PRINCIPLES OF WOUND CARE Flashcards
Name some basic components of aseptic technique
hygiene use of PPE use of sterile feild opening and introducing packets w/out contamination not touching non sterile items
3 components of a well managed wound
well vascularized (not dead or foreign stuff)-debrided
clean (sterile fluid)-irrigation
moist- dressed w/ impregnated layer, then dry layer
define a clean wound and its TX
Uninfected, operative wound, no infl., no Resp/GI/GU. Primarily closed, no abx.
define a clean-contaminated wound and its TX
Operative wound Rsp/GI/GU inv. in cntrld cndtns, debride, irrig, 1rst clos, Cefazolin/Cefotetan
define a contaminated wound and its TX
Trauma (exp. To FB), GI spillage, infl. Encountered. Debride, irrig, 2nd clos. Cefazolin/ofloxacin
define a dirty-infected wound
Old traumatic wounds, active infection. Debride, irrig, 2nd clos, Augmentin.
when is primary closure indicated?
• Primary: clean wound, deep enough to leave excess scar if not closed, suture->hairline scar
When is secondary closure indicated?
gaping, irregular wound, dirty >18hrs-
When is tertiary closure indicated?
wound that is greater than 18 hours. This is a judgement call for wounds that may be infected, but would ideally be closed for cosmetic or functional purposes. clean and debride, allow granulation and reassess in 4-5 days.
When is closure contraindicated
never close infected wounds: FB, contam, puncture, crush, abscess, sig. delay
what is stronger: synthetic or organic suture?
synthetic
what is more reactive: synthetic or organic suture?
organic
what has more tensile strength and is bigger: 1.0 or 10.0?
1.0
What size suture would you use on eyelids/face/penis?
7.0/6.0
What size suture would you use on low tension areas like parts of scalp, oral mucosa, abdomen or hand?
5.0
what size suture would you use on high tension parts of the scalp, the chest or foot?
4.0
what size suture would be appropriate for foot skin, deep in the abdomen or the back?
3.0
what size suture is used for chest tubes and GI tubes?
2.0
Name a strong and low reactive absorbable suture
PDS or Vicryl
Name a weak and high reactive absorbable suture
Gut type sutures (used in face and mouth)
Name a strong and low reactive non absorbable suture
Prolene or Nylon
Name a weak and high reactive non absorbable suture
silk
You just sutured a patient’s cheek, when can she have the sutures removed?
3-5 days
You just sutured a hand laceration, when can your patient have the sutures removed?
7-10 days arms/scalp, 10-14 hands,trunk,legs and 14-21 for palms and soles.
Your patient has to have surgical repair of his wrist what sort of anesthesia will block his entire arm? What are the minimum/ max times for this sort of anesthesia?
regional/bier block
min 30 minutes max 1.5-2 hours
Your patient comes in with a giant abscess on his back and asks for anesthesia before your I&D. What’s a good option?
Local injection
How does lidocaine toxicity present?
metallic taste tinnitus lip tingling agitation seizure arrythmia urticaria anaphylaxis
Your patient has a laceration on her index finger, what is a good option for anesthesia before you debride?
Digital block
Your lidocaine says 1% on it what does this mean?
The concentration is based on kilograms per 100mL. 1% is 10mg/ml.
What is the max dose for lidocaine 1%? w/ epi? How long does it last?
4mg/kg or 300mg or 30mL
7mg/kg or 500mg or 50 mL
lasts 1-2 hours 3 w/ epi
Same for mepivicaine
When is mepivicaine contraindicated?
pregnancy
What is the max dose for bupivicaine .25%?w/ epi? How long does it last?
2mg/kg=>175mg/70cc,
3mg/kg=> 225mg/90cc .
4-8 hours
How long does topical EMLA need to be on to provide anesthesia to your kiddo before he gets a needle stick?
1 hour lasts up to 4 don’t use on broken skin.
How long do lido, bupivicaine and mepivicaine take to start providing anesthesia?
about 5 minutes
Name some examples of anaerobic infections
anaerobes displaced from GI or soil where they don’t belong….
- dead/dying tissue
- pneumonia
- oral or pelvic infections
What ABX work for anaerobic infections
metronidazole
clindamycin
G2 ceph like cefoxitin w/ anaerobic coverage
Name some examples of G- infections
E. coli (UTI)
Klebsiela/Pseudomonas (Pneumonia, bloodstream)
N. Gonn (STD)
What ABX work for G- infections
- Fluoroquinalones (Cipro/levo)
- TSM
- Aminoglycoside (gentamycin)
- 3rd Gen Ceph (ceftazadine, ceftriaxone)
Name some examples of G+ infections
- Staph(abscess and soft tissue, pneumo, etc),
- strep (pneumo, URI, soft tissue)
- enterococcus (UTI, diverticulitis, blood, intra abd.)
- listeria (flu-like)
- clostridium (enteritis C. perf, gas gangrene Cperf., diahrrea for C. diff)
What ABX work for G+ infections
HAMRSA: Vanc,
CAMRSA: TMS. PCN’s, Ceph (1/2), Carbapenim, Macrolides, Tetracyclines
Name 3 infections that affect the epidermis
erysipelas
impetigo
folliculitis
Name two infections that affect the dermis
furuncle
carbuncle
What infection exists b/t dermis and subQ
cellulitis
what infection invades subQ and fascia
necrotizing fasciitis
What infection invades muscle
gas gangrene
DOC for impetigo, ulcer or lac?
mupirocin/ bactroban
TX for simple abscess
I&D no ABX
Complicated abscess/boil (cellulitis, const. sx, immunosup., area diff. to drain)
I&D Oral/IV Vanc/Linezolid/Clinda
Non purulent (strep) cellulitis outpatient
Clinda/tms or doxy+cephalexin/b-lactam
Purulent (staph) cellulitis outpatient
Clinda/TMS/Doxy/Linezolid
