Laceration Management: Closure, Dressings, and Medications (Nursing)

00:00 Treatments for lacerations can range from simple to complex, just like the wounds themselves.

00:06 First of all, you're going to have to get the wound prepared so you may consider what's appropriate anesthesia. Is the patient going to need anesthesia for this treatment.

00:16 So you may look at local infiltration and nerve block or a topical anesthesia something that's appropriate to the wound the patient has sustained.

00:24 Now you're going to irrigate with sterile saline often.

00:28 Now the reason we irrigate is we're looking for just enough pressure that can remove bacteria and debris. But we're not going to additionally damage that tissue.

00:38 So you're looking for about 5 to 8 pounds per square inch.

00:42 This can be changed. It just depends on what's going on with the patient.

00:46 I'm just giving you an example of what is most common.

00:50 Now, in order to get the 5 to 8 pounds per square inch psi,.

00:54 You're going to use a 19 gauge syringe or a catheter on like a 60 mil syringe.

00:59 Or you can use a pressurized bag of IV solution.

01:02 So you put like a one liter bag under 400mm of mercury pressure on the cuff.

01:07 That should get you to the 5 to 8 pounds per square inch.

01:11 So we talked about the appropriate anesthesia.

01:13 We talked about irrigation with sterile saline.

01:15 Now debridement if you've got some tissue that's dead or devitalized that's going to need to be debrided or removed. If there's a foreign body, we're going to discuss how we get rid of that or remove that.

01:28 And if there's jagged edges on the wound and what needs to be actually done to the wound bed to prepare it for healing. When you're closing it and we talked about primary closure, you could use sutures or staples or adhesive strips look like little pieces of tape or even tissue adhesive, which is kind of like superglue for your skin.

01:46 If you're going to delay the primary closure, we may do that if the wound has been contaminated.

01:52 Now, if we're going to heal the wound without closure, that's called secondary intention.

01:57 And you can see some amazing wounds that can actually close.

02:02 I've had patients with large sections of their abdomen, of their chest wall that we used secondary intention.

02:08 We healed that wound without actually closing it.

02:12 It's way more fascinating if it's not your body that you see this wound.

02:16 So the team will decide what's the appropriate closure technique based on the location and the tension of the wound. They'll help pick what is the appropriate suture material and size that should be used. So that will be done by the person who's actually performing the wound closure.

02:32 Now when it comes to dressings, they're going to look for what should we pick for this particular laceration? A primary dressing could be maybe non-inherent it doesn't stick to it.

02:42 It might have antibiotics in it.

02:44 That may be the primary dressing.

02:46 Secondary dressing could be there for absorption and to just protect the wound.

02:50 Now there's lots of specialized dressings, and that's going to be based on the wound characteristics and what you need.

02:56 There's even pressure dressings for hemostasis if we need that, if the wound is still oozing blood.

03:02 You might also consider splinting if the wound is near a joint or over a high movement area.

03:07 And make sure you help the patient find appropriate positioning that's going to reduce the tension or the pulling on that wound.

03:15 That's just like if you had a patient with abdominal surgery, it's much easier for them to right to sit up some.

03:21 So there's not as much tension on their abdominal wall.

03:24 Hopefully they're not coming to you with a laceration on their abdominal wall. But things happen. So when it comes to medications, what are the pharm things we want to consider? Well we've talked about tetanus prophylaxis.

03:34 If they need that antibiotic prophylaxis for wounds that are high risk, they've been exposed to something debris contaminated.

03:41 We want to treat their pain and make sure the pain management is appropriate to how severe their pain has been reported. And if it's appropriate, we may give an anti-inflammatory medication now if the wound is complex. You want to make sure that you get a consult, plastic surgery or a hand surgeon.

03:57 If it's a real complex wound or in a specific spot, that could cause a risk for a really nasty scarring or functional impairment.

04:07 Surgical exploration that's going to be done by a surgeon, but that's going to be for a really deep wound.

04:11 Or if we have a potential for compartment syndrome, which will compromise the blood supply.

04:17 You might use a wound vac that can help with complex wounds and help them close, or it may even be considered to have skin grafting if the wound has significant tissue loss.

04:27 Now, I've listed some things for you in the notes where there are examples of local anesthetic.

04:33 Those are the examples of the medications that we would use.

04:36 There's another list of topical anesthetics we would use that we would put on top of the skin.

04:41 Those are things we can use to help relieve the pain or the sting for the patient.

04:45 I've also listed what goes into a tetanus prophylaxis.

04:49 What goes in that vaccine? Remember, we give that to a client.

04:53 If they've got they've been at risk to be exposed and they haven't had a most recent tetanus toxoid vaccine. So we can also give if the patient has had a high risk wound, we can also give tetanus immunoglobulin.

05:06 And that will help minimize the risk of tetanus.

05:10 Now when it comes to antibiotics, prophylactic antibiotics are used for wounds that are contaminated and wounds that might be older before we saw them.

05:18 We can also use antibiotics for patients that are immunocompromised.

05:22 Now, some specific wounds that tend to get antibiotics because of their risk would be hand wounds, puncture wounds, and bite wounds.

05:29 Whether they're human or dog.

05:31 The antibiotics we might give are also listed in your notes.

05:34 I've got first line agents for you.

05:36 They're alternatives. If someone can't take penicillin and keep in mind you've got special considerations. If it's a bite wound or it's fresh or salt water exposures.

05:47 Now, what we use for pain control are things like acetaminophen, known as Tylenol. Nsaids like ibuprofen or naproxen, and opioids will only be for severe pain.

05:58 Remember, those need to be prescribed with solid patient teaching and really strict guidelines on how they should be used. You may also have some simple things like antibiotic ointments, antiseptic solutions, or agents that will help with hemostasis.