Exam 1 Flashcards
T or F? Negative Pressure Wound Therapy (NPWT) cleans the wound
False, it only drains the exudate (and promotes granulation formation)
Describe Negative Pressure Wound Therapy (NPWT)
Purpose: Enhance healing and promote wound closure
Used for acute, sub-acute, and chronic wound management (Wound must be debrided so it is free of eschar and slough)
Indications: Post-surgical wounds, wounds with exposed deep tissue, skin grafts, traumatic wounds
Contraindications: Necrotic tissue or dry wounds, bleeding, osteomyelitis, individuals on anticoagulants (blood thinners)
In regards to target pressure using NPWT for acute ulcers and chronic ulcers, which pressures should be used?
Acute traumatic / pressure ulcers
- Black Foam: 125mmHg
- Soft Foam: 125-175mmHg
Chronic Ulcers
- Black Foam: 50-75mmHg
- Soft Foam: 125mmHg
When should NPWT be dicontinued?
Large amounts of blood, patient is unable to tolerate pain/pressure, no progress, signs of new infection
Describe pulsed lavage
Used for cleansing/debridement of the wound (can also help soften the tissue if high PSI is used, ultimately making debridement easier)
- 1x per day, At least 3x per week (should be done more if the wound is not granulating), should be discontinued when treatment goals have been met
Indications: eschar tissue that needs to be softened before debridement, tunnels, skin graft prep
Contraindication: Exposed arteries/veins/nerves/tendons/bone, active bleeding, facial wounds, vascular bypass graft sites/flaps
Precautions: Insensate areas (loss of sensation), patients on anticoagulants (blood thinners), wounds near major vessels
What are biofilms?
Communities of microorganisms attached to the wound surface
(can create a barrier to wound healing)
Which pressure should be used with pulsed lavage when using it to clean or debride a wound?
Cleaning: 4-7psi
Debridement: 8/10-15psi
(use low pressure for tunneling)
T or F? Suction for NPWT stimulates granulation tissue production
True
Differentiate between closed and open pulsed lavage
Open Pulsed Lavage: Done in a medical facility, full PPE is mandatory, wound debris sprays from the wound
Closed Pulsed Lavage: Can be done in the patient’s home or somewhere casual due to the utilization of a bag. This bag collected all debris and prevents splashing from the wound
Describe HBOT
Hyperbaric Oxygen Therapy
An oxygen chamber/bed that has the following benefits:
- Increases oxygen concentration gradient (hyperoxia) in the blood
- May reduce bacterial growth
- Enhance angiogenesis, collagen, granulation tissue formation, epithelialization, and wound contraction
- May reduce edema
Oxygen Pressure must be >40mmHg for “normal wound healing” to occur… <40mmHg is considered wound hypoxia
Indications: Gas gangrene, peripheral ischemia, skin grafts, osteomyelitis, thermal burns
Contraindications: Untreated pneumothorax, COPD/asthma, pregnancy, claustrophobia, arterial insufficiency
Duration: 90-120 minutes per session, 2-3x per week, 10-60 sessions total
Describe laser therapy
A machine that uses light waves that has the following benefits:
- Provides cells with photons, then the cells turn energy into ATP
- Increases respiratory chain activity
- Promotes cell repair/reproduction through stimulation of ATP
- Enables cell proliferation
Precautions: Decreased sensation, steroid injection
Contraindications: Pregnancy, malignancy, growth plates in children, gangrene (wagner 4/5), individuals with epilepsy
What are the 4 customizable settings with laser therapy?
- Wavelength (nm):
- Distance between two peaks of a wave
- Power (mW):
- The rate at which energy is produced
- Energy (J/cm^2):
- The amount of energy delivered per unit area
- Continuous or pulsed:
- Whether or not the laser is always on (continuous), or pulsed (sometimes on, sometimes off)
T or F? Length and Power determine the depth of the probe (light)
True
T or F? Power=Probe
True
What are the parameters for acute and chronic wounds using laser therapy
ACUTE WOUNDS
Dosage: 8j/cm^2
Frequency: 700Hz
Application: In and around wound bed and peri-wound
CHRONIC WOUNDS
Dosage: 1-6j/cm^2
Frequency: Continuous
Application: In and around wound bed and peri-wound
What are some examples of resistance to estim?
Fat, Hair, Dirty skin
What are the 4 debridement techniques?
- Autolytic (body’s natural enzymes break down the dead tissue)
- Enzymatic (uses chemical agents to remove the dead tissue)
- Biological (maggots consume the dead tissue)
- Surgical (debridement using scalpel, scissors, etc.)
Describe E-stim (for wound healing)
Typically a monopolar pad placement with negative lead on or around the wound. If placed on the wound, use gauze (soaked with saline) underneath as it will prevent burning
Indications: Muscle re-ed, pain control, wound healing, edema/swelling control
Contraindications: Pacemaker, skin cancer, malignancy, osteomyelitis, thrombosis
Distinguish which types of nerves are recruited by the 3 following phase duration ranges of estim…
20-100, 200-400, 400-1000
20-100: Sensory nerves
200-400: Motor nerves
400-1000: Noxious nerves
What are the parameters for wound healing estim?
High volt (twin spiked monophasic)
> 100 volts (intensity)
<100 usecs (phase duration)
1-120 Hz frequency
Differentiate between a cathode and an anode
Cathode: Negative electrode (pad)… typically used for granulation and epithelialization
Anode: Positive electrode (pad)… typically used for autolytic debridement
What other type of Estim has a polarity?
a) Biphasic symmetrical
b) Biphasic asymmetrical
c) Direct Current
d) Russian
e) IFC
c. Direct current
In a monopolar pad setup, the dispersive and active pad need to be placed how far apart?
15cm
Describe ultrasound
Measured in megahertz (MHz)… 1MHz goes deeper but takes longer to heat, 3MHz is more superficial but is quicker to heat
must be a protective layer between gel and wound
Indications: For clean or infected wounds that have not responded well to other treatments (only use non-thermal US on wounds, thermal on scar tissue)
Contraindications: Malignancy, pregnancy, laminectomy, fx site, osteomyelitis
T or F? Use continuous (laser) for chronic wounds
True
What are the contraindications for HBOT?
“PLACE” mnemonic
- Pregnancy
- Lung issues
- Arterial TCOM <40
- Claustrophobia
- Ear/sinus issues
What are the contraindications for pulse lavage?
“FABLE” mnemonic
- Face
- Active bleeding
- Bypass grafts
- Latex allergy
- Exposed bone, tendon
What are the contraindications for sharp debridement?
“GO PITAS”
- Gangrene
- Osteomyelitis
- PAD/arterial insufficiency <.9
- Immunocompromised
- Thrombocytopenic
- Anticoagulants
- Stage 3-4 w/tunneling
What are the contraindications for NPWT?
“FB Domains” mnemonic
- Fistulas
- Blood vessels
- Dry
- Osteomyelitis
- Malignancy
- Active bleed
- Infection
- Necrosis
- Starved/malnourished Albumin <3.5
What are the contraindications for Estim?
“B SUCTION” mnemonic
- Blood flow compromised
- Seizures
- Unstable fracture
- Chest/cancer
- Titanium okay, all other metals no
- Implants
- Osteomyelitis
- Neck
What are the precautions for Estim?
“SSSSOCCC” mnemonic
- Seizure hx
- Sensation deficits
- Surgical sites
- Skin conditions
- Obesity
- Cognitive deficits
- Cancer hx
- Cardiac issues
What are the contraindications for laser?
“CHEEP EGG” mnemonic
- Cancer
- Hemorrhage
- Eyes
- Endocrine
- Pregnancy
- Epilepsy
- Gangrene
- Growth plate
What are the contraindications for compression?
CC Ideas
- Claustrophobia
- Complex regional pain syndrome
- Infection
- DVT
- Edema of the cardiopulm system
- ABI <.7
- Spasticity
What are the contraindications for ultrasound?
“O SAD” mnemonic
- Osteomyelitis
- Severe arterial insufficiency
- DVT
What are the mnemonics or HBOT, Pulse Lavage, Sharp Debridement, NPWT, Estim, Laser, Ultrasound
HBOT: “PLACE”
Pulse Lavage: “FABLE”
Sharp Debridement: “GO PITAS”
NPWT: “FB DOMAINS”
Estim: B SUCTION
Laser: CHEEP EGG
Ultrasound: O SAD
What are the parameters for estim on wounds?
High volt, twin spiked monophasic, >100 volts (intensity), <100usecs (phase duration), 1-120Hz (frequency)
Should be done daily (5-7 days per week), and for 45-60 minutes per session
T or F? When using estim, the cathode (negative pad) is used for granulation/epithelialization while the anode (positive pad) is used for debridement
True
T or F? transparent films are not used on estim, just ultrasound and laser
True
