Minor Trauma Flashcards
Rank the following from highest to lowest amount of devitalised tissue
Blunt trauma 90 degrees
Knife/shear force
Blunt trauma less than 90 degrees
Knife/shear force
Blunt trauma less than 90 degrees
Blunt trauma 90 degrees
Which of the following has the highest risk of infection?
Shear force
Blunt trauma 90 degrees
Blunt traums < 90 degrees
Blunt trauma 90 degrees
When does a laceration regain its strength?
5% of their previous strength 2 weeks after injury, 30% after 1 to 2 months, and full tensile strength 6 to 8 months after the original injury
When does a trauma have the potential for scarring?
Deeper than the dermis
When does collagen synthesis occur after a lac?
Collagen synthesis begins within 48 hours of the injury and reaches a peak within the following week
When will a scar reach maturity/stability?
6-9 mo
What is the % of infection of sutured wounds?
2%
When should use of antibiotics be considered for a wound?
bites, devitalized tissue, and heavily contaminated
For whom is a tetanus vaccine indicated after a skin lac?
< 3 doses of vaccine
3 initial doses but no booster x 10 years
3 initial doses but > 5y since last
For whom is a tetanus Ig indicated after a skin lac?
< 3 doses of vaccine w dirty wound
Up to how long after injury can a facial lac be repaired?
24hrs
Which wounds ahould be closed within 6 hrs?
high risk for infection such as those in anatomic locations with poor blood supply, contaminated or crush wounds, and those involving immunocompromised hosts
What wounds should NEVER be closed?
Bites or gotten on a farm in an immunocompromised host
How much irrigation is required per cm of wound?
100mL/cm of laceration
What kind of sutures are best for areas with high dynamic and static tension?
Synthetic absorbable
What size sutures should be used for the following situations: Fascia Subcutaneous tissue Oral mucosa Face Scalp, trunk, extremities Thick skin & over large joints
Fascia - 3-0 SubC - 4-0 Oral mucosa - 3-0 to 4-0 Face - 6-0 Scalp/trunk/extremities - 4-0 Thick skin/joints - 3-0 to 4-0
When is a vertical mattresss stitch useful?
deep wounds in which it may be difficult to tie a simple, deep, interrupted suture
How long should original dressing stay on after suture repair?
12-24hrs
Why are topical antibiotics recommended after suturing?
prevent infection, help with reepithelialization, decrease crust formation, prevent wound dehiscence, and aid in suture removal
What antibiotic should be given for wounds secondary to mammalian bite?
Amox-clav
What antibiotic should be given for open fractures?
Amox-clav + aminoglycoside
When should non absorbable sutures be removed?
Neck 3–4 Face 4–5 Scalp 7–10 Upper extremities, trunk 7–10 Lower extremities 8–10 Joint surface 10–14
What size & location of lip laceration does not require repair?
< 2cm, inner aspect of lip without communication to skin surface
What type of suture material is best to close lacs 2-3cm in length with a flap in the buccal mucosa?
coated vicryl 4-0 on round needle
what is the preferred method of anesthesia for nail bed repair?
digital block
when is trephenation commonly performed?
greater than 50% of nail bed surface area involved
When is antibiotic prophylaxis warranted in a dog bite?
crush wound
penetration of tendons, vessels, facial compartments and bones
What are the most commonly isolated bacteria in infected cat and dog bite wounds?
Staph aureus
Pasteurella (gram negative rod)
Bacteria in human bite wounds
Mixed!
Strep viridans
Staph aureus
Bacteroides
Peptostreptococcus
Clinical presentation of cat-scratch disease
papule at scratch site - crusted, erythematous, 2-6mm, 3-10d post-scratch
regional lymphadenitis - tender, 2 weeks after primary fever
Rare:
encephalopathy
exanthem
atypical pneumonia
parotid swelling
Causative organism of cat scratch fever
Bartonella Henselae
Clinical presentation of rat bite fever
1-3 weeks incubation
chills
fever
malaise
headache
maculopapular or petechial rash
Treatment of rat bite fever
IV penicillin
Disease spread by rabbit bites
Tularemia
Treatment of tularemia
Gentamicin, cipro or doxycycline
Minimum amount of NS used to irrigate mammalian wound
200ml
Mammalian bite characteristics at high risk for infection and that should not be sutured
puncture wound
hand or foot wound
initial care sought > 12h post
cat or human bites
immunosuppressed patient
How is rabies prophylaxis given?
Ig x - dose of 20 IU/kg. As much as possible is infiltrated locally around the wound and the remainder is given intramuscularly.
HDCV immunization - IM in the opposite deltoid on days 0, 3, 7, 14 for a total of four doses, each 1.0 mL.
*immunocompromised patients need fifth dose on day 28.
Who needs tetanus immunization after wound?
Unknown or < 3 doses of vaccine
3 or more doses but > 10 yrs since last booster
3 or more doses > 5 years since booster and DIRTY wound
Who needs Tetanus Ig after wound?
Unknown or < 3 doses in vaccine series with DIRTY wound
