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PATASS III > Wound Management > Flashcards

Wound Management Flashcards

1
Q

What investigations are required for certain wounds?

A

X-ray = glass and possible bony injury

Ultrasound = wood FB

Bacteriology = infected wounds

INR = pt is on warfarin and bleeding is a problem

Minor Injury and Minor Illness at a Glance

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2
Q

Describing wound types

what is an abrasion, contusion, laceration, cut and puncture wound?

A

Abrasion = injury caused by friction shearing skin away

Contusion or bruise = caused by blunt force may cause fractures/damage to organs

A laceration is caused by a blunt or crushing force. Skin has been burst open - more ragged and with more tissue damage

A cut = caused by sharp object - neat and easy to close, have higher risk of damage to tendons and nerves

Puncture wound = depth exceeds the width or length of wound

Minor Injury and Minor Illness at a Glance

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3
Q

What are the RED FLAGs in hand injuries?

A
  • Damage to tendon or nerve
  • fractures in crush injury
  • Punch (human bite) injury to dorsum metacarpalpharangeal joint
  • high pressure injection injury

Minor Injury and Minor Illness at a Glance

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4
Q

What are the RED FLAGs in face injuries?

A
  • cosmetic issues e.g. wounds to eyelids and vermilion boarder lip
  • damage to facial nerve and parotid duct

Minor Injury and Minor Illness at a Glance

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5
Q

What are the RED FLAGs in wound infection?

A
  • Patients with systemic signs of infection (temp, riggers, tachy)
  • patients with severe pain and signs of wound infections (necrosting fascitis)
  • diabetic foot infections

Minor Injury and Minor Illness at a Glance

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6
Q

PITFALLS

Infection

A
  • Dirty environment e.g. farm
  • Bites - human bites need antibiotics
  • Delayed heeling e.g. underlying pathology e.g. diabetes, smokers or not getting it seen immediately

Minor Injury and Minor Illness at a Glance

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7
Q

PITFALLS

Delayed Presentation

A
  • Alcohol induced
  • Age / dementia
  • Stubbornness
  • Domestic abuse
  • Remove debridement if already started to heal
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8
Q

PITFALLS

Tendon Injury

A
  • MOI
  • Depth
  • Location
  • Partly severed tear - pain in proportionate to injury
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9
Q

PITFALLS

Vascular/neurovascular injury

A
  • Penetrating wounds
  • Blast Injuries
  • Degloving
  • Self- harm
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10
Q

PITFALLS

Joint Involvement

A
  • Degloving
  • Open wound - infection
  • if its near a joint, may be deeper than what’s seen
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11
Q

PITFALLS

FB

A
  • Could be tamponading blood flow
  • Organic matter e.g wood can cause an infection
  • soil and dirt
  • abrasions from road slash - tar can cause tattooing
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12
Q

PITFALLS

Type of injury

A
  • Crush - bone, compartment syndrome - ECG
    (caused by pressure and reduced blood supply can cause underlying damage e.g. to muscle) = rhmodyalsis (can cause AKI) = increased potassium = arrhythmias
  • lacerations
  • blast - energy travel through body, neumatic drills = air causing surgical emphysema
  • de-gloving = loose tissue = loss vascular supply (ischaemia distally), increase evaporation (insensible volumes), area becomes dry and doesn’t heal properly
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13
Q

PITFALLS

Associated injuries

A
  • Fractures e.g. facial fractures - MOI; mechanical? syncope? intoxication?
  • thermal
    • seizures, hypoglycaemia - fallen onto radiator
    • superficial e.g. sunburn
    • parial thickness - blistering
    • full thickness - white and leathery
  • bites
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14
Q

PITFALLS

Quality of skin/Associated diseases

A
  • Ischaemia
  • Diabetes (sugar toxic)
  • Steroid medication - thins skin, reduces inflammatory response = delayed healing, increased risk of infection
  • Aging = loss of collagen, loss fatty tissue
  • Warfarin = bleeding
  • Allergy = tetanus immunisation status?
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15
Q

Which wounds are best left open or referred to ED?

A
  • Wounds more than 6-12h old (infection risk)
  • Bites esp hand
  • Infected wound
  • heavily contaminated wounds
  • Severe crush injury
  • Evidence or damage to deeper structures

Minor Injury and Minor Illness at a Glance

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16
Q

Classification of wound healing….

Primary and secondary

A

Primary Intention

  • edges clean and held together (aposed) with ligatures
  • little gap to bridge healing
  • quick healing

Second Intention

  • when edges are separated
  • extensive epithelial loss
  • severe contamination
  • e.g. abdo open surgery
  • healing slower
  • granulation - healing from bottom towards surface
  • scaring

EMedicine

17
Q

When would you use steri-strips - what are the advantages?

When to remove?

A

Used for..

  • Pretibial lacerations (poor vascular supply, adhesive strips gives best result, suturing would put wound under to much tension)
  • small face wounds

Advantages

  • easy to apply
  • don’t interfere with blood supply
  • don’t need to use local anaesthetic
  • don’t introduce another wound through needle

Not effective on bleeding wounds

Minor Injury and Minor Illness at a Glance

When to remove..

  • 3–5 days for wounds on the head.
  • 7–10 days for wounds at other sites.

NICE

18
Q

When would you use glue - what are the advantages?

When to remove?

A

Used for…
- effective for facial wounds (NOT eyelid or lips)

Advantages

  • doesn’t interfere with blood supply
  • don’t need to use local anaesthetic
  • don’t introduce another wound through needle

Disadvantages
- can’t be used on denuded skin only on wounded edges

Minor Injury and Minor Illness at a Glance

When to remove..
- It will slough off naturally after 7–10 days.

NICE

19
Q

When would you suture - what are the advantages?

When to remove?

A

Advantages

  • Good for control of bleeding
  • Good for gaping wounds
  • Good for wound across joints and hands
  • Healing by secondary intention
  • interrupted non-absorbable nylon sutures allow drainage and minimise tissue tension and ischaema

Adult Emergency Medicine at a Glance

Remove…

  • 3–5 days for wounds on the head.
  • 10–14 days for wounds over joints.
  • 7–10 days for wounds at other sites.

NICE

20
Q

Advice to patient regarding their wound?

A

1st few days

  • walk as little as poss
  • rest
  • injured leg raised
  • freq move toes - to prevent DVT

until healed

  • keep wound dry
  • eat healthy
  • monitor blood glucose if diabetic
  • stop smoking
signs of infection
- increasing pain that doesn't settle with elevation
redness spreading up leg
- fever / flu like symptoms 
- pus or smelly fluid coming from wound

RCEM

21
Q

What local anaesthetic used for suturing?

A

Lidocaine 1% + adrenaline
1:100000

Adult Emergency Medicine at a Glance

22
Q

When is tetanus and antibiotics given?

A

Tetanus given if..

  • Not up to date with it
  • tetanus immunoglobulin given if heavily contaminated

Antibiotics given if..

  • wound high risk of infection
  • established infection

Adult Emergency Medicine at a Glance

23
Q

What are the indications for referrals to burn specialists?

A
  • superficial burns over more than 10% body surface area
  • < 5 or >60
  • sign burn to hand, face or perineum
  • full thickness to feet
  • circumferential burns
  • inhalation injury

Minor Injury and Minor Illness at a Glance

24
Q

What are the Signs of smoke inhalation?

A
  • increased RR/dyspnoea
  • Soot around nose & mouth
  • Singing of facial/nasal hair
  • Soot in mouth
  • Burns in & around mouth & nose

Minor Injury and Minor Illness at a Glance

25
Q

RED FLAGS in burns

A
  • Airway problems develop quickly after inhalation injury
  • Think about carbon monoxide poisoning (headache, drowsy)
  • cyanide poisoning (shock)
  • Large burns need referral
  • Chemical burns often cause deep injury
  • shock can be caused by; hypovolemia, cyanide, trauma and blast injury
  • High voltage electrical burns cause deep tissue damage
  • Think about non-accidental injury in vulnerable groups

Minor Injury and Minor Illness at a Glance

26
Q

What are pt co-morbidities in burns?

A
  • age >60
  • diabetes
  • heart failure
  • lung disease
  • immunosuppression
  • pregnant

Adult Emergency Medicine at a Glance

27
Q

What is the parkland formula for IV fluids in burns?

A

2-4 mls x (% burn) x (bodyweight in kg) over 24h

half given in first 8h, rest over 16h

Adult Emergency Medicine at a Glance

PATASS III (16 decks)

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