Podcast
Questions and Answers
What is the recommended approach if a wound is more than 8 hours old?
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?
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?
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?
Which material is appropriate to use when closing a wound with potential metal fragments present?
When assessing a wound caused by high-pressure injection, what is crucial to determine?
When assessing a wound caused by high-pressure injection, what is crucial to determine?
What is the primary use of a Horizontal Mattress Stitch?
What is the primary use of a Horizontal Mattress Stitch?
Which method is suitable for avoiding the 'train-track' scar appearance?
Which method is suitable for avoiding the 'train-track' scar appearance?
What is a critical consideration when using tissue adhesive like dermabond?
What is a critical consideration when using tissue adhesive like dermabond?
During suturing in the Emergency Department, which technique is often preferred?
During suturing in the Emergency Department, which technique is often preferred?
What is a recommended approach to align incision with the natural skin lines?
What is a recommended approach to align incision with the natural skin lines?
What is a distinct characteristic of wounds that are typically treated surgically rather than in the Emergency Department?
What is a distinct characteristic of wounds that are typically treated surgically rather than in the Emergency Department?
What might be the consequence of shaving an eyebrow prior to a procedure?
What might be the consequence of shaving an eyebrow prior to a procedure?
In the context of wound closure, what is a disadvantage of using staples?
In the context of wound closure, what is a disadvantage of using staples?
What is the recommended suture size for lacerations on the face?
What is the recommended suture size for lacerations on the face?
Which type of suture is absorbable and requires 60-90 days for absorption?
Which type of suture is absorbable and requires 60-90 days for absorption?
When is it appropriate to use Lidocaine with Epinephrine during suturing?
When is it appropriate to use Lidocaine with Epinephrine during suturing?
Which type of needle cross section is typically used for facial suturing to minimize scarring?
Which type of needle cross section is typically used for facial suturing to minimize scarring?
What is a significant contraindication for using Lidocaine with Epinephrine?
What is a significant contraindication for using Lidocaine with Epinephrine?
What is the maximum dosage of 1% Lidocaine with Epinephrine that can be used for a 10 kg patient?
What is the maximum dosage of 1% Lidocaine with Epinephrine that can be used for a 10 kg patient?
What technique is suggested to make local anesthesia injection less painful?
What technique is suggested to make local anesthesia injection less painful?
What should be avoided during wound preparation according to best practices?
What should be avoided during wound preparation according to best practices?
Which suture material is commonly used for intra-oral lacerations?
Which suture material is commonly used for intra-oral lacerations?
During which procedure should local hemostasis be a major consideration?
During which procedure should local hemostasis be a major consideration?
What is the primary concern regarding the use of cleansing agents during wound preparation?
What is the primary concern regarding the use of cleansing agents during wound preparation?
Which technique should be used for introducing the suture needle into the skin?
Which technique should be used for introducing the suture needle into the skin?
When performing an instrument tie, how should the suture be wrapped around the instrument?
When performing an instrument tie, how should the suture be wrapped around the instrument?
What is a key instruction for achieving symmetrical sutures around the wound?
What is a key instruction for achieving symmetrical sutures around the wound?
What is the minimum number of throws required for 5-0 monofilament suture during an instrument tie?
What is the minimum number of throws required for 5-0 monofilament suture during an instrument tie?
Which type of stitch is characterized by only tying the first and last bites?
Which type of stitch is characterized by only tying the first and last bites?
What is the purpose of everted wound edges in suturing techniques?
What is the purpose of everted wound edges in suturing techniques?
Which instrument is specifically used for cutting and undermining during a surgical procedure?
Which instrument is specifically used for cutting and undermining during a surgical procedure?
How should the short end of the suture be handled during an instrument tie?
How should the short end of the suture be handled during an instrument tie?
What is the role of the forceps in the suturing process?
What is the role of the forceps in the suturing process?
What is the recommended action for a heavily contaminated wound that is more than 12 hours old?
What is the recommended action for a heavily contaminated wound that is more than 12 hours old?
In which scenario is tetanus prophylaxis required for an adult patient?
In which scenario is tetanus prophylaxis required for an adult patient?
What complication should be watched for after cleaning a wound with soap and water?
What complication should be watched for after cleaning a wound with soap and water?
Which of the following is NOT a high-risk wound condition for which antibiotics are usually not needed?
Which of the following is NOT a high-risk wound condition for which antibiotics are usually not needed?
What is the maximum duration for suture removal on the scalp?
What is the maximum duration for suture removal on the scalp?
Which of the following locations requires the longest duration for suture removal?
Which of the following locations requires the longest duration for suture removal?
What action should NOT be taken within the first 24 hours post-wound closure?
What action should NOT be taken within the first 24 hours post-wound closure?
Which type of antiseptic should generally be avoided around facial wounds?
Which type of antiseptic should generally be avoided around facial wounds?
In a patient with diabetes, how should the timeline for suture removal be adjusted?
In a patient with diabetes, how should the timeline for suture removal be adjusted?
Which components are essential to document after a wound care procedure?
Which components are essential to document after a wound care procedure?
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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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