Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

EMED Unit 3 > Skin and Soft Tissue Disorders > Flashcards

Skin and Soft Tissue Disorders Flashcards

1
Q

When should people receive tetanus vaccinations?

A

DTaP
• 2, 4, and 6 months
• 15-18 months
• 4-6 years

Tdap
• 11-12 years
• Once for adults
• Td q10 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Secondary prevention of tetanus includes…

A

Wound cleansing and debridement

Tetanus toxoid as indicated and TIG when indicated

Vaccination if last Td was >5 years ago

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Vaccination protection from tetanus lasts _______

A

10 years

Common secondary prevention if vaccination >5 years ago

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What types of wounds are prone to tetanus?

A

Longer than 6 hours old

Deep (>1 cm) wounds

Grossly contaminated

Avulsion/puncture/crush

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Risk factors for impaired wound healing

A 
Infection
Smoking
Malnutrition
Immobilization
Diabetes
Vascular disease
Immunosuppressive therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

_____ cause 1% of all ED visits

A

Animal bites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What type of animal is most likely to bite you and send you to the ED?

A

DOGS - 60-90% of animal bites

Cats - 5-20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

The microbiology of animal bites is composed of ________ and ______

A

Oral flora of biting animal

Human skin flora

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What microorganisms are most likely to show up in an animal bite?

A

PASTEURELLA (50% of dog bites and 75% of cat bites)

Staphylococcus

Streptococcus

Anaerobes (bacteroides and fusobacterium)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Dog or cat bite:

Animal frequently knows the human they bite

A

Dog

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

60-70% of dog attacks on children <5 involve…

A

The head and neck

Also on 50% of children 5-10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

89% of cat bites are _______

A

Provoked —> wounds from teeth and claws

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What kinds of wounds do cat bites cause?

A

Long slender teeth —> deep wounds

2/3 involve the upper extremities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Punctures due to cat bites that penetrate below the periosteum may lead to …

A

Osteomyelitis or septic arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the two categories of human bites?

A

Occlusive wounds

Clenched fist (fight bites)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What pathogens are most likely in human bites?

A

Eikenella corrodens (gram (-) anaerobe)

Group A strep

Staphylococcus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is a key thing you need to do when dealing with a human bite?

A

Measure that shit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

If the maxillary inter-canine distance is > ______ it is likely an adult bite

A

> 2.5cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What steps are involved in the management of bite wounds?

A 
Hemorrhage control
X-ray
Anesthesia
Inspection
Surface cleaned with POVIDONE IODINE
Copious irrigation to clean the depths
Debridement of devitalized tissues
Exploration for foreign bodies and deeper damage
Surgical consult if indicated
Primary closure for dog bites
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Which bite wounds require surgical consult?

A

Deep, penetrating wounds to the bones, tendons, joints, or other major structures

Complex facial lacerations

Wounds associated with neurovascular compromise

Wounds with complex infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

When are prophylactic antibiotics indicated for bite wounds?

A

Deep puncture wounds

Moderate to severe wounds with associated crush injury

Underlying venous and/or lymphatic compromise

Wounds on hands, genitalia, face, or in close contact with bone/joint

Wounds requiring closure

Compromised hosts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Most common MOA for plantar punctures

A

Stepping on a nail

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How do you manage plantar punctures?

A 
X-ray
Cleansing
Removal of foreign body
Closure by secondary intent
Tetanus
Keep clean and watch for SSx of infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

When should you x-ray a plantar puncture?

A

Inability to completely visualize the interior of the wound
Deep wounds caused by glass
Patient believes there is a retained object
Object is small, breakable, brittle
Object can be seen or felt beneath skin surface
Severe wound pain
Persistent localized pain over wound
Painful mass or discoloration under skin
Missing portion of the object
Injury went through rubber shoe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
There’s only one fucking slide on needle stick injuries. What did it say?
Immediately cleanse the exposed site (soap, water, alcohol) Report and document Determine HIV status of source and person with the stick (also Hep B and Hep C) Post exposure prophylaxis Prevention of spread
26
Indications for laceration closure
Extension into subQ Decrease healing time Reduce likelihood of infection Decrease scar formation Repair loss of structure or function Improve cosmesis
27
Contraindications for laceration closure
Contaminated wounds Wounds greater than 12 hours old Presence of foreign body Wounds involving tendons, nerves, or arteries
28
What are some possible complications of laceration closure?
Infection Loss of function Wound dehiscence Scars, including keloid formation Loss of cosmesis Tetanus
29
Name the wound classification: Surgical incisions w/o involvement of GU, GI, or respiratory tracts
Clean
30
Name the wound classification: Involvement of GU, GI, or respiratory tracts
Clean-contaminated
31
Name the wound classification: Gross spillage into surgical wounds (bile, stool)
Contaminated
32
Name the wound classification: Traumatic wounds
Contaminated
33
Name the wound classification: I&D abscess
Infected
34
Name the wound classification: Gross contamination
Infected
35
What types of wounds are considered clean?
Surgical incisions No involvement of GU, GI, or respiratory tracts
36
What types of wounds are considered clean-contaminated?
Involvement of GU, GI, respiratory tracts
37
What types of wounds are considered contaminated?
Gross spillage into surgical wound (bile stool) Traumatic wounds
38
What types of wounds are considered infected?
Established infection (I&D abscess) Gross contamination
39
Name the wound closure classification: All layers closed
Primary intention
40
Name the wound closure classification: Best chance for minimal scarring
Primary intention
41
Name the wound closure classification: Used for clean and clean-contaminated wounds
Primary intention
42
Name the wound closure classification: Deep layers closed and superficial layers left to granulate
Secondary intention
43
Name the wound closure classification: Can leave wide scar
Secondary intention
44
Name the wound closure classification: Requires frequent wound care
Secondary intention
45
Name the wound closure classification: Deep layers closed primarily and superficial layers closed in 4-5 days after infection is no longer a concern
Delayed primary intention
46
What HPI questions are most important in working up a laceration?
How, when, where injury occurred Tetanus status Chronic illness hx
47
PE for lacerations
Type of wound Location, extent, and contamination level Careful neuro exam Evaluation for concomitant injuries
48
Laceration management involves...
Irrigation of wound Clean wound Closure if appropriate Tetanus if appropriate
49
What types of suture are absorbable?
Vicryl (60-90 days) Polydioxanone (PDS - 6 months) Chronic gut
50
What types of suture are non-absorbable?
Prolene Nylon
51
What is the caution for using nylon sutures
Reactive and may wick microorganisms into the wound
52
Name the suturing method: 3-10mm in length and the same distance apart Frequently used to close skin lacs
Simple interrupted
53
Name the suturing method: Lies in plane perpendicular to skin
Vertical mattress
54
Name the suturing method: Used for deep wounds to help eliminate dead space
Vertical mattress
55
Name the suturing method: Lies in plane parallel to skin
Horizontal mattress
56
Name the suturing method: Useful in flaps or wounds under tension
Horizontal mattress
57
Name the suturing method: Can be performed quickly and if locked provides tighter closure
Continuous
58
Name the suturing method: Used often for surgical or clean wounds but must use absorbable suture
Subcuticular
59
Skin tension lines that indicate orientation of collagen fibers
Langer’s Lines
60
Why do we give shit about langer’s lines?
Lacerations that run at right angles to lines tend to gape
61
What is the best way for patients to keep suture site clean and dry?
No contact with water for 48 hours Soap and water for wound care thereafter, dry well
62
What are the recommendations for post suture care?
Keep site clean and dry Elevate if possible Education patient to observe for signs of infection Consider activity restriction Analgesia Removal
63
Signs of infection to watch for post suturing
Pain Swelling Redness Drainage
64
When should sutures be removed: Scalp
7-14 days
65
When should sutures be removed: Face
5 days
66
When should sutures be removed: Ear
4-5 days
67
When should sutures be removed: Chest/abdomen
8-10 days
68
When should sutures be removed: Back
12-14 days
69
When should sutures be removed: Arm/leg
7/8-10 days
70
When should sutures be removed: Hand
8-10 days
71
When should sutures be removed: Fingertip
10-12 days
72
When should sutures be removed: Foot
12-14 days
73
Risk factors for infection of lacerations (abx indicated)
Wound >12 hours, esp on hands Bites Crush wounds Contaminated wounds Avascular areas (ie ear) Wounds involving joint spaces, tendon, or bone Hx of valvular heart disease Immunocompromised patients
74
Does hair need to be shaved off prior to suturing a hairy area?
No Shaving can increase risk of infection and leave particles in the wound
75
What is the most important means to decrease infection risk for lacerations?
Irrigation Debridement and foreign body removal if necessary
76
Assessment of minor wounds should include...
``` Determination of allergies Status of tetanus MOI FB presence Extent of wound Neurovascular or tendon compromise Cosmetic significance ```
77
When should all sutured wounds be re-checked?
24-48 hours Highly contaminated wounds rechecked in 48-72 hours
78
What are some examples when absorbable sutures may be preferred?
Pediatric/elderly patients in whole suture removal may be difficult Oral mucosa (chromic gut or vicryl) Under splints or casts
79
What is the definition of cellulitis?
Non-necrotizing inflammation of the skin and subcutaneous tissues Usually related to acute infection that does not involve the fascia or muscles
80
Cellulitis is characterized by ...
Localized pain, swelling, tenderness, erythema, and warmth
81
Most common causative agents of cellulitis in immunocompetent patients
Strep A Staph aureus
82
Most common etiology of cellulitis in immunocompromised patients
``` Pseudomonas Proteus Serratia Enterobacter Citrobacter ```
83
What are the four cardinal signs of infection (one more time)?
Erythema Pain Swelling Warmth
84
Common presentation of cellulitis
Site is red, hot, swollen, and tender May have regional LAD Malaise, fever, and/or chills
85
SSx of deep soft tissue infection (severe infection)
``` Violaceous Bullard Cutaneous hemorrhage Skin sloughing Skin anesthesia Rapid progression Gas in tissue ``` All of these require emergent surgical evaluation
86
When is outpatient care of cellulitis indicated?
Mild, local symptoms w/o evidence of systemic disease
87
Outpatient care of cellulitis should include...
Limb elevation to reduce swelling Empiric abx Follow up with in 48-72 hours
88
When is inpatient care of cellulitis indicated?
Facial cellulitis of odontogenic origin Immunocompromised patients Orbital cellulitis Patient with comorbidities (lymphedema, cardiac, hepatic, or renal) Cellulitis affecting more than 1/4 of an extremity
89
Mainstay of treatment for cellulitis
Beta-lactams (Amoxicillin, augmentin)
90
When are cephalosporins used to treat cellulitis?
Cephalexin if strep or MRSA suspected Ceftriaxone if gram (-) organisms
91
When are macrolides used to treat cellulitis?
In PCN allergic patients NOT effective against MRSA
92
Abx treatment of cellulitis should be ______ in duration
10-14 days
93
_____ is the most likely pathogen in wounds without drainage or abscess
Strep
94
Recommended abx for mild cellulitis
Penicillin Cephalosporin Dicloxacillin Clindamycin
95
Recommended abx for moderate cellulitis
Penicillin Ceftriaxone Cefazolin Clindamycin
96
Recurrent cellulitis is usually due to...
Venous or lymphatic obstruction Use penicillin or erythromycin BID for 4-52 weeks
97
Increased risk factors for abscess formation
Staph aureus carrier Break in skin Immunocompromised
98
What types of abscesses require a surgical referral?
Perirectal abscesses Anterior and lateral neck abscesses Hand abscesses Abscesses adjacent to vital nerves or vessels (facial nerve, carotid artery, femoral artery) Breast abscesses near areola and nipple
99
Patients treated for abscesses should follow up in _____
24-48 hours
100
If an abscess if packed, how often should the packing be changed?
Every 24 hours
101
Patients with recurrent abscesses should do what at home?
Bath with chlorhexidine daily
102
What is the decolonization regimen for MRSA?
5 days of the following: • BID nasal mupirocin • Daily chlorhexidine washes • Daily decontamination of personal items
103
Most common organism to cause infection in the first few days after a burn injury
Staph aureus
104
What are the signs of an infection in a burn patient?
Rapid change in condition Fever, increased pain, feeding intolerance
105
How do you manage burn wound infections?
Avoid hyperthermia Culture Systemic abx with sepsis or septic shock • Pipercillin/tazobactam or Carbapenem • Consider adding vancomycin with suspected MRSA
106
Patients with burns who develop cellulitis should be treated with...
IV Cefazolin or clindamycin or vancomycin if MRSA suspected
107
Infection of the deep soft tissues resulting in progressive destruction of muscle fascia and overlying sub-q fat
Necrotizing fasciitis
108
Why does necrotising fasciitis appear smaller on the surface that the infection actually is?
B/c it spreads along the fascia (deep)
109
Pathogens involved in necrotising fasciitis
Can be either poly or monomicrobial Poly —> aerobic and anaerobic Mono —> GAS or beta-hemolytic strep
110
Is fournier’s gangrene mono- or polymicrobial
POLY E. coli, Klebsiella, and Enterocci often involved Also, bactericides, fusobacterium, clostridium
111
Infection of the perineum often involving the scrotum, characterized by severe pain starting in the anterior abdominal wall and migrating to the gluteal muscles, scrotum, and penis
Fournier’s Gangrene
112
How is fournier’s gangrene treated?
Aggressive surgical debridement, broad spectrum abx
113
When should a burn patient be transferred to a burn center?
Partial-thickness burns >10% of TBSA Third-degree burns in any age group Burns to face, hands, feet, genitalia, perineum, major joints Electrical burns (including lightening) Chemical burns Inhalation injury Those with preexisting medical disorders that could complicate management Those with concomitant trauma

EMED Unit 3 (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions