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Wound Care Flashcards

1
Q

What are langer’s lines?

A

correspond to natural orientation of collagen fibers in the dermis

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2
Q

What are langer’s lines parallel with?

A

underlying muscle fibers

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3
Q

Why do we have langer lines?

A

Important for improved cosmetic outcomes

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4
Q

What are the 4 phases of wound healing?

A

Hemostasis
Inflammation
Proliferation
Remodeling

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5
Q

Hemostasis

A
  • immediately after wounding
  • platelet plug forms and blood vessels vasoconstrict
  • thrombus develops later to deal the wound
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6
Q

Inflammation

A
  • Occurs in the first 2-3 days after injury

- WBC remove necrotic tissue and control infection

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7
Q

Which phase of wound healing is most pain present?

A

Inflammatory phase

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8
Q

Proliferation

A
  • Begins 2-3 days after injury
  • lasts 2-4 weeks
  • fibroblasts proliferate into the wound and produce structural proteins (glycosaminoglycans, collagen, elastin)
  • New capillaries form and epithelial cells migrate across the top of the wound (granulation tissue)
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9
Q

Remodeling

A
  • New capilaries atrophy and collagen changes from type 3 to type 1 and is rearranged for best tensile strength
  • Myofibroblast cause scar contracture
  • Forces acting on the wound shape the remodeling process and the best result is obtained when the force is uniaxial
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10
Q

When is the strength of the wound strongest? By how much and how long?

A

Remodeling; 80% of original; up to a year

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11
Q

What must we always do before repair?

A

Confirm neurovascular and sensori-motor condition

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12
Q

6 Types of lacerations

A 
Linear
Stellate (burst)
Corner
Puncture
Penetrating
Gunshot
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13
Q

When do you give tetanus shots?

A
  • update tetanus is over 10 years since last vaccine

- If wound is tetanus prone and last vaccine was over 5 years ago

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14
Q

Tetanus prone wounds

A
  • wounds over 6 hours
  • greater than 1cm deep
  • stellate lacerations
  • soiled with feces, saliva, gunshot, puncture, burn, frostbite
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15
Q

Dtap

A
  • age 6weeks to 6 years
  • 3-5x more diptheria component versus teh adult
  • tetanus amount asme as adult
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16
Q

When do you only give the DT portion of DTap?

A

child can’t have pertussis vaccine

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17
Q

Tdap

A

give to 11 and older

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18
Q

When to clean wound with saline?

A

high pressure irrigation

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19
Q

When to clean wound with iodine?

A
  • anti-septic

- best for cleaning skin around wound because it damages cells

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20
Q

When to clean wound with Hibiclens?

A
  • anti-deptic

- good for cleaning wounds

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21
Q

When to clean wound with peroxide?

A
  • anti-septic

best for removing blood from clothing, not good to clean wounds

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22
Q

When to clean wound with alcohol?

A
  • anti-septic

- good for intact skin cleaning

23
Q

Why do we use anesthesia when cleaning a wound?

A

to allow for successful exploration and closure of a wound/laceration

24
Q

When do we use LET?

A

pediatrics
face or scalp; not effective on extremities
most commonly used

25
Q

Topical LET and dosing

A

4% lidocaine, 1:2000 epinephrine, 0.5% tetracaine

26
Q

Where do we not use LET?

A

where we don’t use epi

27
Q

Onset of LET

A

20-30min

28
Q

Local is most effective when?

A

directly applied to laceration or digital

29
Q

Max dose of lidocaine

A

4mg/kg

30
Q

How much fluid will a finger take

A

no more than 5cc

31
Q

1% lidocaine does what

A

blocks pain stimuli, leaves pressure and touch intact

32
Q

2% lidocaine blocks what

A

blocks awareness of stimuli including pressure and touch

33
Q

Where do we avoid epinephrine

A

digits, nose, ear, penis

34
Q

2 drugs for local anesthesia

A

Lidocaine and Epinephrine

35
Q

When picking a suture, what does a bigger number mean?

A

the smaller the size of the suture

36
Q

Size range for sutures

A

00 to 10-0

37
Q

What are the most commonly used sizes of suture

A

3-0 to 6-0

38
Q

What factors affect suture choice

A 
Tensile strength
Workability
Knot security
Low tissue reactivity
Ability to resist bacterial infections
39
Q

When to use absorbable sutures

A

under the skin, where they are well hidden

40
Q

Which suture leaves a more pronounced scar?

A

absorbable

41
Q

Why does the non-absorbable not leave a dramatic scar?

A

less tissue reactive

42
Q

When do we use non-absorbable sutures

A

on the skin and in the OR

43
Q

MC non-absorbable sutures

A

Ethilon (nylon), Prolene (polypropylene)

44
Q

Absorbable suture used

A

Vicryl

45
Q

Primary closure

A
  • wound edges are neatly approximated
  • rapid return to function
  • good cosmetic outcome
  • best utilized in 6-12hrs
46
Q

Delayed Primary Closure

A
  • used in situations where early primary closure is inappropriate (infected)
  • allows for secondary healing before the wound is closed
  • close after 48-96hrs
47
Q

When to remove sutures of the eye

A

3 days

48
Q

When to remove sutures of the cheek

A

3-5 days

49
Q

When to remove sutures of the nose, forehead, neck?

A

5 days

50
Q

When to remove sutures of the ear, scalp?

A

5-7 days

51
Q

When to remove sutures of the arm, leg, hand, foot

A

7-10days+

52
Q

When to remove sutures of the chest, back, abdomen

A

7-10days+

53
Q

When to use staples

A

scalp; don’t use in cosmetic areas

! (11 decks)

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