| Wounds & Healing | Suture Basics | Fish Hook Removal | Staples / Glue Basics | Best Practice |
|---|---|---|---|---|
|
Wound dehiscence.
What is the separation and opening of wound edges?
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The knot.
What is the weakest point of a suture?
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False; clean technique is required.
T/F: Fish hook removal must be done under sterile technique.
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The scalp.
What is the most commonly used location for staple use?
|
True
T/F: Using non-sterile gloves does not increase the number of infections compared with sterile gloves for outpatient minor / uncomplicated laceration repair in immune-competent adults.
|
|
True
T/F: Applying white petrolatum to a sterile wound to promote healing is as effective as applying an antibiotic ointment?
|
Non-absorbable sutures. (ie: Ethilon, Prolene).
What is the preferred suture material for most wounds due to low tissue reactivity, high knot security, and tensile strength?
|
False; this works well for barbless hooks but has very low success for barbed hooks and typically causes more pain and tissue trauma.
T/F: If a barb is embedded; the best technique for removal is the retrograde or back-out method.
|
Primary intention / Primary closure
What type of healing/closure describes when the wound edges are brought and kept together by sutures or staples.
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A/ <3 doses in adulthood
B/ Last dose >10 years in clean and minor lacerations C/ Last dose >5 years in contaminated / complex wounds
What is an indication to provide Tetanus vaccine following injury?
|
|
Size, location and motion of wound; Age; Genetics; Race; Connective Tissue Disorders; Poor nutrition; Local infection; Glucocorticoid therapy; Diabetes Mellitus; Ischemia; Smoking; Foreign bodies...
What are 3 risk factors for delayed healing?
|
30 - 90 minutes (and will begin working in 45 seconds). Some resources report effect up to 2 hours.
What is typical duration that Lidocaine 1% without Epi will provide anesthesia for?
|
A/ In or near an eye
B/ In or near a joint, bone, or deep in a muscle C/ In or near a vital structure (ie: carotid artery, radial artery; testicle, urethra, etc.) C/ Concern that removal may damage nerves or blood vessels D/ The injured person is not sufficiently calm to perform the procedure safely E/ High risk for tetanus (may require Immunoglobulins)
Name two circumstances someone with an embedded fish hook should be referred to ER for assessment and care.
|
True
T/F: Staples can be used in areas where cosmetic results are not necessary, especially when the laceration is >5 cm?
|
False, evidence is lacking to support this claim; however, it is best to avoid injecting these areas with lidocaine-epinephrine in those with PVD.
T/F: Lidocaine with epinephrine is absolutely contraindicated in areas like the fingers, nose, or ears due to risk of skin necrosis.
|
|
False; bites (especially human and cat) are high risk for infection and typically require prophylactic antibiotics.
T/F: The immediate irrigation and closure of animal and human bites is recommended; if left open this can lead to florid infection.
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Less.
The larger the diameter of the suture, the _____ secure the knot.
|
A/ Immunocompromise
B/ Diabetes Mellitus C/ Peripheral Vascular Disease D/ Deep wounds involving muscle, tendon or ligament E/ Very dirty hook
What are two indications for prophylactic antibiotic therapy following fish hook removal?
|
False: Not to be placed inside the wound.
T/F: Tissue adhesive (skin glue) must be applied across opposed edges, inside the wound, and held closed for 30 seconds. Apply three to four layers with 30 seconds between applications.
|
Tap water
What has been shown to have as low, or lower, infection rates versus antiseptic solutions for wound irrigation?
|
|
Allowing the wound to close by itself.
What is secondary intention healing / secondary closure?
|
Up to 12 hours. Facial wounds can be closed up to 24 hours.
What is the timeframe to close a clean, uninfected laceration following an injury to any body part other than the face?
|
String-Yank Technique
What first-line fish hood removal method is less invasive and should be tried prior to second-line more invasive methods such as push and cut?
|
Used for closing scalp wounds. Opposing strands of hair are brought together with a simple twist and are secured with a drop of tissue adhesive. The technique is best for non-actively bleeding wounds that are less than 10 cm long and when scalp hair is longer than 3 cm. Typically causes less scarring and has fewer complications.
What is the hair apposition suture technique?
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3-5 mg / kg; max dose of 300 mg (30 mL)
What is the recommended maximum total dose of Lidocaine 1% without epinephrine?
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