Bites, Burns Flashcards
T/F: all cases of bite wounds are considered contaminated
True
-open (skin penetration) or closed (skin crushed), contain polymicrobial flora
What is the most commonly cultured organism form a bite wound?
Pasteurella multocidia
What are common aerobic isolates from bite wounds?
Staphylococcus, enterococcus, bacillus, and E.coli
What are common anaerobic isolates from bite wounds?
Clostridium and corynebacterium
Dog bite wounds create what types of injury?
Puncture (iceberg effect)
Crushing
Tearing
Avulsion
Large breed dogs are more likely to have wounds where?
Neck and face
Small breed dogs are more likely to have bite wounds where?
Dorsal
What is big dog/little dog?
Combines lifting, shaking of the skin in addition to crushing and tearing
What is an avulsion injury?
Damage to the major direct cutaneous artery and vein with comprise to the collateral vascular supply
-> wounds continually declare themselves as the collateral damage to the vasculature is slowly released (3-7days)
What is the initial management of bite wounds?
All triaged for cardiovascular and respiratory abnormalities
Cervical injuries often traumatize trachea -> pnumomediastinum
Hemorrhage can be severe in cases requiring immediate exploration for vessel ID/ligation or compressive bandage mgt
Stable for sedation/anesthesia —> full thickness bite wounds should be ASEPTICALLY probed, debrided and reconstructed over drain
What should you do if the thorax/abdomen in involved in a bite?
Imaging to determine if penetration into a cavity has occurred
—>free peritoneal air
—> visible hernia
—>need to probe and explore wound to confirm
If an penetrating abdominal wound is present, how should you proceed with wound management?
MUST do exploratory laparotomy
—> significant potential for damage to abdominal visceral that require aggressive surgical attention
If a penetrating thoracic wound is present, how would you proceed for wound management
Not a surgical emergency
Clip, clean, debride, explore
Careful with lavage
Use imaging/clinical signs to determine chest wall integrity
What is SIRS?
Systemic inflammatory response syndrome
-excessive activation or loss of local control of inflammation leading to generalized inflammatory response
—> coagulopathy, multiple organ dysfunction, and acute respiratory distress syndrome
How do you proceed with managing an abscess?
Drain and debride necrotic tissue
Lavage
Open wound management using non-selective debridment x2-3days
then MRD to allow for 2nd intention healing
OR
En bloc debridement and primary closure
Empirical antibiotics
Analgesia
What is the most common cause of thermal injuries?
Accidental burns associated with application of heat to prevent/treat hypothermia in patients under anesthesia
A superficial burn involves what tissue?
Outermost epidermis
Burn injury
Moist, painful, blanch with pressure
What is the depth of this burn?
Superficial
1st degree
A partial thickness burn involves what tissues?
Epidermis and portion of the dermis
Burn injury
Edematous, painful with marked inflammation
What is the degree of burn?
Partial thickness
2nd degree
A full thickness burn involves what tissues?
All of epidermis and dermis
Burn injury
Dark brown, non painful, eschar
What degree is this burn?
Fulll thickness
3rd degree
What is an eschar?
Comprised of tough denatured collagen fibers (strong protective covering)
NOT a scab which is dead cells
What degree of burn can heal via spontaneous epithelialization ?
Superficial (3weeks) and partial thickness (months)
What is the prognosis for an animal with partial-thickness burns on <15% TBSA?
Good
Require minimal systemic support
At what percent TBSA burn area leads to greater risk of systemic effects?
> 20%
Require intensive monitoring = vital signs, metal status, hematocrit, total protein, urine output, CVP, electrolyte, blood gas and daily body weight
What is the prognosis for massive burned areas approaching 50% of TBSA?
Poor
May warrant euthanasia
What is the best therapy for burn wounds?
Conservative management
Clip wide
Analgesics- topical (1st and 2nd) and systemic
Topical silver sulfadiazine —> best protection against wound colonization and infection
Aloe Vera- faster re-epithelization
Manuka honey
OWM with medicated primary layer
Suggested contact layer for a burn with eschar?
Needs softening and debridment
Hypertonic saline or hydrogel dressing with silver sulfadiazine and biguanide -impregnated gauze
What contact layer should you use if there is no eschar but wound needs further debridment?
Hydrogel or hydrocolloid dressing and biguanide-impregnated gauze
What contact layer should you use on a burn with no eschar but needs granulation tissue?
Hydrogel or calcium alginate and biguanide-impregnated gauze
What contact layer should you use in a burn that needs epithelization ?
Polyurethane foam pad and biguanide-impregnated gauze
What is a shearing injury?
Severe abrasion of the soft tissue and malleoli
- medial tarsus more commonly injured
- subluxation results from injury of the collateral ligament complex or fracture of medial/lateral malleolus
T/F: if a large flap of tissue has be avulsed, it can be viable is reattached quickly
False
Unlikely to be viable
-primary closure will likely fail
