amysdad

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do you guys have any tricks of the trade for road rash??? I give a bucket load of dilaudid and get to cleaning and my pt's still scream. Lido jelly? Emla?

Thanks
 

Blue Dog

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amysdad said:
do you guys have any tricks of the trade for road rash??? I give a bucket load of dilaudid and get to cleaning and my pt's still scream. Lido jelly? Emla?
Sounds like you're being pretty aggressive with your cleaning.

Generally, you can get most of the debris out of road rash by irrigating under pressure with normal saline (using a pistol syringe or a Toomey and splash bell). Rubbing the abraded area only increases tissue trauma (not to mention pain). Large bits of debris can be removed individually with forceps.

After the wound has been cleaned and dried, apply Bacitracin or Silvadene and a dressing, preferably Tegaderm or Duoderm.

Ref: http://www.freewheel.com/mvw/cure.htm
 

stoic

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i've been taughted to be more aggressive than kentw. give the pain meds and then irrigate with saline and get anything big with forceps. but it seems for most moderate and worse road rash, there is so much junk deep to what you can get with irrigation and small/numerous enough that with forceps you'd be there all night... sooo... get out your lido jelly and apply generously. then grab a handful of 4x4's and start debriding. i've seen and found that you sometiems you really have to get aggressive with it but if you use enough pain meds and lido the pt is comfortable enough and you end up getting a lot more of the debris out.

just my 0.02
 
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EMResident

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stoic said:
get out your lido jelly and apply generously. then grab a handful of 4x4's and start debriding. i've seen and found that you sometiems you really have to get aggressive with it but if you use enough pain meds and lido the pt is comfortable enough and you end up getting a lot more of the debris out.
Please remember that lidocaine does have a maximum, weight-based dose. Depending on the absorption (ie depth of abrasion) you may need to consider other methods for debridement -- ketamine in the appropriate patient, perhaps? -- to avoid lidocaine toxicity.
 

Pose

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How much lido jelly would be needed (on your average patient model) to cause toxicity?
 

roja

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Nitrous oxide works great and won't generally tie up your nurses...
 

stoic

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Pose said:
How much lido jelly would be needed (on your average patient model) to cause toxicity?
as long as they are still doing Bier blocks i'm not going to worry about lido toxicity with topical lido jelly on road rash. yea they probably get a decent dose of it if you use a ton for like an hour, but the absorbtion is slow enough that its not going to be causing any seizures. with the bier blocks i've seen they never seem to wait more than 2 minutes from beginning to release pressure to having the tourniquet completely off and that bolus dose is WAY bigger than what they're getting over the entire duration of the debridment.
 

stoic

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roja said:
Nitrous oxide works great and won't generally tie up your nurses...

the ED has nitrous? i honestly had no idea. is that common?
 

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Where I trained, if the road rash was anything more than just superficial, localized injury, the Burn team would admit these patients and take them to the OR to be cleaned up.
 

RRT2MD

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stoic said:
the ED has nitrous? i honestly had no idea. is that common?
No, N2O is not that common, at least in my State. (But it should be.)

~~RRT, NREMT-P :luck: :luck: :luck:
 

roja

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We use it all the time... I love it.. its not just for peds.. shoulders, fractures, difficult i&d's, etc.

its tgreat.
 

stoic

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roja said:
We use it all the time... I love it.. its not just for peds.. shoulders, fractures, difficult i&d's, etc.

its tgreat.
oooooo it would be good for I&D's. those folks can be so hard to get comfortable even with a ton of narcotics on board... and the local sometimes seems completely useless. you could probably cut back the narcotic dosage quite a bit using some adjunct nitrous. i'm gonna find out if we have that here in my med school's ed. if we don't maybe gas could cart some down. i'm anxious to give it a shot on the next big bad abcess i dig into.

you mention using it in kids... do you use it for really fussy kids who won't calm down enough to sew big lacs even with adequate local? cause i swear those kiddos stress me out more than just about anything. i'd love to gas them down a little. or failing that, myself.
 
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