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There are certain things people may thinkum Donnie does but Donnie just Doesn't! Let's model appropriate wound care, okay guys? It may save a friends life-- who knows, that Zombie apocalypse just keeps getting new rewrites!
VVVVVVVVVVVV click for moar if needed VVVVVV
Yesh dA Takes pdf! I can read this. I've grown up in a medically trained family. I was scaring myself off sex with medical diagnosis image collections of VD (aka STDs) cases when I was seven. However, some people in the fandom have No clue what wound care looks like-- not even basic laceration first aide.
Here is exerpts the info included in this non-fic research. More notes and original source location can be found at bottom but this includes basic supplies Don would have on hand to lower infection risks. Saline can easily be found as a recipe online and has a better shelf life than ordinary water.
Lacerations
A. History and initial evaluation
Where and when the injury occurred
Mechanism of injury – Is there possibility of an underlying injury, retained FB, or bite?
Size and location of the wound
Sensory function and vascular integrity
Tetanus status
Contributory past medical history: allergies, bleeding diathesis, medications, etc
B. Objectives
Restore function
Produce optimum cosmesis
Avoid infection
Hemostasis
Improve healing time
If possible have a painless wound repair
C. ED Assessment
Examine wound adequately – You must see the bottom of the wound to
Most times anesthesia is required before adequate inspection can occur
Achieve hemostasis with direct pressure, and or, vasoconstrictors
Decide how you the wound should be closed, or whether you will close it at all
If the wound is dirty, contaminated, or may have a retained foreign body decide to how
you will approach the laceration. You may need to obtain radiographs(to rule out
fractures or foreign bodies), or other studies.
...
Tissue Adhesives: Dermabond (2-Octyl Cyanoacrylate) AKA SUPERGLUE!
Excellent superficial wound closure technique - Quick, easy, safe, no removal
Helps provide an antimicrobial barrier, sealing out infection
Best for small wounds under no tension, or for wounds where a layer of deep sutures have been
placed. Think of it as a superficial skin closure technique. This means that you still will
require anesthesia, a suture tray, irrigation, and sterile gloves
AYesh dA Takes pdf! I can read this. I've grown up in a medically trained family. I was scaring myself off sex with medical diagnosis image collections of VD (aka STDs) cases when I was seven. However, some people in the fandom have No clue what wound care looks like-- not even basic laceration first aide.
...
Approximate the edges of the wound with your fingers, forceps (AKA Gently smush things into correct alignment
Press the vial gently and lightly paint the glue onto the wound. Apply at least 3 layers allowing
the glue to dry between layers. The glue dries with an exothermic reaction that can cause
minor stinging or burning. Advise the parent and child of this. Waving or blowing on the glue
to help it dry faster does not help speed the process, and makes you look ignorant.
Optimal application may require two people, one to hold the wound together, and the other to
apply the glue. Be careful to never let the glue get into the wound, it will delay healing and
increase scarring. If this happens, let the glue dry and peel the glue out, and then redo the
laceration.
Be sure to achieve hemostasis before applying the glue. Bleeding in the area will cause the glue
to discolor and bead up - looks ugly, and decreases effectiveness on the wound.
Use of the Dermabond ampoule involves a learning curve in order to have the right pressure to
get the proper flow of glue.
Studies indicate a rapid attainment of efficiency with Dermabond.
Placing petroleum ointment on surrounding areas will prevent TA from sticking to them. May
choose to use it as a barrier to keep the glue from running. Use with care around the eyes!
Runoff is a significant problem in this area.
The entire area of TA may be peeled off if needed. It comes off slowly as a sheet. Petroleum
ointment may help loosen the glue.
Tape closure ( Steri-strips )
Unless a very small cut over an area of no tension, steri-strips and butterfly bandages are not
the method of choice for wound closure. They may be used as adjuncts for other wound
closure techniques. If using, use with an agent that promotes adhesion, like mastisol or
benzoin
Preparation of the patient
Decide whether the child needs immobilization, sedation, or a combination of both
Be sure the wound is adequately anesthetized prior to starting
Arrange on the stretcher for the most ease in completing the procedure. Usually placing the
patient’s head at the foot of the bed allows easier access for the person suturing.
Have a papoose, a sheet, towels, chucks, and gauze ready as needed
If the patient is immobilized, so your best to avoid any delays which may increase agitation
and decrease your success.
Getting yourself and staff ready
Get everything that you need ready before you start:
gloves
suture kit
suture material
anesthetic
syringe and needles
irrigating solution
antibiotic ointment and dressings
Use disposable gloves and quickly cleanse the wound and areas around it and remove any
obvious foreign body that can be easily taken out.
Prior to injecting anesthesia document the sensation and function distal to the wound.
After wound anesthesia, inspection and preparation, we are ready to suture. Discard disposable
gloves, injection needles and remove wet, or bloody material around the work site.
Get help. Someone to hold the child still, papoose, direct light source to suture site, open suture
packets, etc.….
Now you can put on your sterile gloves.
Suturing, the procedure
Basic rules to remember:
Do not hesitate to cut out and replace any suture you are not completely satisfied with!
If the patient is unable to be sutured consider sedation, or reassess the need to suture at all.
The patient will have the scar for the rest of their life, so take your time and do a good job.
Take pride in your work. Practice will lead to success. This is not an easy skill to learn, it will
take time. Suturing moving targets who are crying is a difficult task, but very doable.
Placing the sutures:
It is better to use smaller sutures placed closer together than larger sutures farther apart.
Wound edges should only be approximated to accommodate edema; tissue should not be
strangulated.
For optimal cosmetic result, wound edges should be everted when closed.
Bites should be about 4-5 mm from wound edges.
Sutures should be spaced about 5 to 7 mm apart, enough to approximate the wound edges but
not so tight to cause ischemic skin edges.
Loose but snug approximation of wounds produce stronger wound margins because
proliferative activity can occur in the wound clefts, and proper wound edge alignment is
encouraged. Too tight is not good.
The actual procedure of suturing:
Make sure to use a needle holder, not the hemostat. The needle holder is flat and not curved.
1. Arming the needle:
Place the needle holder 1/3 of the way from where the suture begins, just below the swag,
where the needle is hollow, and joins the suture material.
2. Using the needle properly
Let the needle do the work!
Use the curve of the needle to guide where the suture will go.
Do not use excessive force, or try to jam the needle through the skin. Never bend the needle
A bent needle is the result of poor technique, positioning, or a bad choice of needle selection
3. Handling the tissue properly
Do not increase trauma to wound or you will increase the risk of infection or scarring
Avoid grasping or pinching the skin with the forceps (a common mistake). There is rarely a
need to do this!
The edge of the forceps may used to lift or expose the areas to be sutured. Avoid puncturing
the skin if at all possible except to place the stitch.
4. Gripping the needle holder
Many people prefer the thenar grip because it allows enough rotation at the wrist to drive the
needle all the way through.
5. Entering the skin. Must be at a 90 degree angle to the skin in order to have a nice circular
stitch that is even all the way around.
6. The simple interrupted suture
Most commonly used method of closing traumatic lacerations.
Appropriate for closing almost all wounds that are under minimal or low tension
Should be the mainstay of your suture technique
Drive the needle in the skin at 90 degrees
Roll the needle holder with your wrist through the tissue
Finish the arc of the needle, and the grasp the needle just below the tip, so not to dull it
Have more tissue at depth than at the surface
Tying the knot (PDF source has images to make the text clearer)
Wrap the suture around the needle holder twice and then grasp the loose end of the suture,
pulling it tight. Lacerations under a lot of tension may require you to wrap the suture around
the needle holder three times on the first throw to keep the tension in the knot. After the first
throw, then you will only need to wrap the suture once around the needle holder. It is
extremely important that your knot be square and lie flat, otherwise they may come undone.
Generally the amount of knots or throws will correspond to the size of the suture.
So, for example 6.0 size suture should have at least 6 knots. As a rule no less than 4 throws
should be ever used. Avoid excessive tension which may break sutures and cut tissue.
Practice will lead to successful use of finer gauge materials. Do not tie sutures used for tissue
approximation too tightly, as this may contribute to tissue strangulation. Approximate -- do not
strangulate.
...
Antibiotic usage - {currently the country of USA is at risk with MRSA antibotic resistant staphylococci infections. Circumcision in certain hospitals can result in this infection!}
Dirty wounds are more likely to develop infection and may benefit from prophylactic
antibiotics. Some recommend IV antibiotics for very contaminated wounds, or for areas such
as the hands.
Most non bite wounds will be contaminated with staph or strep. We use had been using Keflex
or a second generation cephalosporin, but with so much MRSA, clindamycin is a better choice.
Erythromycin or Clindamycin if Penicillin allergic.
Bites
Very superficial bite wounds that do not involve full thickness of the skin may be managed
with local wound care, irrigation and dressing
Deeper bite wounds require a more broad spectrum antibiotic such as Augmentin for 3 – 7
days
#1 Dog bites – Most frequent type of bite. Bacteriology is complex, but most common is
Pasturella Multocida, and Staph Aureus
Cat bites – Very frequently get infected because it is a deep puncture wound. Most common
infecting organism is Pasturella Multocida. Use Augmentin.
Human bites – Open wounds around the knuckles should always raise the suspicion of an
injury involving the human mouth. Augmentin is a good choice.
Tetanus status should always be ascertained and immunization given in accordance to the Red
Book recommendations. Usually if the child has had more than three doses of the tetnus toxoid
than they will only need the Td(adult tetnus and diphtheria), every 10 years for a clean wound
and every 5 years for a dirty wound. Other recommendations for children younger than 7 may
include DTaP.
....
And back to your friendly neighborhood fic fan!!
Some detailed drawn pictures are in the pdf, how doctors should prepare discharge information and of course formatting is so much clearer. This is not my own work and I take no credit or blame for the accuracy. I found it via a Google search and know it to be available in a public document file -- just I knew, already KNEW, the keywords that would get me to hard core surgical research rather than just lucky to happen on it. You do know that once you get an appropriate technobabble you can easily do a search based off a line of text & get documents that use that language, right?
May it give and prompt our fandom to access and interest in the medical arts that are very important to the safety of our 4 fave guys!
© 2013 - 2024 Prophetella
Comments4
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Good to have the information.