wounds: lacerations/burns/punctures Flashcards
what does open palm equal in percentage of burned area?
1% body surface in adult
What burns are referred to ER?
2nd over 20% of body or 3rd degree burn. burn location - eye, hand, face, feet, perineum, joints, electrical or lightening burns
Irrigation of uncomplicated wound is done how?
500-1000ml fluid, 5-8 pounds per inch
How use hydrocolloid?
fibrinolytic, enhance angiogensis, absorbent, partial or FT wound
How use hydrogel?
allows for evaporation w/o drying
absorbs exudate, nonadherent.
good for painful wounds, post-dermabrasion and laser wounds, chemical peels, partial thickness wounds
how use alginates?
absorbant, nonadherent
good for highly exudative wounds, full thickness and post operative.
When use antibiotic treatment for wounds?
more than 8 hours old crushin injury grossly contaminated fingtertip with bone exposure open fracture tendon or joint involvement animal bite paronchia with pus Soft tissue absesee in fingertip wounds in diabetic or immunocompromised patient
When use antibiotic treatment for wounds?
more than 8 hours old crushing injury grossly contaminated fingertip with bone exposure open fracture tendon or joint involvement animal bite paronchia with pus Soft tissue abscess in fingertip wounds in diabetic or immunocompromised patient
when use occlusive or semiocclusive wounds?
minimally exudative wounds
when use occlusive or semi-occlusive wounds?
minimally exudative wounds
Laceration closure occurs when?
12-18 hours (some within 24 -72 hours) . Do not suture after 24 hours! not over 16 hours if extremities! Do not close bites!
Topical use for laceration closure?
LET (lidocaine, epinephrine, tetracaine)
topicals best on highly vascularized areas like scalp and face.
tetanus shot is needed when?
deep or contaminated laceration or puncture wound, bites, or crushing. IF received within 5 years, no need to give Td. IF > 5 years ago, give Td. Otherwise Td every 10 years for clean wound and every 5 years if dirty wound. if younger than 7 and no 3 doses than include DTap.
puncture wounds are at risk for what infections?
staphyloccoccus aureus and strept.
how assess for FB?
visualize after irrigation and debridement. IF not sure do plain radiograph. Still suspect but clear xray? do CT scan. MRI and CT if not resolved and slow to hear and persistent pain.
Are antibiotics needed in puncture wounds?
Not indicated unless a bite and risk of infection. or plantar puncture or high risk patient. use individual judgement.
which antibiotics are used for puncture wounds?
cipro for plantar prophalyxis, bactrim DS!
can use cephalosporin, antistaph PCN or macrolide,
how check for osteomylitis complication?
triple phase radionucleotide bone scan. see signs 2 weeks after injury. swelling, warmth, fever, and systemic complaints with elevated WBC. >/ 2 weeks xray will show. earlier it wont!
indications for primary closure of bite wound?
location: face or scalp
time: within 6 hours
character: simple and single layer
lack of underlying injury or fracture
host - no systemic immunocompromised conditions
bite wounds at high risk for infection?
cat, human, monkey, deep puncture, hand/foot, immunocomporomised
antibiotic tx for cat bite?
Amox- Clav (cat scratch fever - azithromycin) 5-7 days!
antibiotic tx dog?
augmentin - not always needed to be tx. not common!
human bite treatment?
augmentin and acyclovir
PCN allergy -clindamycin w/cipro or TMP-SMX
livestock bite tx?
augmentin
bites risk of rabies?
bats, monkeys, skunks, raccoons, foxes (give rabies immune globulin and vaccine) although dogs a risk, if domestic rarely needed.
tx monkey bites?
acyclovir
freshwater fish bite tx?
flouroquinolone or TMP- SMX
salt water fish bite tx?
fluoroquinolone
rats bite tx?
augmentin (no rabies needed)
Steps of care for bites and or punctures?
- assess for infection, time, location, depth, characteristics (includes assessing tendon and nerve laceration or neurovascular compromise)
- culture
- irrigate
- assess for FB (xray if needed)
- assess if antibiotics needed? tetanus needed? rabies needed?
- follow up
bone and joint infection tx?
21 days of antibiotics
Empiric therapy of bites?
- consider type of bite
- beta lactamase coverage
- PCN allergy use doxycyclne, bactrim, cipro
- can use quinolones
- preg women w/beta lact allergy use macrolides!!
tx of insect bites or stings?
ice pack, cool compress, antihistamines, remove stinger.
topical corticosteroids
antibiotics if needed.
epi-pen if allergy emergency
allergy emergency 0r hypersensitivity tx?
epinephrine 0.3-0.5 mg in adults
0.01 mg/kg in children
Tx burns/heat injuries?
apply cool compress. NO oil or butter tetnanus. prevent infection pain control
signs of lyme disease?
flu-like symptoms (fever, malaise, and regional lymphadenopathy). erythema migrans with annular lesion. pruritis or burning at ite.
anterior or posterior trunk burn covers what percentage?
18%
arm burn covers what percent?
9%
leg burn covers what percent?
18%
gram negative bacteria that cause burn wound infections include?
e coli, P aureginosa, and K pneumoniae.
tx plantar puncture wound?
antibiotic tx covering pseudom –> oral fluroquinolone.
most puncture wounds that aren’t bites or plantars don’t need prophylaxis. on individual basis.
1st degree burn description?
red, superficial, good capillary refill, no blisters, less than 15% (10% children) or
2nd degree burn description?
partial-thickness, injury to dermis. moderate, surface raw and moist.
3rd degree
full thicknessm injury extends into fat. major. wtite and leathery.
steps for burn care?
- assess vitals and BSA
- analgeics before burn care (ibuprofen)
- cleanse with mild soap and water or dilute antiseptic solution
- apply topical antimicrobrial: 1% silver sulfadiazine cream. bacitracin ointment, triple antibiotic ointment (neomycin, polymyxin, bacitracin zinc), consider synthetic occlusive dressing or nonadherent secondary dressing.
- redress BID if silvadene used.
- if remains open (face, neck, perineum) wash 2-3 times a day and topical agent applied.
- tetanus prophylaxis
- follow up 24-48 hours
- wound specialist referal if 2nd or 3rd. or fail healing within 2-3 weeks
Diagnostics for brown recluse?
CBC, BUN, electrolytes, blood glucose, cr, coagulation profile, UA. a
tx for recluse spider?
tetantus and supportive. antibiotics if infection suspect. daily wound care for necrotic lesions and serugery if > 2cm.
tx black window bite?
supportive care, airway, breathing, and circulation. tetanus and local wound care. pain management such as narcotic analgesics, benxo, and calcium gluconate
how long do symptoms of infection post bite take for onset?
24-72 hours after bite.
When does primary closure of bites occur?
if cosmetic such as facial bites.
what bites should be left open?
animal bites, human bites, deep puncture wounds, and infected wounds, wounds > 6-12 hours, and bites on hand SHOULD NOT BE CLOSED. can close by delayed primary or secondary closeure.
Wounds involving hand and foot are cared for how?
refer! but also should be stabilized and immobilized and elevated 1-3 days.
when are diagnostics neede d for burns?
2-3rd, do CBC, glcuose, electrolytes, BUN, cr, UA . xray for inhalation injury.
tx of heat stroke?
vital sign monitoring, EKG assessment of mental status. IV solution for hydration, oxygen. cool well ventilated area. cool mist and fan helpful.
signs of heat stroke?
confusion, seizure, malaise, tremor, hallucinations, HA. dehydration, tachy, tachypnea. red hot dry skin.
heat exhastion: cramps, nausea, HOTN. sweating thirst, anxiety, no CNSinvolvement. skin flushed, cool, moist. fast pulse, rapid and shallow breathing. core temp 98.6 - 104.
heat syncope - vertigo, lighteness, cramps, syncope.
Frost bite s&s?
can be superficial or partial thickness, or full thickeness/deep.
superficial - appear waxy.white and firm. insensitive but resilienc
partial thickness - blistering if in 24-48 hours. .w/rewarming skin will be swollen and superficial blisters.
deep - hard, wooden appearance, edema progresses to nonblanching cyanosis, hemmor blisters to necrosis.
what is hypothermia?
cold injury, body temp
s&s hypothermia
tachy followed by afib and bradycardia.
BP lwoered, repsiation decrease. slurred speech, loss of DTR, LOC, coma, respir acidosis.
daignostics for hypothermia?
pulse ox, ABG, xray, ECG if cardiac symptos. BUN, CBC, Cr, clotting factors couldbe done.
tx of hypothermia
blankets, warm water baths,splinted and elevated affected area. active ROM. pain control as needed. if frost bite - antibiotics for contaminated area and nonadherent dressing.
debridement and physical therapy may be needed.
emergency tx = ER, IV access, check heart before chest copressions, oxygen. passive rewarming if mild. moderate to severe need active core rewarming.
wounds that are not tetanus prone
wounds
