Describe type of wound, location, timing, mechanism of injury, length, width, depth, orientation, bleeding, contamination and proximity to deeper vital structures.
Do a neurovascular, sensory assessment, especially distal to the wound. Sensation testing by 2 point discrimination is sensitive (e.g., 5 - 7 mm at tip of fingers). Use the corresponding uninjured area as a control to test the 2 point discrimination - for sensory testing. Do the neurovascular testing prior to inflitrating topical anesthetic. Use capillary refill < 2 - 3 sec as indication for tissue perfusion.
Need for Td. If given within 5 years and wound is clean: not needed. For contaminated wound give Td regardless.
Clean contaminated wound after anesthetizing.
Antimicrobial soap for scrub
Povidone-iodine for paint: inwards out in circles
NS irrigation of wound (50 - 100 mL qcm of wound)
Limits:
Face and scalp lac closed in 12 hours
Torso and ext lac. closed in 6 hours
Lidocaine: 30 - 60 min
Bupivicaine: 4 - 6 hours
Do not use epinephrine in areas with an end capillary blood supply (e.g.) digits, penis, nose, and ears - may lead to necrosis
Toxic doses of:
Lidocaine: 5 mg/kg
Lidocaine + epinephrine: 7 mg/kg
Bupivacaine: 2 mg/kg
Bupivacaine + epinephrine: 3 mg/kg
1 part NaHCO3 to 10 parts of lidocaine 1% to increase pH and reduce pain.