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1、WoundManagementWoundManagementObjectivesPreserveviabletissueRestoretissuecontinuityandfunctionAvoidinfectionMinimizescarformationWoundManagementLacerations-areoneofthemostcommonproblemstreatedintheEDAccountsformorethan25%ofmalpracticeFailuretodx.RetainedforeignbodyFailuretodx.
2、nerveortendoninjuryinfectionInitialApproachABC’sRelevantH&PHistoryAllergies,tetanusstatusWoundmechanism,contamination,potentialFBOtherinjuriesOccupation,handednessHighRiskWoundsLocationHand,foot,jointsScalporfaceConfigurationPuncture,linear,stellateMechanismCrush,objectcausing
3、lacHighRiskWoundsHistoryofpatientDiabeticAge>50ChronicalcoholicHIV,chronicsteroidsPeripheralvasculardiseaseProstheticcardiacvalveAsplenicPhysicalExamControllocalbleedingExposeptandlookforotherwoundsEvaluatedistalneurovascularfunctionMotorfunction,2pointsensationDescribethewoun
4、dLaceration,puncture,abrasion,avulsion,crush,biteConsiderX-raysR/OFB,bonyinjuryStepsinWoundClosureInspectionPreparationAnesthesiaIrrigationExplorationDebridementClosureDressingsInspectionPhysicalexamDescriptionofwoundLocation,length,widthNeurovascularcheckPreparationFirststepi
5、nreducinginfectionandoptimizingcosmesisPositioningpatientUniversalprecautionsGloves,gown,gogglesSkincleansingPovidine-iodine(betadine)Polaxamer-188(SurClens)AnesthesiaTopicalLocalNerveblocksIVsedationLocalAnesthesiaThroughtheopenedgeofthewoundAtthejunctionofdermisandsuperficia
6、lfasciaLacerationlengthequalscc’sofanestheticUsesmallneedle(27or25)andslowinfiltrationtominimizepainIrrigationPurposeistoremoveforeignmaterialanddebriswithoutdamagingtissueHighpressure,largevolume16or18gaugeangiocathattachedto30ccsyringeNSorsterilewaterExplorationAfterwoundina
7、nesthetizedWithfingertip,q-tiporhemostatLiberaluseofX-raysWoundClosureMaterialsSutureSteri-stripsStaplesTissueadhesive(Dermabond©)SutureTypesAbsorbablePlaingutChromicgutMonocrylVicrylNon-absorbableSilkNylonProlenePolyester/dacronDebridementRemovalofforeignmatter,bacteriaanddev
8、italizedtissueCreatessharpwoundedgeswhichareeasiertorepairRes
