Wound Management Flashcards
What is an erosion?
Partial break in the epidermis
An abrasion (aka graze) is a subtype caused by rubbing or scraping
What is a laceration?
Cut/tear in the skin from blunt trauma causing shearing or crushing force
What is an incision?
A cut in the skin from a sharp-edged object (e.g. knife)
What is an ulcer?
A complete break in epidermis +/- dermis and subcutaneous tissue.
Management:
Most are managed at A&E. Where would patients with more extensive injuries be referred to?
Surgical debridement
Grafting
Complex repairs
Wound closure:
(1) How is the wound cleaned?
(2) Local anaesthesia:
- Lidocaine is used for pain. Why is adrenaline added? - 2
- Why is adrenaline not given in extremities?
- What can be used as regional anaesthesia?
Irrigation with normal saline
Vasoconstriction reduces bleeding
It allows for a greater level of lidocaine to be given if needed
Due to the risk of ischaemia
Nerve block
Procedural sedation
Wound closure:
(3) What should be removed?
(4) Wound closure:
- Primary intention can be used. What is it and how is it done?
- Vicryl and monocryl are used. Why are they used for internal sites?
- Why other material can be used?
Remove foreign objects or dead tissue
Deliberate closure using sutures
They are absorbable
Nylon
Silk
Prolene
Wound closure:
(4) Wound closure:
Higher numbers in the USP sizing system means the suture is finer.
- What parts of the body have a lower tension and will, therefore, need a higher USP number?
- Will the USP be high or low for cosmetically-sensitive areas?
- What parts of the body have a higher tension and will, therefore, need a lower USP number?
Face and hands
Higher USP number needed for cosmetically-sensitive areas
Trunk
Limbs
Scalp
Wound closure:
(5) Removal:
- After how many days are non-absorbable sutures removed from the face/scalp?
- After how many days are non-absorbable sutures removed from the arms/trunk?
- After how many days are non-absorbable sutures removed from the legs?
- How long do absorbable sutures take to absorb?
5 days
7 days
14 days
1 wk to several months
Suture alternatives:
Steri-strips:
- Where is it good for?
Glues:
- What is the glue called?
Non-hairy skin that is unlikely to get wet
Dermabond
Secondary intention healing - what is it?
Basically conservative management - they are left to heal on their own (e.g. abrasion, small puncture wounds)
Tertiary intention healing - what is it?
You delay primary closure - considered for a large, contaminated wound
Tetanus:
What is it?
What does it result in?
Where does it commonly affect?
Post-wound prevention:
- What is provided?
A toxin enters the spinal cord and prevents the release of inhibitory neurotransmitters (e.g. GABA) at the synaptic cleft.
Muscle spasm and hypertonia
Neck and jaw
Vaccine = booster may be needed if unsure if it is complete.
