Wounds

Question 1

When does epithelialization of surgical wounds closed primarily complete?

Answer 1

24-48 hours

Question 2

When does a wound closed by primary intention reach max strength?

Answer 2

3 months (70-80% that of normal skin)

Question 3

What are the 6 steps of wound healing

Answer 3

1. Coagulation
2. Inflammation
3. Collagen synthesis
4. Angiogenesis
5. Epithelialization
6. Contraction

Question 4

What cells perform collagen synthesis

Answer 4

fibroblasts

Question 5

Early surgical site infections in the first 24 hours are typically from which 2 organisms?

Answer 5

1. Streptococcus
2. Clostridium

(because they grow really fast and excrete enzymes that digest local tissue and impair host defenses)

Question 6

What is the magic number for dose of contaminating microorganisms required to result in an increased risk of wound infection?

Answer 6

100,000 (10^5)

Question 7

What are the 5 W’s of post operative fever?

Answer 7

1. Wind (atelectasis, not moving enough air)
2. Water (UTI from prolonged foley catheter)
3. Walking (DVT)
4. Wound
5. Wonder about drugs

Question 8

What is the most common cause of post operative fever in the first 24 hours?

Answer 8

atelectasis

Question 9

What are the classic signs of infection (4)

Answer 9

1. Redness
2. Swelling
3. Heat
4. Pain

Question 10

What is the proper work up for febrile patient? (4)

Answer 10

1. CBC
2. blood and urine cultures
3. Urinalysis
4. Chest Xray

Question 11

Best prophylactic antibiotic for anaerobes

Answer 11

1. Metronidazole (Flagyl)

2. Clindamycin

Question 12

Best prophylactic antibiotic for gram-negative rods

Answer 12

1. Third gen cephalosporin

2. Aminoglycosides

Question 13

Best prophylactic antibiotic for gram-positive cocci

Answer 13

1. First or second gen cephalosporin