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Wound Care EMED

keliansherman201 Englisch 63 Karten

Wound Care EMED

Karten in diesem Stapel (63)

  1. 1How do you irrigate a wound?Irrigation – tap water has been shown to work just as well
    contaminated wounds need High Pressure Irrigation (18g catheter) = > 7 psi; otherwise, slow gentle wash
    use 50-100cc per cm of wound length
  2. 2Epithelialization: when does it occur?Epithelial cells migrate across closed traumatic wound at 24-48 hour making the wound impervious to water
    *Start washing wounds 24 hours depending on location
  3. 3When does Neovascularization (Angiogenesis) occur?New vessel growth occurs at 72 hours with peak period between 7-10 days. This accounts for erythema at this time
    Vascular growth decreases to normal level by 30 days
  4. 4Fibroplasia timing?-Collagen synthesis peaks at day 7
    -Replaces inflammatory mass at 3 weeks
    -Period between 7-10 days most vulnerable to wound separation due to balance between collagen synthesis and breakdown
  5. 5Wound Contraction and Scar RemodelingOccurs up to 6 months
    after injury
  6. 6Tetanus ProphylaxisUpdate if last Tetanus was > 10 years ago
    If very dirty or high risk, consider updating if last dose 5-10 years ago
    Tdap if adult; DTaP if pediatric
  7. 7If a wound is very dirty consider...Tetanus vaccination if last
    dose was 5-10 years ago
  8. 8Will there be a Wound Infection?-Microbiology
    -Technical
    -Patient Condition
    -Infection Prevention : Irrigation Debridement, Blood Supply,
    Prep
  9. 9Debridement of wounddead/devitalized tissue nay need to be removed
  10. 10Prep solutions for wound cleaningPrep – usually NS or tap water is all this needed; can use baby soap, but full strength Iodine , full strength H2o2 can devitalize healthy tissue as well
  11. 11Cat, dog, or fight bites require which antibiotic?Augmentin 3-5 days
  12. 12Closure considerations for bites?(Almost) Never close a dog bite on the extremity
    Can consider closure if gaping, or cosmesis a concern
  13. 13Cat bite rate of infection, and bacteria?up to 80% infection rate
    Pasteurella multicida-PCN,
    Augmentin 3-5 d.
    Elevate and splint if necessary
  14. 14Fight bite infection normally caused by which bacteria?Eikenella corrodens (Augmentin)
  15. 15Dog bite infection normally caused by which bacteria?Polymycrobial; Augmentin 3- 5 d.
    *only 5% become infected
  16. 16Rabies : which animals account for most exposures in US?*8% of exposures are from domestic animals
    -1% from dogs, 4% from cats; horses, cows, etc
    * wildlife account for 92% of exposures
  17. 17Which type of wildlife account for 92% of exposures to rabies in US?Raccoons mostly (36% of all cases of rabies)
    skunks 23%, bats 23%, foxes 7%,
  18. 18Internationally > 90% of cases of rabies come fromstray dog bites
  19. 19there has never been a case of transmission of rabies to a human from one of these animals.Small rodents:
    such as squirrels, chipmunks, rats, hamsters, gerbils, guinea pigs, mice, rabbits, are almost NEVER identified as infected with rabies virus
  20. 20before anesthesia you should always check what during wound care?Document 2 point discrimination
  21. 21Lidocaine duration of action1-2 hours
  22. 22Bupivicaine duration of action4-6 hours
  23. 23No epi on?on fingers, toes, nose, hose, or ears (any thing that hangs)
  24. 24Why is epi commonly added to local anesthetic?-provides hemostasis
    -a longer duration of action
    -slows systemic absorption thus decreasing potential toxicity
    -allows a greater volume to be injected.
  25. 25Dose limit for lidocaine?4 mg/kg
  26. 26dose limit for lidocaine w/ epi7 mg/kg
  27. 27dose limit with bupivicaine2 mg/kg
  28. 28Ways to Limit Pain on Injection*Pain occurs because of the acidic pH of anesthetics
    -Sodium bicarbonate 1:10 (shelf life 1 week)
    -Warming the solution
    -Size of the needle
    -Injecting slowly
    -Use of a topical anesthetic
    -Ice on wound (especially helpful in kids)
  29. 29Regional Blocks, Advantages Over InfiltrationNo tissue distortion
    Avoids infiltrating highly sensitive areas (palm)
    Longer duration of anesthesia
    Smaller amount of anesthetic needed
    Abrasion cleaning
    Fracture analgesia
  30. 30Supraorbital, infraorbital and mental nerves all line up along an imaginary vertical line drawn through thepupil
  31. 31—
  32. 32Primary intention : wound closuresurgical repair with initial reapproximation of tissue layers
  33. 33Secondary intention: wound closureepithelialization and growth from base. Used in ulcerations, abscess cavities, avulsions, punctures
  34. 34Tertiary intention: wound closure(delayed primary closure) surgical closure in 3-5 days after injury. Used in high velocity wounds, contaminated wounds, old wounds, stab wounds
  35. 35skin anatomyEpidermis
    Dermis
    Subcutaneous tissue (hypodermis)
    Superficial fascia
    Muscle layer
    Deep fascia
  36. 36absorbable suture(vicryl, chromic, cat gut, Dexon, PDS)
    subcutaneous, mucus membranes
  37. 37Non-absorbable suturesNon-absorbable : (nylon, prolene,, silk)
    Colored, used on skin, don’t use deep
  38. 38Monofilament vs braidedBraided sutures incite greater inflammatory response/ risk for infection
    but need fewer ties to maintain
    integrity
  39. 39needle type?*Reverse cutting needle penetration of tough skin and fascia.
    *Tapered needles are used on soft tissue, such as bowel and subcutaneous tissue, or when the smallest diameter hole is desired
  40. 40needle sizinginverse relationship
    (bigger #= smaller needle)
  41. 41Vicryl suturehas 2-4 weeks of tensile strength, can take 2+ months to dissolve. Braided.
  42. 42plain gut suturePlain Gut: 7-10 days of tensile strength; up to 90 d. to absorb. Monofilament
  43. 43fast absorbing gut sutureFast Absorbing Gut: 5-7 days of strength, absorbs in 3-4 weeks. Monofilament (she sometimes uses on face)
  44. 44Suture sizesFace 6-0
    Trunk 3-0, 4-0
    Extremities 4-0
    5-0 on hands, toes
    Scalp 4-0
  45. 45suture size for faceFace 6-0
  46. 46suture size for trunkTrunk 3-0, 4-0
  47. 47suture size for extremitiesExtremities 4-0
    5-0 on hands, toes
  48. 48suture size for scalpScalp 4-0
  49. 49special wound concernsLip - vermillion border
    Oral - thru and thru (need antibiotics)
    Hand lacerations – FB, joint/tendon
    Eyelid lacerations – lacrimal system
    Nose – septal hematoma
    Ear – dressing is key (need bulky)
    Puncture wounds - pseudomonas
    Hand Lacs – fight bite
    Cheek laceration - facial nerve
  50. 50Puncture WoundsDo not close these; heal by secondary intention
    Plantar Wounds – cover for Pseudomonas with Cipro, especially if went through a shoe
    Remove FB if present
    Soak, don’t suture
  51. 51hand lacMust examine in position of injury, and through full range of motion, in a bloodless field
    Consider a fight bite – antibiotics
    Xray for foreign body
  52. 52Hand InjuriesTest Motor and Sensory function distally
    Perfusion/Cap Refill
    Tendon lacs get referred
  53. 53ear lacUse 6-0 nylon to close skin
    Cartilage needs only to be approximated, via skin closure
    dressing is key
  54. 54lip lacLook for intraoral / thru and thru lacerations
    Look for dental injury
    First external throw is to approximate vermillion border
    Otherwise, start on mucousal aspect
    Then repair orbicularis oris
    Consider Abx – PCN or clindamycin
  55. 55Eyelid lacerationsWhen to refer –1. inner surface of lid 2. Lid Margins 3. LACRIMAL DUCT involvement 4l Ptosis 5. Tarsal plate involvement
  56. 56nasal lac/traumaLook for, and drain, a septal hematoma
    Align the skin surrounding nasal canals
    Mucousal involvement, close with absorbable
  57. 57facial lacParotid gland is located superficially in the cheek
    Consider Parotid gland or duct injury, and test for Facial Nerve deficits
  58. 58wound dressingThink about immobilization
    Layers
    Ointment
    Nonadherent layer
    Adaptic
    Tagaderm
    telfa
    Gauze sponges
    Gauze wrap
    Tape
    Pressure stocking
  59. 59f/u instructionsCleaning
    Dressing in place at least 24 hours
    50-50% solution of h2O2 around wound edges; or just baby shampoo and water
    Topical abx ointment
    No soaking (hot-tubbing, swimming)
    Signs of infection
    Recheck wounds 48 hours if high risk
    Cat bites 24 hours
    Timing of removal
    Sun exposure
    Sunscreen for first 6 months
  60. 60suture removal timesFace 3-5 days
    Scalp 7-10 days
    Hands 7-10 days
    Feet 7-10 days
    Extremities 7-14 days (joints)
    Trunk 7-12 days
  61. 61foreign bodyX-ray- 98% glass > 2mm will show up on film, metal, and gravel
    If the patient feels FB sensation it’s in there
    Infection
    Organic material: soil, wood, clay become infected
    Referral
  62. 62nailbed repairMay not need to remove nail if <50% subungual hematoma
    Trephination is an option
    Repair nailbed
    Replace nail plate under nail fold
  63. 63failures to avoidFailure to irrigate with proper technique
    Failure to consider delayed primary closure
    Using dermabond on high tension areas
    Using improper aftercare instructions
    Using abx to make-up for poor wound cleaning
    Failure to use clinical judgment when considering golden periods for wound closure
    Failure to find a foreign body
    Using betadine to irrigate
    Failure to warn patients of potential infection risk and scarring
    Failure to align the vermillion border
    Failure to examine in a bloodless field

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Karteikarten am Wound Care EMED , erstellt von keliansherman201 am 24/10/2015.
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keliansherman201
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