Suturing Management Flashcards
What questions should you ask to identify the mechanism of injury of a wound?
What caused the wound? Was it a clean implement? Was it a stab injury? Was the damage shearing? When did the wound occur?
What things should you examine a wound for?
Site of injury
Depth + length of wound
Is deeper structure of damage visible/suspected (?exploration under GA req)
Tendon damage visible/suspected?
Sensation around normal + distal to wound
FB visible/suspected?
Other injuries/reported degree of pain
What questions should you ensure to ask a patient who has had a wound to establish their health status?
Tetanus status
Any known allergies, prev experiences with LA?
Diabetic?
Taking steroids/anticoagulants?
What is the criteria for identifying a tetanus prone wound?
>6h old Deep/penetrating Involving devitalised tissue Showing clinical evidence of sepsis Contaminated with soil/manure/unclean water, esp gardening/farming/sport injuries
What size of suture should you use for large wounds?
3/0
What size of suture should you use for face wounds?
5/0, 6/0
What size of suture should you use for wounds in children ?
6/0
What kind of sutures are usually used?
Monofilament, e.g. prolene
Sometimes other, e.g. vicryl rapide in child/mucous membrane
What LA can you use before suturing?
Lidocaine/lignocaine 1%
What is the max dose of LA you can use?
3mg/kg wo adrenaline, 7mg/kg w adrenaline
In which situations can you not use adrenaline with LA?
End organs as adrenaline causes vasoconstriction
After giving a LA what should you do before starting to suture?
Check for pin prick sensation
Check wound to assess depth and any underlying structure damage
Remove FBs/debride
What is involved in wound cleaning?
Thorough cleansing
Shave area if req.
How should sutures be put in?
Start in middle and half the areas
What is the issue with putting too many sutures in?
Create too much tension, reducing BF
