3. Wounds

Question 1

What is important to know about wounds?

Answer 1

Anatomical loc
cause of trauma
degree of contaimination
duration of injury

Question 2

What are some questions to ask as part of history?

Answer 2

When did it happen, how, where (inside/outside/unseen)?
If a bite -> lg dog, sm dog, wild, is either rabies vxinated?
Puncture wound - what was object
has first aid been provided

Question 3

What is an erosion type of wound?

Answer 3

The depth of wound does not go past the basement membrane of the dermis

Question 4

What is an ulcer type of wound

Answer 4

the depth of the wound goes past the basement membrane of the dermis

Question 5

What is important when describing the wound?

Answer 5

Location
overall shape
width
length
depth
edges

Question 6

What is a laceration wound?

Answer 6

Cut or tear that only affect a specific area w/ a fairly defined edges and little to no tissue loss (also most surgical wounds)

Question 7

What is avulsion? What’s its other name?

Answer 7

Degloving injury - A peeling injury where there is significant loss of skin

Question 8

What is a puncture wound?

Answer 8

A small entry point that may or may not be easily visible, potential to extend deep into tissue

Question 9

What is a blunt trauma wound?

Answer 9

A would result of force of impact, such as hit by car. Usually massive soft tissue +/- bone injury

Question 10

What are bite wounds?

Answer 10

A combo of laceration, avulsion, puncture wound and blunt trauma.
Always containimated

Question 11

Why are large dog bites more complicated than cats?

Answer 11

Cats usually cause deep wounds with lacerations
Lg dogs grab and shake which tears the skin from underlying subcutis which can rip blood vessel supply to the skin -> risk of ischemic injury, tissue necrosis, infected pockets of muscle

Question 12

What are thermal burns?

Answer 12

Burns caused from fires, radiation injury or inappropriate heating sources

Question 13

Why differentiates each degree of burns?

Answer 13

1st degree: only superficial epidermis affected
2nd degree: epidermis affected, hair follicles not affected
3rd degree: complete loss of epidermis, all hair gone, can extend to bone

Question 14

What is a chemical burn?

Answer 14

Inappropriately applied medications, disinfectants. Can include feces, urine, serum

Question 15

Describe a clean wound, what is the infection risk?

Answer 15

Surgical wounds using aseptic technique
infection risk is <2.5% depending on cleanliness of surgery

Question 16

What is a clean-contaiminated wound? What is its infection risk?

Answer 16

Minimal contaimination
surgical wound w/ a dran; surgical wounds near area with normal flora (bladder)
infection risk ~5%

Question 17

What is a contaminated wound? What is its infection risk?

Answer 17

GI surgery, open fresh woulds <4 hrs old that do not appear to have debris and caused by a non-contaminated object
infection risk 5-20%

Question 18

What is a dirty wound? What is its infection risk?

Answer 18

ANy wound over 4 hrs. Wound w/ visible debris, foreign objects, feces. All bite wounds
20-40% infection risk
left open for 8_ hours have 100% infection risk

Question 19

What is the golden wound period?

Answer 19

The first 8 hrs of any wound. If they’re cleaned + dressed within the first 8 hrs have a much better prognosis

Question 20

What is stage 1 in wound healing? What happens?

Answer 20

Acute inflammation - trauma to blood vessels release signal for inflam response
inflam cells and proteins enter damaged area and clean out foreign material and damaged tissue
platelets, fibrin, clotting factors enter damaged area and stop bleeding
inflam stage is PRISS, starts minutes of wound

Question 21

What is stage 2 in wound healing? What happens?

Answer 21

Epithelialization - epithelial cells at edges of wound start to replicate and migrate towards centre of wound, early as 24 hrs after wound

Question 22

What is stage 3 of wound healing?

Answer 22

Cellular phase - Fibroblasts enter area, wall of damaged area create scaffold for repair/regrowth of blood vessels and tissue
endothelial cells and other cells enter into wound area and start to fill in space w/ appropriate tissue

Question 23

what is stage 4 of wound healing?

Answer 23

Blood vessels reform, tissue will raise and be red + slightly moist (bleeds if disturbed). <- granulation tissue
Around 7-14days

Question 24

What is proud flesh?

Answer 24

Where it extends past the natural borders of the wound and prevents proper healing

Question 25

What is step 1 of treating a wound?

Answer 25

Assessment - History, PE, problem list + prioritizing the problems.
Assess the wound - loc, side, depth, wound type, degree of contain, duration of wound

Question 26

What is step 2 in treating wounds?

Answer 26

Restrict movement - restricts amount of contamination by halter/tying, placing in a pen/stall/kennel, leach and move indoors
prevent self-trauma w/ e-collar for dogs, padding against rough posts

Question 27

What is step 3 in treating wounds?

Answer 27

Stop bleeding- hand pressure, pressure wrap, as long as necessary to top blood loss

Question 28

What is step 4 in treating wounds?

Answer 28

Lavage - wound cleaning
removing debris to reduce bacteria numbers
using garden hose, tap, running water
35 cc string w 16g needle/cath
avoid too high pressure or debris will go deeper
clip + wash, saline or 1:40 CHX

Question 29

What is step 5 of wound treatment?

Answer 29

Treat infection - OTC first aint ointments (polysporin), prescription antibiotics

Question 30

what is step 6 in wound treatment

Answer 30

Wound closure - may need several different types of wound treatment (surgery, drains, bandagages, etc)
dry the area after lavage, apply protective bandage and arrange for assessment by vet

Question 31

What is first intention would closure? Give a examplw

Answer 31

Best for lacerations + wounds not dirty. Edges of wounds sutured closed.
Ex surgical spray incision closed by suturing wounds in the muscle, subcutis and skin

Question 32

What is second intention would close?

Answer 32

open wound healing
wound is cleaned and left to heal on its own. may need bandages, antibiotics, hydrotherapy or nursing care

Question 33

What are some general dos and donts of wound care

Answer 33

dont rub
avoid tight bandages
dont get wet or expose to air
they should not smell bad
change bandages often
use correct bandages
if you won’t put it in your eye don’t put it in a wound

Question 34

Explain hydrotherapy, what is it

Answer 34

Application of clean water at a steady pressure to an open wound
10-20 min at a time
apply stream while moving over surface of wound
2x per day with time to dry completely
pressure inc rate of epithelialization and cellular stage of healing
will keep wound clean without risk of chemical toxicity to fragile cells.