Hey guys, anyone else annoyed at the lengthy Rosen's chapters? Remember we still have access to Tintinalli's for FREE online @ AccessEmergencyMedicine.com (login: nymh, pass: medicine). Sift through it at your leisure on your iPad instead of lugging the fat text around.
Here are what I think are some cool take-home points from the chapter on wound care:
#1 Important hx questions: blunt vs. sharp?, occupation & handedness? chronic med conditions? self-attempted wound care @ home & time elapsed until initial cleansing? hx of keloid?
#2 For adults: Ask if they feel a foreign body! Those who feel they do are much more likely to have a foreign body in the wound --> LR = 2.49 vs LR = 0.69
#3 Dirty wounds --> axilla, perineum, toe webs, intertriginous areas have *millions of bacteria per sq CM
#4 Finger Lac: finger tourniquets OK if less than 30 min, you CAN use lido with EPI for digital blocks/local!
#5 Sterility in wound care has no evidence for preventing infection! Use common-sense cleanliness.
#7 Ultrasound can detect foreign bodies if they are hyperechoic *look for shadowing.
#8 You can use chlorhexidine/betadine AROUND the wound to clean the skin, but do not let it get in the wound or near edges as it impairs healing.
#9 Irrigation: a) do not SOAK
b) Low pressure = 0.5 psi (for delicate tissue e.g. eyelid, or uncontaminated wound)
c) high pressure = 7 psi for most wounds * 50ml syringe w/ 18G catheter = 20psi
d) Volume = 60mL per cm of wound, OR just remember 200mL's total for typical
e) USE STERILE SALINE (least toxic)
#10 Abx: Debris or feces, bites, or wounds in avascular areas ** GIVE
Human bites (anywhere) and mammal bites to the hands: give amox/clavulanate to cover
Pasteurella and Eikenella
Fresh water wounds or puncture through rubber/sneaker = cover pseudomonas
Duration of abc: 3-5 d for non-bite , 5-7 d for bites