and not typically used anymore

60
Q

absorbable sutures

A

gut, chromic gut, dexon, vicryl, PDS

61
Q

how long will to take for absorbable sutures to biograde?

A

2-6 weeks

62
Q

when is it best to use absorbable sutures?

A

layered closure

63
Q

importance of gut sutures

A

from cows/sheep submucosa, varied knot tie holding

64
Q

importance of chromic gut sutures

A

gut with chromium salts, doubles life of the suture

65
Q

importance of dexon/vicryl/PDS sutures

A

synthetic, minimal tissue reaction, worse knot holding

66
Q

which numbers are for smaller sized stitches?

A

higher number therefore, smaller numbers are for larger stitches

67
Q

how do you determine the size of the stitch you should use?

A

location, tension, cosmesis

68
Q

size of stitch for the face

A

5-0/6-0

69
Q

size of stitch for the scalp and joint surfaces

A

3-0/4-0

70
Q

size of stitch for trunk

A

4-0/5-0

71
Q

shape of stitch needles

A

tapered,cutting and reverse cutting

72
Q

when should tapered needles be used?

A

in the OR on delicate tissue

73
Q

when should cutting needles be used

A

MOST common, 3 edges

74
Q

when should reverse cutting be used?

A

tough skin and ligaments

75
Q

if you need to take big bites, what size needle should you use?

A

bigger needle

76
Q

if you need to stitch more delicate tissue, what size needle should you use?

A

smaller needle

77
Q

rule of 5s for simple interrupted sutures

A

sutures placed 5 mm from wound edge, 5 mm apart

78
Q

what is the goal for the edge of sutures?

A

evert! wounds will flatten as they heal

79
Q

whats so special about a lac on the vermillion border?

A

regardless of the wound, repair border first, cosmesis first
NYLON (or another non-absorbable) for skin
VICRYL (or some absorbable) for the lip itself

80
Q

whats so special about an eye lac?

A

lid lacs NOT involving the edges are okay to repair

anything involving the medial or lateral canthus/lid margain needs an ophthamologist

81
Q

how do you handle a flap lac?

A

B-C
| |
A D
A and D tied together

82
Q

when would you use a vertical mattress suture?

A

larger wound

83
Q

what’s the issue with vertical mattress sutures?

A

risk of dehiscence

84
Q

when would you use a horizontal mattress suture?

A

larger wounds or unequal skin flaps

85
Q

when would you use a figure 8 stitch?

A

bleeding vessels and varicose veins

86
Q

what is dermabond?

A

synthetic adhesive that polymerize on contact in an exothermal reaction to form a strong wound closure bond

87
Q

how long until dermabond sloughs off?

A

7-10 days

88
Q

can dermabond get wet?

A

yes

89
Q

pros of dermabond

A

fast, cheap, east, low skill level

90
Q

cons of dermabond

A

water exposure breaks it down, low tensile strength, ?cosmesis

91
Q

how to apply dermabond

A

clean and irrigate, approximate the edges or have an assistant hold, squeeze tube and roll on, no need to “paint it”, apply one layer, wait and apply another, MUST be dry or bloodless, tegaderm or vaseline to help create borders

92
Q

uses of steri-strips

A

close primary wound, reinforce repairs or after suture removal

93
Q

tools needed to apply steristrips

A

steri-strip, benzion, suture removal kit and TWO sets of gloves

94
Q

how long to steri-strips last?

A

usually a few days, more water exposure will decrease duration

95
Q

steps to apply steristrips

A

apply benzion to the skin around the wound, open the steri-strips, cut to length, grab the steri-strips with the forceps, for a primary closure, have an assistant approximate the wound edges and apply the steri-strips still using the forceps

96
Q

when are staples used?

A

usually surgery or in the ER for scalp lacs

97
Q

what should you do when removing sutures?

A

COUNT THEM and make sure it’s the same amount that went in

98
Q

which part of the staple remover goes under the staple?

A

ALWAYS the two teeth side

99
Q

what stitch is the most important?

A

the first one

100
Q

who gets a tetanus shot?

A

> 6 hrs old, >1 cm deep, stellate/avulsion configuration, devitalized tissue, contaminated with soil/feces/saliva, from a missle, puncture or crush, associated with a burn or frostbite

101
Q

if the lac was non-tetanus prone and they have a shot within 10 years, do they need another?

A

no

102
Q

if the lac was tetanus prone and they had a shot within 5 years, do they need another?

A

nah

103
Q

if the patient has no history of a tetanus shot and they get any lac, do they need a shot?

A

YES

104
Q

if someone had a face lac, how long do you have to give the tetanus shot?

A

24 hours

105
Q

if someone has a lac anywhere but the face, how long until they get the tetanus shot?

A

18 hours

106
Q

how long until removal of face stitches?

A

4-5 days

107
Q

how long until removal of scalp stitches?

A

6-8 days

108
Q

how long until removal of trunk stitches?

A

8-10 days

109
Q

how long until removal of extremity stitches?

A

8-10 days

Clinical Skills (2 decks)

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