2. Describe the wound, clinical examination of the injured equine patient Flashcards
What is a wound?
Loss of continuity in the skin, mucous membrane or in an organ or witout underlying tissue damage
Name causes/etiology of wounds:
- Mechanical caused trauma
- Chemicals:
- Acids = coagulation necrosis
- Alkalis = Colliquation necrosis - Thermal effects
- Burn
- Frostbite - Radioactive injuries
- Electricity caused injuries
How would you classify a wound?
By:
1. Localisation
2. Shape and size
3. deep or superficial
4. Origin
5. Age
6. Healing stadium
7. What type of wound is it:
What do we mean by localisation in classification of a wound?
Which anatomical region or which organ is affected (head, neck, skin, mucous membrane, muscle)
What do we mean by Shape and size in classification of a wound?
point like
lime like
lobed
cavernous
loss of materia
loss of body part
regular edges
irregular edges
What do we mean by superficial or deep in classification of a wound?
If its superficial = denuding of epidermis, minimal bleeding, some serum exudation
Deep = Several strucutres are affected
What do we mean by Origin in classification of a wound?
Surgical or traumatical
Surgical = aseptic
Traumatical = Always contaminated
What do we mean by age in classification of a wound?
If its fresh or old
Old = granulation tissue is deep, epithelisation - no primary closure indicated
What do we mean by healing stadium in classification of a wound?
Regular healing
Irregular healing
Infected or with compulsion
What do we mean by type in classification of a wound?
We have 6 type of wounds:
1. Incised
2. Laceratged
3. Contused
4. Punture
5. Gunshot
6. Bite
Latin name for incised wound:
Vulnus scissum et caesum
Latin name for lacerated wound:
Vulnus lacerum s. ruptum
Latin name for contused wound:
Vulnus contusum
Latin name for puncture wound:
Vulnus punctum
Latin name for Gunshot wound:
Vulnus sclopetarium
Latin name for bite wound:
Vulnus morsum
Which type of wound is this?
Vulnus scissum et caesum
What type of wound is this?
Vulnus lacerum s ruptum
What type of wound is this?
Vulnus contusum
Vulnus scissum et caesum.
Cause, edges, tissue damage, painful?, prognosis
Produced by sharp objects
Wound edges: linear, smooth
Minimal tissue damage
Underlying tissue may be damaged only in the line
Minimal pain
Prognosis: in general good
Vulnus lacerum s ruptum
Cause, edges, tissue damage, painful?, prognosis
Produced by irregular objects
Wound edges: Smooth-lacerated
Extensive tissue damage, loss of materia
Extensive damage of the underlying tissue
Painful
Prognosis: Depends on the individual case
Vulnus contusum
Cause, edges, tissue damage, painful?, prognosis
Produced by dull objects
Wound edges: irregular
Extensive tissue damage
Extensive damage to underlying tissue
-> check for synovial cavity involvement; fill the joint with aspetic fluid, check for leakage
Very painful, initially block
Prognosis: unfavourable, anaerobic wound infections are common
Vulnus punctum
Cause, edges, tissue damage, painful?, prognosis
Produced by sharp objects
Have both penetration and perforation
Penetration: Into tissue byt does not go through, only the entrance of the wound
Perforation: Both entrance and exit wound
Prognosis: Highly depends on presence of anaerobic infections
Vulnus morsum
Cause, edges, tissue damage, painful?, prognosis
Caused by teeth
Carnivores: produce puncture wounds, risk of anaerobic infections
Herbivores: Produce contused wound
Prognosis: Depends on the level of tissue damage and presence of anaerobic infections
Vulnus sclopetarium
Cause, edges, tissue damage, painful?, prognosis
Cause: gunshot wound, arrow, ball, bullet, splinter, shrapnel
Inlet: primer necrotical zone
Channel: Necrobiotical zone
Outlet: Molecular commotional zone
Possibilities of a bullet:
- Can wonder within the tissue
- Can produce a capsule around it
Which steps would you do for the clinical examination of the injured horse?
- Emergency help and stabilization for transport to clinic
- Relief anxiety and pain
- Clinical examination
- Rule out the risks in case of wounds
- Examination of wounds
Emergency help and stabilization for transport to clinic, which measures do we do?
- check circulatory and mental stata briefly
- Stop bleedings
- Prevent further injury
- Wounds: sterile coverage, gauze bandage, self-aticky gauze
- Allow safe transport
What to use for anxiety and pain relief?
Seadtion -> Alpha-2 agonists
- Xylazine
- Detomidine
- Butorphanol
NOT ACE = hypotensive effects
Orthopaedic painkillers:
- COX-2: firocoxib
- be carefull in severe hydration/shock
Which parameters do we check in clinical examination?
We check the circulatory system and mental state.
Heart rate: Normal=28-42
Respiratory rate: Normal 10-18
MucousMembrane, CRT: Normal: light pink, CRT=below 2
Temperature: Normal: 37-38
Check for hydration: check for skin turgor
Take blood sample: biochemistry, electrolyte
Name some risks in case of wound injuries:
- Shock
- Pneumothorax
- Internal bleedings
- Perforation of internal organs
Especially important to assess the risks if the wound is above the chest
How would you examine the wound?
- Take a swab for microbiology before cleaning
- Pre-OP antibiotics
- Aseptic preparation of the wound
- Wound debridement
- Lavage
- Check for involvement of underlying strucutre: joints, tendon sheaths, tendons, bones
- check for presence of foreign material
- Primary wound healing: closure
- Secondary wound healing in case of: high contamination, lack of tissue, huge loss of materia, location with huge moveability = results in formation of granulation tissue
Steps for aseptic preparation of the wound:
- Clipping hair
- Disinfection of the skin: Povidine iodine, chlorhexidine
What is lavage, and precasionally steps:
Cleans the wound of debris and bacteria, and stimulates the microcirculation.
Precautions:
- Avoid too much pressure
- Solution: Sterile isotonic, normothermic, non-toxic (NaCl, Lavanid solutions
What is meant by wound debridement?
Remove injured and necrotic tissue to get fresh, intact wound margins for primary wound closure.
