Trauma EM

Question 1

superficial thickness burn

Answer 1

*epidermis only
*skin is erythematous, mildly painful
*normal capillary refill
*usually heals in several hours
*if it remains after a day or so, it is likely a partial thickness burn

Question 2

superficial partial thickness burn

Answer 2

*epidermis to superficial dermis
*blisters, look wet, usually more painful
*normal capillary refill

Question 3

deep partial thickness burn

Answer 3

*epidermis to deep dermis
*sluggish capillary refill
*possibly less painful due to nerve destruction
*grafting generally needed to minimize scarring

Question 4

full thickness burn

Answer 4

*all layers of skin and subcutaneous tissue, including fascia
*often appear white or brown and leathery
*no capillary refill
*usually painless
*surgery required
*highest risk of infection

Question 5

calculating total body surface area (TBSA) of burns

Answer 5

*note - NEVER include superficial thickness burns to calculate
*rule of palms: the palmar surface of the patient’s hand, including the fingers, if approx 1% of TBSA
*rule of 9s for burns:
-head & neck = 9%
-arms = 18% (9% each arm)
-trunk = 36% (18% front, 18% back)
-legs = 36% (18% each leg)
-genitals = 1%

Question 6

management of open fractures in the ED

Answer 6

1. size < 10 cm: cefazolin
2. size > 10 cm and/or extensive/contaminated wound: ceftriaxone & vancomycin

Question 7

organisms from animal bites

Answer 7

Pasteurella > Staph > Strep > Capnocytophaga > Bartonella henselae

Question 8

organisms from human bites

Answer 8

Eikenella corrodens, aerobic/anaerobic gram positive cocci mix

Question 9

absolute indications for antibiotics in bite injuries

Answer 9

*deep puncture wounds
*crush injury
*wounds closely overlying a joint or bone
*wounds on hands, face, genitalia, feet
*any wounds that undergo primary closure
*ay patient that is immunocompromised

Question 10

outpatient antibiotic prophylaxis of choice for bite injuries

Answer 10

amoxicillin/clavulanic acid (“dogmentin”) & tetanus vaccination