创伤和战伤 英语.ppt

Wound Management Objectives Preserve viable tissue Restore tissue continuity and function Avoid infection Minimize scar formation Wound Management Lacerations-are one of the most common problems treated in the ED Accounts for more than 25% of malpractice Failure to dx. Retained foreign body Failure to dx. nerve or tendon injury infection Initial Approach ABC’s Relevant HP History Allergies, tetanus status Wound mechanism, contamination, potential FB Other injuries Occupation, handedness High Risk Wounds Location Hand, foot, joints Scalp or face Configuration Puncture, linear, stellate Mechanism Crush, object causing lac High Risk Wounds History of patient Diabetic Age 50 Chronic alcoholic HIV, chronic steroids Peripheral vascular disease Prosthetic cardiac valve Asplenic Physical Exam Control local bleeding Expose pt and look for other wounds Evaluate distal neurovascular function Motor function, 2 point sensation Describe the wound Laceration, puncture, abrasion, avulsion, crush, bite Consider X-rays R/O FB, bony injury Steps in Wound Closure Inspection Preparation Anesthesia Irrigation Exploration Debridement Closure Dressings Inspection Physical exam Description of wound Location, length, width Neurovascular check Preparation First step in reducing infection and optimizing cosmesis Positioning patient Universal precautions Gloves, gown, goggles Skin cleansing Povidine-iodine (betadine) Polaxamer-188 (Sur Clens) Anesthesia Topical Local Nerve blocks IV sedation Local Anesthesia Through the open edge of the wound At the junction of dermis and superficial fascia Laceration length equals cc’s of anesthetic Use small needle (27 or 25) and slow infiltration to minimize pain Irrigation Purpose is to remove foreign material and debris without damaging tissue High pressure, large volume 16 or 18 gauge angiocath attached to 30cc syringe NS or sterile water Exploration After wound in anesthetized With fingertip, q-tip or hemostat Liberal use of X-rays Wound Cl