Encountering Wounds ppt

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Questions and Answers

What is the recommended approach if a wound is more than 8 hours old?

Use topical antiseptics before closing the wound.

Allow the wound to heal from the inside out. (correct)

Surgically close the wound immediately.

Apply a tight bandage and wait for further assessment.

Which of the following factors should be evaluated first in wound assessment?

The depth and measurement of the wound.

The patient's medication history.

The estimated blood loss from the wound.

The mechanism of injury. (correct)

What indicates that there may be an underlying injury when evaluating a wound?

The presence of a foreign body larger than 2mm.

Altered mental status of the patient.

Motor function disturbances in the surrounding area.

All of the above. (correct)

Which material is appropriate to use when closing a wound with potential metal fragments present?

Non-absorbable sutures with imaging to confirm no foreign body. Signup and view all the answers

When assessing a wound caused by high-pressure injection, what is crucial to determine?

The type of injection substance involved. Signup and view all the answers

What is the primary use of a Horizontal Mattress Stitch?

For high tension wounds requiring most tension on one side Signup and view all the answers

Which method is suitable for avoiding the 'train-track' scar appearance?

Subcuticular Stitch Signup and view all the answers

What is a critical consideration when using tissue adhesive like dermabond?

The wound must be clean and dry with no active bleeding Signup and view all the answers

During suturing in the Emergency Department, which technique is often preferred?

Preferring smooth needle drivers Signup and view all the answers

What is a recommended approach to align incision with the natural skin lines?

Align incisions carefully along natural tension lines Signup and view all the answers

What is a distinct characteristic of wounds that are typically treated surgically rather than in the Emergency Department?

They are vertical, clean, and can be designed by the surgeon Signup and view all the answers

What might be the consequence of shaving an eyebrow prior to a procedure?

It could lead to irregular regrowth Signup and view all the answers

In the context of wound closure, what is a disadvantage of using staples?

They leave noticeable scars Signup and view all the answers

What is the recommended suture size for lacerations on the face?

5.0 - 6.0 Signup and view all the answers

Which type of suture is absorbable and requires 60-90 days for absorption?

Polyglactin Signup and view all the answers

When is it appropriate to use Lidocaine with Epinephrine during suturing?

On scalp wounds that are highly vascular Signup and view all the answers

Which type of needle cross section is typically used for facial suturing to minimize scarring?

Conventional cutting Signup and view all the answers

What is a significant contraindication for using Lidocaine with Epinephrine?

Patients with severe heart disease Signup and view all the answers

What is the maximum dosage of 1% Lidocaine with Epinephrine that can be used for a 10 kg patient?

70 mg Signup and view all the answers

What technique is suggested to make local anesthesia injection less painful?

Inject slowly Signup and view all the answers

What should be avoided during wound preparation according to best practices?

Soaking the wound in Betadine Signup and view all the answers

Which suture material is commonly used for intra-oral lacerations?

Absorbable sutures Signup and view all the answers

During which procedure should local hemostasis be a major consideration?

Closing large wounds with persistent bleeding Signup and view all the answers

What is the primary concern regarding the use of cleansing agents during wound preparation?

They are generally toxic to tissue. Signup and view all the answers

Which technique should be used for introducing the suture needle into the skin?

At a 90-degree angle. Signup and view all the answers

When performing an instrument tie, how should the suture be wrapped around the instrument?

One loop should be made towards the wound. Signup and view all the answers

What is a key instruction for achieving symmetrical sutures around the wound?

Sutures should be placed perpendicular to the wound. Signup and view all the answers

What is the minimum number of throws required for 5-0 monofilament suture during an instrument tie?

6 throws. Signup and view all the answers

Which type of stitch is characterized by only tying the first and last bites?

Simple Running (Baseball) Stitch. Signup and view all the answers

What is the purpose of everted wound edges in suturing techniques?

To enhance aesthetic appearance and healing. Signup and view all the answers

Which instrument is specifically used for cutting and undermining during a surgical procedure?

Iris scissors. Signup and view all the answers

How should the short end of the suture be handled during an instrument tie?

It should be Grasped with the driver and pulled through. Signup and view all the answers

What is the role of the forceps in the suturing process?

To grasp tissue and suture needle. Signup and view all the answers

What is the recommended action for a heavily contaminated wound that is more than 12 hours old?

Administer antibiotics immediately. Signup and view all the answers

In which scenario is tetanus prophylaxis required for an adult patient?

A tetanus prone wound without adequate immunization. Signup and view all the answers

What complication should be watched for after cleaning a wound with soap and water?

Signs of infection. Signup and view all the answers

Which of the following is NOT a high-risk wound condition for which antibiotics are usually not needed?

Wounds less than 12 hours old. Signup and view all the answers

What is the maximum duration for suture removal on the scalp?

6-8 days. Signup and view all the answers

Which of the following locations requires the longest duration for suture removal?

Back. Signup and view all the answers

What action should NOT be taken within the first 24 hours post-wound closure?

Changing the dressing frequently. Signup and view all the answers

Which type of antiseptic should generally be avoided around facial wounds?

Peroxide. Signup and view all the answers

In a patient with diabetes, how should the timeline for suture removal be adjusted?

Add 2-3 days to the standard removal time. Signup and view all the answers

Which components are essential to document after a wound care procedure?

Demographics and discussion of risks. Signup and view all the answers

Study Notes

Patient and Wound Evaluation

Gather patient history, including medication, allergies, and tetanus status.
Evaluate wound characteristics: mechanism of injury, timing, and environment.
Assess estimated blood loss and functional ability (sensation/movement).
Check for additional injuries or possible foreign bodies (metal, wood, glass).

Choosing Materials for Closure

Use appropriate suturing material based on wound type and characteristics.
Types of sutures include nylon, polypropylene, polyglactin, polydioxylene, silk, and chromic gut.
Staples offer quick closure but are typically used for scalp wounds in ER settings.
Adhesive skin glue (e.g., Dermabond) can be effective for clean, non-bleeding wounds.

Suture Selection Guidelines

Monofilament synthetic non-absorbable sutures (sizes 3.0 - 6.0) preferred for most lacerations.
Absorbable sutures (e.g., polyglactin, gut) are used for deeper or intra-oral lacerations.
Consider suture needles: tapered (for smoother skin) vs. cutting (for more tension and strength).

Anesthetic Choices

1% Lidocaine is standard, with or without epinephrine for hemostasis and prolonged effect.
Maximum dosages vary by weight; consider patient health conditions before use.
Digital nerve blocks can be used for finger lacerations, with bupivacaine for longer action.

Preparing the Wound

Irrigation is crucial for infection prevention; should be thorough and done prior to closure.
Use sterile saline for wound cleaning; do not reuse saline bottles between patients.
Skin preparation should avoid contact with the wound and ensure agent is washed away.

Suturing Technique

Suture placement must be at a 90-degree angle for proper closure.
Approximate wound edges, maintain equal spacing, and use symmetrical stitches.
Secure knots to the side and ensure the suture's bite is consistent with wound depth.

Common Stitch Types

Simple interrupted, running, and mattress stitches each have specific applications.
Subcuticular stitches avoid visible scarring and are suitable for clean wounds.
Everted edges are crucial for optimal healing and preventing inward scar contraction.

Post-Procedure Care

Keep the wound dry and covered for initial 24 hours; observe for signs of infection.
Wound rechecks are essential for dirty wounds within 48 hours; clean with soap and water.
Provide detailed follow-up instructions based on wound type and healing progress.

Tetanus Prophylaxis Guidelines

Tetanus shots recommended based on wound type and patient immunization history.
Tetanus-prone wounds require attention if the patient hasn’t been vaccinated within 5-10 years depending on wound characteristics.

Documentation

Thorough documentation of encounters and procedures is critical for medical records.
Include all relevant details such as injury mechanism, wound assessment, and chosen treatment method.
Record patient consent, demographics, risks, and follow-up care instructions clearly.

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Description

This quiz covers the essential aspects of patient wound evaluation, focusing on the history of the wound, patient medications, allergies, and physical examination details. Understand the mechanisms of injury, optimal healing considerations, and the assessment of blood flow and sensation. Test your knowledge on effective evaluation techniques.