#8 Initial wound management

Question 1

The first step in wound management is

Answer 1

assessment of the overall stability

Question 2

First aid for the wound should be performed as soon as safely possible. Active bleeding can be controlled with:

Answer 2

with direct pressure

Question 2

• , instead of a tourniquet, should be used in cases of severe arterial bleeding; the cuff should be inflated until hemorrhage is controlled.

Answer 2

A pneumatic cuff,

Question 3

Treatment for any local wound should be guided by the fundamentals of

Answer 3

debridement, infection or inflammation control, and moisture balance

Question 4

Wound lavage serves two purposes.

Answer 4

Irrigation of the wound washes away both visible and microscopic debris.

Question 4

lavage

Answer 4

-This reduces the bacterial load in the tissue, which helps decrease wound complications.
-The lavage also allows better examination of underlying tissues.
-most effective when delivered under appropriate pressure.

Question 5

A recommended lavage system delivers moderate pressure with

Answer 5

35-mL syringe and a 19-gauge needle to generate 8 lb/sq in. of pressure.

Question 6

causes a detrimental side effect by driving debris deeper into the healthy tissue.

Answer 6

Excessive pressure

Question 7

has sustained residual activity against a broad spectrum of bacteria while causing minimal tissue inflammation

Answer 7

Chlorhexidine diacetate 0.05%

Question 8

Debridement may involve removal of

Answer 8

-large segments of tissue (nonselective) or may be performed in a
-more selective manner
-enabling preservation of specific tissues

Question 8

After wound preparation and hair removal, —
can be performed

Answer 8

debridement

Question 9

is an effective antiseptic, but it has minimal residual activity and may be inactivated by purulent debris

Answer 9

Povidone-iodine

Question 9

debridement may be performed

Answer 9

mechanically, enzymatically, or biologically (maggot therapy).

Question 10

is the simplest method of wound management, it should be used only in appropriate situations to avoid wound complications.

Answer 10

primary closure

Question 11

Wounds may be closed with

Answer 11

suture, staples, or cyanoacrylate.

Question 12

may not be appropriate for a grossly contaminated or infected wound

Answer 12

Primary closure

Question 13

Minimally contaminated wounds may be closed after

Answer 13

24–72 hours

Question 14

Wounds closed >5 days after the initial wounding are considered to be

Answer 14

secondary closure

Question 15

When a wound cannot or should not be closed, open wound management ei,

Answer 15

second-intention healing)

Question 16

Such wounds include those in which there has been

Answer 16

-loss of skin that makes closure impossible or those that are
- too grossly infected to close.

Question 17

injuries of the extremities are especially amenable to open wound management.

Answer 17

Longitudinal degloving

Question 18

enables progressive debridement procedures and does not require specialized equipment (such as may be needed with skin grafting). However, it increases cost, prolongs time for healing, and may create complications from wound contracture.

Answer 18

Open wound management

Question 18

is based on repeated bandaging and debridement as needed until the wound heals.

Answer 18

Open wound management

Question 19

Traditional therapy calls for

Answer 19

wet-to-dry dressings initially

Question 20

With the concept of moist wound healing, bandaging is combined with

Answer 20

autolytic debridement to promote wound healing.

Question 21

A decision to use open wound management or delayed wound closure is based on several factors. These may include patient

Answer 21

morbidity, cost, wound location, and the technical expertise required for closure

Question 22

• is placed into the wound cavity in a layer 1-cm thick and covered with a thick dressing to absorb fluid drawn from the wound.

Answer 22

Granulated sugar

Question 22

. Because a large volume of fluid can be removed from the wound, the hemodynamic and hydration status of an animal with a large wound must be monitored to avoid

Answer 22

hypovolemia and low colloid osmotic pressure.

Question 22

is based on its high osmolality, drawing fluid out of the wound and inhibiting the growth of bacteria.

Answer 22

SUGAR

Question 23

from the manuka bush in New Zealand has the highest methylglyoxal levels and is believed to the most effective for medicinal purposes

Answer 23

Leptospermum honey

Question 23

Some of the beneficial effects of honey are a result of high osmolality, low pH, and hydrogen peroxide activity.

Answer 23

Honey

Question 24

has been used as a topical agent in various formulations for several hundred years.

Answer 24

Silver

Question 24

However, the major contribution to honey’s antibacterial activity is

Answer 24

methylglyoxal

Question 25

It is available in a cream (silver sulfadiazine) or in the newer form as

Answer 25

nanocrystalline silver (ANITIINLAMMATIORY)

Question 26

The primary benefit of silver is its

Answer 26

antimicrobial effects and therefore is indicated for use in the inflammatory phase.

Question 27

may also be useful in the proliferative phase

Answer 27

nanocrystalline

Question 27

The use of silver-containing dressings to prevent

Answer 27

infection

Question 28

usually in ointment formulation) are proteolytic compounds used to liquefy necrotic tissue.

Answer 28

Enzymatic Agents

Question 28

Topical antibiotics may have two benefits:

Answer 28

-The antibacterial efficacy may be beneficial with topical infections
-Zinc-containing antibiotics (eg, bacitracin-zinc) may also be beneficial for wound healing by the donation of zinc into the wound bed.

Question 29

These agents are used in the inflammatory phase of healing. Their application is indicated in cases where surgical debridement may be detrimental

Answer 29

Enzymatic agents

Question 30

used during the inflammatory stage of wound healing to remove necrotic tissue and debris

Answer 30

Maggots

Question 31

The maggots debride necrotic tissue by s

Answer 31

secreting several proteolytic enzymes to liquefy the debris

Question 32

is used as the source of medical grade maggots.

Answer 32

common green bottle fly (Lucilia sericata