#8 Initial wound management Flashcards
The first step in wound management is
assessment of the overall stability
First aid for the wound should be performed as soon as safely possible. Active bleeding can be controlled with:
with direct pressure
- , instead of a tourniquet, should be used in cases of severe arterial bleeding; the cuff should be inflated until hemorrhage is controlled.
A pneumatic cuff,
Treatment for any local wound should be guided by the fundamentals of
debridement, infection or inflammation control, and moisture balance
Wound lavage serves two purposes.
Irrigation of the wound washes away both visible and microscopic debris.
lavage
-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.
A recommended lavage system delivers moderate pressure with
35-mL syringe and a 19-gauge needle to generate 8 lb/sq in. of pressure.
causes a detrimental side effect by driving debris deeper into the healthy tissue.
Excessive pressure
has sustained residual activity against a broad spectrum of bacteria while causing minimal tissue inflammation
Chlorhexidine diacetate 0.05%
Debridement may involve removal of
-large segments of tissue (nonselective) or may be performed in a
-more selective manner
-enabling preservation of specific tissues
After wound preparation and hair removal, —
can be performed
debridement
is an effective antiseptic, but it has minimal residual activity and may be inactivated by purulent debris
Povidone-iodine
debridement may be performed
mechanically, enzymatically, or biologically (maggot therapy).
is the simplest method of wound management, it should be used only in appropriate situations to avoid wound complications.
primary closure
Wounds may be closed with
suture, staples, or cyanoacrylate.
may not be appropriate for a grossly contaminated or infected wound
Primary closure
Minimally contaminated wounds may be closed after
24–72 hours
Wounds closed >5 days after the initial wounding are considered to be
secondary closure
When a wound cannot or should not be closed, open wound management ei,
second-intention healing)
Such wounds include those in which there has been
-loss of skin that makes closure impossible or those that are
- too grossly infected to close.
injuries of the extremities are especially amenable to open wound management.
Longitudinal degloving
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.
Open wound management
is based on repeated bandaging and debridement as needed until the wound heals.
Open wound management
Traditional therapy calls for
wet-to-dry dressings initially
With the concept of moist wound healing, bandaging is combined with
autolytic debridement to promote wound healing.
A decision to use open wound management or delayed wound closure is based on several factors. These may include patient
morbidity, cost, wound location, and the technical expertise required for closure
- 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.
Granulated sugar
. 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
hypovolemia and low colloid osmotic pressure.
is based on its high osmolality, drawing fluid out of the wound and inhibiting the growth of bacteria.
SUGAR
from the manuka bush in New Zealand has the highest methylglyoxal levels and is believed to the most effective for medicinal purposes
Leptospermum honey
Some of the beneficial effects of honey are a result of high osmolality, low pH, and hydrogen peroxide activity.
Honey
has been used as a topical agent in various formulations for several hundred years.
Silver
However, the major contribution to honey’s antibacterial activity is
methylglyoxal
It is available in a cream (silver sulfadiazine) or in the newer form as
nanocrystalline silver (ANITIINLAMMATIORY)
The primary benefit of silver is its
antimicrobial effects and therefore is indicated for use in the inflammatory phase.
may also be useful in the proliferative phase
nanocrystalline
The use of silver-containing dressings to prevent
infection
usually in ointment formulation) are proteolytic compounds used to liquefy necrotic tissue.
Enzymatic Agents
Topical antibiotics may have two benefits:
-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.
These agents are used in the inflammatory phase of healing. Their application is indicated in cases where surgical debridement may be detrimental
Enzymatic agents
used during the inflammatory stage of wound healing to remove necrotic tissue and debris
Maggots
The maggots debride necrotic tissue by s
secreting several proteolytic enzymes to liquefy the debris
is used as the source of medical grade maggots.
common green bottle fly (Lucilia sericata
