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- asplenic patients: sickle cell, surgery: very susceptible to c. canimorsus
(cat and dog), rapidly fatal.
- 3. P. multocida: cat bites, some dog. Oxacillin for prophylaxis.
- if animal unavailable standard rabies procedures
- if available and unvaccinated: animal control will sacrifice and test.
Usual protocol says to delay postexposure prophylaxis until animal tests
positive -- personally the potential delay makes me nervous.
- 20% false-negative rate for plain film studies?
- Any pt w/ 1 spinal fx needs entire spine series
- initial films cervical collar
- need lateral (7 vertebrae + C7-T1 junction), AP, Odontoid
- if inadequate, try swimmer's view (one arm over head). If still inad,
repeat or CT
||C1/C2 lateral aspects align
equal space between odontoid process and lateral C1
(space between odontoid process and ant portion C1 ring)
|3 mm or less
||4 to 5 mm or less
||3 mm or less
||4 to 5 mm or less
||< 6 mm at C2, < 22 mm at C6
||1/2 to 2/3 vertebral body distance anteroposteriorly
|Angulation of spinal column at any single interspace level
||< 11 degrees
||10 to 13 mm
||Adult size by 6 yo
- frostbite not affected by wind chill, exposure must be < -2 to -3 C
- worse at high altitudes for same exposure
- treat with rapid rewarming in circulating water from 90-108 F (eg.
body temperature water)
- start at margin of lesion and extend distally
- reverse direction and extend proximally
- consider mixing xylocain with nutricane, a base neutralizing
solution mix 1:5 with xylocaine to reduce sting
- TAC gel (tetracaine, adrenaline, cocaine)
- LAT gel (lidocaine 4%, adrenaline 1:2000, tetracaine .5%
- apply then check for anesthesia q10 minutes for 30 minutes
- punch biopsy:limit to under 4 mm punch, else do elliptical excision
- undermining: 3 cm required to get 1 cm relaxation (3:1). Do just at
dermal/fat junction, nerves run through fat.
- recover from a V incision
- pull on subdermis then cut straight down
- place suture while tugging subdermis inwards to get flask type
A Practical Guide to
Dermabond - March 1, 2000 - AFP
- maximum strength in 2.5 minutes
- strength similar to that of 7-day old healed tissue
- can replace 5-0 sutures on face,extremity or torso; really sub-q sutures
on deeper sites or sites with stress. Consider splint immobilization in high
- can wipe away with dry gauze within first 10 seconds of application
- if need to remove, put petroleum jelly or antibiotic ointment on for 30
minutes (patients must be instructed to avoid antibiotic ointment)
- don't drip on wound, squeeze vial until drop appears at end, then allow
suction to retract it
- edge eversion does not appear to be very important
- apply light layer, hold for 30 seconds, then apply two more layers in
oval. Later layers take longer to dry. Fanning does not help.
- wound irrigation key, oral antibiotic if suggestion infection
- hemostasis critical: pressure or 1:1000 topical epi solution. Fluid will
increase heat reaction, make use much harder
- no baths until 7-10 days (will wash off top skin and adhesive)
- if gets in wound may produce foreign-body reaction
- non-toxic to eye, if lids glued apply lots of ophthalmic ointment
- test thenar group by oppose thumb and 5th fingers
- test adductor pollicis by see if thumb IP flex when grip paper (Froment's
- don't repair flexor tendor injuries, consult hand surgeon
- extensor tendon with horizontal mattress 5-0 nylon
- nail bed laceration: remove nail and repair (?)
Nail and Nailbed
- suture nail margins with fast absorbing gut
- if remove nail, keep nail bed open with an foil splint or nail body
- small study suggests no differece between suture and not
- suture for significant through and through lesions, or where a part of
tongue may be lost
- Fishhook Removal -
June 1, 2001 - American Family Physician is a very complete review.
- The "string technique" is probably best suited to smaller hooks
with partial implantation.
- If hook is reasonably close to a complete in and out arc probably best to
anesthetize, push out, cut and retract.
- Don't mess around with dinky wire cutters. Have a serious bolt cutter in
the office that will slice smoothly through a serious hook.
- If multiple barbs along the hook see the article above.
- Tetanus, soaks, etc.
- FB in Foot: Removal via anesthetic
ejection -- inject lidocaine beneath foreign body, use fluid pressure
to force upwards and eject. May need to enlarge opening.
- eye: see Corneal
Abrasion & Foreign Body
- occlude opposite nares, have pt do valsalva and then blow sharply. If
young the occlude nares and use ambu-bag to generate force or have
parent blow into child's mouth
- apply strong bonding glue to tip cotton-tipped applicator, touch to fb
for 15-20 seconds
- cockroach: apply lidocaine solution into canal, cockroach will back
- soak in lukewarm water 15-20 minutes to soften nail
- shave nail over splinter with No 15 blade (proximal to distal nailfold)
- betadine prep must extend well beyond perimeter of undraped field.
- dont use fenestrated drapes fields are way too large.
- always use two drapes: one on patient, one for work
- make ellipse over pore (don't remove ellipse from cyst)
- use ellipse for traction while removing the cyst with dissection
- hymenoptera: poultice of baking soda or salt
time (assuming a deep vicryl layer)
- face: 5.0-6.0 vicryl and 6.0 nylon: 3-5 days with steristrips
- scalp: 7 days
- neck: 7-10 days
- upper extremity: 7-9 days
- trunk: 8-10 days
- lower extremities: 10-30 days (longer with smoking, obesity)
Tegaderm dressing to wound for 1st six hours
Scalp wounds: apply pressure by patient lying on head
Author: John G. Faughnan.
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