Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Clin Specialties - EMed > Lecture 2 - Wound Management > Flashcards

Lecture 2 - Wound Management Flashcards

1
Q

Puncture

A

deeper than it is wide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Avulsion

A

no bone

a chunk missing (like cutting off the tip of your finger)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Laceration

A

longer than it is deep

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Amputation

A

bone is included

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

A pt comes in with a wound, before you suture, what neurovascular exam needs to be done?

A 
Vascular: 
cap refil 
distal pulses
temperature 
pulsatile flow 
edema

Nerve/Sensory:
perform BEFORE anesthesia
measure appropriate region distal to wound
compare sensation to uninjured side
measure 2 point tactile discrimination in digits (test along distal radial and ulnar aspects and distal to PIPJ only - normal range 2-8 mm, compare to unaffected digit)

Motor:
done AFTER anesthesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

2 point tactile discrimination in digits

A

test along distal radial and ulnar aspects and distal to PIPJ only - normal range 2-8 mm
give pt baseline reference in unaffected digit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What do you do for a pt who comes in complaining of feeling a foreign body in their palm or plantar?

A

STANDARD OF CARE:

X-ray:
80-90% FB detected on x-ray –if its radiopaque
look for changes in tissue density

US:
more sensitive for organic matter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Primary intention

A

wound is closed at or near time of injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Secondary intention

A

wound is allowed to close by natural process

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Tertiary Intention

A

(aka Delayed Primary Repair)

wound prepped in Er and brought back later for primary repair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What do you tell pts in regards to wound scarring?

A

yes it will scar

but we wont know the exact extent until about a year out

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Explain wound healing from onset of injury to a year out

A

platelets aggregate on exposed wound surface –> clotting cascade –> hemostatic coagulum

inflammatory response

after wound repair –> initial epithelialization within 24-48 hours

peak collagen between 5-7 days
wound is at 5% tensile strength in 2 weeks and 35% in 1 month

wounds contiune to remodel over 3-12 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the primary closure recommendations?

A

face up to 24 hours
UE up to 12 hours
LE up to 8 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When do we use staples to close wounds?

A

scalp in the ER only

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the procedure of primary closure?

A

clean and debride devitalized tissue from wound
apply saline damp gauze and cover
after 72 -96h wound should be re-irrigated and closed
close follow up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When do we use running sutures?

A

in the OR

we use interrupted in the ER d/t risk of infection and possibilities of needing to open a portion of the wound back up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Why do wounds along Langer Lines scar less?

A

lower tension

wounds with an orientation >45 degree from the Langer line are under higher tension and more likely to have significant scaring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How do we close wounds under high tension?

A

like on the face

multi layered closure to help minimize tension on healing wound and promote cosmesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What layers can NOT hold a suture?

A

muscle or fat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Galea

A

layer of tissue closure

decrease dead spread against bone of skull

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Where on the hand are the only places on the hand where sutures other than percutaneous?

A

thenar and hypothenar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How do you apply local anesthesia before suture a wound?

A

inject within the wound edges using a 27g needle/3cc syringe
inject slowly to decrease pain of injection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

When do nerve blocks get used?

A

wounds that wound otherwise require large volume of anesthesia
wounds in which tissue distortion needs to be avoided (lip, digit)
wounds where local infiltration is particularly painful (plantar foot)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Which is faster, lidocaine or bupivicaine?

A

lidocaine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
How do you determine mg/ml from percentage for anesthetic agents?
move the decimal 1% --> 10mg/ml 0.25% --> 2.5 mg/ml
26
Which anesthesia is contraindicated in pregnancy?
Bupivacaine
27
Epi is often added with anesthetic agents, when is Epi contraindicated?
areas below the neck (classically the fingers, nose, toes, and genitalia) areas with decreased blood flow or increased risk of infection areas where blanching of tissue will interfere with alignment of anatomical borders infected wounds pts with significant cardiac or vascular disease pts on propranolol
28
What 3 instruments are used for suturing?
webster needle driver adson forceps iris scissors (cut at 45 degrees to avoid cutting out the knots)
29
What are the rules for hair removal near wound cultures?
do not remove the hair (no shaving) | you can trim it or slick it back with gel (abx ointment)
30
Why don't we remove hair when doing wound closure?
hair follicles are a significant source of bacteria eyebrows may not regrow always maintain landmarks
31
Devitalized tissue
Weak or dead tissue can increase risk of infection and scaring remove devitalized tissue and loose adipose in the wound
32
What should NEVER be used to clean out a wound?
alcohol chlorhexidine peroxide
33
When during the wound closure procedure is irrigation done?
AFTER anesthesia use isotonic saline (normal saline)
34
What pressure is used for wound irrigation?
5-8 PSI | provides adequate mechanical debridement without tissue destruction
35
What hemostasis options are available during wound closure?
direct pressure epinephrine (not idea, really not used below the neck) digital tourniquet - use sterile wide tourniquet (penrose drain) or specifically designed digital tourniquet - apply for up to 30 minutes ligation of bleeding vessel or suture SQ over vessel to tamponade vessel BP cuff inflated over SBP or CAT type for up to 2 hours
36
Absorbable vs non-absorbable suture material
absorbable: synthetics: vicryl (polglactic acid), PDS (polydiaxnone) non-synthetics: gut non-absorbable: synthetic: ethilon (nylon), prolene (polypropylene) non-synthetic: silk
37
Which increases the risk of infection, braided or monofilament suture material?
braided increases risk of infection but is better at secure knotting monofilatment has a lower risk of infection but less dependable knotting
38
Which type of sutures should you avoid in contaminated wounds?
highly reactive sutures -- silk and gut
39
Ethilon suture material
``` non-absorbable good knot security good tensile strength minimal issue reactivity good workability any anatomical site ```
40
Of the absorbable types, which have the longest days of integrity?
PDS - 45-60 days | Vicryl - 30 days
41
A pt comes in with a lac on their scalp, which absorbable sutures can you use?
vicryl rapide | chromic gut
42
A pt comes in with a lac on their nailbed, which absorbable sutures can you use?
vicryl | chromic gut
43
When do you use PDS suture?
this is an absorbable suture used for fascia/galea/tendon
44
When do you use chromic gut suture?
mucosa tongue nailbed scalp
45
When do you use vicryl suture?
intradermal | nailbed
46
Which is a smaller suture, 7-o or 4-o?
7-o is the smallest the most 'o' the smaller
47
When do we use 6-o and 7-o sutures?
percutaneous closures on the FACE
48
Which suture type do you use for high tension areas?
4-o
49
The greater the curve of the needle the greater the....
depth
50
Conventional cutting
third cutting edge TOWARD the wound edge | good for softer tissue
51
Reverse cutting
third cutting edge is AWAY from wound edge good for tougher tissue like fascia and skin good for weaker wound edges
52
When suturing, where on the body do you NOT want eversion to happen?
the face you never want inverting, anywhere
53
What is the MC suture done in the ER?
simple interrupted single percutaneous stitches individually knotted (keep all knots on one side of wound)
54
What is the MC suture done in the OR?
subcuticular running intradermal horizontal bites allows suture to remain for a longer period of time without development of crosshatch scarring typically not used in acute wounds
55
When do we not use intradermal sutures?
``` adipose poorly vascular wounds wounds with higher risk of infection hands (except thenar fascia), feet, cartilage areas where SQ tissue is minimal ```
56
Vertical mattress
improves wound edge eversion reduces "dead space" help minimize tension two-step stitch far far, near near
57
Horizontal mattress
improves wound edge eversion high tension wounds -palms and soles, elbow two step suture
58
How does the way you close the suture affect how you prep for it?
it doesnt regardless of how you close the wound, the WAY you prep is the same anesthetize, explore, clean
59
What is a "lose" closure?
you close it but you spread the sutures out further
60
When do we use staples?
scalp equivalent cosmesis does not pull on hair fast - emergency hemostasis anesthesia still required check that the edges are not overlapping after staple is placed
61
Steri strips
sterile adhesive tapes low tensile strength weaken and fall off when wet high dehiscence rate frequently used with subcuticular sutures used following staple and suture removal
62
When is tissue adhesive appropriate to use?
cyanoacrylate and formaldehyde simple linear low tension, self approximating wounds on the face proper wound prep is still essential don't let glue enter between the wound edges
63
How long should non-facial wounds be covered?
24-48 hours to allow enough epithelialization to reduce risk of wound contamination
64
What should you do for a 1cm lab on the hand?
splint it does NOT need to be sutured as long as the hand is immobilized
65
Which wounds should we be splinting?
splint post repair to minimize movement: wounds with risk of edema open fx/joints tendon lacerations lacs over joints (splint in position of function) wounds with risk of infection (ex. dog bit on hand)
66
Which wounds absolutely need PO ABX?
open bone, cartilage or joint tendon lacerations through and through lip lacerations cat bites ``` consider: highly contaminated wounds high risk pts food puncture wounds (psudeomonas coverage) pre-tibial lacerations dog/human bites ```
67
What is something to keep in mind when using neomycin or bacitracin topical ABX?
8-11% contact allergen in US
68
When do you vaccinate for tetanus in a pt coming in with a wound?
if >7 years have elapsed since last vaccine give booster Tdap rather than Td in those >19 years old who have not received Tdap previously
69
How long after applying a face suture should it be removed?
3-5 days (5 days is more ideal i think)
70
How long after sutures were placed on the scalp should they be removed?
7 days
71
How long after sutures were placed on torso or UE should they be removed?
7-10 days
72
How long after sutures were placed on LE should they be removed?
8-12 days
73
Sutures on joints can be removed after how long?
may stay in for up to 14 days
74
What do you do after removing sutures?
apply steri strips in cosmetic and high tension wounds send pt home with directions to apply topical (bacitracin, mederma, vitamin E, aquaphor, or vaseline) and sunscreen/avoiding the sun
75
What percentage of dog and cat bites become infected?
dog bits: 3-18% cat bites: 20-80% (MUST start on ABX)
76
A pt comes in with a cat bite, what are your next steps?
you MUST get an XRAY for possible retained teeth copious irrigation consider loose closure of extremity wounds presenting within 8 hours that are amenable to effective irrigation and then you MUST start them on ABX
77
Which ABX prophylaxis is used for bite wounds?
3-5 days of: augmentin if PCN allergy: flouroquinolone + clinamycin monkey bites --> valacyclovir/acyclovir for 14 days
78
Who gets rabies prophylaxis?
high risk bites and animal escapes if animal is captures: send animal's head to state health lab for path exam treat only if lab confirms rabid animal (brain sections show Negri bodies) low risk animal + animal captured: observe animal for 1 week
79
How can you tell if an animal is rabid?
State health lab will do a path exam and the brain will show Negri bodies
80
For non-immunized, what is the post exposure prophylaxis in regards to rabies?
begin with soap and water then irrigate with povidine -iodine RIG - infiltrated around the areas of the wound if you cant give the full dose of RIG at the site of the wound, change syringe and give IM to a site distant from vaccine administration Vaccine HDCV or PCECV 1.0mL, IM (deltoid area) given on days 0,3,7 and 14 (if immunocompromised give 5th dose on day 28)
81
For post exposure, when are people given HDCV or PCECV?
day 0, 3, 7, and 14 | if immunocompromised they get a 5th dose at day 28

Clin Specialties - EMed (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions