wound section 6 Flashcards
most predictive factors for infection
wound characteristics of location, age, depth, configuration, and contamination
hypertropic scars
due to tissue tension during wound healing, and the scars stay within the original wound boundaries and tend to undergo partial spontaneous regression within 1 to 2 years
Keloids
genetically linked variations in wound healing, resulting in the production of excess collagen beyond the original wound boundaries. Keloids rarely decrease in size.
major inorganic soil component responsible for infection
Clay
Finger tourniquets time
not more than 30 minute
*history of fight + lacerations in these areas are considered as human bites
Lacerations over the metacarpophalangeal joints
Sonography usefulness in Foreign body detection
good for detecting wood >2.5mm size
visible on plain radiographs
Metal, bone, teeth, pencil graphite, certain plastics, glass>2mm, gravel, sand, some fish bones, some painted wood, and most aluminum
Full sterile technique and infection
(cap mask gloves) does not reduce the incidence of postrepair infections
hand antisepsis
hand antisepsis prior to wound repair in the ED is unproven
gloves and infection
Clean, nonsterile gloves have similar postrepair infection rates when compared to sterile gloves
on infection and ED
time and cost savings per laceration by using common-sense cleanliness.
Prior to local anesthesia, one must?
sensory, motor, and vascular examination should be performed at, and distal to, the wound site.
Low pressure irrigation
0.5psi, uncontaminated wounds and for loose tissues around the scrotum or eyelids
high pressure irrigation
7psi or higher, high levels of contamination, especially in areas of the body that are at higher risk of infection such as the extremities, 18 gauge intravenous catheters
50-mL syringe with a splash guard
Outdated methods to clean wounds
Wound soaking, Routine scrubbing
recommended irrigation amount
60ml per cm of wound length, at least 200ml
most commonly used irrigant
PNSS- lowest toxicity, comparable to tap water.
antiseptic and irrigants (benefit)
no benefit
most effective type of debridement
excision
what to excise
tissue with poor capillary refill, jagged edges, contused tissues
antibiotic prophylaxis for traumatic wound
initiated before significant tissue manipulation is done, administered in routes that achieve desired blood levels, agents that are effective against predicted pathogens
PO or IV antibiotics for prophylaxis?
same. just use PO with rapid absorption
most nonbite wound infections
staphylococcus, streptococci tx with beta-lactam despite mrsa (3-5days non bite wounds)
human bites prophylaxis
amoxicillin-clavulanate 5-7days (bite wounds)
treatment for laceration <2cm
clean wound, secondary closure
head laceration golden period
100 hours
trunk or extremities had lower rates of healing if closed morethan x hours
closed more than 19 hours
wounds with high risk of infection should be closed after x days
4 days
sutures advantage
strongest of all the closure devices and allow the most accurate approximation of the wound edges
Nonabsorbable sutures retain their tensile strength upto X days
60 days
