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Urgent Care Guide > Skin 6 > Flashcards

Skin 6 Flashcards

1
Q

ear laceration - consider ___ block

A

auricular

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2
Q

ear lacerations - exposed cartilage

A

must be covered w/ skin to avoid infection; if complex, consider transferring

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3
Q

ear laceration hematomas tx

A

I/D recommended as soon as possible

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4
Q

auricular hematoma tx
4

A
  1. I/D
  2. ear sandwich dressing; apply rolled gauze w/in the auricle to provide anterior support then repeat w/ rolled gauze posteriorly; suture rolls together
  3. keep in place 7 days
  4. ENT f/u recommended
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5
Q

subungual hematoma - nail removal?

A

rarely necessary if the nail is intact and firmly adherent

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6
Q

subungual hematoma - crush injuries, consider what

A

x ray for distal phalanx tuft fx

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7
Q

open tuft fx tx

A

w/ adequate irrigation and wound care, infection is rare and the need for abx is controversial

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8
Q

subungual hematoma - acute hematoma tx
4

A
  1. consider drainage if painful and larger than half of the nail bed
  2. 18 G needle over hematoma w/ rapid twisting and pressure until drainage occurs
  3. electrocautery - often several holes required, or tap tap tap then use 18 gauge to make hole bigger
  4. clean, put on abx ointment, loose bandaid
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9
Q

subungual hematoma - drainage, patient education
4

A
  1. use alcohol pad to keep it draining
  2. loose bandaid
  3. topical abx
  4. if we didn’t drain, it is painful, can loose nail
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10
Q

ingrown nail tx
3

A
  1. consider digital block
  2. use scissors to cut off offending nail adjacent to area of skin overgrowth distal to proximal
  3. separate from the nail bed and remove
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11
Q

indication for nail removal and nail bed repair
2

A
  1. significant fractures of the nail
  2. significant fractures of distal phalanx
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12
Q

nail and nail be repair steps
9

A
  1. digital block
  2. irrigation and hemostasis (tourniquet, t ring, cut off finger of glove) are important
  3. lift cuticle w/ scissors and gently remove nail
  4. inspect and clean nail bed
  5. nail bed lacerations require absorbable suture 6-0
  6. eponychial fold will need temp elevation to allow new nail formation
  7. clean and inspect nail for reattachment - if nail is unusable plan alternative
  8. use scissors to lift cuticle and slide nail underneath
  9. secure w/ absorbable suture
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13
Q

nail bed will need what type of sutures

A

absorbable sutures 6-0

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14
Q

nail bed repair - use scissors to lift cuticle and slide nail underneath - if nail is too thick then do what

A

use 18-20 G needle to put a hole in nail first

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15
Q

nail bed repair - secure nail w/ absorbable suture, what type of suture pattern is recommended

A

horizontal mattress

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16
Q

nail bed repair - what to do if you have no nail to place under the eponychial fold and nail bed repair

A

use the foil from the suture package to create an artificial nail

17
Q

new fingernail growth time

A

up to 6 months

18
Q

new toenail growth time

A

up to 18 months

19
Q

nail care instructions

A

keep clean, dry, covered during growth time

20
Q

ring removal - try 1st
2

A
  1. elevate hand for several minutes
  2. then use liquid soap or lubricant to aid in removal
21
Q

ring removal - try 2nd
1

A

string method

22
Q

ring removal - last resort

A

cut the ring

23
Q

to repair skin that is thin or delicate (elderly) use sterile strips how

A

along the borders of the tear and suture through the sterile strips

24
Q

when using skin adhesive in an area close to the eyes apply what

A

a barrier of bacitracin (can get OTC) on either side of the wound so the adhesive doesn’t drip

25
Q

wounds - tap water for irrigation?

A

yes - ok to use

26
Q

do not bathe wounds in what and why
2

A

iodine or hydrogen peroxide - can delay healing

27
Q

iodine can be used to clean skin where

A

around a laceration

28
Q

bleeding varicosity/wound - consider what
4

A
  1. surgicel or hemostatic dressing w/ compression wrap
  2. lidocaine w/ epi
  3. ice
  4. suture - figure 8
29
Q

zipper injury - administer what

A

analgesia/anxiolysis/local anesthesia (EMLA), then apply mineral oil to zipper teeth and trapped skin; skin may gently release after 10 mins

30
Q

zipper injury - for faster release than mineral oil, do what

A

cut zipper’s median bar

31
Q

soft tissue abscess I/D - what is typically not adeuqate

A

needle aspiration of a soft tissue abscess

32
Q

soft tissue abscess I/D procedure tips
6

A
  1. always consider underlying structures before procedure 0 nerves, blood vessels, etc
  2. adequate anesthesia is key - field block around the abscess site
  3. make incision parallel to skin creases/skin tension lines
  4. incision should be large enough to ensure continued drainage after procedure
  5. probe cavity and consider saline flush irrigation
  6. packing is controversial - might be needed in larger abscesses
33
Q

fingertip avulsions - bleeding info

A

even superficial wounds may bleed for a prolonged time

34
Q

fingertip avulsion wound repair - 1st try
3

A
  1. maintain pressure w/ gauze soaked with lidocaine w/ epi
  2. elevate
  3. consider surgical-foam dressing for residual bleeding
35
Q

fingertip avulsion wound repair - try 2nd
2

A
  1. fingertip tourniquet until bleeding stop then
  2. paint tip with several layers of skin adhesive to seal wound
36
Q

fingertip avulsion repair - try 3rd
1

A
  1. consider figure 8 sutures
37
Q

lacerations/wounds - when to refer to ER
4

A
  1. high pressure injection injuries - serious injury that occurs when a substance is accidentally injected into the skin under high pressure
  2. consider for ped pts w/ extensive injuries
  3. wounds caused by penetrating trauma and near a joint; typically require irrigation and tx in the OR
  4. large foreign body who require US or CT scan to identify

Urgent Care Guide (38 decks)

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