Why should you avoid overpacking a drained abscess?
It can cause ischemia
What is the goal of packing a drained abscess?
You don't want the edges to heal in the bacteria and cause a new abscess to form in the cavity, you can cut an elipse if not in a sensitive area and then packing is not as essential. The packing allows for healing and continued drainage
After an I and D when should the pt follow up to have the drain removed?
48hrs
If there is cellulitis associated with the abscess what should you perscribe the patient?
Bactrim DS x2 BID or if allergic Clindamycin
Your patient has a facial wound (that needs sutures) that they got yesterday morning it is now the next day in the afternoon and by your calculation has been 29 hours. Should you suture this wound? Consult plastic surgery? Or allow natural healing?
Consult plastics it has been more than 24 hours
For wounds not on the face if the wound was sustained __ to ___ hours before they present to you, you should consult plastics on whether to suture or not.
12-18 hours
What is included in a suture kit?
2 sterile bowls
scissors
needle holder
sterile gauze
sterile drape
normal saline
betadine
suture material
Name three non-dissolvable sutures
ethilon
Prolene
Silk (usually only used in the OR or on a chest tube)
Name 4 dissolvable sutures
Vicryl-braided � 60 days
Monocryl-monofilament
Gut
Rapid absorbing
What is the drawback to rapid absorbing type sutures?
They are weak and cannot take high tension wounds
What is the drawback to using Gut sutures?
It stiffens as you suture and you have to keep it wet so it is hard to use
What is the drawback to vicrylbraided sutures?
The braid can carry bacteria and puts the pt at risk for wound site infection
Are higher numbers a finer thread or a wider thread in sutures?
Higher number narrow thread
What type of suture should you use on the face?
5-0 or a 6-0 ethilon or prolene
What areas of the body should you not use prolene and why?
Areas of tension or movement because it has more stretch than ethilon and will loosen with repetative movement
What type of suture is typically used for internal sutures?
Gut or monocryl
Why do you do internal sutures?
Used to take off the tension on the more superficial stitches by holding the deeper wound edges together
What 4 things can you do to help hemostasis of a wound?
Elevation, pressure, ice, tourniquet
Which has a quicker onset (lidocaine or bupivicaine)?
Lidocaine
which has a longer duration? Lidocain or bupivicaine?
Bupivicaine
Why do you use bicarb with a lidocaine injection?
Because lidocaine is acidic and causes a sting upon injection so the bicarb neutralized the lidocaine making it sting less. Unfortunatly it also decreases the effectiveness of the anesthetic
What can you give with an lidocain injection to make it last longer and slow bleeding?
Epinephrine
Where can you not use epinephrine injection with lidocaine?
Fingers, toes, penis or nose
What are the 3 active agents in LET?
Lidocaine, epinephrine, tetracaine
What is EMLA?
An anesthetic cream, eutectic mixture of local anesthesia
Which topical anesthetic must be applied to closed skin, has an onset of 30 mins and is used for LP, IV, and blood draws?
EMLA
What topical anesthetic must be applied to an open wound, has an onset of 15 mins and lasts up to one hour?
LAT
What stitch should you use for a wound with no tension?
Simple interrupted or simple running stitch
what stitchin style should you use for a lac with edge tension?
Horizontal mattress and vertical mattress
What stitching style should you use for a deep wound with tension?
Subcuticular
what stitch should you use for an edge with a corner flap?
Corner stitch
What should you cover a recently sutured area with?
Bacitracin or xeroform, dry sterile dressing
At minimum you should change the dressing over stitches how often?
Twice a day
Should you leave a suture site dry? Or soak it
dry for 24 hours no soaking wet until sutures come out
When do you take out face sutures?
5-7 days!
When do you take out non flexor surface sutures?
7-10 days
When do you take out flexor surface sutures?
10-14 days
Why cant you saturate an area that was recently sutured?
Water softens the skin and the suture can rip through the skin and come out also causing a new wound in the process and making new stitches more difficult
Where should you use staples?
The head, scalp injuries
When can you use dermabond?
When there is no pressure on the wound and the edges come together perfectly
Do you shave the scalp before closing a scalp wound?
No, shaving actually increases the risk of infection
Can the patient shower after having a scalp wound closed?
No they cannot shower until staples come out (for this reason it is nice to clean off as much blood as possible for the patient)
How can you decrease keloid scarring?
Constant pressure on the scarring tissue
Blood under the nail is call a _____
subungual hematoma
Subungal hematomas are best drained __ to __ days after injury
3-5
your pt has what looks like a subungal hematoma but reports it has been there for years and thinks the bruise is permanent what should you be worried about?
Malignant melanoma
What are 3 instruments you sould use to trephinate a SH?
Heated paper clip
electrocautery penicillin18g needle
What are 3 indications to repair the nail bed
uncontrolled bleeding
obvious laceration
base is avulsed from matrix
What anesthetic do you use for a digital block?
Lidocaine, bupivocaine
can you do a nailbed repair without a digital block?
NO
In a nailbed repair what doyou do with the old nail?
Clean the old nail and splint it to the finger so that it can serve as a guide for the new nail to grow
What is another name for nursemaid's elbow
radial head subluxation (partial dislocation)
What causes nursemaid's elbow?
External rotation distraction or torquing of the elbow via the forearm
A child presents to you with their arm held at their side with slight elbow flexion holding their arm in place over their lap. They do not appear to be in any pain what is your diagnosis?
Nursemaid's elbow
Nursemaid's elbow typically happens in children age ___ to ___
15 months to 3 years
Name 3 techniques for fixing nursemaid's elbow
Flexion
Felexion with hand in external rotation
Extension with hyperpronation
What are some good follow up instructions for nursemaid elbow (3)
no lifting or twisting it for 2-3 days
NSAID for pain
Eductaion to cause and prevention
A patient presents to you with erythema, swelling, and tenderness around the nail of the big toe they state that they just had a pedicure to make their toes look good for those new coach shoes that they got on sale because they were a size too small. What do you diagnose? What cool new shoe should you give this patient after you fix their problem?
Ingrown toenail, post op shoe
How would you educate a pt with an ingrown toenail?
Wear comfortable shoes
warm soaks twice daily
follow up with pcp or podiatry within a week
return if symptoms worsen
post op shoe for comfortabletrim nail straight across not rounded
wear wider shoes if possible
2 causes of paronychia
nailbiting and work trauma
what is the treatment for paronychia?
Warm soaks, drainage, avoidance
What should you place an avulused tooth in to preserve it?
Milk
How should you hold a tooth that has fallen out?
Handle by the crown never by the root
What conditions can you splint with a butterfly, short leg or posterior leg spint?
Fibula fracture
Stable ankle fracture
severe ankle sprain
What spint should you use for a collies fracture?
Sugar tong
What can you use a sugar tong splint for?
Collie fracture
surpacondylar fracture
mid shaft forearm fracture
What splint do you use for a supracondylar fracture?
Sugar tong splint
What splint do you use for a mid shaft or forearm fracture?
Sugar tong splint
What do you use a ankel short let/posterior splint plus a sugar tong spling for ?
Unstable ankle fracture
severe ankle sprain
foot fracture
What splint do you use for a boxer's fracture
ulnar gutter
What do you use a volar splint for?
Distal forearm fracture
wrist sprain
laceration or immobilization
carpal fracture
What should you use a thumb spica splint for?
Scaphoid fracture
thumb sprain/dislocation
DeQuervain's tendontitis
Gamekeepers thumb
Other thumb fractures
What do you use a posterior elbow/long arm splint for?
Supracondylar
elbow sprain
radial head fracture
Velcro wrist splint is used for what?
Wrist sprain
wrist laceration
When would you use a lewenstern splint?
Thumb injury including
fracture
lacerations
dislocation
What would you use a Post op shoe for?
Toe and food fracture and sprain
Laceration- immobilization and protection
what is the first line proceedure for a nasal foreign body in a kid?
Parental kiss and blow
What are some other methods you can try for a nasal foreign body besides blowing
