Skin 5

Question 1

lacerations - ask about
2

Answer 1

circumstances of injury - mechanism, location, timing
tetanus status

Question 2

lacerations - note what on PE
5

Answer 2

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

Question 3

lacerations PE - eyelid lacerations
2

Answer 3

1. EOMs
2. fundoscopic exam

Question 4

lacerations PE - nasal lacerations
1

Answer 4

evaluate for septal hematoma

Question 5

lip lacerations PE
2

Answer 5

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

Question 6

nail bed lacerations - may use what for repair
2

Answer 6

may use absorbable or wound adhesive for repair

Question 7

scalp lacerations PE - evaluate for
1

Answer 7

evaluate for signs of head injury

Question 8

scalp lacerations PE - signs of head injury
3

Answer 8

1. battle sign
2. raccoon eyes
3. hemotympanum

Question 9

joint lacerations PE eval
2

Answer 9

1. isolate each joint
2. ROM

Question 10

joint lacerations - deformity and decreased ROM indicates

Answer 10

complete or partial tendon laceration

Question 11

joint lacerations - on PE what indicates tendon injury

Answer 11

pain with ROM
deformity
extension lag

Question 12

joint lacerations - asses for __ ___ involvement

Answer 12

joint space involvement - may need higher level of care

Question 13

lacerations - img to identify tendon rupture

Answer 13

US if available

Question 14

for scalp lacerations img/testing - consider what rule

Answer 14

Canadian head CT rule

Question 15

lacerations - plain films can identify what foreign bodies
3

Answer 15

1. glass
2. metal
3. stone

Question 16

lacerations - what size glass is usually visible on plain film

Answer 16

<1mm

Question 17

lacerations - shadow from displaced tissue may be visible how

Answer 17

on plain film for larger material

Question 18

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

Answer 18

1. wood
2. plastic
3. larger material

Question 19

indications for laceration repair
3

Answer 19

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

Question 20

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

Answer 20

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

Question 21

lacerations - time frame for closure
2

Answer 21

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

Question 22

laceration repair - shave?

Answer 22

no need to shave hair, avoid razors

Question 23

lacerations - indications for wound adhesives
6

Answer 23

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

Question 24

lacerations repair anesthesia options + needle G
4

Answer 24

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

Question 25

lacerations - irrigate w/

Answer 25

NS or tap water

Question 26

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

Answer 26

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

Question 27

laceration repair - suture types 2 overall types

Answer 27

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

Question 28

laceration repair - suture size w/ body part 6

Answer 28

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

Question 29

laceration repair - staples 4

Answer 29

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

Question 30

laceration- abx? 2

Answer 30

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

Question 31

lacerations - if topical abx needed use what

Answer 31

mupirocin topical/Bactroban - TID x 10 days

Question 32

lacerations - consider specialty consult for which types of lacerations 3

Answer 32

eyelid ear lip

Question 33

lacerations - suture/staple removal guide/days

Answer 33

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