Minor Trauma

Question 1

Rank the following from highest to lowest amount of devitalised tissue
Blunt trauma 90 degrees
Knife/shear force
Blunt trauma less than 90 degrees

Answer 1

Knife/shear force
Blunt trauma less than 90 degrees
Blunt trauma 90 degrees

Question 2

Which of the following has the highest risk of infection?
Shear force
Blunt trauma 90 degrees
Blunt traums < 90 degrees

Answer 2

Blunt trauma 90 degrees

Question 3

When does a laceration regain its strength?

Answer 3

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

Question 4

When does a trauma have the potential for scarring?

Answer 4

Deeper than the dermis

Question 5

When does collagen synthesis occur after a lac?

Answer 5

Collagen synthesis begins within 48 hours of the injury and reaches a peak within the following week

Question 6

When will a scar reach maturity/stability?

Answer 6

6-9 mo

Question 7

What is the % of infection of sutured wounds?

Answer 7

2%

Question 8

When should use of antibiotics be considered for a wound?

Answer 8

bites, devitalized tissue, and heavily contaminated

Question 9

For whom is a tetanus vaccine indicated after a skin lac?

Answer 9

< 3 doses of vaccine
3 initial doses but no booster x 10 years
3 initial doses but > 5y since last

Question 10

For whom is a tetanus Ig indicated after a skin lac?

Answer 10

< 3 doses of vaccine w dirty wound

Question 11

Up to how long after injury can a facial lac be repaired?

Answer 11

24hrs

Question 12

Which wounds ahould be closed within 6 hrs?

Answer 12

high risk for infection such as those in anatomic locations with poor blood supply, contaminated or crush wounds, and those involving immunocompromised hosts

Question 13

What wounds should NEVER be closed?

Answer 13

Bites or gotten on a farm in an immunocompromised host

Question 14

How much irrigation is required per cm of wound?

Answer 14

100mL/cm of laceration

Question 15

What kind of sutures are best for areas with high dynamic and static tension?

Answer 15

Synthetic absorbable

Question 16

What size sutures should be used for the following situations:
Fascia
Subcutaneous tissue
Oral mucosa
Face
Scalp, trunk, extremities
Thick skin & over large joints

Answer 16

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

Question 17

When is a vertical mattresss stitch useful?

Answer 17

deep wounds in which it may be difficult to tie a simple, deep, interrupted suture

Question 18

How long should original dressing stay on after suture repair?

Answer 18

12-24hrs

Question 19

Why are topical antibiotics recommended after suturing?

Answer 19

prevent infection, help with reepithelialization, decrease crust formation, prevent wound dehiscence, and aid in suture removal

Question 20

What antibiotic should be given for wounds secondary to mammalian bite?

Answer 20

Amox-clav

Question 21

What antibiotic should be given for open fractures?

Answer 21

Amox-clav + aminoglycoside

Question 22

When should non absorbable sutures be removed?

Answer 22

Neck
3–4
Face
4–5
Scalp
7–10
Upper extremities, trunk
7–10
Lower extremities
8–10
Joint surface
10–14

Question 23

What size & location of lip laceration does not require repair?

Answer 23

< 2cm, inner aspect of lip without communication to skin surface

Question 24

What type of suture material is best to close lacs 2-3cm in length with a flap in the buccal mucosa?

Answer 24

coated vicryl 4-0 on round needle

Question 25

what is the preferred method of anesthesia for nail bed repair?

Answer 25

digital block

Question 26

when is trephenation commonly performed?

Answer 26

greater than 50% of nail bed surface area involved

Question 27

When is antibiotic prophylaxis warranted in a dog bite?

Answer 27

crush wound
penetration of tendons, vessels, facial compartments and bones

Question 28

What are the most commonly isolated bacteria in infected cat and dog bite wounds?

Answer 28

Staph aureus
Pasteurella (gram negative rod)

Question 29

Bacteria in human bite wounds

Answer 29

Mixed!

Strep viridans
Staph aureus
Bacteroides
Peptostreptococcus

Question 30

Clinical presentation of cat-scratch disease

Answer 30

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

Question 31

Causative organism of cat scratch fever

Answer 31

Bartonella Henselae

Question 32

Clinical presentation of rat bite fever

Answer 32

1-3 weeks incubation

chills
fever
malaise
headache
maculopapular or petechial rash

Question 33

Treatment of rat bite fever

Answer 33

IV penicillin

Question 34

Disease spread by rabbit bites

Answer 34

Tularemia

Question 35

Treatment of tularemia

Answer 35

Gentamicin, cipro or doxycycline

Question 36

Minimum amount of NS used to irrigate mammalian wound

Answer 36

200ml

Question 37

Mammalian bite characteristics at high risk for infection and that should not be sutured

Answer 37

puncture wound
hand or foot wound
initial care sought > 12h post
cat or human bites
immunosuppressed patient

Question 38

How is rabies prophylaxis given?

Answer 38

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.

Question 39

Who needs tetanus immunization after wound?

Answer 39

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

Question 40

Who needs Tetanus Ig after wound?

Answer 40

Unknown or < 3 doses in vaccine series with DIRTY wound