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Urgent Care Guide > Skin 5 > Flashcards

Skin 5 Flashcards

1
Q

lacerations - ask about
2

A

circumstances of injury - mechanism, location, timing
tetanus status

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2
Q

lacerations - note what on PE
5

A
  1. length
  2. depth
  3. any tissues/tendons visible
  4. evaluate for foreign body
  5. assess sensation (light touch) before anesthesia
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3
Q

lacerations PE - eyelid lacerations
2

A
  1. EOMs
  2. fundoscopic exam
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4
Q

lacerations PE - nasal lacerations
1

A

evaluate for septal hematoma

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5
Q

lip lacerations PE
2

A

wounds >0.25 cm that gape at rest often need repair, evaluate for vermillion border

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6
Q

nail bed lacerations - may use what for repair
2

A

may use absorbable or wound adhesive for repair

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7
Q

scalp lacerations PE - evaluate for
1

A

evaluate for signs of head injury

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8
Q

scalp lacerations PE - signs of head injury
3

A
  1. battle sign
  2. raccoon eyes
  3. hemotympanum
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9
Q

joint lacerations PE eval
2

A
  1. isolate each joint
  2. ROM
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10
Q

joint lacerations - deformity and decreased ROM indicates

A

complete or partial tendon laceration

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11
Q

joint lacerations - on PE what indicates tendon injury

A

pain with ROM
deformity
extension lag

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12
Q

joint lacerations - asses for __ ___ involvement

A

joint space involvement - may need higher level of care

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13
Q

lacerations - img to identify tendon rupture

A

US if available

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14
Q

for scalp lacerations img/testing - consider what rule

A

Canadian head CT rule

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15
Q

lacerations - plain films can identify what foreign bodies
3

A
  1. glass
  2. metal
  3. stone
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16
Q

lacerations - what size glass is usually visible on plain film

A

<1mm

17
Q

lacerations - shadow from displaced tissue may be visible how

A

on plain film for larger material

18
Q

lacerations - consider CT scan, US, or MRI to identify what types of foreign bodies
3

A
  1. wood
  2. plastic
  3. larger material
19
Q

indications for laceration repair
3

A
  1. improve healing and cosmetic
  2. hemostasis
  3. decrease risk for infection
20
Q

lacerations - consider delayed closure or healing by secondary intention for
3

A
  1. gross contamination
  2. animal bites - typically close facial wounds, consider others case by case
  3. old laceration - up to 18 hours for clean, non infected laceration to body and up to 24 hours on the face
21
Q

lacerations - time frame for closure
2

A

up to 18 hours on clean wounds, on body
up to 24 hours clean wounds on face

22
Q

laceration repair - shave?

A

no need to shave hair, avoid razors

23
Q

lacerations - indications for wound adhesives
6

A
  1. wounds < 4-6 hrs old
  2. clean and linear
  3. bleeding controlled
  4. no increased tension on the wound
  5. does not involve a joint, mucous membrane
  6. not from an animal bite
24
Q

lacerations repair anesthesia options + needle G
4

A
  1. lidocaine - 0.5, 1, 2% quick onset 3-5 minutes, short acting 30-60 mins
  2. bupivacaine 0.25 or 5% slower onset 8-12 mins, longer lasting 2-4 hrs
  3. lidocaine and bupivacaine w/ epi - ideal for highly vascular areas
  4. recommend 25-30 G needle
25
Q

lacerations - irrigate w/

A

NS or tap water

26
Q

laceration repair - adhesive strips are good on what type of wound
3

A
  1. low tension
  2. linear
  3. superficial wounds or skin tears
27
Q

laceration repair - suture types
2 overall types

A

nylon and polypropylene - non absorbable
polyglactin, gut, and chromic gut - absorbable (consider in peds and elderly)

28
Q

laceration repair - suture size w/ body part
6

A
  1. scalp 5-0
  2. face 5-0, 6-0
  3. mucosal/oral 5-0 absorbable
  4. joint 3-0 4-0
  5. hand 5-0
  6. extremities, trunk 4-0 5-0
29
Q

laceration repair - staples
4

A
  1. easy to use
  2. appropriate for low tension areas
  3. linear lacerations
  4. mostly used on scalp
30
Q

laceration- abx?
2

A
  1. usually not needed unless bites, grossly contaminated, joint/bone/tendon involvement, immunocompromised
  2. topical abx helps keep wound moist, increases healing, decreases risk of infection - mupirocin topical TID x 10 days
31
Q

lacerations - if topical abx needed use what

A

mupirocin topical/Bactroban - TID x 10 days

32
Q

lacerations - consider specialty consult for which types of lacerations
3

A

eyelid
ear
lip

33
Q

lacerations - suture/staple removal guide/days

A

face/scalp - 5-7 days
torso, upper extremities - 7-10 days
extensor surfaces, lower extremities, over a joint - 10-14 days

Urgent Care Guide (38 decks)

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