Wound ER

Question 1

What is the most predictive factors for infection

Answer 1

Location, age, depth, configuration, and contamination

Question 2

When you examine a wound what do you have to make sure is intact

Answer 2

Sensory (nerve), motor (msk), vascular

Question 3

What do you do with an avulsion wound

Answer 3

cellulose wrap

Question 4

What do you do with a superficial vessel

Answer 4

direct pressure +wound repair- if sutiring can use epi

Question 5

What to do with an arterial bleed

Answer 5

apply direct pressure +call vascular surgery

Question 6

If I have a FB in me what should you do first

Answer 6

Irrigate and probe the wound with forceps

Question 7

Treat my wound

Answer 7

1) Clean
2) anesthetize
3) Irrigate- under pressure
4) Debridement of nonviable tissue
5) re-irrigate
6) suture/wound closure
7) antibiotics?

Question 8

What antibiotics should you give with a wound

Answer 8

Keflex 500mg TID
MRSA?- bactrim DS ID for 10 days
Cat bite- augmentin

Question 9

If I got a nail through my shoe what antibiotics should i get

Answer 9

anything that covers pseudomonas

Question 10

How should you irrigate a wound

Answer 10

Under pressure

Question 11

These are the strongest and most accurate methods of closure

Answer 11

Sutures

Question 12

These are quick and easy method of closure

Answer 12

Staples

Question 13

What is the most cost effective way of closing a wound

Answer 13

Adhesive tapes

Question 14

This method of closing lasts for 5-10 days and is like glue

Answer 14

tissue adhesives

Question 15

How far should tissue adhesive extend on either side of the wound edges

Answer 15

5-10mm

Question 16

I have a facial lacerations what size suture should you use on me

Answer 16

6-0

Question 17

I have a lip laceration what part do you suture up first…and what size suture do you use

Answer 17

vermillion border. 6-0

Question 18

I have an intraoral laceration treat me!

Answer 18

4-0 absorbable, antibiotics and salt water gargles

Question 19

I have a laceration on trunk and extremities what size suture

Answer 19

4-0

Question 20

I have a laceration on my scalp what should you do

Answer 20

Staples or 3-0 to 4-0 sutures

Question 21

What is the classic suture for the ER

Answer 21

Simple interrupted

Question 22

I have a really deep cut, what suture shoudl you put in first to provide good tensile strength

Answer 22

deep dermal

Question 23

How long after an injury do you have to get sutures in your face

Answer 23

24 hrs

Question 24

How long after an injury do you have to get sutures on your body

Answer 24

12 hours

Question 25

Should lacerations on your hand be sutured

Answer 25

No- allow to heal by secondary intention

Question 26

For bit wounds what antibiotic should you give me

Answer 26

Amoxicilin-clavulanic acid (Augmentin)

Question 27

I have a hand injury who should I go see

Answer 27

Hand surgeon

Question 28

When should you admit me for a "Fight Bite" injury

Answer 28

Issue with compliance Co morbid illness Current evidence of infection Joint/tendon involvement

Question 29

If I admit you what antibiotics should I give you

Answer 29

Ampicillin-sulbactam or cefoxtin

Question 30

I cut my extensor tendon is urgent repair essential

Answer 30

No- can wait a bit

Question 31

I cut my flexor tendon is urgent repair essential

Answer 31

YES- Scaring can occur if not

Question 32

What do you do while waiting for my flexor tendon lac repair

Answer 32

Antibiotics Clean dry steril dressing Splint- MCP flexed, PIP and DIP extended

Question 33

Tx my nail bed avulsion

Answer 33

Suture nail back on Antibiotics follow up

Question 34

What do you need to do for a subungaual hematoma

Answer 34

X-ray first to ensure no Fx | Clean, anesthesia, heated cautery tip, bacitracin, bandage

Question 35

What do you do with ring tourniquet syndrome

Answer 35

Cut the ring off or get it off somehow

Question 36

My wound isn't healing. Why?

Answer 36

FB

Question 37

Should you get an X- ray of my FB

Answer 37

Yeah probably-

Question 38

What can you see on X- ray

Answer 38

Metal, bone, teeth, pencil, some plastics, gravel, snad, aluminum

Question 39

Is glass visible on x ray

Answer 39

Yup- 95%

Question 40

What types of things can you NOT see on x ray

Answer 40

Wood, thorns, some small fish bones

Question 41

What type of FBs should you give me antibiotics for after removal

Answer 41

soil-covered objects, teeth, anything dirty looking

Question 42

What is the only contraindication to tetanus toxoid

Answer 42

Hx of neurologic or severe systemic rxn

Question 43

What antibiotics for a FB

Answer 43

Augmentin, or Clinda for pen allergic

Question 44

I&D procedure

Answer 44

1) Consent 2) universal precautions 3) Prepare area 4) anesthesia 5) Use 11 or 15 blade 6) express pus 7) Insert hemostat into cavity 8) Break up loculations 9) Irrigate 10) pack loosley 11) pts should apply warm compresses 12) Schedule follow up 13) Antibiotics - Keflex TID for 10 days