Wound Management

Question 1

Goals of wound care?

Answer 1

1. Facilitate hemostasis
2. Decrease tissue loss
3. Promote wound healing
4. Minimize scar formation

Question 2

3 different types of forces thta cause wounds?

Answer 2

1. Shear
2. Compressive
3. Tensile

Question 3

Describe shear forces?

Answer 3

Result from sharp objects
1. Low energy
2. Minimal cell damage
3. Result in straight edges, little contamination
4. Heals with a good result

Question 4

Describe compressive forces?

Answer 4

Result from blunt objects impacting the skin at a right angle
1. Results in stellate or complex laceration
2. Ragged or shredded edges
3. More prone to infection

Question 5

Describe tensile forces?

Answer 5

Result from blunt objects impacting the skin at an oblique angle
1. Results in triangular wound
2. Sometimes produces a flap
3. More prone to infection

Question 6

Evaluation of wounds?

Answer 6

1. ABC’s first > Always!
2. Ensure hemostasis
   - Saline gauze dressing
   - Compression
3. Remove obstructions
   - Rings, clothing, other jewelry
4. History

Question 7

History of wounds?

Answer 7

1. Symptoms
2. Type of Force
3. Contamination
4. Event
5. Potential for foreign body
6. Function
7. Non-accidental trauma
8. Tetanus status
9. Allergies
10. Medications
11. Comorbidities
12. Previous scar formation

Question 8

Wound examination?

Answer 8

1. Location
2. Size
3. Shape
4. Margins
5. Depth
6. Alignment with skin lines
7. Neuro function
8. Vascular function
9. Tendon function
10. Underlying structures
11. Wound contamination
12. Foreign bodies

Question 9

When to seek a consultation for the wound?

Answer 9

1. Tarsal plate or lacrimal duct
2. Open fracture or joint space
3. Extensive facial wounds
4. Associated with amputation
   5, Associated with loss of function
5. Involves tendons, nerves, or vessels
6. Involves significant loss of epidermis
7. Any wound that you are uncertain about

Question 10

Wound preparation steps?

Answer 10

1. anesthesia
2. hemostasis
3. foreign body removal
4. irrigation
5. debridement
6. antibiotics
7. tetanus prophylaxis

Question 11

Anesthesia in wound preparation?

Answer 11

1. topical
2. local
3. regional block

Question 12

Topical anesthesia?

Answer 12

1. Solution or paste
2. LET
3. EMLA

Question 13

Local anesthesia?

Answer 13

1. Direct infiltration
2. 1% lidocaine with or without epinephrine
3. Bupivicaine or sensorcaine for longer acting anesthesia

Question 14

Regional block anesthesia?

Answer 14

1. Local infiltration proximally in order to avoid tissue disruption
2. Smaller amount of anesthesia required

Question 16

Hemostasis in wound preparation?

Answer 16

1. Physical vs. chemical
   - Direct pressure
   - Epinephrine
   - Gelfoam
   - Cautery
2. Refractory
   - Use a tourniquet

Question 17

Foreign body removal in wound preparation?

Answer 17

1. Visual inspection
2. Imaging
   - Glass, metal, gravel fragments >1mm should be visible on plain radiographs
   - Organic substances and plastics are usually radiolucent
3. Always discuss and document possibility of retained foreign body

Question 18

Irrigation in wound preparation?

Answer 18

1. Local anesthesia prior to irrigation
2. Do not soak the wound
3. Use normal saline
4. Large syringe (60mL) with Zerowet attachment
5. Do not use iodine, chlorhexidine, peroxide or detergents

Question 19

Debridement in wound preparation?

Answer 19

1. Removes foreign matter & devitalized tissue
2. Creates sharp wound edge
3. Excision with elliptical shape
4. Respect skin lines

Question 20

Antibiotic use in wound preparation?

Answer 20

1. Infections occur in ~3-5% of traumatic wounds seen in the ED
2. Factors that increase risk
   - Heavily contaminated wound, especially with soil
   - Immunocompromised patients
   - Diabetics
   - Human bites > animal bites
3. Most important prevention > adequate irrigation & debridement