Wound ER Flashcards
What is the most predictive factors for infection
Location, age, depth, configuration, and contamination
When you examine a wound what do you have to make sure is intact
Sensory (nerve), motor (msk), vascular
What do you do with an avulsion wound
cellulose wrap
What do you do with a superficial vessel
direct pressure +wound repair- if sutiring can use epi
What to do with an arterial bleed
apply direct pressure +call vascular surgery
If I have a FB in me what should you do first
Irrigate and probe the wound with forceps
Treat my wound
1) Clean
2) anesthetize
3) Irrigate- under pressure
4) Debridement of nonviable tissue
5) re-irrigate
6) suture/wound closure
7) antibiotics?
What antibiotics should you give with a wound
Keflex 500mg TID
MRSA?- bactrim DS ID for 10 days
Cat bite- augmentin
If I got a nail through my shoe what antibiotics should i get
anything that covers pseudomonas
How should you irrigate a wound
Under pressure
These are the strongest and most accurate methods of closure
Sutures
These are quick and easy method of closure
Staples
What is the most cost effective way of closing a wound
Adhesive tapes
This method of closing lasts for 5-10 days and is like glue
tissue adhesives
How far should tissue adhesive extend on either side of the wound edges
5-10mm
I have a facial lacerations what size suture should you use on me
6-0
I have a lip laceration what part do you suture up first…and what size suture do you use
vermillion border. 6-0
I have an intraoral laceration treat me!
4-0 absorbable, antibiotics and salt water gargles
I have a laceration on trunk and extremities what size suture
4-0
I have a laceration on my scalp what should you do
Staples or 3-0 to 4-0 sutures
What is the classic suture for the ER
Simple interrupted
I have a really deep cut, what suture shoudl you put in first to provide good tensile strength
deep dermal
How long after an injury do you have to get sutures in your face
24 hrs
How long after an injury do you have to get sutures on your body
12 hours
Should lacerations on your hand be sutured
No- allow to heal by secondary intention
For bit wounds what antibiotic should you give me
Amoxicilin-clavulanic acid (Augmentin)
I have a hand injury who should I go see
Hand surgeon
When should you admit me for a “Fight Bite” injury
Issue with compliance
Co morbid illness
Current evidence of infection
Joint/tendon involvement
If I admit you what antibiotics should I give you
Ampicillin-sulbactam or cefoxtin
I cut my extensor tendon is urgent repair essential
No- can wait a bit
I cut my flexor tendon is urgent repair essential
YES- Scaring can occur if not
What do you do while waiting for my flexor tendon lac repair
Antibiotics
Clean dry steril dressing
Splint- MCP flexed, PIP and DIP extended
Tx my nail bed avulsion
Suture nail back on
Antibiotics
follow up
What do you need to do for a subungaual hematoma
X-ray first to ensure no Fx
Clean, anesthesia, heated cautery tip, bacitracin, bandage
What do you do with ring tourniquet syndrome
Cut the ring off or get it off somehow
My wound isn’t healing. Why?
FB
Should you get an X- ray of my FB
Yeah probably-
What can you see on X- ray
Metal, bone, teeth, pencil, some plastics, gravel, snad, aluminum
Is glass visible on x ray
Yup- 95%
What types of things can you NOT see on x ray
Wood, thorns, some small fish bones
What type of FBs should you give me antibiotics for after removal
soil-covered objects, teeth, anything dirty looking
What is the only contraindication to tetanus toxoid
Hx of neurologic or severe systemic rxn
What antibiotics for a FB
Augmentin, or Clinda for pen allergic
I&D procedure
1) Consent
2) universal precautions
3) Prepare area
4) anesthesia
5) Use 11 or 15 blade
6) express pus
7) Insert hemostat into cavity
8) Break up loculations
9) Irrigate
10) pack loosley
11) pts should apply warm compresses
12) Schedule follow up
13) Antibiotics - Keflex TID for 10 days
