Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

SU-18 ER > Wound care 2 > Flashcards

Wound care 2 Flashcards

You may prefer our related Brainscape-certified flashcards:
Royal College: Emergency Medicine flashcards
1
Q

wound approximation

A 
layer matching
wound edge eversion 
wound tension 
dead spcae
spacing and style
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

layer matching

A

match ea. layer of wound edge to counter part

best achieved one side at a time

failure here = improper healing and increased scarring

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

wound eversion

A

needle penetrates skin at 90 degree angle to surface

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

technique for reduction in wound tension

A

placing adequate amount of suture to reduce tension and preserve capillary blood flow

should not be secure too tight so they dont strangulate tissue

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

dead space wound approx

A

use subQ sutures (deep/buried sutures)

wound undermining to eliminate empty space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

spacing and style of stitch

A

number needed varies but distance between suture should equal to the bite distance from wound edge

knots on same side and not overlying wound

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

simple interrupted suture

A

MC used in simple wounds

instrument ties knot – double fist throw which offers good knot security, followed by 3-4 alternating single throws

spacing = should be equal to bite distance from wound edge

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

vertical mattress suture

A

repair large, gaping wounds in area of high tension

useful over extensor joints (elbows and knees)

deep AND superficial closure

1st bite = 1.5 cm from wound edge, crossing they to = distance on opposite side of wound

needle = reversed and returned with smaller bite 2-3 mm form wound edge

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

horizontal mattress suture use

A

approximate point of greatest tension of large wound

starting anchor suture in large complex wound

fragile skin, distributes tension along side

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

mechanism horizontal mattress suture

A

normal introduction to skin, then second bite is taken along opposite side 0.5 cm from exit site

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

continuous running suture use + con

A

long wounds, low tension, cosmetic

CON: one site of damage req. restart of entire process, purse string effect

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

continuous running suture technique

A

normal suture placed but NOT CUT

suture is continued to opposite side (like normal sowing)

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

SubQ suture

A

used to close gaping wounds (lots of dead space where hematoma formation risk is high)

increase strength of wound closure and eliminate dead space

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

deep suture placement

A

drive needle from deep to superficial then start superficially and go deep

knot is then tied deep and away from wound surface

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

bevel wound flap management

A

must use unequal bites from wound space

larger pit used on “flap” portion

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

subcuticular technique

A

cosmetic, monofilament used

limited to straight lacerations <4-6 cm

may prevent keloid formation

pass parallel thru wound (S formation) secured with tape/buried

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

v technique

A

wound is in a V shape

use to avoid devitalization of apex of laceration

flap portion of suture passes horizontally thru dermis

decried subQ fat )remove subQ fat in dermal superficial fascia plane)

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

V to.Y technique

A

break down non-viable edges

after debridement if flap is not large enough to fill defect, corner stitch used to close wound as a Y

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

y technique use

A

Y is used to close flaps w.o. viable edges

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

devitalized flap

A

extend the wound to an eclipse and close primarily

length of eclipse should > 3:1 of owund

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

dog ear deformity tx

A

extend wound at 45 degree angle on side of redundancy

excise redundant tissue and close

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

skin avulsions on distal finger tip

A

will heal completely with secondary closure

use gauze

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

contaminated hand wound

A

leave open and heal with secondary closure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

subQ suture in hand or foot

A

NEVER place subQ suture in hand and fit due to increased infection risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

neurovasular exam

A

should always check NV status and document

capillary refill, distal pulses, 2 point differentiation

26
Q

tendon injury

A

check ROM of extremities and digit

explore for FB

identify which one is injured and grade it (25% increments)

27
Q

ear laceration

A

coverage of all exposed cartilage with skin

uncomplicated = close with interrupted 6-0 nonabsorbable suture

drain all perichondria hematomas, excise <5cm of cartilage and pull skin over

DO NOT SUTURE CARTILAGE

28
Q

vermillion border laceration transects obicularis oris

A

approximate muscle and fix with 6-0 vicryl absorbable subQ suture

then approximate vermillion border and close with 6-0 nylon or proline suture

then close wound

29
Q

vermillion border laceration DOESN’t transect obicularis oris

A

approximate vermillion border with 6-0 nylon or proline suture then close wound

30
Q

thru and thru lip laceration

A

2 layer closer (epidermal side and mucosal side)

give prophylatic ABX for augmenting and clindamycin

31
Q

what tongue lacerations require suture

A

ABSORBABLE

large (>1cm)
large, gapping wounds
those that need stitch for hemostats
anterior split tongue laceration

32
Q

what tongue lacerations DO NOT require suture

A

<1 cm

non gaping

33
Q

nail bed laceration Transverse lacerations

A

remove the distal nail and suture

repair nail bed with absorbable suture + digit block anesthesia

34
Q

longitudinal lacerations

A

complete removal of nail

The original nail or Adaptec packing can be used to separate the eponychium from the germinal matrix

35
Q

Complete avulsions to the tip of the finger

A

anesthesia, exploration, possibly x-ray and hemostasis with a Surgicele, tube gauze dressing

heal well without intervention

if > 1/3 XR for fracture

36
Q

a partial avulsion of the finger tip

A

attempt to re-approximate the tissue with 1-3 sutures to provide a layer of protection while the wound is healing.

37
Q

Empiric antibiotics

A

indicated for all complex/high risk wounds to prevent infection

38
Q

The most commonly prescribed empiric antibiotic:

A

Cephalexin Keflex 500 mg tid x 5 days

39
Q

strict return precautions:

A

Increased pain, bleeding, discharge, fevers, redness, swelling or red streaks moving away from the wound

40
Q

Cat & Human bites

Treat with:

A

Amoxicillin-Clavulanic Acid (Augmentin) 875 BID x 10 days (first dose provided in the ED)

12-24 hour follow up wound check

41
Q

management Wounds caused by broken glass:

A

X-ray all wounds you suspect any kind of retained foreign body, especially a glass foreign body.

CT scan is more sensitive

42
Q

Through and through lip lacerations

ABX

A

high risk of infection and scarring

Consider x-ray to evaluate for retained tooth fragments

Empirically treat with empiric antibiotics
Pen-Vee K 500 mg qid x 5-7 days
Augmentin 875 mg bid 5-7 days
Clindamycin 300 mg tid x 5-7 days

43
Q

Indications for Dermabond wound adhesive:

A

Used for simple lacerations that ~ 1-2 cm and easily approximated with gentle pressure

44
Q

Avoid using Dermabond on: (6)

A
  1. Laceration > 2 cm
  2. Finger lacerations
  3. Lacerations over joints
  4. Laceration involving the eye brow or in proximity to the eyes
  5. Gapping wounds
  6. Wounds under tension i.e.: chin, joints, knees, elbows
45
Q

Dermabond

A

when the adhesive dries they may feel a brief burning sensation

usually requires 3-4 layers of adhesive (new layer/minute)

has an antibiotic component to it, will go away in 7 days

46
Q

puncture wound management

A

extend wound for irrigation with a 15 blade

Use a hemostat for exploration.

Do not suture closed give Empiric antibiotics
Keflex 500 mg tid x 5 days

Tetnus?

47
Q

Definitive treatment of soft tissue abscesses

A

Incision and drainage

Results in marked improvement of symptoms and rapid resolution of the infection

48
Q

Induration I and D

A

early stage of a skin abscess

I&D prior to localization of pus will not be curative

49
Q

incision and drainage work up

A

U/S

CT

50
Q

I and D Ultrasound use

A

localize the most fluctuant area within an abscess

determine the depth and proximity to vasculature (axilla, anticubital fossa or inguinal crease)

Large, deep abscess in proximity to major neurovascular structures

51
Q

I and D CT scan use

A

determine the extent of abscess in the perineal area

Fournier’s gangrene vs. scrotal wall abscess

Large pilonidal cyst vs. perirectal abscess

Large perineal abscesses and abscesses that involve the rectum and deep abscesses that req. sx

52
Q

Incision & Drainage Procedure

A
  1. Prep the area with antiseptic skin scrub (betadine, Chlorahexidine)
  2. Local anesthesia may only be partially effective due to the low pH of the infected tissue and local anesthesia will cause more distention and pain (IV opioids or benzo)
  3. 11 blade scalpel to nick the skin over the fluctuant area + linear incision along total size of cavity
  4. Hemostat probe to determine depth (most painful, but don’t skip)
  5. Wound irrigation
  6. loose packing of gauze (prevents closing and encourage draining)
  7. gauze on top and return in 2 days
53
Q

paronychia

A

Inflammation iof lateral and proximal fingernail folds

54
Q

paronychia Predisposing factors

A

Overzealous manicuring
Nail biting
Thumb sucking
Diabetes Mellitus

55
Q

paronychia tx

A

Warm compresses

Oral antibiotic therapy

Incision/Drainage

56
Q

paronychia I and D

A

Ethyl chloride or Digital Block prior to procedure

Prep skin with Betadine or Chlorahexidine

Sterile drape

Insertion of an 11 blade scalpel under the affected cuticle margin and extension of the incision along the lateral nail bed.

57
Q

felon

A

Infection of the distal pulp

severe pain, swelling and erythema of finger PAD

Predisposing factors include: untreated paronychia or puncture wound

58
Q

Treatment of a felon

A

is an emergency situation, requiring I/D

can lead to osteomyelitis, flexor tenosynovitis, permanent nail deformities and ischemic necrosis of the fingertip.

59
Q

HERPETIC WHITLOW

A

viral infection of 1 finger

acute onset of vesicles, vesicopustuels, edema, erythema and pain

caused by HSV (tzanck staining +)

60
Q

herpetic whitlow Clinical presentation

A

tingling, burning finger/hand pain disproportionate to clinical findings, fevers and lymphadenopathy

61
Q

Mild ingrown toe nail

tx

A

Warm soaks 20mins. 3x per day

place a cotton wedge or dental floss underneath the lateral nail plate to separate the nail from the nail fold to relieve pressure.

70% of patient’s respond to this therapy.

62
Q

Moderate to severe ingrown toenail

A

digital block + hemostat to separate nail

use scissors to remove portion of ingrown nail, silver nitrate cauterization

Apply bacitracin or mupirocin ointment 2-3 x per day.

SU-18 ER (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions