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Surgical skills > Early wound management > Flashcards

Early wound management Flashcards

1
Q

What are 4 history questions to ask?

A
  1. duration of injury
  2. mechanism of injury
  3. estimation of blood loss
  4. treatments (thus far)
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2
Q

What are 4 history questions to ask?

A
  1. duration of injury
  2. mechanism of injury
  3. estimation of blood loss
  4. treatments (thus far)
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3
Q

What are recommendations for wound @ site? (b4 get to hospital)

A
  1. restrict movement
  2. garden hose lavage–decontaminate
  3. control hemorrhage (pressure bandage–don’t leave on long!)
  4. see to the case! don’t just let go to hospital
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4
Q

What are two aspects of patient assessment?

A
  1. systemic assessment

2. wound assessment

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5
Q

What are three things examine to assess systemic condition of the patient?

A
  1. cardiovascular status
  2. resp status
  3. body condition
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6
Q

What are three things to look at when assessing cardiovascular status?

A
  1. pulse
  2. mucus membrane colour
  3. capillary refill time
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7
Q

What does a good pulse indicate?

A

That the pressure is ok

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8
Q

What is the most significant indicator to see if animal has lost a significant amount of blood?

A

mucus membrane colour

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9
Q

Why is it hard to assess cardiovascular state during hemorrhage?

A
  1. heart rate is up

2. PCV and protein will not change for a few hours (until fluid compartments are reestablished)

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10
Q

What is the golden period?

A
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11
Q

Is the golden period longer on the head and body or on the limbs?

A

longer on the head and body

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12
Q

What are three ways to examine a wound?

A
  1. visual examination
  2. digital examination (gloves)
  3. diagnostic imaging
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13
Q

What can you find out about a wound by looking at it?

A
  1. location of wound
  2. extent of injury
  3. age of wound
  4. condition of wound
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14
Q

How old does a wound have to be before you see granulation tissue macroscopically?

A

4-5 days

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15
Q

How do you perform a digital examination?

A
  1. sedate (small animal, maybe horse)
  2. local anesthesia
  3. sterile lube in wound
  4. clip and prep
  5. explore wound, involved structures
  6. joint evaluation (arthrocentesis, fluid injection)
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16
Q

What can diagnostic imaging be used to do when looking at a wound?

A
  1. assess bone
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17
Q

What are recommendations for wound @ site? (b4 get to hospital)

A
  1. restrict movement
  2. garden hose lavage–decontaminate
  3. control hemorrhage (pressure bandage–don’t leave on long!)
  4. see to the case! don’t just let go to hospital
How well did you know this?
1
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2
3
4
5
Perfectly
18
Q

What are two aspects of patient assessment?

A
  1. systemic assessment

2. wound assessment

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19
Q

What are three things examine to assess systemic condition of the patient?

A
  1. cardiovascular status
  2. resp status
  3. body condition
How well did you know this?
1
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2
3
4
5
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20
Q

What are three things to look at when assessing cardiovascular status?

A
  1. pulse
  2. mucus membrane colour
  3. capillary refill time
How well did you know this?
1
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2
3
4
5
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21
Q

What does a good pulse indicate?

A

That the pressure is ok

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the most significant indicator to see if animal has lost a significant amount of blood?

A

mucus membrane colour

23
Q

Why is it hard to assess cardiovascular state during hemorrhage?

A
  1. heart rate is up

2. PCV and protein will not change for a few hours (until fluid compartments are reestablished)

24
Q

What is the golden period?

A
25
Q

Is the golden period longer on the head and body or on the limbs?

A

longer on the head and body

26
Q

What are three ways to examine a wound?

A
  1. visual examination
  2. digital examination (gloves)
  3. diagnostic imaging
27
Q

What can you find out about a wound by looking at it?

A
  1. location of wound
  2. extent of injury
  3. age of wound
  4. condition of wound
28
Q

How old does a wound have to be before you see granulation tissue macroscopically?

A

4-5 days

29
Q

How do you perform a digital examination?

A
  1. sedate (small animal, maybe horse)
  2. local anesthesia
  3. sterile lube in wound
  4. clip and prep
  5. explore wound, involved structures
  6. joint evaluation (arthrocentesis, fluid injection)
30
Q

What can diagnostic imaging be used to do when looking at a wound?

A
  1. assess bone
31
Q

What can diagnostic imaging be used to do when looking at a wound?

A
  1. assess bone
32
Q

What are three things to remember with client communication?

A
  1. lead with best treatment option
  2. may have to compromise
  3. need to be upfront and honest if the client is not willing to do enough for the animal
33
Q

What are the goals of wound debridement?

A
  1. remove contamination
  2. remove devitalized tissue
  3. eliminate infection
34
Q

What are three methods of debridement?

A
  1. sharp dissection
  2. curettage
  3. irrigation
35
Q

what is the best method of debridement?

A

sharp dissection

36
Q

What is bad about devitalized tissue?

A

it can harbor bacteria

37
Q

What are the goals of wound lavage?

A
  1. remove debris

2. reduce bacterial numbers

38
Q

How is wound lavage performed?

A
  1. use 3mL syringe with 20 gauge needle to get 7 psi pressure
    (not more or less)
39
Q

What are three lavage instruments (some more formal than others)

A
  1. garden hose
  2. syringe
  3. pulsavac
40
Q

The ideal lavage solution has what two characteristics?

A
  1. nonirritating

2. bactericidal

41
Q

What is the #1 and #2 solutions used for lavage?

A
  1. lactated ringers

2. saline

42
Q

Why is lactated ringers a better choice than saline for a lavage solution

A

Because saline is more irritating to tissue because it has a lower pH. May not be a big deal with a large wound but may cause an issue in synovial joints

43
Q

What are 4 solutions that can be used as lavage solutions?

A
  1. lactated ringers
  2. saline
  3. povidone iodine
  4. chlorhexidine
44
Q

Why is lactated ringers a better choice than saline for a lavage solution

A

Because saline is more irritating to tissue because it has a lower pH. May not be a big deal with a large wound but may cause an issue in synovial joints

45
Q

Why is povidone iodine not a good lavage solution?

A

it must be >1% to be bactericidal but is histotoxic at 0.5%. It inhibits neutrophil migration. It is not better than lactated ringers. However it is not irritating

46
Q

Why is chlorhexidine not a good lavage solution?

A

a low level is bactericidal but an even lower level is histotoxic. It also trashes synovial structures!

47
Q

What can chlorhexidine lavage solution be used for?

A
  1. canine wounds
  2. endometrial lavage (diluted!!)
  3. mouth washes?
48
Q

Why is chlorhexidine in trisEDTA used as a lavage solution?

A

the trisEDTA is a detergent and lowers the necessary % of chlorhexidine. Retains the effects of chlorhexidine and can be used in joints and wounds. may not be more efficatious

49
Q

What lavage solution can be used to manage pseudomonas

A

chlorhexidine in trisEDTA

50
Q

What are two antibiotics used in lavage solutions?

A

neomycin

gentocin

51
Q

Is there evidence that antibiotics are useful in lavage solutions?

A

no
most of the drug does not end up in the wound. put the antibiotic in AFTER lavage (closed joint or local perfusion with tournequet)

52
Q

When are antibiotics best used in wound management?

A
  1. prophylaxis (surgical wound)
  2. cellulitis therapy
  3. open synovial structure therapy
  4. severe muscle injury (beta lactam to prevent clostridial myositis in horse–cattle vaccinated)
53
Q

Who was alfred hegar?

A

a german gynecologist who was kind to his patients and bad tempered with his assistants

Surgical skills (23 decks)

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