Wound Management Flashcards
Rates of infection for repaired wound?
6.5%
Why are crush injuries difficult to heal?
It creates devitalized tissue
What’s most important regarding tetanus status?
If they recieved 3-shot regimen as a child
When do you need a tetanus booster?
- Minor, unconcerning wound: 10 years
2. Major or concerning wound: within 5 years
When would you give tetanus immune globulin?
If it’s a major or dirty wound, and you don’t know if patient has received primary series
What’s in LET?
- Lidocaine
- Epinephrine
- Tetracaine
How do you know if LET is working?
Look for pallor at the edges
How does LET get absorbed?
Only through wounds, not through intact skin
Where shouldn’t you use LET?
Fingers, nose, penis, toes
Why is injecting too much anesthetic a bad idea?
It can distort the wound and hinder proper closure
How long does bupivicaine work?
4x longer than lidocaine
Why does lidocaine hurt with injection?
It’s stored in acidic solution
What are two benefits with lidocaine with epi?
- Can help control bleeding
2. Epi makes agent work longer
How do you perform a digital nerve block?
- Place needle on dorsum of hand, lateral to MCP
- Inject and slowly retract (to hit the palmar and dorsal nerve)
- Repeat on the other lateral side of the joint
**There are 4 nerves per finger, so you need to get them all
What is the most important factor to prevent wound infection?
Copious, copious irrigation (tap water equivalent to normal saline)
The solution to pollution is dilution
After irrigation, how do you further clean wound?
- Betadine or chlorhexadine
2. Hydrogen peroxide can help remove clotted blood
What are the most common sutures used in the ED?
Monofilament
- Prolene
- Ethilon
What is the most common absorbable suture used in the ED?
Vicryl
When is a running suture good?
Long wounds over low tension areas?
When are horizontal mattress sutures good?
Over areas of tension (joints)
When are vertical mattress sutures good?
Over deep wounds
What type of animal bite has highest risk of infection?
Human bites
What human bite don’t you typically close?
On the hand
- Copiously irrigate
- Maybe prophylactic antibiotic
Would you close a human bite on the face?
Most of the time yes, especially if the wound is less than 12 hours old
What bacteria do you worry about with dog bite?
Pasteurella (although most infections are polymicrobial)
Same for cats
What types of dog bites would you be hesitant with closing?
Those that have a lot of crushed tissue or devitalized tissue
If a patient can afford augmentin for a bite injury, what can you use?
Keflex + PCN (to cover pasteurella)
For a non-closed wound, how soon can they shower?
After 48 hours. This is how long it takes for a new epithelial layer to be layed down.
How long does it take epidermis to become organized after a wound?
Day 5. Thats why we keep sutures on the face that long.
How can you decrease the appearance of scars?
Using SPF > 15 will decrease pigmentation
