Week 3 - Lacerations

Question 0

What are the top 7 wound complications?

Answer 0

1. Infection
2. Irregular closure
3. Dehiscence - wound ruptures along surgical suture
4. Contact dermatitis
5. Suture reaction
6. Keloid formation
7. Necrosis

Question 1

What are the top 6 history questions one should ask?

Answer 1

1. When injury occurred
2. Cause of injury
3. Where injury occurred
4. Other injuries
5. Medications
6. Other health problems

Question 2

In examining a wound what are the top 8 physical exam components?

Answer 2

1. Depth
2. Edges (of wound & tissue loss)
3. Circulation
4. Nerve Injury
5. Tendon injury
6. Foreign body
7. Fracture
8. Orientation

Question 3

What are the top 7 methods of closing a wound?

Answer 3

1. Nonabsorbable sutures
2. Staples
3. Glue
4. Tape
5. Absorbable suture
6. Secondary closure - doing nothing, wound is allowed to granulate and is packed
7. . .?

Question 4

What should you do to a bleeding wound?

Answer 4

Apply pressure to stop bleeding

Question 5

Why can injury to a local artery be dangerous for a distal limb?

Answer 5

Can cause compartmentalization and loss of muscle - ex: ulnar artery laceration

Question 6

What can punching someone in the face cause?

Answer 6

Wound over the knuckle that gets infected - it’s the worst type of infection that you can have - don’t want mouth flora entering the bursa/sheath space

Question 7

What do people with open fractures need?

Answer 7

Realignment and antibiotics

Question 8

What are langers lines?

Answer 8

Lines of skin tension that surgeons try to cut along to prevent scarring

Question 9

What bites are the worst?

Answer 9

Human, then cat (you want a wound wider than it is deep), then dog -due to bacteria

Question 10

What should you remember when giving local anesthesia injections?

Answer 10

Be generous but giving too much can distort wound edges, making closure more difficult and some areas of skin do not allow for much injection (nose, ear)

Question 11

What anethesia is most likely to cause an allergic reaction?

Answer 11

Procainamide - an ester

Question 12

What is Lidocaine?

Answer 12

An anesthesia that is an amide

Question 13

What is Bupivacaine and mepivacaine?

Answer 13

Longer acting anesthetics are used often with dental pain

Question 14

Why should you be careful with epinephrine?

Answer 14

It decreases bleeding but be cautious using at distal points of the body - like nose or finger - you could potentially completely cut off the blood supply

Question 15

How should you give an injection?

Answer 15

-Use a needle smaller than 25, inject slowly, buffer with sodium bicarbonate and inject through the sides of the wound edges into adjacent tissue

Question 16

How do you do a digital nerve block?

Answer 16

Inject on both sides of the finger and top

Question 17

When you prepare/clean a wound, what should you keep in mind?

Answer 17

• The more volume you use, the cleaner the wound
• Any clean solution can be used bc volume and pressure are more important to creating a clean wound
• Irrigate with moderate pressure
• Do NOT use Hydrogen peroxide
• Always dilute betadine

Question 18

When should you avoid using Tissue Adhesive?

Answer 18

Bites, mucosal surfaces, high moisture areas, areas of skin tension (avoid any ointments or fluids)

Question 19

What is the timeline for wound healing after suturing?

Answer 19

Epithelialization -sealing of wound edges by 24 hours
-Peak collagen formation by 7 days
-Wound tensile strength 20% of full by 3 weeks, 60% of full by 4 months – never exceeds 80%
Mature scar = 6-12 months

Question 20

What is dehiscence? How is it caused?

Answer 20

Reopening of a wound, sutured wound or surgical wound.

It can be caused by sutures being removed too soon or too much wound tension.

Question 21

What are some common complications associated with laceration wounds?

Answer 21

Contact dermatitis, Infection, Dehiscence, Necrosis, Suture reaction, Keloid formation