One method of dog ear correct is to elevate the excess skin flap; then from the apex of the wound, make an oblique incision toward the flap. Trim off the triangle of skin this creates, and finish closing the wound.
Roberts, JA et al. Clinical Procedures in Emergency Medicine and Acute Care, 2019; 683-684.
Visit Prepared Physician and see our selection of suture kits, you can be prepared for any wound care at home or on the go this summer!
Nathan Whittaker, MD
Prepared Physician
]]>He arrived in the Emergency Department with his foot twisted laterally and beginning to have a dusky appearance, with his distal capillary refill pushing 10 seconds.
We quickly performed a hematoma block and reduced the ankle and foot back to anatomical position, with nearly no pain. His foot quickly became a healthy color, and his capillary refill was now less than 3 seconds.
Hematoma Block is a reasonable, safe means of anesthesia for simple, closed distal extremity fractures requiring quick reduction maneuvers. Prep the skin over the fracture site with antiseptic solution, confirm needle placement in the fracture hematoma by aspiration of blood. Slowly inject 5-15 mL of plain lidocaine into the fracture cavity and around the associated periosteum. Allow 5-15 minutes for anesthetic effect to be achieved.
Roberts, JA et al. Clinical Procedures in Emergency Medicine and Acute Care, 2019; 536-537.
With Prepared Physician’s Suture Kits, outfitted with Lidocaine and Sam Splint, you can comfortably avoid the complications of neurovascular compromise with quick action, until you can get your injured loved one to definitive Orthopedic care.
Nathan Whittaker, MD
Prepared Physician
]]>Immobilizing such extremity injuries with proper splinting will decrease pain, bleeding and helps avoid additional soft tissue, vascular and neurological injury.
Muttath, et al. Overview of finger, hand and wrist fractures. UpToDate April 2019.
Prepared Physician has Sam Splints available so you can be prepared to reduce the pain and suffering of your loved one’s simple extremity fractures.
Check out what all Prepared Physician has to offer, so you can avoid the Covid congested Emergency Department and be prepared to take care of grandma Ruby or nephew Johnny!
Nathan Whittaker, MD
Prepared Physician
]]>It is recommended that initial fluid replacement be completed with crystalloid solution. This raises the question of which fluid, 0.9% saline or a buffered crystalloid solution, such as lactated ringers. A review of the literature tells us that in small volume resuscitation, less than or equal to 2 L, neither solution has been proven to be consistently superior. With large volume resuscitation, greater than 2 L, this should be an informed decision individualized by factors such as patient chemistries, estimated volume of resuscitation, potential for adverse effects of the solution, as well as facility and physician preference.
Mandel,MD; P. Palevsky,MD; et al. “Treatment of severe hypovolemia or hypovolemic shock in adults”. Jan 2021 UpToDate.
Prepared Physician has IV hydration kits available with your choice of 0.9% saline or lactated ringers, so you can be prepared for volume resuscitation within the comforts of your usual practice and home! Check out our IV hydration kit options today!
Nathan Whittaker, MD
Prepared Physician
]]>With the quandaries of quarantine confounding easy access to health care, a prepared physician can provide treatment at home with ease and efficiency using our IV hydration kits!
For intravenous access in the upper extremity, the metacarpal and dorsal veins comfortably allow access with 22-20 gauge IV catheters. Accessing these veins still allows functional mobility of the arm while IV access is in place.
For short term IV access, when extremity mobility is not a concern, access of the more proximal cephalic, medial cubital, or basilic veins is appropriate. These veins can accommodate IV catheters sized 22-16 gauge.
Roberts, JA et al. Clinical Procedures in Emergency Medicine and Acute Care, 2019; 395-396.
Prepared Physician’s IV hydration kits come with 22, 20, and 18 gauge IV catheters, so you are prepared for any scenario.
Check out Prepared Physician’s great options for IV Hydration Kits and be prepared for any illness to strike!
Nathan Whitaker, MD
Prepared Physician
]]>The mental nerve exits the mental foramen within the mandible. It is located in line with the infraorbital and supraorbital foramen. We prefer using the intraoral approach for this nerve block.
Palpate the mental foramen, using a 25 or 27 gauge needle, insert the needle just medial to the mental foramen, directed toward the foramen at the inferior gum line. If the patient experiences any paresthesia withdraw the needle until the symptoms resolve. Inject 2mL of anesthetic into this location. With wounds that are near the midline, a bilateral block will need to be performed to achieve sufficient anesthesia.
Hollander, JU et al. Assessment and management of facial lacerations. UpToDate November 2017.
Provider Prepared Laceration Repair Kits with Lidocaine will have you prepared at home and on the go for facial laceration anesthesia and repair!
Provider Prepared
Nathan Whittaker, MD
]]>Landmarks for the nerve block are: the second bicuspid, the pupil with a straight forward gaze and the inferior bony otrbit notch. The infraorbital foramen is located in the mid portion of the zygomatic arch, inline with these landmarks, and frequently can be palpated.
For an intraoral approach; insert a 27 or 25 gauge needle through the gum line, oriented in line with these landmarks at the second bicuspid, directed toward the infraorbital foramen. Keep a finger at the infraorbital foramen, when the pressure of the needle is palpated stop advancing the needle. If the patient develops paresthesia withdraw the needle a short distance until paresthesia resolves. Inject 1-2 mL of anesthestic in to this area.
Hollander, JU et al. Assessment and management of facial lacerations. UpToDate November 2017.
Provider Prepared Laceration Repair Kits with Lidocaine will have you prepared at home and on the go for facial laceration anesthesia and repair.
Provider Prepared
Nathan Whittaker, MD
]]>Regional facial nerve blocks are a very useful alternative to local anesthesia. There are three facial nerve blocks that are frequently used for facial lacerations. Mental nerve block, infraorbital nerve block and supraorbital nerve block.
The Mental nerve block provides anesthesia for the lower lip, skin inferior to the lower lip and chin.
Infraorbital nerve blocks anesthetize the upper lip, lateral nose, lower eyelid and medial cheek.
The supraorbital nerve block is useful for anesthesia of the forehead and anterior scalp.
Hollander, JU et al. Assessment and management of facial lacerations. UpToDate November 2017.
Provider Prepared has lidocaine as an option for your Laceration Repair Kits! You can be prepared with all the tools of the trade at home or on the go.
Provider Prepared
Nathan Whittaker, MD
]]>Pain associated with a subungual hematoma is caused by pressure building in a contained space between the nail bed and the nail plate.
Trephination is indicated for the relief of pressure and thus pain of a subungual hematoma; when the injury is less than 24-48 hours old, is not draining spontaneously, and has intact nail folds. Trephination can be accomplished with electrocautery devices or with the boring technique using a needle. Use of a heated paperclip is discouraged, many paperclips are now made of materials that are not capable of retaining sufficient heat for trephination. Fastle, RE et al. Subungual hematoma. UpToDate December 2016.
Provider Prepared's Laceration Repair Kits come with a selection of needles that allow you to perform the boring technique at home. Check out our smashing options for honest and affordable wound care at home and on the go.
Provider Prepared
Nathan Whittaker, MD
]]>
As with all facial lacerations, cheek lacerations should have careful examination. When deep tissues of the cheek are involved, examination must include assessment for injury to the parotid gland, parotid duct and facial nerve.
The anatomy of the deep structures of the cheek must be understood for proper evaluation. The parotid gland and facial nerve branches are just anterior to the ear, they are also superficial to the masseter muscle. Since these structures are superficial to the masseter muscle, they can easily be involved in lacerations of the cheek. The parotid duct extends from the gland to the intra-oral mucosa with the opening adjacent to the second molar. Parotid duct injury must be considered when deep tissue laceration is present. Injury to these deep structures requires specialty consultation.
Hollander, JU et al. Assessment and management of facial lacerations. UpToDate November 2017.
This patient was found to have wound extension into the parotid gland, we subsequently obtained consultation with our Maxilofacial Surgeon, who took the patient to the operating room.
Visit Provider Prepared for honest and affordable wound care at home and on the go!
Provider Prepared
Nathan Whittaker, MD
]]>Lacerations to the nose that involve the entrance of the nare require special attention. The alar margins should be used as a guide to ensure proper alignment. Suturing should be done using 6–0 nonabsorbable suturing material in a simple interrupted fashion. The curvature of the nose must be taken into consideration as the wound is carefully repaired to achieve appropriate shape and alignment. Exposed cartilage should be appropriately covered with reapproximation of the overlying tissue to ensure no development of infection. Lacerations involving the mucosal surfaces should be closed using absorbable suture.
Hollander, JU et al. Assessment and management of facial lacertions. UpToDate November 2017.
Visit Provider Prepared to keep your nose clean and repaired with honesty and integrity, using our affordable laceration repair kits!
Provider Prepared
Nathan Whittaker, MD
]]>When the vermillion border is involved in a lip laceration, the first stitch should placed at the vermillion border, achieving perfect cosmetic alignment of the border. Nonabsorbable 5-0 or 6-0 suture should be used.
Superficial wet vermillion lacerations that are not gaping, less than 2 cm and without oozing of blood do not require repair. Wounds that are gaping, with bleeding and greater than 2 cm do require repair. This repair should be completed with buried absorbable 5-0 or 6-0 suture.
Lacerations of the dry vermillion should be closed similarly with simple interrupted sutures, when the wound extends into submucosal tissue with no vermillion border involvement.
Hollander, JU et al. Assessment and management of lip lacerations. UpToDate November 2017.
See all the lip smacking wound care goodness Provider Prepared has to offer for wound care at home and on the go!
Provider Prepared
Nathan Whittaker, MD
]]>
Repair of tongue lacerations should be considered when the laceration is greater than one centimeter, extends into muscular layers or that are full thickness. Additionally repair should be considered when the lateral border of the tongue is involved, if large gaping of the wound is present, or flaps are created by the wound.
Tongue wounds that are less than one centimeter and non-gaping, without previously mentioned anatomical involvement, typically do not need repair.
When repair is indicated, absorbable suture material that is 3-0 or 4-0 should be used.
Jasper, JI et al. Evaluation and repair of tongue lacerations. UpToDate June 2017.
Visit Provider Prepared and check out our tasteful array of options for all types of wound repair at home and on the go!
Provider Prepared
Nathan Whittaker, MD
]]>Complex auricular lacerations are those that expose the cartilage or extend through the cartilage. These wounds require very careful and detailed closure. In general, sutures should not be passed through the cartilage itself. In order prevent notching or a step-deformity, the perichondrium must be reapproximated. The cartilage must also be covered with skin for appropriate cosmetic repair.
The skin of the ear is so thin and firmly adhered to the perichondrium, stitches that simultaneously reapproximate both layers are acceptable. The perichondrial layer should be the deepest layer of sutured tissue.If absorbable suture is used, it should not be dyed material to avoid tattooing of the repaired tissue.
Malloy, KE et al. Assessment and management of auricle lacerations. UpToDate, November 2016
Visit our website, ProviderPrepared.com to be on your wound care game at home and on the go!
Provider Prepared
Nathan Whittaker, MD
]]>Simple lacerations of the ear are those that spare the cartilage. The most common location for a simple laceration of the ear is the ear lobe. These are appropriately closed with 6-0 nonabsorbable suture.
A 6-0 absorbable suture is reasonable to use in young children and in patients without certain follow up for suture removal. Most experts recommend fast-absorbing gut, as the absorbable suture material.
Auricular anesthesia can be obtained with local injection of Lidocaine without epinephrine, or by regional auricular block using Lidocaine with epinephrine.
Malloy, KE et al. Assessment and management of auricle lacerations. UpToDate, November 2016.
This patient's laceration did not have involvement of the cartilage, it was easily repaired with 6-0 prolene in a simple interrupted fashion.
Checkout Provider Prepared to see your options for honest and affordable wound care at home, be prepared for what ever care or may strike!
Provider Prepared
Nathan Whittaker, MD
Wounds that are small and superficial, requiring only a few staples or sutures for closure, can have suture or staple removal in 7-10 days. Larger more complex wounds should be considered for suture or staple removal after 10-14 days.
Hollander, JU et al. Assessment and management of scalp lacerations. UpToDate February 2018.
See Provider Prepared for the most affordable and honest way to be prepared for wound care at home and on the go!
Provider Prepared
Nathan Whittaker, MD
]]>
Proper examination of hand wounds requires an understanding of hand anatomy and function. During assessment of the wound, function and sensation of the digits must be evaluated. The thumb requires special attention for proper examination. The thumb is made up of two phalanges, in comparison to the other digits which have three. The thumb has more movement capabilities than the other fingers. At the carpometacarpal joint the thumb can flex, extend, abduct, adduct, oppose, and retropulse. The metocarpophalangeal joint allows the thumb to flex, extend, abduct, and adduct. The interphalangeal joint provides for flexion and extension.
Bassett, RE et al. Finger and thumb anatomy. UpToDate, July 2016.
Evaluation to ensure all these thumb movements are intact must be part of thumb wound evaluation.
This patient has all movements of her left them intact with good strength, sensation is intact as well. On exploration of the wound there is no evidence of any deep structure injury. The laceration was closed with a single layer repair without complication. A thumb spica splint was then placed to immobilize the thumb, promoting less tension on the wound.
Visit Provider Prepared to see our options for all your home laceration care needs!
Provider Prepared
Nathan Whittaker, MD
Dehisced wounds should be carefully examined for infection. With any signs of infection topical and systemic antibiotic treatment should be used as clinically appropriate.
Be prepared for wound care at home and on the go with tools of the trade from Provider Prepared!
Provider Prepared
Nathan Whittaker, MD