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SU-18 ER > Wound Care > Flashcards

Wound Care Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

layers of the skin

A
  1. epidermis
  2. dermis
  3. superficial fascia
  4. deep fascia
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2
Q

epidermis

A

cutaneous layer

few cell layers thick

undifferentiated from dermis

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3
Q

dermis

A

layer used to approximate for closure

easily ID

replaced by scar tissue

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4
Q

superficial fascia

A

subcutaneous layer

loose CT, fat, nerves

can be liberally debrided, susceptible to infection

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5
Q

deep fascia

A

thick, dense, fibrous off white sheath

supports and protects the muscle

requires closure

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6
Q

injury and tension line

A

laceration parallel to tension lines heal better than lacerations perpendicular

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7
Q

types of injury list

A
  1. shearing injury
  2. tension injury
  3. compression injury
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8
Q

shearing injury

A

sharp objects

little energy transfer

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9
Q

tension injury

A

higher energy transfer
potential devitalized tissue
higher risk of infection

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10
Q

compression injury

A

significant risk of devitalization

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11
Q

what to consider when deciding sedation or anesthesia

A

procedural complexity
duration
pt population

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12
Q

conscious sedation agents

A

ketamine
propofol

ketamine + propofol

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13
Q

considerations for LOCAL anesthetics

A
  1. location
  2. onset of action
  3. duration of action
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14
Q

location for local anesthetics

avoid lidocaine where?

A

in combination with epinephrine when

fingers, nose, lips, toes, anything that grows

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15
Q

when do you use bupivicaine 0.5%

A

nerve blocks

aka marcaine, sensorcaine

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16
Q

esters list

A

cocaine
benzocaine
tetracaine
Procaine (Novocaine)

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17
Q

Amides list

A

Bupivicaine (95% protein bound)
Mepivicaine (78% protein bound)
Lidocaine (64% protein bound0

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18
Q

lidocaine MOA

A

prevents sodium influx across nerve membrane = decreased polarization = inadequate formation of AP = no nerve impulse

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19
Q

lidocaine

A

immediate onset of action

MC used

epi extends duration of action

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20
Q

anesthetic buffering

A

mix 1 mL bicarb per 9 Ml 1% lidocaine

reduces time to onset and increases intensity

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21
Q

small needles

A

reduce the speed of injection

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22
Q

topical anesthesia combos

A

TAC (Tetracaine, epinephrine, cocaine)

LAT (lidocaine, epinephrine, tetracaine)

pediatric pts

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23
Q

direct wound infiltration

A

inject plane just below dermis at jxn with superficial fascia

MC approach

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24
Q

list of nerve blocks (5)

A
  1. supraorbital n.
  2. infraorbital n.
  3. mental n.
  4. digital n.
  5. auricular block

should all be done with Marcaine

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25
Q

supraorbital block

A

forehead block

parallel margin infiltration in continuous track at brow level

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26
Q

infraorbital

A

intra or extra orally

intraoral is less painful (insert needle from maxillary banana to infraorbital foramen)

1-3 cc

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27
Q

mental block

A

insert needle at gingival buccal margin inferior to second bicuspid

extend to mental nerve foramen midway between up and low margin of mandible

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28
Q

Digital nerve block and epi

A

DO NOT use vasoconstrictors bc it can cause tissue extravasation (ischemia and scarring)

if you do - Phentolamine

29
Q

digital nerve

A

all 4 digits

go in and numb right around bone

30
Q

best strategy for repairing wound to external ear

A

auricular n. block

parallel margin, 2-3 mL of anesthesia

do not use lidocaine + epi

inject below dermis at subQ jxn

31
Q

components of wound prep

A 
personal precautions 
anesthesia 
foreign material 
wound soaking 
wound periphery cleansing
irrigation
32
Q

foreign material

A

all should be considered harmful

MC reason for malpractice suit

33
Q

irrigation

A

irrigate until no visible contaminate around wound

NS is MC used

34
Q

3 categories of wound closure

A

primary closure
secondary closure
tertiary closure

35
Q

primary intention

A

clean wounds

must be repaired within 6-8 hrs of injury ( < 24 hrs on face)

36
Q

secondary intention

A

wounds >8 hrs old (>24 hrs on face)

abscess, punctures, bites

NOT closed with suture but allowed to heal gradually by granulation of re-epithelialization

37
Q

tertiary intention

A

clean, debrided, observe wound 4-5 days then come back and close again

grossly contaminated wound with vital tissue

38
Q

wound exploration

A

should be done whenever there is minor possibility of FB

XR before explore if glass, gravel, metallic FB suspected

I.e. tooth fracture - XR to see fragment

39
Q

how to get hemostasis

A 
direct pressure (most effective) 
vasoconstrictor 
gelfoam 
direct clamping 
cautery 
tourniquets

** NO BLIND CLAMPING

40
Q

active bleeding and wound care

A

hemostasis prior to closure is idea bc active bleeding limits exportation and visualization

can cause hematoma formation

41
Q

tourniquets time

A

can only be on 30 min max in large extremities (20 min max in digit)

42
Q

common instruments in suture kit

A 
needle holder
forceps/skin hooks
scissors
hemostats
scalpel/blade
43
Q

needle driver

A

hold like a pencil

rings are designed to be used for closing and release

44
Q

forceps

A

used to grasp fascia

incorrect use may cause crushing injury to dermis and epidermis

can be used as skin hook

45
Q

functions of hemostat

A
  1. clamp small blood vessels for hemorrhage control
  2. grasp and secure undermining and deriding wound
  3. expose, explore, visualize deeper area of wound
46
Q

scapel sizes

A

numer 11 blade
number 10 blade
number 15 blade

47
Q

numer 11 blade

A

I and D of superficial abscess

removing small sutures

48
Q

number 10 blade

A

used for cutting skin

helpful for extending wounds during revision

49
Q

number 15 blade

A

versatile

precise depribement and wound revision

50
Q

simple excision

A

wound edge revision

minimal excision of macerated and devitalized tissue

51
Q

full wound excision

A

involved more extensive excision of devitalized and contaminated epidermal, dermal, subQ tissues

must score the epidermis, dermis

reserved for wounds when skin is not viable but must have tissue redundancy

lenticular (length:width = 3:1)

52
Q

considerations in selecting suture material

A

tensile strength
knot security
pliability
ability to resist infection

53
Q

classes of suture material

A
  1. non absorbable (primary surface skin closure)

2. absorbable (dead space in lg wound, reduce closure tension)

54
Q

non absorbable suture material (monofilament)

A

nylon, polypropylene (ethylene, proline)

MC suture material for percutaneous dermal layer closure

less tissue reactive, strong, able to resist infection

greater material memory = knot loosen if not secure

55
Q

common absorbable suture material

A

vicryl
chromic gut
monocole

56
Q

vicyrl

A

MC used absorbable

buried subQ suture, oral mucosa, perennial area

braided threat

57
Q

chromic gut used where

A

MC oral, perennial and scrotal tissue

mucosal closure

58
Q

monocle

A

new

reduced hypertrophic scar formation

monofillamnet

59
Q

location and suture size scalp

A

4-0 ethilon or proline

60
Q

location and suture size face

A

6-0 proline ethilon

61
Q

trunk location and suture size

A

4-0 ethilon

62
Q

extremities location and suture size

A

4-0 ethilon

63
Q

digits location and suture size

A

5-0 proline, ethylene

64
Q

sutures last

A

7-10 days then removed

5 days if in face

65
Q

types of needles

A
  1. reverse cutting

2. tapered

66
Q

reverse cutting needles

A

wound and laceration repair
more sharp
less traumatic

code P designation

67
Q

tapered needle

A

less expensive
less sharp
code C or FS

68
Q

undermining

A

used to reduce tension in wound

releases dermis and superficial fascia from deeper attachment

can be done by hemostats or scissors

distance should be = to gap of wound

69
Q

where MC undermining use

A

where skin is under great deal of natural tension

scalp, forehead, lower legs

SU-18 ER (11 decks)

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