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Z Dermatology Clin Med > Wounds & Repair (1st 6 pg's) > Flashcards

Wounds & Repair (1st 6 pg's) Flashcards

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Dermatology Board Prep flashcards
1
Q

What are the three basic goals of wound care?

A
  1. Eliminate Complications (infection)
  2. Restore f(x) - asses nerves, tendons…
  3. Reduce scarring as much as possible
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2
Q

Steps to achieve goals of wound care

A
  1. Cleansing
  2. Hemostasis
  3. Anesthesia - prior to irrigation
  4. Irrigation “Soloution to Pollution is Dilution
  5. Wound Exploration - check for fb, esp. glass, numb then do x rays if unsure…
  6. Removal Devitalized/Contam. Tissue (necrotic)
  7. Tissue preservation
  8. Closure tension
  9. Deep sutures if necessary
  10. Tissure handling durring closure
  11. Dressings
  12. Follow-ups - good to schedule appts after suturing
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3
Q

What is formed consent with wound care?

A
  1. Risks
  2. Benefits
  3. Alternatives

*Never make promises about txt…say “I’ll do the best I can to minimize effects…”

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4
Q

What three things may interfere with normal wound healing?

A
  1. Infection
  2. Poor repair technique
  3. Underlying conditions

*We can only control repair technique

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5
Q

What are the three general stages in wound healing?

A
  1. Inflammatory & hemostasis
  2. Proliferative
  3. Remodeling/maturation
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6
Q

Key components of Inflammatory phase

A
  1. Occurs when hemostasis is completed
  2. Granulocytes to wound, as well as lympho & immunoglobulins
  3. Control bacterial growth/infection
  4. Often resembles PURULENCE (PUS)
    1. part of normal drainage
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7
Q

At what days is infection most apparent?

A

4-5 days after accident

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8
Q

Three key components of Proliferative phase of would healing

A
  1. Epitheliation
  2. Neovascularization
  3. Collagen synthesis
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9
Q

What occurs in epithelization?

A

Inflammation

Re-establishment of epidermis

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10
Q

Key parts of neovascularization part of Proliferative stage?

A

New vessel formation

Gives erythematous appearance

granulation

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11
Q

Collagen synthesis points on proliferative stage of wound healing

A

Collagen fibril production from fibroblasts

Final tensile strengths take several months

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12
Q

Remodeling/maturation phases (2) of the wound healing process

A
  1. Contraction/remodeling-takes several months
  2. Scar management - to alter final scar can do cryotherapy, pressure dressigs, dermabration, radiation, or intralesional corticosteroids
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13
Q

What should you consider with patients about scar management & revision?

A

Patients with hx of keloids/hypertrophic scar formation

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14
Q

Factors interfering with healing

A
  • Stasis dermatitis
  • Chronic med conditions-age, alcoholism, acute uremia, severe anemia, malnutrition, DM
  • Peripheral vascular dx
  • Technical - inadequate wound prep, excessive suturing, reactive suture material, local anesthetics
  • Anatomy - skin tension, pigmented skin, oily skin, & location
  • Drugs - corticoster, NSAIDS, pencillamine, B blockers, anticoagulants, colchicines, antineoplastic agents, & tobacco
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15
Q

What are the ABS’s?

A

Airway

Breathing

Circulation

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16
Q

Up to how many years should a tetanus be given to patient?

A

If it has been more than 5 years give Tdap

17
Q

Wound Eval/Documentation components

A
  • Mechanism of injury - what hapenned, presence foreign body, tendon/nerve injury?
  • Age of wound - <6-8 hrs…?
  • Assoc. Symptoms - systemic (headache/dizzy), numbness/tingling (nerve injury), or loss f(x)
  • Past med/social - disorders (DM, seizures, immunosuppress), prior healings (keloids?), allergies, last tetanus, meds (anticoag, cortico, tobacco), handedness
18
Q

What to asses in the physical?

A
  • Vitals
  • General/system findings
  • Wound descrip
  • Location
  • Length/extent
  • Depth - usually measured by structures seen…vessels, nerves, tendons, subq, bone…
  • Condition (clean, contam, sharp, irreg)
  • Functional asses
19
Q

Documentation with procedure of suturing

A
  • Patient informed consent - risk, ben, & alternatives
  • Anesthesia - type & amt
  • Wound cleaning - agent, irrig
  • Exploration, debridement
  • Suture type, size, #, OR closure used
  • Dressing type - note if nonstick
20
Q

A few variables to consider when choosing anesthetic

A
  • Type of wound
  • Location
  • Estimated repair time
21
Q

Three common toxic rxns to injection anesthetic

A
  • Cardiovascular rxn
  • Excitatory CNS effects
  • Vasovagal syncope secondary to pain/anxiety
22
Q

3 most common anesthetics for local infil or simple n. blocks

A
  • Lidocaine (xylocaine)
  • Mepivacaine
  • Bupivacaine (marcaine)

Z Dermatology Clin Med (18 decks)

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