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WoundManagementWoundManagementObjectivesPreserveviabletissueRestoretissuecontinuityandfunctionAvoidinfectionMinimizescarformationWoundManagementLacerations-areoneofthemostcommonproblemstreatedintheEDAccountsformorethan25%ofmalpracticeFailuretodx.RetainedforeignbodyFailuretodx.nerveortendoninjuryinfectionInitialApproachABC’sRelevantH&PHistoryAllergies,tetanusstatusWoundmechanism,contamination,potentialFBOtherinjuriesOccupation,handednessHighRiskWoundsLocationHand,foot,jointsScalporfaceConfigurationPuncture,linear,stellateMechanismCrush,objectcausinglacHighRiskWoundsHistoryofpatientDiabeticAge>50ChronicalcoholicHIV,chronicsteroidsPeripheralvasculardiseaseProstheticcardiacvalveAsplenicPhysicalExamControllocalbleedingExposeptandlookforotherwoundsEvaluatedistalneurovascularfunctionMotorfunction,2pointsensationDescribethewoundLaceration,puncture,abrasion,avulsion,crush,biteConsiderX-raysR/OFB,bonyinjuryStepsinWoundClosureInspectionPreparationAnesthesiaIrrigationExplorationDebridementClosureDressingsInspectionPhysicalexamDescriptionofwoundLocation,length,widthNeurovascularcheckPreparationFirststepinreducinginfectionandoptimizingcosmesisPositioningpatientUniversalprecautionsGloves,gown,gogglesSkincleansingPovidine-iodine(betadine)Polaxamer-188(SurClens)

AnesthesiaTopicalLocalNerveblocksIVsedationLocalAnesthesiaThroughtheopenedgeofthewoundAtthejunctionofdermisandsuperficialfasciaLacerationlengthequalscc’sofanestheticUsesmallneedle(27or25)andslowinfiltrationtominimizepainIrrigationPurposeistoremoveforeignmaterialanddebriswithoutdamagingtissueHighpressure,largevolume16or18gaugeangiocathattachedto30ccsyringeNSorsterilewaterExplorationAfterwoundinanesthetizedWithfingertip,q-tiporhemostatLiberaluseofX-raysWoundClosureMaterialsSutureSteri-stripsStaplesTissueadhesive(Dermabond?)SutureTypesAbsorbablePlaingutChromicgutMonocrylVicrylNon-absorbableSilkNylonProlenePolyester/dacronDebridementRemovalofforeignmatter,bacteriaanddevitalizedtissueCreatessharpwoundedgeswhichareeasiertorepairResultsinmorecosmeticallyacceptablescarDebridementSutureTechniquesSimpleinterruptedContinuous(running)VerticalMattressHorizontalMattressSutureTipsFirstsuturesaremostcrucialShouldbeplacedwithregardstoaligninglandmarksHandletissuegentlyApproximateandevertwoundedgesDonotstrangulatetissueAlignknotsononesideofwoundDecreasesinflammatoryresponseEversionofwoundedgesEversionofwoundedgesHandlingtheNeedleHolderMotionoftheNeedleHolderSimpleInterruptedSutureVerticalMattressHorizontalMattressStellateLacerationParallelLacerationsAftercareChecktetanusstatusPre-printedwoundcareinstructionsWoundcheck24-48hrsHandwoundsBitesHeavilycontaminatedWoundsrequiringantibioticsPtmustunderstandsignsofinfectionAftercareDressingsNon-adherentAntibioticointmentAvoidsunexposure

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