2. Wound management

Question 1

First aid and stabilization

Answer 1

assess systemic status
Active arterial hemorrhage
Structural support

Question 2

Diagnostics

Answer 2

PE - clostridium tetani
Rads
US
Probe wound

Question 3

Wound management

Answer 3

Assessment - move to a better location when stable
Restraint/analgesia
Treatment
Prognosis

Question 4

Classification of wounds

Answer 4

Open - partial vs full thickness
Closed
Clean
Clean-contaminated
Contaminated
Infected/dirty

Question 5

Golden period in Horses

Answer 5

NO

Question 6

Choice of closure

Answer 6

Decision:
time appearance, type of injury, location,complications
Must understand wound healing

Question 7

Closure options (4)

Answer 7

Primary (intention) closure (healing)
Delayed primary closure
Secondary closure
Second intention healing

Question 8

Primary closure

Answer 8

immediate closure

Clean and clean-contaminated

Question 9

Delayed primary closure

Answer 9

2-5d after injury - before granulation
Contaminated/questionable to properly treat
Edema and tension

Question 10

Secondary closure healing

Answer 10

> 5d after injury - after granulation tissue

Contaminated/infected wounds

Question 11

Second intention healing

Answer 11

Granulation tissue, wound contraction, epithelization

Question 12

Phases of would healing

Answer 12

Inflammation/log
Proliferation
Remodeling

Question 13

Inflammation/log phase

Answer 13

hemostasis and acute inflammation
Hemostasis: platelets, vasoconstriction -> vasodilation, fibrin deposition
Inflammation: activated platelets, PMNs, macrophages, fibroblast

Question 14

Proliferation phase

Answer 14

Tissue formation
Macrophages - growth factors, initiation proliferation
Angiogenesis - via O2 tension, high lactate, low pH
Fibroplasia/collage/granulation tissue deposition
Collagen 2-3d after wounding (40% type 3)
Epitheliazation and wound contraction

Question 15

Remodeling phase

Answer 15

Regaining of strength - begins in 2nd week - for years

Final scar: 15-50% weaker than original

Question 16

First aid protocols

Answer 16

CV support
Prevent further injury
Hemostasis
Minimize contamination
Stabilize limb
Tetanus toxoid

Question 17

Optimal wound care

Answer 17

Adequate restraint: A2 agonists, NSAIDs, Opioids
Analgesia - multimodal
DEBRIDEMENT - single most important factor
Lavage - non toxics
Closure + bandage

Question 18

Preventing bacterial infection of wounds

Answer 18

Effective wound cleansing and debridement

Dressings and bandages

Question 19

Appropriate topicals

Answer 19

scarlet oil - granulation
Silver sulfadiazine
Polysporin ointment

Question 20

Wound dressings

Answer 20

Hypertonic saline
Antimicrobial dressing
Honey
Negative pressure therapy
DO NOT USE CORTICOSTEROID

Question 21

Hypertonic saline dressing

Answer 21

good for exudative or necrotic wounds

Question 22

Antimicrobial dressing

Answer 22

Kerlix AMD - best: Polyhexamethylene biguanide

Microbes are unable to become resistant

Question 23

Chronic wounds

Answer 23

Due to delay of owners - potions!!

Requires surgical excision, few topical agents, bandaging