Exam 2: Lecture 15: Bandaging and Open Wound Management Flashcards
what should you always do on the initial exam FIRST
STOP THE BLEEDING!!
what are the 4 things we need to look at during our initial exam
- time elapsed
- blood loss
- prior treatment/vaccine
- mechanism of injury
how much time can pass for primary closure in horses
12 hours
how can you tell the amount of blood loss in the patient (other than looking at the blood on the ground)
heart rate, respiratory rate, membrane colors, CRT
why do we need to know if the there was any prior treatment or vaccine status for wounds
need to know if owner gave any meds prior to you showing up
why does the mechanism of injury matter
because higher energy at impact = greater tissue damage = vascular compromise
what is the most important vaccine status to check
tetanus!
what should we do if there is no history of tetanus vaccine or it is greater than 12 months
give tetanus toxoid and tetanus anti-toxin
what should we do if the tetanus vaccine status is greater than or equal to 2 months ago
give a tetanus toxoid booster
what should we do if the tetanus vaccine status is less than 2 months
no booster needed!
what can we use for patient restraint
twitch, ace, alpha-2 agonists, opiods
what should we look for when visually assessing the wounds
location and contamination/infection
what is important to look for with wound location
is there blood supply? Is there a synovial structure involved? Any other structures involved?
what should we do when clipping and cleaning wounds
apply sterile lube to wound and clip at least 2 inches around the wound
what type of antiseptic may/may not be used on wounds
can use - providone iodine, chlorhexidine, or sterile saline
should not use - alcohol or garden hose (causes edema)
what position is the horse usually in when suturing lacerations
standing!
what type of medications can we use for wound anesthesia
lidocaine or mepivacaine
what type of local anesthesia options are there for wounds
peripheral nerve blocks or local infiltration
what type of technique should we use for wound blocks
block away from wound
how can we explore wounds
digital palpation, sterile prob, radiographs
what is the correct way to lavage a wound
10-15 psi by using a 18g needle on 35ml or 60ml syringe
what do we do if there is synovial involvement in a wound
complete a synoviocentesis (with sterile prep away from wound), sample the fluid, pressurize the structure and inject antibiotic
what are the 3 types of wound debridement
- sharp
- mechanical
- autolytic
what is sharp wound debridement
using a scalpel blade to debride the most superficial layer
what is mechanical wound debridement
wet to dry bandage but do not use once epithelialization has started
what is autolytic wound debridement
moist wound healing where WBCs and enzymes degrade necrotic tissue leaving the healthy tissue alone
what are the 3 less common ways of wound debridement
chemical, enzymatic, and biological
what are the 2 types of wound closure
primary and delayed primary
when can we do primary closure
close immediately, warn owner of possible dehiscence, and must be <12 hours
what is delayed primary wound closure
close after a period of debridement that is within 3-5 days of the injury
when do we use second intention healing
no closure, large wound, chronic, contaminated, or skill loss, or after there is granulation tissue
what are the different drains for wound closure
closed drain = jackson-pratt (doesnt have to be ventral)
open drain = penrose (must be placed most ventral)
what type of drain is this
jackson-pratt
what type of drain is this
penrose
what should we remember when picking suture material
we want minimal tissue reactivity with sufficient strength
what type of suture material should we use for wounds
non-absorbable monofilament (nylon or prolene)
what type of suture patterns should we use for non tension areas
simple interrupted
what type of suture pattern should we use for high tension areas
vertical mattress and near-far-far-near
how far should should the suture be placed away from wound edge
0.5cm
what are the different types of wound dressings
gauze, telfa pad, hypertonic saline dressing (curasalt), calcium alginate (curasorb)
how do we use gauze for wound dressings
wet-to-dry bandages, debridement of heavily contaminated/exudative wounds
when do we use telfa pads
on surgical wounds or sutured wounds (non-adherent or non-occlusive)
how do we use hypertonic saline dressing (curasalt)
aggressive wound debridement, first few days only
when/how do we use calcium alginate (curasorb)
on moderately exudative wounds and/or substantial tissue loss
creates a gel that promotes moist wound healing
what are the guidelines for bandaging
even tension, appropriate tension, and cover the required areas
what is included in the inner bandage for horses
non-adherent first layer held in place with kling gauze
what is included in the outer bandage
sheet cotton, gamgee, or combiroll combined with vet wrap
what type of bandage is this
carpal bandage
what type of bandage is this
tarsal bandage
what are some of the complications of bandages
pressure sores or bandage bows
what is a bandage bow
extensor/flexor tendon inflammation, no actual disruption of the tendon via too little padding or wrapped too tight
what should we always warn owners about with wounds
dehiscence!!!
what is “proud flesh”
exuberant granulation tissue
what are predisposing factors for exuberant granulation tissue (proud flesh)
bandaging after granulation tissue is present, movement, large wound with second intention healing, bone sequestrum, wound irritation
what is the treatment for proud flesh
sharp debridement, topical steroids, or skin grafting
what is bone sequestrum
dead, infected piece of bone via bacteria from a wound/necrosis from damage to blood supply
what are the signs of bone sequestrum
a non-healing wound
how do we treat bone sequestrum
typically requires surgical removal
what is cellulitis
severe edema in the limb associated with a relatively small wound
how do you treat cellulitis
systemic antibiotics, anti-inflammatories, and bandaging
