Wounds etc. Flashcards
Examples of nonabsorbable suture
PTFE Nylon Polyester Polypropulene Silk Stainless steel
examples of absorbable suture
catgut
polyglycolic (dexon)
Polyglactin (vicryl)
poligleacaprone (monocryl)
suture removal times for body parts
Face and neck: 3 to 5 days
Scalp and body: 5 to 7
Extremities: 7 to 12 days
What are the areas of the body or situations that require special attention and or hospitalization?
- Partial thickness greater than 20% body
- Burns of face, hands, feet, genitalia, major joints.
- 3rd degree burns
- Electrical burns
- Chemical burns
- Inhalation injury
Clinical features that are suspicious for child abuse?
- delay seeking medical advise
- burn in shape of object
- sharp demarcated boarder, bilateral
- cigarette burns
Ratings of hypothermia, 3 levels?
Core body temp below?
Mild: 32-35 Celsius 35 = 95 F
Moderate: 28-31.9 C
Severe: <28
Dysbarism?
Decompression sickness, arterial gas embolism, barotrauma
Decompression sickness
Path
Sx
Tx
Nitrogen bubbles in tissues during ascent
Type 1: Deep aching pain in large joints (bends).
Type 2: Cardiorespiratory
Type 3: arterial gas embolism: air in the interstitial space or pulmonary veins
Tx: 100% O2, Iv fluids, possibly hyperbaric chamber.
Acute mountain sickness
Sx:
Tx:
Sx: HA with GI disturbance, dizziness, fatigue or sleep disturbance
Tx: Decent is definitive treatment
- Rest, supplemental O2, NSAIDs, antiemetic
- Dexamethasone for moderate or severe cases only
High altitude pulmonary edema
Sx:
Tx:
Rapid ascent above 8000ft.
Most lethal of all altitude sickness
Sx: dry cough, decrease exercise perf,
- late: dyspnea at rest, productive cough, pink frothy sputum
- later: AMS, coma
Tx: O2 and decent best treatment, Nifedipine
Burn assessments regarding surface area?
Rule of nines: Each area represents 9%
- head, anterior chest, anterior abdomen, each arm, anterior each leg, posterior each leg.
Can use palmar method: size of patients palm represents 1% of their body surface area.
Define first degree burns
Pres
w/u
tx:
Superficial, epidermis
Presentation: erythema only, no blistering
w/u: consider cause of burn
Tx: irrigate w/ NS, non-adherent dressing, topical abx, elevate, NSAIDs, OP follow up
- No systemic abx unless signs of infection then keflex
Define 2nd - 4th degree burns
Pres
w/u
tx:
2nd: Partial thickness, epidermis and dermis = erythema plus blisters
3rd: Full thickness, subQ = pink, white or brown, skin appears smooth and leathery, painless
4th: Burns to muscle and bone = eschar, “deep burn necrosis”
W/u: survey for immediate life threats
- Calculate TBSA
- ABG, carboxy-hgb, CBC, electro, ect.
- CXR
Tx: ABCs!, IV fluids, wounds etc.
Burn severity scale
Mild: < 10% body, <5% child or elderly
Moderate: 10-20%, 1/2 for kids, elders
Major: >20% partial thickness burns or 3rd degree or specific types or locations of burns
Complications from burns?
Fluid, electrolyte, protein loss…
Infection
Airway compromise
Circumferential burns: compartment syndrome
Black widow spider bite
S/s
Tx
Pain can spread to entire extremity, erythema in 20-60 minutes, target lesion 1-2cm, muscle cramping of large muscle groups, severe ABDOMINAL wall cramping
Tx: latrodectus antivenom, opioids, benzos
Bee and wasp stings
complications
indications for admission
comp: severe local reaction
- anaphylaxis (usually within 15 minutes, no longer than 6 hours from sting)
- Delayed reaction: Serum sickness like symptoms; 5-14 days,
- Greater than 100 stings or significant comorbidities = hospital admission
Cat and dog bites:
Pathogens
Tx:
Cat bites: pasturella
Cat scratch: bartonella
Tx: Augmentin, do not close wound
Human bites tx:
Augmentin for all bites
