Ncm106 Notes 2012 ABC

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NCM106 notes – Acute Biologic Crisis Archeans

2012

1 Ayie/Trix/Rheiz/Noemi/Faye*

SHOCK AND INTERNAL INJURIES

Shock is the common denominator in a wide variety of disease processes that presents as an immediate threat to life

Simply defined, shock is inadequate tissue perfusion This inadequate tissue perfusion is the result of failureof one or more of the ff:- The heart (pump failure)- Blood Volume- Arterial Resistance Vessels- The capacity of the venous beds

Any condition that significantly affects any of the abovemay precipitate a shock state

CLASSIFICATIONS OF SHOCK

1. Hypovolemic Shock

Occurs when a significant amount of f luid is lost fromintravascular space

This fluid may be blood, plasma, or electrolyte solution May result from hemorrhage, burns, GI losses or fluid

shifts.

2. Cardiogenic Shock Occurs when the heart fails as a pump Primary causes of this failure are myocardial

infarction (MI), serious cardiac dysrhythmias,and myocardial depression

Secondary causes include mechanicalrestriction of cardiac function or venousobstruction (cardiac tamponade, vena cavaobstruction, tension pneumothorax)

3. Distributive Shock - Septic- Anaphylactic (systemic vasodilation)- Neurogenic

a. Septic Shock - caused by infection- characterized by symptoms of sepsis

plus hypotension and hypoperfusiondespite adequate fluid volumereplacement

b. Anaphylactic Shock A severe, whole body allergic

reaction After being exposed to a substance

like bee sting venom, the person’s

immune system becomes sensitizedto that allergen

On a later exposure, an allergicreaction may occur. This reaction issudden, and involves the whole body

Anaphylaxis can occur in response toany allergen

c. Neurogenic Shock Sometimes called vasogenic shock , results

from the disruption of ANS control overvasoconstriction

The veins and arteries immediately dilate,drastically expanding the volume of thecirculatory system, with a correspondingreduction of BP

Other classifications (rare types):

Spinal Shock Insulin Shock

Primary Assessment and Interventions

Rapid recognition and prompt intervention areessential to increase the chance of survival because adownward spiral of physiologic responses will occur if shock is not treated

The initial priorities in the assessment are the same forall types of shock - Is the airway open?- Is the patient breathing?- Is there a circulation problem?

Initiate immediate interventions as indicated.- Resuscitate as necessary.- Administer O2- Start cardiac monitoring- Control hemorrhage

Assess LOC (important indicator of shock because it reflects cerebral perfusion)

Changes may include:- Confusion- Irritability

- Anxiety- Agitation- Inability to concentrate

Watch for increasing lethargy progressing to obtundationand coma, indicating progression of shock

Monitor arterial blood pressure.(Fall in the systolic pressure)

- There is no absolute value in BP that indicates a shock state

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- It is the deviation from normal that isimportant

- A systolic pressure below 80 mmHgor a MAP below 60 mmHg isindicative of shock

Assess pulse quality and rate change.- The rate is usually increased- Weak, thread pulse due to decreased

cardiac output and increasedperipheral vascular resistance

Assess urine output.- A decrease in renal BF or pressure

will result in decreased urine output - Ideally in an adult, the urine output

should be 30 to 60 mL/hour- An output of less than 25 mL/hour

may indicate shock Assess capillary perfusion.

- Pale, ashen, mottled, cold and sweatyskin indicates potent vasoconstriction

- Capillary refill greater than 2seconds indicated vasoconstriction

Also assess for:- Subjective feeling of impending

doom- Metabolic acidosis due to anaerobic

metabolism within the cells- Excessive thirst

General Interventions Administer 100% O2 by nonbreather face

mask to maintain the partial pressure of arterial oxygen at 90 to 100.

Assist with intubation if the patient is unableto maintain airway.

Fluid resuscitation.- Two large bore IV lines should be

established- Ringer’s Lactate is the initial fluid

choice (normal saline is the second choice because hyperchloremic

acidosis may develop if massiveamount of normal saline is infused)

- Rate of infusion depends on severityof blood loss and clinical evidence of hypovolemia

- Packed RBCs are infused when thereis massive blood loss

- Additional platelets and coagulationfactors are given when large

amounts of blood are neededbecause replacement blood isdeficient in clotting factors.

- Warm the blood (commercialwarmer)

*massive blood replacement has acooling effect that can cause cardiacdysrhythmias, paradoxical hypotension, decreased oxyhemoglobin dissociation, or cardiac arrest.

Insert an indwelling urinary catheter.- Record urine output every 15-30

minutes- Urinary volume reveals adequacy of

kidney and visceral perfusion Maintain patient in supine position with the

legs elevated.- This position is contraindicated in

patients with head injuries ECG monitoring

- Dysrhythmias may contribute toshock

Maintain ongoing nursing surveillance of totalpatient to assess patient response totreatment

- Color- V/S- CVP- ABGs

- Urine output - ECG- decreased HCT and Hemoglobin- decreased coagulation profile- decreased electrolytes

Immobilize fractures to minimize blood loss Maintain normothermia.

- Too much heat producesvasodilation can increase fluid lossthrough perspiration

- A patient who is in septic shock should be kept cool because highfever will increase the cellularmetabolic effects of shock

Pharmacologic Interventions- Vasopressors (ADH) may be

necessary, but not until volume isreplaced

- Antibiotics (broad spectrum for septicshock)

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NURSING ALERT!

Trendelenburg’s position is no longerrecommended because of the potentialrespiratory compromise because of pressure

on abdominal organs

HEAD INJURIES

Can include fractures to the skull and face,direct injuries to the brain (as from a bullet),and indirect injuries to the brain (such as aconcussion, contusion, or intracranialhemorrhage).

Specific Head Injuries

Concussion: A temporary loss of consciousness that results from a transient interruption of the brain’s normal functioning

Contusion: A bruising of the brain tissue.Actual small amounts of bleeding into thebrain tissue

Intracranial Hemorrhage: bleeding into aspace or potential space between skull andbrain

- Complications of a head injury arerising intracranial pressure (ICP) andbrain herniation

- Can be classified as epiduralhematomas, subdural hematomas, or

subarachnoid hemorrhagesdepending on the site of bleeding

NURSING ALERT! Assume a cervical spine fracture for

any patient with a significant headinjury, until proved otherwise

PRIMARY ASSESSMENT

Airway: assess for vomitus, bleedingand foreign objects. Ensure cervicalspine immobilization, use jaw thrust

technique without head tilt. Suctionheavy vomitus. Do not stimulate thegag reflex as this can cause increasein ICP.

Breathing: assess for abnormallyslow or shallow respirations. Anelevated CO2 partial pressure canworsen cerebral edema. Administerhigh flow O2, the most common

cause of death from head injury iscerebral anoxia.

Assist inadequate respirations with abag-valve mask as necessary.Prophylactic hyperventilation not

indicated. Control bleeding – Apply a bulky,loose dressing with no pressure to allhead injuries. Do not attempt to stopthe flow of blood or CSF from nose orears

Initiate two IV lines. The rate of flowshould be determined by thepatient’s hemodynamic status.

Irreversible brain damage: 4 mins. Circulation: assess pulse and

bleeding Disability: assess the patie nt’s

neurologic status

SUBSEQUENT ASSESSMENT

History- Mechanism of injury- Duration of loss of consciousness- Memory of the event - Position found

LOC- Change in the LOC is the most sensitive

indicator of a change in patient’s condition

-

Glasgow Coma Scale Vital Signs- HTN and bradycardia are late signs of

increasing ICP.- Head-injured patients may have associated

cardiac dysrhythmias, noted by an irregular orrapid pulse

Unequal or unresponsive pupils Confusion or personality changes Impaired vision One or both eyes appear sunken Seizure activity Periauricular ecchymosis (battle’s sign) Rhinorrhea or otorrhea (indicative of leakage of CSF) Periorbital ecchymosis

NURSING ALERT!

If basilar skull fracture or severe midface fractures aresuspected, a NGT is contraindicated. An orogastric tubemay be considered for insertion

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Keep the neck in a neutral position with the cervicalspine immobilized

Establish an IV line of normal saline or LactatedRinger’s fluid volume should be restricted

Be prepared to manage seizures- if seizures occur, they

should be controlled immediately Maintain normothermia

Pharmacologic Interventions

Anticonvulsants – to control seizures Mannitol (Osmitrol) – to reduce cerebral edema and

decrease ICP Antibiotics Antipyretics to control hyperthermia.

CERVICAL SPINE INJURIES

Serious injuries because the crushing, stretching androtational shear forces exerted on the cord at the timeof trauma can produce severe neurologic deficits

Edema and cord swelling contribute further to the loff of spinal cord function

Any person with a head, neck or back injury or fracturesto the upper leg bones or to the pelvis should besuspected of having a potential spinal cord injury untilproved otherwise.

Primary Assessment

Provide immediate immobilization of the spine while

performing assessment Airway. Breathing.

- Intercostal paralysis withdiaphragmatic breathing

- Shortness of breath producesincreased respiratory rate anddifficulty in speaking

Circulation Disability – assess neurologic status

Subsequent Assessment

Immobilize the cervical spine Open the airway using the jaw-thrust technique without

head tilt If the patient needs to be intubated, it may be done

nasally If respirations are shallow, assist with bag-valve mask

(ambu bag) Assess the position of the patient when found; this may

indicate the type of injury incurred

Forearms flexed across the chest – C6 injury Arms stretched out above the head – cervical injury Hypotension and bradycardia accompanied by warm,

dry skin suggests spinal shock Neck and back pain/extremity pain or burning

sensation to the skin History of unconsciousness Total sensory loss and motor paralysis below level of

injury Loss of bowel and bladder control; usually urinary

retention and bladder distention Loss of sweating and vasomotor tone below level of

cord lesion Priapism – persistent erection of penis. Hypothermia – due to inability to constrict peripheral

blood vessels and conserve body heat Loss of rectal tone

NURSING ALERT!

A spinal cord injury can be made worse during the acutephase of injury, resulting in permanent neurologicdamage. Proper handling is priority.

GENERAL INTERVENTIONS

Insert an NG tube Keep the patient warm Initiate IV access Insert an indwelling urinary catheter to avoid bladder

distention Monitor for hypotension, hyperthermia andbradycardia

Continue with repeated neurologic examinations todetermine if there is deterioration of spinal cord injury

Be prepared to manage seizures Pharmacologic interventions: high dose steroids

(Methylprednisolone) - The standard regimen is 30 mg/kg IV

loading dose over 15 mins followedby a 5.4 mg/kg/hr infusion to beinitiated 45 mins later

- Continue the infusion for 23 hours.

MAXILLOFACIAL TRAUMA

Injuries to the head frequently resulting in the faciallacerations and fractures to the facial bones (i.e. nasal fractures, orbital fractures, maxillary fractures, and mandibular fractures)

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PRIMARY ASSESSMENT

Initiate immobilization of the spine while performingassessment

Airway obstruction can occur due to tongue swelling

(fractured jaw) , bleeding, or broken or missing teeth Breathing – may be impaired due to an obstructedairway

Circulation – control bleeding Disability

PRIMARY INTERVENTIONS

Establish and maintain an airway- This includes having high flow O2- Inserting an oral airway, or assisting

with intubation- A nasopharyngeal airway should be

used only if there is no evidence of nasal fractures or CSF leakage fromnose

Control bleeding – do not apply pressure tothe injury site

Apply a bulky, loose dressing Do not attempt to stop the flow of blood or CSF

from the nose or ears

SUBSEQUENT ASSESSMENT

Examine the mouth for broken or missingteeth

Assess for a potential eye injury, vision loss,double vision or pain in the eye

Examine the eye for dysconjugate gaze-incoordination of eye movements

Paralysis of the upward gaze is indicative of aninferior orbit fracture (blowout fracture)

Crepitus or a cracking feeling on palpationaround the nose usually indicates a nasalfracture

Malocclusion of the teeth is indicative of amaxilla or mandible fracture

*Zygoma (cheekbone) fracture

- A palpable flattening of the cheek and aloss of sensation below the orbit

Spasms of the jaw (trismus) and mobility of thejaw indicate a maxilla fracture

Rhinorrhea or otorrhea (indicative of leakageof CSF).

Gently apply ice to areas of swelling orecchymosis.

- This may reduce further swelling andpain

- However, if you suspect an injury to

the eye itself, do not apply ice If other injuries permit, elevate head of bed With the potential for a CSF leak, the patient

should be instructed not to blow the nose,cough, sneeze

Nursing Alert!

Do not apply pressure on an injured eye

Nursing Tip

Do not use chemical ice packs near a victim’s

eye; chemical ice packs could leak and burnice.

Possible pharmacologic interventions

MSO4 (Duramorph)Pain Management

Diazepam (Valium)Sedation

ABDOMINAL INJURIES

Account for a large percentage of trauma-relatedinjuries and deaths

The visceral organs contained within the abdomen canbe classified as either hollow or solid.

Damage to a hollow organ can result in acuteperitonitis leading to shock within a few hours

Penetrating abdominal injury- Usually the result of gunshot wounds

or stab wounds Blunt abdominal injuries

- Usually caused by motor vehicleaccidents of falls

Trauma to the abdomen is frequentlyassociated with extra-abdominal injuries (i.e.chest, head, and extremity injuries) and severeconcomitant trauma to multipleintraperitoneal organs

Causes more delayed complications, especiallyif there is injury to liver, spleen or bloodvessels which can lead to substantial bloodloss into the peritoneal cavity

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PRIMARY ASSESSMENT & INTERVENTIONS Assess airway, breathing and circulation Initiate resuscitation as indicated Control bleeding, and prepare to treat shock If there is an impaled object in the abdomen,

leave it there Stabilize the object in place with bulky

dressings along the sides of the object. Obtain history of mechanism of the injury,

type of weapon, and estimated amount of blood loss

- If the patient was stabbed, how longwas the blade?

- Was the person who stabbed thepatient a man or a woman?

- Men usually hold a knife underhand& stab/thrust upward

- Women usually will stab/thrust downward with an overhand motion

- If the patient sustained a gunshot wound, attempt to ascertain the typeof gun and range at which shot

- Time of onset of symptoms- Passenger location (driver frequently

sustains spleen/liver rupture). Weresafety belts worn? Did the airbagdeploy?

Inspect the abdomen for obvious signs of injury (penetrating injury, bruises)

Evaluate for signs and symptoms of

hemorrhage- frequently accompanies abdominal

injury, especially if the liver and spleen have been traumatized

Note tenderness, rebound tenderness,guarding, rigidity and spasm

- Press area of maximal tenderness(let patient point the area)

Remove fingers quickly to check for reboundtenderness (pain suspected point indicatesperitoneal irritation)

Ask about referred pain: Kehr’s sign - pain radiating to the left shoulder

may be a sign of blood beneath theleft diaphragm

- pain in right shoulder can result fromlaceration of liver

Looking for increasing abdominal distention Measure abdominal girth at umbilical

level in early assessment Serves as a baseline from which changes can

be determined

Auscultate for bowel sounds- A silent abdomen accompanies

peritoneal irritation Auscultate for loss of dullness over solid

organs (liver, spleen)

- Indicates presence of f ree air; dullnessover regions normally containing gasmay indicate presence of blood

Look for chest injuries, which frequentlyaccompany intra-abdominal injuries

Cullen’s sign - A slight bluish discoloration

around the navel, a sign of hemoperitoneum

Pain is a poor indicator of an abdominal injury- Rebound tenderness and boardlike

rigidity are indicative of asignificant intra-abdominal injury

A rectal exam and examination of theperineum should be done on all patients

- The presence of blood maybe indicative of trauma.

GENERAL INTERVENTIONS

Goals are to control bleeding, maintain bloodvolume and prevent infection

Keep the patient quiet and on the stretcher(movement may fragment or dislodge a clot in alarge vessel and produce massive hemorrhage)

Cut the clothing away from the wound- Do not cut through bullet holes or

stab marks, this will be needed bylaw enforcement authorities asforensic evidence

Count the number of wounds Look for entrance and exit of wounds If the patient is comatose, immobilize the

cervical spine until after cervical films are taken andcleared Apply compression to external bleeding

Insert two large bore IV lines and infuseRinger’s Lactate

- If possible, one of the linesshould be in a centralvenous location

Insert an NG tube to decompress theabdomen

- This will serve to empty thestomach, relieve gastricdistention and facilitateabdominal assessment

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- If blood is found, it mayindicate stomach injury oresophageal injury

Do not attempt to replace theprotruding organs into the abdomen

Use sterile saline dressings to protect viscera from drying

Cover open wounds with drydressings

Withhold oral fluids to prevent increased peristalsis and vomiting

Insert an indwelling urethral catheter toascertain the presence of hematuria and tomonitor urine output

- If the fracture of the pelvis issuspected, a catheter should not be placed until the integrity of theurethra is ensured

Prepare for peritoneal lavage whenthere is uncertainty about intraperitoneal bleeding

Prepare for surgery if the patient shows evidence of:

- Unexplained shock - Unstable VS- Peritoneal irritation

*Prepare the patient for diagnostic procedures

1. Catheterization and urinalysis

As a guide to possible urinary tract injury and to monitor urine output 2. Type and crossmatch and serial Hgb

and Hct levels Their trend reflects presence or

absence of bleeding3. Complete Blood Count (CBC) WBC is generally elevated with

trauma4. Serum Amylase Elevation Indicates pancreatic injury or

perforations of GI tract 5. CT Scan

Permit detailed evaluation of abdominal and retroperitonealinjuries

6. Abdominal and Chest Xrays May reveal free air beneath diagram

Pharmacologic Interventions

Tetanus prophylaxis

Broad spectrum antibiotics becausebacterial contamination is a frequent complication (depending on history and nature of wound)

INJURIES TO THE BONE AND JOINTS Common Usually obvious injuries and may be dramatic in nature Rarely are these injuries life-threatening

Fractures may be caused by:

Direct trauma- Projectiles, crush injuries

Indirect trauma- Bones being pulled apart or rotational forces

Pathologic reasons

- Weakness in the bone s/t disease process suchas metastatic cancer

Other injuries include:

Dislocation- Complete displacement or separation of a

bone from its normal place of articulation- It may be associated with a tearing of the

ligaments- Example, shoulder, elbow, finger, hips, and

ankles are the joints most frequently affected Subluxation

- Partial disruption of the articulating surfaces- Can cause minimal transition problems

Sprains- Injuries in which ligaments are partially torn

or stretched- Usually caused by a twisting of a joint beyond

its normal range of motion- The severity can range from mild-severe

Strains- Stretching or tearing of muscle and tendon

fibers- Usually caused by overexertion or

overextension- Ex. Hamstrings muscle tear

PRIMARY ASSESSMENT Always ensure the adequacy of airway, breathing and

circulation before initiating treatment Occult blood loss into a closed space from the fracture

may be significant enough to produce Hypovolemicshock

death by exsanguination can occur from pelvic andfemoral fracture

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Estimated blood loss from closed fractures in L- Tibia – 1.5 L- Femur – 2 L- Pelvis – 6 L- Humerus – 2 L

A fractured cervical spine, pelvic fracture of fracturedfemur may produce life threatening injuries

Posterior dislocations of the hip are life and limb-threatening emergencies due to the potential for bloodloss and disruption in blood supply to the head of thefemur

The patient may develop avascular necrosis of thefemoral head and subsequently may require a hipreplacement

Support airway, breathing, circulation if compromised Initiate IV line and treat for shock if evident Protect injured part from movement or further trauma.

Splinting in position may be helpful Seek information on the mechanism of injury How did the injury occur?

In what position was the limb after the injury? Did the person fall? How many feet did the person fall? What was the direction and amount of force? Certain

musculoskeletal injuries commonly occur together. Assess for the presence of concomitant injuries. A fractured calcaneus as a result of a fall from a great

height may also include a compression fracture of thespine

Perform neurovascular assessment to include the areaabove and below the injury

Assess for ischemia to the extremity Pallor suggests poor arterial perfusion, cyanosis

suggests venous congestion Assess neurologic supply of the injured extremity to

determine peripheral nerve insult. Damage to aperipheral nerve can be the result of a direct injury,compression or edema

- Test sensory, motor function- Numbness or paralysis may require

immediate medical intervention Examine the bones and joints adjacent to the injury If there was enough force to produce one injury, there

may be other injuriesSigns and symptoms of fractures

Pain & tenderness over the site Grating or Crepitus over the fracture site Swelling due to internal bleeding and edema Deformity, unnatural position, or movement where

there is no joint Loss of use or guarding Discoloration due to bleeding in the surrounding tissue Shortening of an extremity or rotation of extremity Loss of joint motion – may appear “frozen” Obvious deformity – lump, ridge, excavation Severe pain

Signs and symptoms of sprain Pain in the joint area Swelling

Limited use or movement Elevate to prevent or limit swelling Apply ice packs or cold compresses; ice should not be

placed directly on skin Cover open fractures with sterile dressings Splint the extremities Handle the part gently and as little as possible Provide pain management Assess for compartment syndrome

Six P’s of CS Pain Development of a different type of pain or the return of

pain after tx/splinting had caused pain relief Pallor Pulselessness Paresthesias Paralysis – late sign Puffiness – late sign If CS is suspected, do not elevate limb above the level of

the heart, this may decrease perfusion to compromisedextremity

SOFT TISSUE INJURIES- Involve the skin and underlying subQ tissue and

muscles- Can be classified as open or closed injuries- A closed wound is an injury to the soft tissue but without

a break in the skinClosed wounds include:

- Contusion – bleeding beneath the skin into the soft tissue. Bleeding can be minor or extensive. Extensivebleeding can cause severe pain and swelling, leading toa compromised vital structures

- Hematoma

- An open wound is an injury to soft tissue with a break inthe skin generally they are more serious than closedinjuries due to the potential for blood loss andinfections.

Open wounds include: Abrasion – superficial loss of skin resulting from

rubbing/scraping the skin over a rough surface Laceration Puncture – occurs when skin is penetrated by a pointed

object, can be penetrating (entrance wound only) orperforating (entrance and exit wound). Do not causeexternal bleeding but there may be significant internalbleeding and damage

Avulsion – involves a tearing off or loss of a flap of skin Amputation

PRIMARY ASSESSMENT Always ensure the adequacy of ABC before initiating

treatment If bleeding from injury is significant, be aware of the

clinical symptoms and signs of shock Skin pale, mottled, cold diaphoretic Tachypnea, tachycardia, hypotension, restlessness

(confusion and anxiety)

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Assess for arterial or venous bleeding Arterial bleeding (bright red, spurts from wound) Venous bleeding (darker red, will flow steadily from a

wound) Wounds that result in severe arterial bleeding should be

considered life threatening. Tx is second only to CPR Primary goal: Control severe bleeding Direct Pressure Cover injury with sterile dressings Apply firm, direct pressure to the site of injury Should be maintained until bleeding stops, pressure

dressing applied, definitive tx undertaken If dressing becomes unsaturated, reinforce dressing After bleeding has stopped, apply pressure dressing. A pressure bandage is made by securing several gauze

pads with a rolled gauze bandage- Allows the nurse freedom to assess the injury

site Elevate injured area. Do not elevated if there is a presence of pain Pressure points Used when direct pressure and elevation cannot control

bleeding alone or when DP cannot be applied to ableeding site due to a protruding bone

Locate pressure point, apply firm steady pressure If heavy bleeding is still not controlled and patient may

exsanguinate, tourniquet and vascular clamp may beapplied to the artery, torniquet is the last option

Expose the wound, cut away clothing as necessary, donot removed impaled objects

Assess vascular status Perform neurologic assessment Determine tetanus immunization History of injury, including when and how wound

occurred: any wound that is more than 6hrs old isconsidered high risk for infection, and primary closureby suturing may not be an option

Wound prep Shave the area necessary, eyebrows are never shaved Irrigate gently with isotonic sterile saline solution or

sterile water to remove dirt and debris Catheter tip syringe may be used

General rules (wound irrigation) Irrigate with 50mL/inch of wound per hour of age of

wound. Use more irrigant for grossly contaminatedwounds, clean with a surgical scrub sponge and irrigate

The wound may f irst be anesthesized if patient cannot tolerate wound irrigation

Infiltrated with local anesthetic IV thru wound marginsor by regional nerve block

Devitalized tissue and foreign matter are removed(inhibits wound healing and enhances chance of bacterial infection)

Wound closure Closure by primary intent Wound is repaired without delay after injury, yields the

fastest healing

Primary closure may be with sutures, skin tapes, staplesand adhesives

Closure by secondary intent Wound is allowed to granulate on its own without

surgical closure Wound is cleaned & covered with a sterile dressing

Closure by secondary intent with surgical closure Wound is cleaned and dressed Patient returns in 3-4 days for definitive closure Wound dressing Should be applied in 3 layers. 1 st layer: contact layer.

Ex. Adaptic, petroleum gauze, xeroform gauze 2 nd layer: absorbent layer, dressing pads, 4 x 4 gauze

dressings 3 rd layer: outer wrap, holds dressing in place. Consists

of rolled gauze and tapePHARMA INTERVENTIONS

Give antimicrobial tx as directed depending on infectionpotential: how injury occurred, age of wound, presenceof soil

Give tetanus prophylaxis based on patient’simmunization status and wound. Tetanus toxoid withdiphtheria and TIG

PATIENT EDUCATION Inform patient that pain should subside within 24hours Acetaminophen (Tylenol) or prescribed analgesic, taken

for the first 24hrs after a simple laceration Elevate extremity for 1 st 28hours Sleep with the head elevated if facial lacerations are

present Recommend that the wound would be elevated to limit

accumulation of fluid in the interstitial space

Documents

Ncm106 Notes 2012 ABC