EM E1: Wound Management

5.0(1)
studied byStudied by 10 people
learnLearn
examPractice Test
spaced repetitionSpaced Repetition
heart puzzleMatch
flashcardsFlashcards
Card Sorting

1/91

flashcard set

Earn XP

Description and Tags

Study Analytics
Name
Mastery
Learn
Test
Matching
Spaced

No study sessions yet.

92 Terms

1
New cards

Which stage of wound healing:

initiated at time of injury, compression of small bleeding vessels, plts aggregate

hemostasis

2
New cards

Which stage of wound healing:

stimulated by chemotactic factors from plts, complement cascade begins, vasodilation

inflammation

3
New cards

Which stage of wound healing:

inflammatory response stimulates cell division in stratum germinativum -24hrs post injury

Epithelialization

4
New cards

Which stage of wound healing:

vital, new vessel growth 72 hrs post

Angiogenesis

5
New cards

Which stage of wound healing:

collagen synthesis and breakdown of old/damaged collagen (peak at 7 days)

Fibroplasia

6
New cards

Which stage of wound healing:

occurs of next several months, contraction modifies cosmetic appearance

Wound contraction & scar remodeling

7
New cards

Which stage of wound healing:

collagen remodeling, balance between new and removal of old, peaks 60 day post, only reaches 80% strength of old skin, remodeling begins ~21 days after injury, can last indefinitely

Maturation

8
New cards

What wound are at a high risk of infection?

bite wounds (check for presence of a FB)

visible contamination also inc risk (soil contains fungal spores, bacteria, fecal matter)

9
New cards

What injury is more susceptible to infection?

crush injuries

10
New cards

What is directly related to the growth of bacterial inoculum?

time interval from injury to repair

11
New cards

After how many days of open wound management does the risk of infection after closure substantially dec?

4 days

12
New cards

What areas of the body have low density for bacterial colonization?

upper arms, legs, torso

13
New cards

What areas of the body have a high density for bacterial colonization?

moist areas (axilla, perineum, intertriginous, toe webs)

14
New cards

In addition to bacterial flora, plays a role in determining the likelihood of infection?

regional blood flow -highly vascular areas are less likely to be infected

15
New cards

Who is more prone to keloids?

AA & Asian populations, hx keloid formation

16
New cards

What are keloids?

grow beyond the original wound boundaries, often larger and more pronounced

17
New cards

What are hypertrophic scars?

stay w/in wound boundaries, d/t tension during healing

18
New cards

What can epinephrine containing anesthetic solutions be helpful with if not contraindicated?

stopping wound bleeding (small bleeds)

19
New cards

What test is used for wooden FB and organic material?

US

20
New cards

What materials are visible on XR?

*radiodensity varies on the material

metal, bone, teeth, pencil, plastics, gravel, sand, fish bones, aluminum, glass > 1 mm thick

21
New cards

What imaging is good for all foreign substances?

CT

*but is $$ and significant exposure to radiation

22
New cards

What do you use to disinfect the skin surrounding the wound?

Betadine or chlorhexidine (Hibiclens)

*apply from wound edge outwards

23
New cards

What do you need to minimize the wounds exposure to?

undiluted Betadine and Hibiclens

*disastrous if eye is exposed

24
New cards

What is the most crucial step for wound healing and minimizing infection risk?

debridement

25
New cards

Which wound cleanser:

most widely used iodophor; lower free iodine (free iodine is toxic to tissues); available in 10% solution (1% free iodine) OR 1% solution -safe and effective

Povidone-iodine (Betadine)

26
New cards

Which wound cleanser:

effective when used w/ high-pressure irrigation

NaCl 0.9% (NS)

27
New cards

Which wound cleanser:

nonionic surfactant, NO toxicities, does NOT interfere w/ wound healing, impedes the development of infection, loosens debris, suitable for delicate tissues (mucous membranes & eyes)

Poloxamer 188 (Pluronic F-68)

28
New cards

What is the most effective form of wound cleansing?

high pressure irrigation (> 7 psi)

29
New cards

What is the most commonly used wound irrigation solution d/t safety and physiologic factors?

normal saline

30
New cards

Why is it better to create incisions or lacerations parallel to skin tension lines?

less likely to create widened scars than those perpendicular

31
New cards

What helps identify skin tension lines?

follow natural wrinkles/fold, pinch test, Langer’s lines, muscle orientation

32
New cards

What is primary closure?

wound is immediately closed by approximating its edges → reduced healing time, bleeding, and discomfort

33
New cards

What is secondary closure?

wound is left open and allowed to close on its own; suited for highly contaminated or infected wounds, and pts at high risk of infection → low risk of infection, but is slow and uncomfortable

34
New cards

What is tertiary closure?

(delayed primary)

combines advantage of primary & secondary; wound is left open for 4-6 days after which it may be closed if no infection supervenes

35
New cards

What is the preferred closure method for linear lacerations?

can be closed by any method as they are subject to tension (expect joints)

36
New cards

What is the preferred closure method for low-tension irregular lacerations?

ex: cut on thumb

sutures → allow greatest degree of precision and accurate wound approximation

37
New cards

What is the preferred closure for high tension lacerations?

deep dermal sutures and wound immobilization

38
New cards

What is the strongest wound closure device?

sutures

39
New cards

Which sutures are absorbable?

Catgut, polyglycolic acid (PGA), polyglactin 910 (Vicryl), poliglecaprone (Monocryl), polydioxanone (PDS)

40
New cards

Which sutures are non-absorbable?

Polypropylene (Prolene), Nylon (polyamide), Silk, Polyester

41
New cards

Which suture is used for:

internal soft tissue approximation, ligation

Catgut

42
New cards

Which suture is used for:

general soft tissue approximation, ligation

Polyglycolic Acid (PGA) & Polyglactin 910 (Vicryl)

43
New cards

Which suture is used for:

subcuticular skin closure, soft tissue approximation

Poliglecaprone (Monocryl)

44
New cards

Which suture is used for:

fascia closure, pediatric cardiovascular surgery

Polydioxanone (PDS)

45
New cards

Which suture is used for:

vascular anastomosis, skin closure

Polypropylene (Prolene)

46
New cards

Which suture is used for:

skin closure, ophthalmic surgery, neurological surgery

Nylon (Polyamide)

47
New cards

Which suture is used for:

general soft tissue approximation, ligation

Silk

48
New cards

Which suture is used for:

cardiovascular surgery, tendon repair

Polyester

49
New cards
<p>Reference slide 68</p>

Reference slide 68

more 0 = smaller suture

50
New cards

How long do non-absorbable sutures retain their tensile?

at least 60 days

51
New cards

What are non-absorbable sutures used for most often?

close outermost layer of skin

52
New cards

Which non-absorbable sutures have lowest rate of infection and are the most non-absorbable ones used in the ED?

Monofilament synthetic: nylon or polypropylene

53
New cards

How long do absorbable sutures retain their tensile?

lose most of their strength < 60 days

54
New cards

What are absorbable sutures best for?

closure of deep structure: dermis and fascia

55
New cards

Which size suture should you used for laceration in the hand/fingers?

4-0/5-0

56
New cards

Which size suture should you use for facial lacerations?

6-0/7-0

57
New cards

Which size suture should you use for most locations?

4-0

58
New cards

Which closure device has the least precision in wound approximation?

staples

59
New cards

What should staple closure use be limited to?

linear, non facial lacerations; particularly helpful for scalp lacerations

60
New cards

Which closure device is the least reactive, inexpensive, and easy to use?

Adhesive tapes

61
New cards

What is closure with adhesive tape limited to?

very low-tension simple wounds or closure of fragile skin subject to low tension

62
New cards

How should adhesive tapes be applied?

perpendicular to wound edges ~2-3 mm apart, first strip should be placed across the center of the wound

63
New cards

What type of closure polymerizes into a stable bond when in contact with moisture to form an occlusive dressing?

Liquid monomers

64
New cards

What are the limitations of liquid monomer closure?

use w/ caution around eyes, should not be used alone for high-tension wounds bc of its strength

65
New cards

Which typed of tissue adhesive is stronger, more flexible, and OCA-based?

Dermabond

66
New cards

Which tissue adhesive is butyl-cyanoacrylate based?

Indermil

67
New cards

What should a wound be cleaned w/ post-op?

normal saline

68
New cards

If an injury is closed ____ hours after occurrence, infection rates inc exponentially w/ closure.

12 hours

69
New cards

What wounds need prophylactic abx?

human bites, cat bites, certain dog bites, intraoral alcerations, open fxs, wounds w/ exposed joints or tendons

70
New cards

What pts need prophylactic abx?

lymphedema, prosthetic joints or permanent hardware, grossly contaminated lacerations & prone to infective endocarditis

71
New cards

What is the abx of choice for prophylactic tx?

Cephalexin/Keflex OR Dicloxacillin

PCN allergy: Tetracycline

72
New cards

What is the abx of choice for intraoral wounds?

PCN or Clindamycin

73
New cards

What is the abx of choice for animal bite wounds?

Augmentin

74
New cards

What is the abx of choice for open fractures or joints?

Cephazolin + aminoglycoside (gentamicin, tobramycin)

75
New cards

If TD update is within 5 years is another shot needed?

nope

76
New cards

If TD update is btwn 5-10 yrs is another shot needed?

not for superficial laceration and minor injuries

77
New cards

If TD update is > 5yrs old and the injury is significant is another shot needed?

yes

78
New cards

What NEEDs to be done for bite wounds?

irrigation

79
New cards

Where are bites most likely to be infected?

hands

80
New cards

If a pt presents w/ an animal bite and is not previously vaccinated what should be done?

clean wound, HRIG, and rabies vax

81
New cards

If a pt presents w/ an animal bite and is previously vaccinated what should be done?

clean wound, rabies vax

82
New cards

Which bites develop infection faster: cats or dogs?

cats

83
New cards

What is the MC bacteria infecting cat bites?

Pasteurella species

84
New cards

Dog bites usually cause what type of wound?

crush-type wound d/t high pressure

85
New cards

What is the MC & most serious type of human bite injury?

closed-fist injury “fight bite”→ closed fist strikes the teeth of another individual and creates a small wound

86
New cards

What causes 90% of osteomyelitis cases from a foot puncture wound?

Pseudomonas

87
New cards

What is the tx for a foot puncture wound?

Cipro

88
New cards

What is the tx for shark bites?

Cipro

89
New cards

When should face sutures be removed?

3-5 days, replace w/ steri-strips

90
New cards

When should scalp & trunk sutures be removed?

7-10 days

91
New cards

When should arm or leg sutures be removed?

10-14 days

92
New cards

When should joint sutures be removed?

14 days