Wound exam

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.