Lacerations

Question 1

What is the first thing you should do with all lacerations?

Answer 1

apply pressure

If that doesn’t work to stop the bleeding, apply a tourniquet

clamping it could work, but you have to be sure you know where the bleeding is coming from otherwise you coudl clamp a nerve

elevating the limb really doesn’t work that well because ou blood pressures are strong enough to overcome gravity

Question 2

What are the 6 questions you need to ask someone with a laceration?

Answer 2

1. What caused the injjry?
2. WHere did it happen?
3. WHen did it happen?
4. Other injuries?
5. Other heath problems (AIDS, diabetes, bleeding disorders)
6. ANticoagulants

Question 3

What are 8 thinks you need to evaluate the wound for?

Answer 3

1. depth
2. location (can if affect a distal limb through damage to circulation or nerves)
3. contamination
4. foreign bodies
5. able to move it?
6. Able to feel distally?
7. any fracture?
8. Orientation (with regards to langer lines)

Question 4

What is the classic dirty wound that almost always become infected?

Answer 4

boxers fracture when you broke the skin punching someone in the face

human mouths are just about the dirtiest things ever

Question 5

What are the important steps for open fractures?

Answer 5

reset it to regain circulation

always treat with antibiotics

Question 6

What are 3 contraindications to primary wound closure?

Answer 6

1. infected or inflamed wounds - they should stay open
2. serious crush injuries (lots of subcutaneous tissue damage)
3. Primary time contraints not med

Question 7

What are the preferred time constraints for facial lacerations and body lacerations?

Answer 7

face: within 24 hours
body: within 18 hours (6 preferred)

Question 8

What are some ways to “anesthetize” a patient without using meds?

Answer 8

have them keep their eyes open

distract them (jiggle something, pull on their ear)

talk calmy - carefulw hat you say!

cool the wound with ice

Question 9

)What are the options for topical anesthesia (3)?

Answer 9

1. TAC (tetracain, epinephrine and cocaine)
2. LET (lidocaine, epinephrine and tetracaine)
3. EMLA (Eutectic Misture of Local Anesthetic - licodaine and prilocaine) - needs 90 minutes to work so apply early

Question 10

How do you give local anesthetics in a laceration?

Answer 10

Be generous but don’t distort the wound edges because that would make closure more difficult

make injections from inside the wound into normal skin - it’s less painful if you don’t have to make additional breaks in the skin.

Question 11

Which local anesthetic is most likely to cause an allergic reaction?

Answer 11

procainamide

Question 12

Which is hte most onnly used local anesthetic?

Which 2 are used for dental pain?

Answer 12

lidocaine

bupividaine and mepivacaine for dental pain

Question 13

what does epinephrine do with the anesthesia?

Answer 13

it dcreases bleeding

Question 14

How can you reduce the pain of local anesthetic injections?

Answer 14

1. go thorugh the wound edges
2. inject slowly
3. use smalll needles

Question 15

WHat general types of medications can you give for general anesthesia?

Answer 15

1. narcotics (morphine, dilaudid, fentanyl, hydroxodone, oxycodone)
2. Benzodiazepam (ativan, versed)
3. DIssociative (ketamine)

Question 16

WHat is the general rule of thumb for cleaning a wound?

Answer 16

more volume is better and use moderate pressure

any clean solution can be used - volume and pressure are both more important than the cleaner itself.

Question 17

What are 5 different ways you can close a wound (besides secondary intention)?

Answer 17

1. tape
2. staples
3. sutures
4. glue
5. hair knots

Question 18

WHere are staples ideal?

Answer 18

in the scalp

Question 19

Where shouldn’t you use tissue adhesive to close a wound?

Answer 19

when there’s still active bleeding - has to be dry

avoid using on bites or mucosal areas

don’t use in areas of high skin tension

Question 20

What are the two basic categories of sutures?

Answer 20

nonabrosbable (nylon)

and

absorbable (catgut, polylglycotes)

Question 21

What are the 3 most comon suture techniques?

Answer 21

interrupted

continuous

subcuticular (popular in surgery)

Question 22

What are the 6 complications related to lacerations post closure?

Answer 22

1. contact dermatitis due to topical agents like neomycin applied to the wound)
2. infection
3. dehiscence
4. necrosis (from insufficiency blood supply or suture tension)
5. reaction to the suture
6. keloid scarring

Question 23

WHen are scars more likely to be seen?

Answer 23

1. healing by secondary intention
2. bisect langer lines
3. wound had irregular borders
4. closed with irregular surface (uneven, or the edges weren’t everted during closure and sunk)

Question 24

What are some health conditions that can delay wound healing?

Answer 24

chronic steorid use

diabetes

chemotherapy

malnutrition

lymphedema

PVD

Question 25

What should you do if someone presents with a erythematous and tender laceration that was closed a few days ago?

Answer 25

you need to take the sutures up

treat with oral antibiotics

you can do warm soaks as well - helps reduce inflammation

Question 26

When should sutures be taken out?

On face?

On most places?

In areas of tension?

Answer 26

face: 3-5 days

most places: 10-12 days

areas of straing: 10-14 days

Question 27

Why should you put oiuntment like bacitracin over sutures?

Answer 27

to avoid scab formation - this would be more likely to scar

Question 28

Why must you apply sunscreen to scars for at least 6 months?

Answer 28

they soak up the ligment and won’t let go

Question 29

How long should you wait to consider revision of a scar?

Answer 29

at least a year - they take a long time to heal