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CEN > Orthopedic and Wound Emergencies > Flashcards

Orthopedic and Wound Emergencies Flashcards

1. Describe concepts related to the assessment of emergency department patients experiencing orthopedic and wound emergencies. 2. Describe various patient presentations related to orthopedic and wound emergencies. 3. List interventions necessary for patients presenting with orthopedic and wound emergencies.

1
Q

assessing orthopedic injuries

A 
edema
deformity
abrasion, contusion, hematoma
lacerations, avulsions
puncture wounds
crepitus
point tenderness
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2
Q

assessing neurovascular perfusion for ortho injuries

A 
circulation, motor, sensation
pain
pulses
paralysis
paresthesia
pallor
temp
cap refill
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3
Q

when to assess function of ortho injury

A

admission
manipulation
before/after immobilization
regular intervals until edema resolved

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4
Q

causes of radial nerve injuries

A

fx of humerus, elbow, distal radius

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5
Q

function of radial nerve

A

extend wrist or thumb

sensation on dorsum of thumb

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6
Q

causes of median nerve injuries

A

elbow dislocation

wrist or forearm injury

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7
Q

function of median nerve

A

oppose thumb to base of small finger

sensation on tip of index finger

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8
Q

causes of ulnar nerve injuries

A

fx of medial humeral epicondyle

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9
Q

function of ulnar nerve

A

abduct (fan) fingers

sensation on tip of 4th and 5th fingers

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10
Q

causes of tibial nerve injuries

A

fx or injury to back of knee or lower leg

direct trauma, nerve compression

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11
Q

function of tibial nerve

A

plantar flex toes (curl down)

sensation on bottom of foot

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12
Q

cause of peroneal nerve injuries

A

fibular fx

direct trauma to region near head of fibula

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13
Q

function of peroneal nerve

A

dorsiflex toes (curl up)

sensation on first toe of web space

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14
Q

pediatric considerations for ortho injuries

A

more cartilaginous

fx tend to not extend through to bone cortex

epiphyseal growth plates remain open until after puberty and are areas of weakness; fractures may arrest healing and bone growth

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15
Q

geriatric considerations in ortho injuries

A

increased risk 2/2 osteoporosis
decreased muscle mass that protects
limited mobility
increased healing time

fewer physiologic reserves against acute blood loss or prolonged immobilization

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16
Q

common interventions for ortho injuries

A

splinting
reduce edema
pain management

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17
Q

splinting ortho injuries

A

r/o life/limb threatening complications

immobilize to reduce blood loss, pain, further injury

above and below injury

pad and secure, assess and document distal circulation

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18
Q

reducing edema for ortho injuries

A

elevate
ice
remove constrictive items

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19
Q

fitting crutches

A

while wearing shoes

arm pieces 2 in below axilla when crutch is at 25 degree angle with tips 6-8 inches to side and in front of foot

adjust hand pieces so elbow has 30 degree angle of flexion

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20
Q

crutch teaching

A

crutches 12 in forward and 6 in to side

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21
Q

MOI for traumatic amputations

A

guillotine (sharp)

blunt (crushing)

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22
Q

causes of traumatic amputation

A 
farm machinery
heavy machinery
motorcyclists
snow blowers
lawn mowers
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23
Q

two goals for traumatic amputation

A

protect life and limb

preserve amputated part

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24
Q

risks for poor outcomes with traumatic amputation

A 
crush/nerve injury
long ischemic times > 6 hr
proximal amputation
hypotensive shock
contamination
concomitant injuries
comorbidities
age
poor nutrition
psych illness
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25
Q

assessing traumatic amputation

A

sx hypovolemic shock 2/2 blood loss

determine amount of soft tissue injury and degree of wound contamination

obtain hx of MOI and timeline

xrays of extremity and amputated part

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26
Q

intervene for traumatic amputation

A 
ABCs
immobilize
prep for replantation
abx, tetanus
preserve amputated part
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27
Q

prepping traumatic amputation patient for replantation

A

support/splint partial amputation in anatomic fxn

brush off gross contamination, irrigate, dress, elevate residual limb

do not use distilled water

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28
Q

preserving amputated part after traumatic amputation

A 
brush of gross contamination
no direct iodine
do not soak
wrap in saline soaked gauze
sealed plastic bag/container
sealed container on crushed ice/water
label and send with pt

if part placed directly in water or on ice, risk of cellular freezing and death

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29
Q

define compartment syndrome

A

pathologic process in which excessive pressure develops within a closed body space

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30
Q

pathology of compartment syndrome

A

musculoskeletal trauma affects extremities where closed spaces contain bone, muscle, vessels, nerves

usually lower leg, forearm

closed spaces surrounded by non-elastic fascia

as intracompartmental pressure increases, microcirculation is compromised, causing more edema

pressure exceeds intra-arterial hydrostatic pressure, causing small vessel collapse, ischemia, necrosis

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31
Q

timeline of compartment syndrome

A

sx 6-8 hrs after injury but ould be delayed 48-96 hrs

irreversible damage w/in 4-6 hrs of ischemia

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32
Q

causes of compartment syndrome

A

fracture
soft tissue/vascular injury
edema
external compression

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33
Q

soft tissue or vascular injuries causing compartment syndrome

A

crush injury
bleeding
recent surgery

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34
Q

types external compression that could cause compartment syndrome

A

circumferential casts, splints, tape, elastic bandages

circumferential burns

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35
Q

assessing compartment syndrome

A

disproportional pain with passive motion

pressure measurement - can determine need for fasciotomy

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36
Q

intracompartmental pressures during compartment syndrome

A

< 10 mmHg: normal

20-30 mmHg: observe, elevate to heart level, remove external compression

> 40 mmHg: surgical decompression

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37
Q

Six Ps of compartment syndrome

A 
pain
paresthesia
pallor
poikilothermia
paralysis (late)
pulselessness (late)
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38
Q

pain in compartment syndrome

A

earliest sign is a deep ache disproportionate to injury

as it worsens, pain exacerbated by external pressure or movement distal to injury

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39
Q

paresthesia in compartment syndrome

A

nerves are compressed, leading to sx of numbness/tingling or feeling “asleep”

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40
Q

pallor in compartment syndrome

A

loss of circulation as microcirculation impaired

pale or dusky

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41
Q

poikilothermia in compartment syndrome

A

extremity becomes generally cool to touch but warmer proximal to affected compartment

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42
Q

paralysis in compartment syndrome

A

late sign

indicates poor outcome

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43
Q

pulselessness in compartment syndrome

A

late sign

usually not evident until pressures close to systolic pressure, obstructing arterial blood flow

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44
Q

intervene for compartment syndrome

A

remove restrictive items, external pressure

neutral position at level of heart

fasciotomy

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45
Q

contusion

A

black/blue discoloration of tissue

yellow/green hue whilehealing

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46
Q

hematoma

A

collection of blood in tissue
pain

risk for swelling, compartment syndrome

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47
Q

intervene for contusion/hematoma

A

ice, elevate, pain management, no dressing

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48
Q

define costochondritis

A

inflammation of cartilage at costochondral or costosternal joint

idiopathic, benign, not cardiac

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49
Q

characteristics of costochondritis

A

self-limiting but can be recurrent or persistent

insidious onset

presents with chest wall pain, hx repeated minor trauma or unaccustomed activity

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50
Q

sx costochrondritis

A 
local pain, tenderness
sharp, nagging, aching, pressure
maybe severe
may wax/wane
may radiate (esp when 1+ area affected)
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51
Q

how to make costochondritis better/worse

A

worse: trunk movement, coughing, deep inspiration, exertion
better: decreased movement, quiet breathing, change of position

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52
Q

intervene for costochondritis

A 
pain management
prevent complications
NSAIDs
local heat
gentle stretching
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53
Q

define foreign bodies in ortho injuries

A

retained objects in wounds

dirt, debris, gravel, glass, metal

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54
Q

assessing foreign body in ortho injury

A

circulation, motor, sensory

xray

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55
Q

intervene foreign body in ortho injury

A 
control bleeding
copious irrigation
remove by provider
tetanus, abx prn
do not soak w/ vegetative matter
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56
Q

how are fractures classified

A

according to status of soft tissue around break

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57
Q

patient-specific considerations that can affect bone structure and composition r/t fractures

A 
growth and development
nutritional status
repetitive trauma
hormonal changes
disease processes
medications
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58
Q

open fracture

A

aka compound

penetrating foreign body enters bone or creates opening in tissue over bone

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59
Q

open fractures are at increased risk of:

A

neurovascular compromise
blood loss
infection

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60
Q

intervene for open fractures

A

surgical debridement
irrigation
soft tissue repair
tetanus

do not remove penetrating objects until it is determined if they affect structures underneath

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61
Q

closed fracture

A

skin intact

assess for associated tissue damage

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62
Q

transverse fracture

A

direct trauma

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63
Q

oblique fracture

A

twisting, loss of leverage

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64
Q

spiral fracture

A

rotating force along axis of limb (twisting)

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65
Q

comminuted fracture

A

multiple fractures

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66
Q

avulsion fracture

A

muscles and ligaments contract forcefully, tear fragments from bone

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67
Q

impacted fracture

A

bone ends jam together

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68
Q

greenstick fracture

A

incomplete (children)

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69
Q

compressed fracture

A

vertebrae forced together

axial load injury

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70
Q

depressed fracture

A

blunt trauma to flat bone

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71
Q

clavicle fractures

A

80% in middle third d/t direct force to shoulder

skin tenting over fx; can’t raise arm; c-spine, hemopneumothorax

sling, rest

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72
Q

scapula fractures

A

rare, high energy force

point tenderness; associated with rib, humerus, skull fx, lung, splenic injuries, CNS/PNS injury

sling, cold packs

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73
Q

proximal/midshift humerus fractures

A

assess radial nerve damage

pain, deformity; associated with chest trauma

proximal: sling
midshaft: sugar-tong

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74
Q

distal humerus fractures

A

assess brachial artery lac, median/radial/ulnar nerve involvement

pain, deformity

radial head fx: closed reduction, cast, sling

comminuted/intraarticular fx: open reduction, fixation

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75
Q

radius/ulna fractures

A

fall on outstretched hand or elbow (FOOSH), direct blow

pain, point tenderness, swelling, deformity angulation, shortening of elbow

closed reduction, cast with elbow at 90 degrees, sling

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76
Q

distal radius fractures

A

FOOSH
assess median nerve damage

pain, deformity
Smith: angulates up
Colles: angulates down

manipulation, closed reduction, cast

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77
Q

scaphoid (carpal bone) fractures

A

FOOSH

wrist pain (snuff box)

thumb spica cast

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78
Q

hand/metacarpal fractures

A

boxer’s fracture

swelling, knuckle depression

compression or ulnar splint, open reduction/internal fixation (ORIF) if displaced

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79
Q

hand/phalange fractures

A

sports-related in young, falls/crush/machinery in adults

rotational deformity

splint, open reduction/internal fixation

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80
Q

pelvis fractures

A

major trauma
8-10% mortality for closed, 40-60% if open

paresis/hemiparesis
Coopernail sign, ecchymosis, blood at urinary meatus/vagina/rectum

oxygen, IVs, elevate knees, ORIF

81
Q

femur fractures

A

major trauma, osteoporotic elderly, fall on hip

pain, deformity, swelling, shortening/external rotation of leg, muscle spasms, blood loss

midshaft fx: traction, splint
femoral head fx: ORIF

82
Q

patella fractures

A

fall on knee, knee into dashboard, severe muscle upull

knee pain, obvious deformity

long leg cylinder cast, surgery

83
Q

tibia/fibula fractures

A

frequently open
major force (tibial shaft)
ground level falls, sports, high-energy injuries

deformity, blood loss, soft tissue damage, neurovasc damage, Volkmann contracture
can ambulate with isolated fibula fx

usually cast: depends on type and location, open vs closed

84
Q

ankle talus/malleolus fractures

A

eversion, lateral rotation forces

sprained ankles more often associated with inversion forces

displaced - immediate reduction
nondisplaced - splint, cast

85
Q

foot metatarsals/phalange fractures

A

direct trauma, kicking, stubbing toes, athletics, crush injuries

pain, deformity, swelling

displaced: short leg walking cast, ORIF
nondisplaced: buddy tape to adjacent toes

86
Q

calcaneus fractures

A

fall from heigh (Don Juan fx)

assess lumbar spine, leg, foot injuries; pain increased with hyperflexion

compression dressing, crutches

87
Q

physiology of joints

A

connect bones via fibrous connective tissue and cartilage

structures provide stability, , mobility, strength, motion

peripheral blood vessels and nerves share joint space

88
Q

soft tissues that surround exterior of joint

A

provide stability and protection

tendons and ligaments

when excessive force applied, joint structure can separate

89
Q

define dislocation

A

complete disruption of bony articulating surfaces in joint

90
Q

define subluxation

A

partial joint dislocation that maintains some contact between surfaces

91
Q

shoulder dislocation (AC separation)

A

direct blow to top of shoulder or FOOSH

tenderness, swelling over acromioclavicular joint; inability to raise arm or adduct across chest

sling for pain, active ROM

92
Q

anterior shoulder dislocation

A

FOOSH

abducted, cannot bring elbow to chest or touch opposite ear with hand

reduce, sling/swath/immobilizer

93
Q

posterior shoulder dislocation

A

sz or forceful blow to front of shoulder

arm held to side and cannot externally rotate

reduce, sling/swatch/immobiilzer

94
Q

elbow dislocation (radial, head subluxation or nursemaid’s

A

children pulled, jerked, lifted by arm

refuses to use arm, limited supination, can flex/extend
recurring until 5 yo

reduce

95
Q

elbow dislocation (radius, ulna)

A

FOOSH with elbow extended

loss of arm length, rapid swelling, neurovasc compromise

reduce, supportive splints

96
Q

hip dislocation

A

front seat MVC

anterior: flexion, abduction, ext rotation
posterior: flexion, adduction, internal rotation

reduce in < 6 hrs to prevent femoral head necrosis

97
Q

patella dislocation

A

blow to/fall on knee

flexed knee, palpable lateral femoral condyle

extend leg to reduce, apply compression or knee immobilizer

98
Q

knee dislocation

A

unstable joint with tibial fx

deformity

admission to monitor peroneal nerve and popliteal artery injury)

99
Q

ankle dislocation

A

usually w/ leg fx and soft tissue injury

deformity

splint, open reduction

100
Q

define sprain

A

injury to ligaments which have been stretched or torn by excessive force

graded via degree of damage/instability

101
Q

grade I sprain

A

mild
microdamage
stable joint
+ pain

102
Q

grade II sprain

A

moderate
partial tearing of ligament
stable joint
+ pain, weakness

103
Q

grade III sprain

A

severe
significant ligament tears
unstable joint
+ pain, weakness, loss of function

104
Q

define strain

A

stretching or tearing injury to muscle or tendon d/t excessive force

graded by degree of damage and instability

105
Q

risk factors for strains

A

physically demanding occupations, atypical activities, contact sports, extensive gripping actions

106
Q

grade I strain

A

mild

stretching of few muscle fibers

107
Q

sx grade I strain

A

local pain
point tenderness
slight muscle spasm

108
Q

grade II strain

A

moderate

partial tearing of muscle or tendon

109
Q

sx grade II strain

A 
bruising
moderate pain, swelling
local pain
point tenderness
swelling
discoloration
inability to use limb for prolonged period of time
110
Q

grade III strain

A

severe

complete muscle rupture, possible involvement of fascia

111
Q

sx grade III strain

A

small avulsion fx, local pain, point tenderness, swelling, discoloration, “snapping noise” at time of injury

112
Q

interventions for sprains and strains

A

RICE

113
Q

define bursitis

A

excessive fluid or infection of bursa sac

114
Q

risk factors for bursitis

A 
hx overuse
repetitive movement
inflammatory disease
trauma
infection
115
Q

common areas of bursitis

A 
subacromial
olecranon
trochanteric
prepatellar
infrapatellar
116
Q

what are pts with bursitis at increased risk for?

A

kidney stones

117
Q

sx bursitis

A

pain with use
redness, warmth, swelling
decreased ROM

118
Q

intervene bursitis

A

immobilize, RICE
NSAIDs, analgesics
bursal aspiration
intrabursal steroid injection

119
Q

define gouty arthritis

A

overproduction of uric acid

120
Q

sx gouty arthritis

A

pain in affected joint
worse at night
worse with weight, movement, weight bearing
elevated uric acid levels

121
Q

intervene for gouty arthritis

A

NSAIDs
steroid injections
colchicine

122
Q

dc teaching for gouty arthritis

A 
avoid:
thiazide diuretics, alcohol
herring, mussels, salmon, sardines, anchovies
yeast, veal, bacon, organ meats
aspirin
123
Q

define rhabdomyolysis

A

breakdown of muscle resulting in release of myoglobin, CK, electrolytes

124
Q

potential causes of rhabdo

A 
prolonged immobilization
illicit drugs
heatstroke
infection
trauma, crush injuries
metabolic disorders
inflammatory myopathies
125
Q

pathophysiology of rhabdo

A

fluids pulled into intravascular bed leading to extravascular dehydration

myoglobin molecules become trapped in glomeruli, leading to acute renal failure

126
Q

sx rhabdo

A

malaise, fever, muscle tenderness
dark brown urine
increased K, uric acid, CK
decreased Ca

127
Q

intervene for rhabdo

A

ABCs with lots of fluid
urine alkalinization, mannitol, loop diuretics
sodium bicarb
correct electrolyte, acid-base, metabolic abnormalities
HD for acute renal failure

128
Q

define joint effusion

A

collection of fluid in joint space

129
Q

causes of joint effusion

A

knee most common

trauma, overuse, undelrying disease/condition

130
Q

sx joint effusion

A

pain
swelling
stiffness
redness, warmth

131
Q

intervene joint effusion

A

NSAIDs
RICE
arthrocentesis

132
Q

define low back pain

A

muscle pain
disc injury
overuse
degenerative changes

133
Q

assessing low back pain

A 
location/duration
provocation/palliation
hx of injury
numbness to extremities
incontinence

xrays/MRIs if neurovasc compromise or incontinent

134
Q

intervene low back pain

A

analgesia
PT
pain meds
surgery

135
Q

define osteomyelitis

A

bone and tissue infection

can lead to sepsis

136
Q

causes of osteomyelitis

A

open fx
infection over previous x
puncture wounds
trauma

137
Q

sx osteomyelitis

A

pain
malaise
fever
redness, warmth, swelling

138
Q

assessing osteomyelitis

A

inspection
neurovasc
blood cultures

139
Q

intervene osteomyelitis

A 
IV abx
specialty consults:
-ortho
-ESS
-ID
140
Q

causes of achilles tendon rupture

A 
sudden forced plantar flexion
unsuspected dorsiflexion
systemic diseases
direct trauma, jumping, pushing off, overuse
fluoroquinolone use
direct steroid injections
141
Q

sx achilles tendon rupture

A

sharp pain or pop in hell
flat-footed walking
unable to stand on ball of foot
unable to plantar flex foot

142
Q

assessing achilles tendon rupture

A

xrays to r/o bony injuries
US to r/o DVT, Baker cyst
MRI for definitive diagnosis

143
Q

intervene achilles tendon rupture

A

ice
splint in plantar flexion
crutches
surgery

144
Q

define blast injuries

A

when explosives detonated

as gas expands, equal amount of air is displaced and travels after blast wave

145
Q

complications of blast injuries

A

disruption of tissue
evisceration
traumatic amputation

d/t mass movement of air

casing fragments become high-velocity projectiles

146
Q

define primary blast injuries

A

initial blast or air wave

affects air-filled organs

147
Q

injuries associated with primary blast

A 
tympanic membrane perf
blast lung (pneumo, alveolar rupture)
air embolus
GI contusion, rupture, perf
CNS
-focal, diffuse cerebral hemmorhage
-cerebral air embolism
148
Q

define secondary blast injury

A

flying debris acts as projectiles

injuries vary depending on size of projectile and site of impact

149
Q

injuries associated with secondary blast

A

penetrating injuries
lacerations
impaled objects

150
Q

define tertiary blast injury

A

injuries from being thrown from blast site

151
Q

injuries associated with tertiary blast

A

blunt or crush
fractures
traumatic amputation
brain injury

152
Q

define quaternary blast injury

A

inhalation of dust or toxic agents

153
Q

injuries associated with quaternary blast

A

thermal burns
radiation
CBRN
lungs, skin, eyes most commonly injured

154
Q

define abrasion

A

rubbing skin against hard surface removes epithelium and exposes dermis or SQ layer

155
Q

characteristics of abrasions

A

yellow, white, pink, bloody
superficial or multiple skin layers

embedded foreign objects can cause permanent tattooing if not removed

same physiologic effects as partial thickness burns

large abrasions may cause fluid loss and hypothermia 2/2 evaporation

high risk for infection

156
Q

intervene abrasions

A 
soap, water, irrigation
pain control prior to cleaning
topical abx
nonadherent dressings qd
open to air if minor
tetanus
157
Q

define laceration

A

blunt trauma causing tissue tearing or crushing

superficial or deep

linear or stellate with jagged or smooth edges

158
Q

intervene lacerations

A 
bleeding control
wound irrigitation
distal neurovasc assessment
thin layer abx ointment
nonadherent dressing

wound closure: approximation of edges and closure

159
Q

define avulsion

A

full-thickness skin loss where approximation of wound edges is not possible

160
Q

characteristics of avulsion

A

peeling of skin from underlying tissues compromises blood supply

common with thin skin, long-term steroids

161
Q

degloving injury

A

avulsion where skin peeled away from scalp, hand, digits, foot, toes

162
Q

intervene avulsion

A

local anesthesia for pain management during irrigation and debridement

split thickness skin graft if large

some edges approximated w/ adhesive strips or occlusive dressing

cover with bulky dressing to protect exposed tissue

163
Q

purpose of wound dressings

A

absorb drainage
protect from contamination
hold abx ointments in place

164
Q

why bulky wound dressings?

A

provide additional protection

absorb significant drainage

165
Q

how long is a dry, sterile dressing applied for

A

2 days

166
Q

when can pts shower after open wound

A

following wound closure - will not increase incidence of inection

167
Q

adhesive tape closure for wounds

A

closure with sterile microporous tape strips

for well-approximated edges in areas with minimal skin tension

for transerve lacs on face - not for edematous wounds

leave until falls off on its own

168
Q

staple closure for wounds

A

faster, lower rates of tissue reactivity and wound infection

cannot align wound margins neatly - better for areas where scarring is tolerated

lower degree of hemostasis than sutures

remove 10-14 days

169
Q

tissue adhesive for wounds

A

wound glue makes contact with alkaline ph and polymerizes to form thin, waterproof bandage

1 sec on moist skin, several secs on dry skin

avoid liquids, ointments

will slough off 5-10 days

170
Q

essential wound care dc instructions

A 
anticipate suture/staple removal
activity restrictions
sx infection
sx circulatory compromise
reasons to see PCP or ED
sunscreen
elevate for edema
171
Q

define missile injuries

A

penetrating injuries from guns, industrial accidents, paint guns, nail guns

172
Q

characteristics of missile injuries

A

appearance of entry wound does not always reflect amount of damage

do not remove impaling objects

173
Q

firearm injuries

A

extensive damage to underlying tissues and organs

fragments from scattered bones = secondary projectiles

passage of gullet forms negative pressure cavity that pulls debris into wound

shock wave travels through tissue, shearing and crushing nerves, vessels, muscles, organs

bullets from rifles have higher velocity than handguns and have greater tissue damage

174
Q

intervene with missile injuries

A 
ABCs
would eval
bleeding control
surgical vs non surgical
projectile path unpredictable
preserve forensic evidence
175
Q

paint or nail gun injuries

A

high pressure injuries from paint or grease guns inject pain/grease for several centimeters, typically following tissue plane

in volar aspect of hand, can travel down tendon sheaths and along digits

176
Q

intervene for paint or nail gun injury

A 
ABCs, bleeding control
wound assessment
eval foreign object
abx, tetanus
sx to drain pain/oil
177
Q

define pressure ulcer

A

local damage to skin and underlying tissue caused by compression between bony prominence and external surface

178
Q

risk factors for pressure ulcers

A

sensory deficits
debility/paralysis
meds
malnutrition

179
Q

define stage I pressure ulcer

A

nonblanchable erythema of intact skin

discoloration, warmth, induration

180
Q

intervene stage I pressure ulcer

A

turn, alleviate pressure

protect/cushion/cover area

181
Q

define stage II pressure ulcer

A

partial thickness skin loss involving epidermis and/or dermis

superficial ulcer, presents as abrasion or blister

182
Q

intervene stage II pressure ulcer

A

cover/protect with dressing

lotion/emollients with padding

183
Q

define stage III pressure ulcer

A

full thickness
may extend to fascia
high rate of infection

184
Q

intervene stage III pressure ulcer

A

prevent infection
cover/protect wound
alleviate pressure

185
Q

define stage IV pressure ulcer

A

extensive destruction

tissue necrosis/damage to muscle, bone, underlying structures w/ w/o full thickness skin loss

186
Q

intervene stage IV pressure ulcer

A

prevent infection

surgical removal of necrotic tissue

187
Q

define puncture wounds

A

penetrating injury where depth > diameter

nails, glass, pins move vessels and nerves aside rather than sever

188
Q

complications of puncture wounds

A

difficult to clean, quick to close
abscess
septic arthritis (joint spaces)
osteomyelitis (cartilage, bone, periosteum)

189
Q

intervene puncture wounds

A

irrigate, clean uncomplicated, uncontaminated wounds < 6 hrs old

tetanus

routine abx not recommended

monitor for complications

190
Q

plantar puncture wounds

A

weight-bearing on sharp object

often involves bone penetration causing osteomyelitis (adults), osteochrondritis (children)

pain worse 4-7 days later w/ redness, swelling
50% with foreign body
prophylactic abx d/t pseudomonas in soles of sneakers

191
Q

characteristics of bite wound

A

all bites from humans or animals contaminate wound with bacteria

tetanus-prone

192
Q

bite wound interventions

A

bites to face close immediately

bites to hand close 3-5 days or are packed and left open

irrigate, debride
tetanus
rabies prophylaxis?

193
Q

bites to back of hand

A

high risk of joint penetration with osteomyelitis, joint effusion

possibly from hitting another in the mouth

194
Q

intervene bites to back of hand

A

meticulous cleaning
immobilization
abx

195
Q

characteristics of dog bites

A

tissue damage depends on size and state of animal

multiple punctures, avulsion

underlying crush injury (limbs)

196
Q

dog bite interventions

A

abx prophylaxis

wound culture

197
Q

characteristics of cat bites

A

deep puncture wounds

high infection rate

198
Q

cat bite interventions

A

abx prophylaxis (penicillin)
open wounds unless on face
wound culture

CEN (12 decks)

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