Monday, June 4, 2012

Wound Care ... Take-Home Points From Tintinalli

Hey guys, anyone else annoyed at the lengthy Rosen's chapters? Remember we still have access to Tintinalli's for FREE online @ (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.

#6 A "Bleeder" , if it is a small superficial vessel can be compressed using horizontal mattress or figure eight suture seen in the image above.

#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

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