Skin 6

Question 1

ear laceration - consider ___ block

Answer 1

auricular

Question 2

ear lacerations - exposed cartilage

Answer 2

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

Question 3

ear laceration hematomas tx

Answer 3

I/D recommended as soon as possible

Question 4

auricular hematoma tx
4

Answer 4

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

Question 5

subungual hematoma - nail removal?

Answer 5

rarely necessary if the nail is intact and firmly adherent

Question 6

subungual hematoma - crush injuries, consider what

Answer 6

x ray for distal phalanx tuft fx

Question 7

open tuft fx tx

Answer 7

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

Question 8

subungual hematoma - acute hematoma tx
4

Answer 8

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

Question 9

subungual hematoma - drainage, patient education
4

Answer 9

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

Question 10

ingrown nail tx
3

Answer 10

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

Question 11

indication for nail removal and nail bed repair
2

Answer 11

1. significant fractures of the nail
2. significant fractures of distal phalanx

Question 12

nail and nail be repair steps
9

Answer 12

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

Question 13

nail bed will need what type of sutures

Answer 13

absorbable sutures 6-0

Question 14

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

Answer 14

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

Question 15

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

Answer 15

horizontal mattress

Question 16

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

Answer 16

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

Question 17

new fingernail growth time

Answer 17

up to 6 months

Question 18

new toenail growth time

Answer 18

up to 18 months

Question 19

nail care instructions

Answer 19

keep clean, dry, covered during growth time

Question 20

ring removal - try 1st
2

Answer 20

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

Question 21

ring removal - try 2nd
1

Answer 21

string method

Question 22

ring removal - last resort

Answer 22

cut the ring

Question 23

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

Answer 23

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

Question 24

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

Answer 24

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

Question 25

wounds - tap water for irrigation?

Answer 25

yes - ok to use

Question 26

do not bathe wounds in what and why 2

Answer 26

iodine or hydrogen peroxide - can delay healing

Question 27

iodine can be used to clean skin where

Answer 27

around a laceration

Question 28

bleeding varicosity/wound - consider what 4

Answer 28

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

Question 29

zipper injury - administer what

Answer 29

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

Question 30

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

Answer 30

cut zipper's median bar

Question 31

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

Answer 31

needle aspiration of a soft tissue abscess

Question 32

soft tissue abscess I/D procedure tips 6

Answer 32

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

Question 33

fingertip avulsions - bleeding info

Answer 33

even superficial wounds may bleed for a prolonged time

Question 34

fingertip avulsion wound repair - 1st try 3

Answer 34

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

Question 35

fingertip avulsion wound repair - try 2nd 2

Answer 35

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

Question 36

fingertip avulsion repair - try 3rd 1

Answer 36

1. consider figure 8 sutures

Question 37

lacerations/wounds - when to refer to ER 4

Answer 37

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