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Emergency Medicine > Lecture 13: Pain + Wound Management > Flashcards

Lecture 13: Pain + Wound Management Flashcards

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1
Q

() is the MC presenting symptom to the ED

A

PAIN

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2
Q

The two ways we rate pain are via the () scale or () faces

A
  • 1-10 scale
  • Wong-baker faces
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3
Q

Systemic opioids are used when pain is severe and ()

A

Severe nociceptive pain

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4
Q

Almost all NSAIDs should be used with caution in () dysfunction

A

Renal dysfunction

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5
Q

Almost all NSAIDs cause:
* () upset
* () dysfunction
* Cannot be used in () dysfunction
* ()spasm

A
  • GI upset
  • Platelet dysfunction
  • Cannot be used in renal dysfunction
  • Bronchospasms

Exception: ASA has no bronchospasm

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6
Q

Once you give an initial dose of an opioid, you should then () it to effect

A

Titrate to effect

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7
Q

Fentanyl is especially useful in opioid-tolerant breakthrough pain in () patients

A

Cancer

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8
Q

Tramadol is risky because it can contribute to () syndrome

A

Serotonin syndrome

It is a weak NE and 5-HT reuptake inhibitor

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9
Q

() describes misuse of a medication to the detriment of a patient’s well being.

() describes that abrupt cessation of a medication with cause acute withdrawal symptoms.

A
  • Addiction
  • Dependence
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10
Q

Generally, never take tylenol or advil within () hrs of an opioid combined with tylenol or advil.

A

6 hours

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11
Q

The MC source of misused Rx opioids in adolescents comes from…

A

Parent’s medicine cabinet

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12
Q

Epinephrine injections are avoided in patients with () vascular injuries

A

Digital

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13
Q

Topical anesthestics can be applied in 3 major situations:

  • On () skin prior to dermal instrumentation
  • On () mucosa
  • On () skin for pain control or prior to wound repair.
A
  • Intact skin
  • Intact mucosa
  • Open skin
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14
Q

Nerve blocks are used in place of subdermal injections of large volumes because they do not () the wound.

A

Distort

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15
Q

Peripheral nerve blocks take about () minutes for a lido injection and () minutes for a bupivacaine injection.

A
  • 10-20 for lido
  • 15-30 for bupi
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16
Q

T/F: A flexor tendon sheath will fully anesthetize the distal fingertip

A

False

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17
Q

Chronic pain lasts either () months or more, beyond reasonable time for an injury to heal, or () months beyond the usual course of an acute disease.

A
  • 3 months
  • More than 1 month past the usual healing time for an acute disease
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18
Q

T/F: Opioids are highly recommended for ED treatment of chronic pain.

A

False

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19
Q

Should you write drug-seeking behavior in a chart?

A

No. List actual facts not opinions

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20
Q

Lower back pain in the ED is managed primarily with (drug) and (lifestyle) and a 3-day supply of (drug)

A
  • NSAIDs, like naproxen or advil
  • Restriction of activity
  • 3 day supply of opioid (Not first-line)
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21
Q

Wounds greater than () cm and located in () vascular areas are more likely to be infected.

A

Longer than 5 cm and in LESS vascular areas are more likely to be infected.

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22
Q

Nonabsorbale sutures retain strength for () days and must be removed. (name some of the non-absorbable ones)

A
  • 60 days.
  • Silk, nylon, prolene

You should use these on the Outermost layer!!!

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23
Q

Generally, the scalp should use () or () -0 sutures, while the face uses ()-0

A
  • 3 or 4 for scalp
  • 6-0 for face
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24
Q

In simple interrupted sutures, you should aim to do () ties relative to suture size

A

Same ties as suture size (i.e. 4 ties for a 4-0)

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25
Q

Running stitches are specifically not used in (shaped) wounds

A

Irregular wounds

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26
Q

Buried dermal sutures should not be placed in what layer of skin?

A

Adipose tissue

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27
Q

Vertical mattress sutures are good in () skin, such as over the shin.

A

Thin/lax skin

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28
Q

Horizontal sutures require less stitching, but the main DISadvantage is that they are ()

A

Very difficult to do

Horizontal is Hard

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29
Q

What wound closure device is the LEAST reactive and most cost-effective?

A

Adhesive tape

Aka steristrips

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30
Q

T/F: A patient needs to come back to get dermabond removed.

A

False. Sloughs off on its own after 5-10 days.

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31
Q

Why is debridement generally avoided on the face/scalp?

A

Because it is so vascularized, it generally heals itself well.

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32
Q

Forehead wounds that fall () to the lines of skin tension, () to muscle fibers yield the best cosmetic results.

A

Parallel to skin tension, perpendicular to muscle fibers

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33
Q

Forehead muscle fascia should be closed via ()-0 suture, whereas the epidermal layer should be closed via ()-0 suture.

A

5-0 for muscle, 6-0 for epidermal

34
Q

These 5 kinds of eye injuries should be referred to ophtho instead:

  • Involves the () surface of the eyelid
  • Wounds that go across () margins
  • Injuries to the lacrimal ()
  • Wounds with associated ()
  • Injuries that extend into the () plate
A
  • Inner surface of eyelid
  • Wounds going across lid margins
  • Injuries to the lacrimal duct
  • Wounds with associated PTOSIS
  • Injuries extending into the TARSAL plate
35
Q

Eyelid injuries within 6-8mm of the () are at risk of canalicular laceration.

A

Medial canthus

36
Q

The most important assessment of nasal lacerations is to determine their () and involvement of ()

A
  • Depth
  • Deeper tissue layers and septum
37
Q

A septal hematoma of the nose can produce 3 major complications:

  • Permanent () of the septum
  • Necrosis and () of the septum
  • Septal erosion leading to a () deformity
A
  • Permanent thickening
  • Erosion
  • Saddle Nose Deformity
38
Q

Besides checking the nose in direct blunt trauma, you must check the cribiform plate to see if there is any () rhinorrhea

A

CSF rhinorrhea

39
Q

For superficial lacerations to the nasal skin, you should use a (size) (abs/non-abs) monofilament simple interrupted stitch.

For anything deeper, you use (size)

A
  • 6-0 Non-absorbable
  • 5-0 absorbable for deeper

Since its at the skin surface.

Same for ears pretty much, just use 6-0 non-absorbable.
Face is pretty much 6-0 on surface

40
Q

Mucosal lip lacerations do NOT need sutures if they are () and the wound edges sponatenously ()

A

Isolated with spontaneous approximation

Otherwise, big gaping wounds need absorbable 5-0.

41
Q

Lip laceration suture techniques are decided by the () border.

A

Vermilion border

42
Q

Lip lacs that do NOT include the vermilion border should be closed in ().

A

Layers

43
Q

The order in which you close a lip lac WITHOUT vermilion border inclusion:

  1. Mucosal layer: (size) (abs/non-abs)
  2. Orbicularis oris muscle fascia with (size) (abs/non-abs) via simple int or horizontal mat
  3. Skin with (size) (abs/non-abs)
A
  • Mucosal: 5-0 absorbable
  • Muscle fascia: 4-0 or 5-0 absorbable
  • Skin 6-0 NON-absorbable
44
Q

The process in which you suture lip lacs WITH vermilion border involvement:

  1. First stitch must repair vermilion border via (size) (abs/non-abs) suture to align edges precisely
  2. Repair vermilion + skin with (size) (abs/non-abs)
  3. Repair mucosa + muscle with (size) (abs/non-abs)
A
  1. 6-0 nonabsorbable for first stitch
  2. Vermilion + skin with 6-0 nonabsorbable
  3. Mucosa + muscle with 5-0 absorbable
45
Q

Intraoral lacerations only need closure if they are large enough to () or have a tissue flap that interferes with ()

A
  • Trap food
  • Interferes with chewing
46
Q

An intraoral suture uses (size) (abs/non-abs)

A

4-0 absorbable

Drip some 1% lido in their wound first

Your cheeks got lots of muscles/movement so more bigger suture needed

47
Q

Most cheek/facial lacs can be repaired via 6-0 non-abs or dermabond and stuff. However, if the () duct is injured, operative repair is indicated.

A

Parotid duct

48
Q

In a full-thickness cheek lac, you want to repair the wound in ()

A

Layers

49
Q

Scalp sutures/staples should be removed after () days

A

14 days

50
Q

Forehead, external ear, or lip sutures should be removed after () days

A

5 days

5 face things: forehead, 2 ears, 1 lip, 1 face.

51
Q

Eyelid, nose, or face sutures should be removed after () days

A

3-5 days

3: 1 nose, 2 eyes, 5: face things

52
Q

Intranasal packing should be removed after () days

A

1-2 days

53
Q

Generally, the wrist, forearm, and hand should use (size) sutures, while the arm should use (size) sutures.

A
  • Wrist/forearm/hand: 5-0
  • Arm: 4-0
54
Q

An upper extremity wound is generally more prone to infection if it is sutured more than () hours after the injury occurred.

A

> 12 hrs post injury

55
Q

The mainstay of treating a subungal hematoma is via…

A

Trephination of the nail plate

Stabbing a hole in the nail via scalpel or cautery

56
Q

You should only remove a nail if there is associated partial () or surrounding () disruption

A
  • Associated partial nail avulsion
  • Surrounding nail bed disruption
57
Q

Generally, foot and leg wounds use (size) sutures and are removed after () days.

A
  • 4-0 sutures
  • 10-14 days.
58
Q

T/F: You should remove all foreign bodies within soft tissue

A

False. Weigh risk vs benefit

59
Q

Any splinter parallel to skin surface should be removed along its () axis

A

Long

60
Q

The technique to remove deep fishhooks is…

A

Advance-and-cut

61
Q

For normal fishhooks, the most successful technique is…

A

Incision technique

Make wound entrance bigger

62
Q

The MC organism seen in puncture wounds

A

Staph aureus

63
Q

The MC organism in plantar puncture wounds that resulted in osteomyelitis

A

Pseudomonas

64
Q

ABX prophylaxis is indicated in puncture wounds that are (location), due to a (), or with heavy ()

A
  • Plantar located
  • Due to a bite
  • Heavy contamination
65
Q

ABX prophylaxis for a established infected puncture wound are (), () or ().

If it is a plantar puncture, you must use ()

A
  • Normal infected wound: First-gen cephalo, augmentin, or FQ.
  • Plantar: Ciprofloxacin (anti-pseudomonal FQ)

F/u in 48 hrs!

66
Q

For needle sticks, you can get Post-exposure prophylaxis for () and (), but not ()

A
  • HIV and Hep B
  • You’re out of luck for Hep C

Crap, its Hep C!

67
Q

In high pressure wounds, it is recommended to avoid (), which can increase pressure in the finger compartments. Ideally, you should do surgical () within 6 hours to reduce the risk of subsequent ()

A
  • Avoid digital nerve blocks
  • Do surgical debridement
  • Reduces risk of amputation
68
Q

Bites

The current practice is to () primary wound closure in patients with systemic immunodeficiencies and higher-risk wounds

A

AVOID PRIMARY WOUND CLOSURE

Suturing showed higher infection rate. Re-eval in 24-48 hrs!

You just debride and clean

69
Q

The MC organism within dog and cat bites is…

A

Pasteurella Multocida

70
Q

ABX are indicated in bite wounds:

  • all (animal) bites
  • Bites in () hosts
  • (animal) bites that puncture
  • hand wounds
  • Any injury that will undergo surgical repair
A
  • All cat bites
  • Immunocompromised hosts
  • Dog bites that puncture

Use augmentin.

Pen V or ampicillin works for Pasteurella infections too

71
Q

In PCN-allergic pts, the abx for a cat bite is () or ().

For a dog bite, it is () + ()

A
  • Cat bite: Doxy or cefuroxime
  • Dog bite: Clinda + FQ

Cats and Dogs, or Dogs and Cats

72
Q

What is worse, a human bite or a cat/dog bite?

A

A human bite

73
Q

What is one of the MC ways you can get a human bite equivalent injury?

A

Closed-fist injury

Punching their mouth

74
Q

There is a very specific G- rod that is present in human bites known as (E)

A

Eikenella corrodens

75
Q

The initial ABX for a human bite is:

A

Cephalexin

Augmentin alternative.

You should give to every human bite unless its extremely superficial.

76
Q

The only place where you SHOULD do primary wound closure on a human bite is…

A

Face

77
Q

The treatment for a rodent is IV () followed by oral ()

A
  1. IV PCN for 5-7 days
  2. Oral PCN for 7 more days
78
Q

Freshwater fish bites can contain (bacteria), which saltwater can contain (bacteria)

ABX for freshwater bites is:
ABX for saltwater bites is:

A
  • Freshwater = aeromonas = FQ or bactrim
  • Saltwater = Vibrio = FQ or doxy

Salty docks vibrate, Fresh arrows are trimmed

79
Q

Rabies MC comes from () in the US

A

BATS

80
Q

Tetanus guidelines

A
  • No tetanus vaccination or Ig if minor wound with complete vaccination hx.
  • Tdap + Ig is for incomplete hx and contaminated wound
81
Q

After draining an abscess, your patient should follow up in () days

A

2-3 days

Emergency Medicine (29 decks)

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