TCRN Review - Extremity and Wound
Trauma
List some special considerations for abrasions. - Answer -Pain control - full thickness abrasions may be
associated with nerve damage and may have less pain
Evaporative heat loss - consider warming measures
Evaporative fluid loss - consider need for fluid replacement
Scarring - anesthetize wound and aggressively remove debris
Define contusion. - Answer -Rupture of subcutaneous blood vessels with extravasation of erythrocytes.
Define hematoma. - Answer -Rupture of artery or vein that will continue to expand until the pressure in
the tissue exceeds the pressure in the ruptured vessel.
Contusions and hematomas have the potential for what significant complication? - Answer -
Compartment Syndrome
List 2 special considerations related to contusions / hematomas. - Answer -Potential for enough blood
loss to cause hypovolemia, especially in areas of the body with greater dispensability (like the thigh).
Blood is a medium for bacterial growth, therefore wounds with contusions and hematomas may have a
greater risk for infection.
,What are the treatments for contusions / hematomas? - Answer -Elevation
Application of Ice Packs
Puncture wounds have a high rate of _____. - Answer -Infection
What treatment should be done with puncture wounds? - Answer -Soaking
At time of discharge, what teaching should be given to a patient who sustained a puncture wound? -
Answer -Soak wound 2-3 times per day for 2-4 days
What type of bites tend to be deep wounds involving crushing of the tissue or avulsion? - Answer -Dog
Bites
Are larger bites or smaller bites more susceptible to infection? - Answer -Smaller. The larger size of
wounds allows bacteria to exit, decreasing the incidence of infection.
How many hours after a cat bite does infection usually start? - Answer -12 hours
What complications are often associated with cat bites? - Answer -Abscess, Cellulitis, Osteomyelitis
Smaller puncture wounds traps bacteria increasing rate of infectious complications.
What type of bites have very high infection rates? - Answer -Human bites
How many days after a human bite does infection usually start? - Answer -1-2 days after bite
What diseases can be associated by human bite? - Answer -Hepatitis B, Hepatitis C and potentially HIV
Teeth marks over knuckles from "punching someone" are associated with _____. - Answer -Fractures of
the third and fifth metacarpal, osteomyelitis and joint infection.
, Wounds caused by high pressure devices (paintball gun, grease gun) can cause _____. - Answer -
Compartment Syndrome
If a device triggers releasing foreign matter into the wound, it may travel deep into the tissue separating
fascial planes and causing _____. - Answer -Compartment Syndrome
_____ requires high triage prioritization and potential surgical intervention. - Answer -Compartment
Syndrome
List the 3 types of tissue damage that occur with gunshot wounds. - Answer -Permanent cavity
Temporary cavity
Pressure Wave
What is the permanent cavity associated with a gunshot wound? - Answer -Penetrating trauma
following the path of the projectile
What is the temporary cavity associated with a gunshot wound? - Answer -Crush injuries around the
permanent cavity caused by temporary displacement of tissue as the projectile moves through the
tissue.
What is the pressure wave associated with a gunshot wound? - Answer -Damage in areas adjacent to the
permanent cavity as the projectile moves through the tissue (increased damage to hollow organs).
In gunshot wounds, the faster the projectile is moving as it passes through the tissue, the _____. -
Answer -Greater the size of the temporary cavity and pressure wave.
The longer the barre of the firearm, the _____ the projectile will strike the patient. - Answer -Faster
The farther the patient is from the firearm when it is fired, the _____ the projectile will be moving as it
enters the body. - Answer -Slower
Trauma
List some special considerations for abrasions. - Answer -Pain control - full thickness abrasions may be
associated with nerve damage and may have less pain
Evaporative heat loss - consider warming measures
Evaporative fluid loss - consider need for fluid replacement
Scarring - anesthetize wound and aggressively remove debris
Define contusion. - Answer -Rupture of subcutaneous blood vessels with extravasation of erythrocytes.
Define hematoma. - Answer -Rupture of artery or vein that will continue to expand until the pressure in
the tissue exceeds the pressure in the ruptured vessel.
Contusions and hematomas have the potential for what significant complication? - Answer -
Compartment Syndrome
List 2 special considerations related to contusions / hematomas. - Answer -Potential for enough blood
loss to cause hypovolemia, especially in areas of the body with greater dispensability (like the thigh).
Blood is a medium for bacterial growth, therefore wounds with contusions and hematomas may have a
greater risk for infection.
,What are the treatments for contusions / hematomas? - Answer -Elevation
Application of Ice Packs
Puncture wounds have a high rate of _____. - Answer -Infection
What treatment should be done with puncture wounds? - Answer -Soaking
At time of discharge, what teaching should be given to a patient who sustained a puncture wound? -
Answer -Soak wound 2-3 times per day for 2-4 days
What type of bites tend to be deep wounds involving crushing of the tissue or avulsion? - Answer -Dog
Bites
Are larger bites or smaller bites more susceptible to infection? - Answer -Smaller. The larger size of
wounds allows bacteria to exit, decreasing the incidence of infection.
How many hours after a cat bite does infection usually start? - Answer -12 hours
What complications are often associated with cat bites? - Answer -Abscess, Cellulitis, Osteomyelitis
Smaller puncture wounds traps bacteria increasing rate of infectious complications.
What type of bites have very high infection rates? - Answer -Human bites
How many days after a human bite does infection usually start? - Answer -1-2 days after bite
What diseases can be associated by human bite? - Answer -Hepatitis B, Hepatitis C and potentially HIV
Teeth marks over knuckles from "punching someone" are associated with _____. - Answer -Fractures of
the third and fifth metacarpal, osteomyelitis and joint infection.
, Wounds caused by high pressure devices (paintball gun, grease gun) can cause _____. - Answer -
Compartment Syndrome
If a device triggers releasing foreign matter into the wound, it may travel deep into the tissue separating
fascial planes and causing _____. - Answer -Compartment Syndrome
_____ requires high triage prioritization and potential surgical intervention. - Answer -Compartment
Syndrome
List the 3 types of tissue damage that occur with gunshot wounds. - Answer -Permanent cavity
Temporary cavity
Pressure Wave
What is the permanent cavity associated with a gunshot wound? - Answer -Penetrating trauma
following the path of the projectile
What is the temporary cavity associated with a gunshot wound? - Answer -Crush injuries around the
permanent cavity caused by temporary displacement of tissue as the projectile moves through the
tissue.
What is the pressure wave associated with a gunshot wound? - Answer -Damage in areas adjacent to the
permanent cavity as the projectile moves through the tissue (increased damage to hollow organs).
In gunshot wounds, the faster the projectile is moving as it passes through the tissue, the _____. -
Answer -Greater the size of the temporary cavity and pressure wave.
The longer the barre of the firearm, the _____ the projectile will strike the patient. - Answer -Faster
The farther the patient is from the firearm when it is fired, the _____ the projectile will be moving as it
enters the body. - Answer -Slower
