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LA DX & TX I > Exam 1 - Advanced Wound Management > Flashcards

Exam 1 - Advanced Wound Management Flashcards

1
Q

what is the number one reason horse owners seek veterinary care?

A

equine wounds

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2
Q

T/F: only 25% of equine wounds successfully undergo healing by primary intention

A

true

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3
Q

what is responsible for 16% of adult horse euthanasias?

A

wounds

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4
Q

what are the 4 phases in wound healing?

A
  1. inflammatory
  2. debridement
  3. fibroblastic/proliferative
  4. remodeling
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5
Q

what is contraction?

A

wound gets bigger/expands up to 1 week after before getting smaller

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6
Q

what days does contraction typically occur in wound healing? why is this important?

A

days 5-7

want to impede expansion of the wound

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7
Q

why are sutures removed around 14 days?

A

the wound has better tensile strength

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8
Q

when does collagen synthesis begin in wound healing?

A

day 3 - getting closer to wound contraction

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9
Q

at the end of wound healing, how much healing is expected? why can this be concerning?

A

80% original strength 1-2 years after injury

concerns about re-injury

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10
Q

during the acute phase of wound healing, what are your big enemies? why?

A

motion, infection, foreign body, & ischemia

continues inflammation, pain, & poor blood supply

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11
Q

what do the enemies of wound healing in the acute phase cause chronically?

A

proud flesh, sequestrae, fibrosis, & weak scar tissue

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12
Q

other impediments to healing?

A

geriatrics - uncontrolled PPDH

poor nutrition, poor perfusion, seroma/hematoma, NSAIDS, & steroids

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13
Q

why are steroids bad for healing?

A

they inhibit collagen crosslinking & impede epithelialization which extends the healing time

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14
Q

therapy for wound healing should be aimed at mitigating what 3 factors?

A
  1. motion
  2. foreign bodies
  3. infections
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15
Q

how do you avoid motion therapeutically in wounds?

A

coaptation, stall rest

more motion - more gap to fill & more granulation tissue

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16
Q

how do you avoid foreign bodies therapeutically in wounds?

A

radiographs, ultrasound, wound exploration

soil decreases the dose needed to cause infection in regards to bacteria

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17
Q

how do you avoid infection therapeutically in wounds?

A

cllp/clean, surgical debridement, delayed closure, bandaging, & +/- antimicrobials

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18
Q

during the chronic period of wound healing, what other factors must you consider?

A

cosmesis, functionality, & reinjury

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19
Q

what should you be concerned about in the acute period of wounds?

A

synovial structure involvement!!!!

entrance into other body cavities, SQ emphysema, TBI, & hemorrhage

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20
Q

why is it important to know the wound classification?

A

helps decide what treatment should happen & helps predict how the wound may behave over time

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21
Q

what is a crush wound?

A

injury occurring when the body part is subjected to a high degree of force between 2 heavy objects

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22
Q

what is a contusion?

A

a blow to the skin in which blood vessels are damaged or ruptured

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23
Q

what is an abrasion?

A

damage to the skin epidermis & portions of the dermis by blunt trauma or shearing forces

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24
Q

what is an avulsion?

A

loss of skin or tissue characterized by tearing of the tissue from its attachments

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25
Q

what is an incision?

A

a wound created by a sharp object that has minimal adjacent tissue damage

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26
Q

what is a laceration?

A

an irregular wound created by tearing of tissue - skin & underlying tissue damage can be variable

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27
Q

what is a puncture?

A

a penetrating injury to the skin resulting in minimal skin damage & variable underlying tissue damage - contamination with dirt, bacteria, & hair is common

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28
Q

what are the big 3 steps of the approach when looking at a wound on a horse?

A
  1. overall impression of the patient - TPR, hemorrhage, etc
  2. sedation & local anesthesia - don’t overdue sedation if severely lame
  3. rule out serious/catastrophic injuries - fractures, soft tissue structures, & synovial structure involvement
29
Q

why should you use a water soluble lube when clipping/cleaning a wound?

A

keeps hair out

30
Q

what should you clean a wound with?

A

chlorhexidine & betadine - DILUTED!!!!

saline after

31
Q

T/F: antiseptics are toxic to wounds

A

true

32
Q

why is it so important to assess for synovial structure involvement?

A

it will start with infection & some mild inflammation that leads to distension which is what causes SEVERE LAMENESS

33
Q

how do you check a wound for synovial structure involvement?

A

sedate the horse, clip/clean the wound, block it

place a needle away from the wound

34
Q

what is the exception to checking a wound for synovial structure involvement?

A

evidence of cellulitis - may accidentally seed the joint

35
Q

what is the procedure for tapping a joint?

A

use 4 syringes every time

  1. get a sample using a 3mL syringe - need at least 0.5mL
  2. get a wash if no sample using a 6ml syringe using saline
  3. distend the joint - variable for each joint volume
  4. put antibiotics into the joint before withdrawing the needle - usually amikacin
36
Q

what is the normal color of joint fluid?

A

light straw color & transparent

37
Q

what is the normal total nucleated cell count of joint fluid?

A

<1,500 cells/uL

38
Q

what is the normal total solids of joint fluid?

A

<1.5g/dL

39
Q

what is the normal lactate of joint fluid?

A

slightly higher than peripheral, up to ~3 mmol/L

40
Q

what is the normal SAA of joint fluid?

A

zero

41
Q

what is the normal glucose of joint fluid?

A

roughly equivalent to peripheral except after sedation

42
Q

what is an abnormal color of joint fluid?

A

turbid, serosanguineous, & not clear

43
Q

what is an abnormal total nucleated cell count of joint fluid?

A

30,000 cells/uL = suspicious
100,000 cells/uL or higher = slam dunk

44
Q

what is a normal WBC differential of joint fluid?

A

90% or greater lymphocytes

45
Q

what is an abnormal WBC differential in joint fluid?

A

90% or greater neutrophils

46
Q

what two measurements are best used serially to evaluate trends in regards to joint fluid?

A

lactate & SAA

47
Q

what is an abnormal total solids of joint fluid?

A

high, often 5-6 g/dL

48
Q

what is an abnormal lactate of joint fluid?

A

4-7mmol/L

why we don’t use LRS as a wash

49
Q

what is an abnormal SAA of joint fluid?

A

hundreds-thousands

50
Q

what is an abnormal glucose of joint fluid?

A

50mg/dL less than peripheral & <50mg/dL total

51
Q

what is primary closure?

A

immediate suture closure without tension

52
Q

what wound types are best suited for primary closure?

A

clean or clean-contaminated wound converted to a clean wound

53
Q

what is delayed primary closure?

A

performed 2-5 days after injury before granulation tissue appears - tissue debridement & wound lavage before closure

54
Q

what wounds are best suited for delayed primary closure?

A

clean-contaminated or contaminated wound with questionable tissue viability, edema, or skin tension

55
Q

what is secondary closure?

A

performed at least 5 days after injury - after granulation tissue appears & epithelialized skin edges are excised at the time of closure

56
Q

what wounds are best suited for secondary closure?

A

contaminated or infected wounds

57
Q

what is second intention healing?

A

healing by granulation tissue, wound contracture, & epithelialization

58
Q

what wounds are best suited for second intention healing?

A

wound tissue that is unsuitable for closure, large skin defects, & extensive tissue devitalization

59
Q

what halsted’s principles are you thinking of with wound closure?

A

hemostasis with preservation of blood flow, asepsis/wound cleaning, accurate debridement, tension, compression, & dead space

60
Q

why is dead space important to consider in wound closure?

A

wounds do not heal in the absence of ventral/distal drainage

61
Q

what are your options for addressing dead space?

A

direct closure, compression, & drains

62
Q

what are the 4 big treatment options you can pursue when dealing with a chronic wound/granulation tissue?

A
  1. sharp excision
  2. immobilization
  3. steroids
  4. silicon bandages
63
Q

what is sharp excision with a chronic wound?

A

converting the chronic wound into a healthy, acute wound - start distally & work proximally

64
Q

for treating a chronic wound, why is immobilization a double-edge sword?

A

using splints/bandages/casts to prevent excessive motion that leads to granulation tissue but these can cause pressure sores

65
Q

when may you use steroids in a chronic wound?

A

angry, exudative wound

66
Q

what is the downfall of using steroids for a chronic wound?

A

impedes epithelialization

67
Q

why are silicon bandages a better alternative to steroids?

A

they provide peripheral microvascular occlusion but don’t impede epithelialization

68
Q

what are your big three differentials for a non-healing wound?

A
  1. habronemiasis
  2. cancer - SCC & sarcoids
  3. pythiosis

LA DX & TX I (45 decks)

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