Obj. 20-30 miscellaneous Flashcards
What is the indication for tetanus immune globulin?
Give a single IM injection before wound debridement because exotoxin may be released during wound manipulation.
What is the SAFEST approach used for? What is it?
~Used when interacting with potentially violent patients.
Spacing - maintain distance from pt; allow access to exit
Appearance - professional; security staff visible
Focus - watch hands, look for weapons
Exchange - empathy, avoid judgment
Stabilization - restraints before weapon comes out
Treatment
Name 2 acceptable ways to irrigate wounds and 2 unacceptable ways.
YES: syringe with saline, faucet of chlorinated tap water
NO: bulb syringe, soaking in saline
What are the 3 methods of wound closure?
Primary closure: wound immediately closed by approximating its edges
Secondary closure: wound left open, allowed to close on its own
Delayed primary closure: primary closure delayed for 48-96 hrs
When is each of the 3 methods of wound closure used?
primary
secondary
delayed primary
~Primary: preferable, but best within 6 hours or for uncontaminated wounds
~Delayed primary: contaminated wounds are cleaned, debrided, packed, covered, left open for 48-96 hrs, then closed if no infection
~Secondary: wounds that are still contaminated after consideration for delayed primary closure
Firstline abx prophylaxis for wounds in general:
augmentin
When is peritoneal lavage indicated?
When you want to determine whether intraperitoneal hemorrhage has occurred and the patient is too unstable for CT or U/S is inconclusive
When is abdominal paracentesis indicated?
to determine cause of ascites, obtain fluid for analysis and culture (not usually to lower intra-abdominal pressure, in ED)
What should you do as soon as you place a chest tube?
obtain xray to check position of tube
What is the most commonly used site for LP?
L3-L4 interspace
