First Aid & Wound Management 2

Question 1

What are catheters for?

Answer 1

• catheters allow venous access for:
  - fluid therapy
  - pain medications
  - emergency drugs
  - induction of anaesthesia
• all patients presented for an emergency must have a catheter placed

Question 2

What are some emergency situations where an endotracheal tube is required?

Answer 2

• status epilepticus (seizure lasting more than 5 minutes)
• airway obstruction
• distressed patients (require sedation/anaesthetisation)
• collapsed

Question 3

Describe how to place an endotracheal tube.

Answer 3

• choose the ET tube of appropriate size
• inflate the cuff
• lubricate the end of the ET tube with local anaesthetic gel
• intubation is performed on a patient under general anaesthesia with Intravenous catheter placed and in lateral/sternal recumbency
• assistant holds the maxilla
• tongue is caught by gauze compress and pulled out of oral cavity
• head is bent backward to allow better visualisation of airway
• laryngoscope is inserted into oral cavity
• when laryngeal entrance is opened, ET tube is inserted
• secure tube by non-elastic bandage around mandibular
• check the position, compress thorax and check the air flow
• inflate the cuff

Question 4

What are immediate treatments for haemorrhage (bleeding)?

Answer 4

• direct pressure: pressure bandages (preferable); digital pressure; additional layer of bandage can be applied if required
• tourniquet (only on distal limbs): applied above the wound; very temporary option only

Question 5

What must you remember about pressure bandages?

Answer 5

• must be removed

- if left for too long, can cut of blood circulation

Question 6

What is a seizure?

Answer 6

• a seizure is a sudden, involuntary electrical disturbance in the brain that causes changes in the behaviour, movements and consciousness of an animal
• a classic seizure is known as a grand mal seizure

Question 7

What are some characteristics of a grand mal seizure?

Answer 7

• loss of consciousness
• violent bodily movements
• typically lasts up to a minute

Question 8

What is the role of a veterinary nurse in treatment of a patient with seizures?

Answer 8

• ensure the patient has soft blankets/towels
• is free of any obstruction that may cause physical injury
• call the vet

Question 9

What are some treatments for seizures?

Answer 9

• vet may administer anti-seizure drugs (e.g. diazepam)
• IV catheter
• sedation + maybe intubation (if required)
• ongoing monitoring
• intravenous fluid therapy (IVFT)

Question 10

How to diagnose cyanosis and what are the treatments for cyanosis?

Answer 10

• the presence of blue/purple mucous membranes (except for in chowchows)
• patients with cyanotic membrane have a severe lack of oxygen
  (- can be due to heart/lung disease or obstruction of airway)
• requires oxygen support immediately (intubation, by mask, flow by)
• Treatment: oxygen support, IV catheter, spO2 (oxygen level) monitoring, primary cause needs to be treated

Question 11

A patient is in cardiopulmonary arrest if…

Answer 11

• they are not breathing

- they are non-responsive

Question 12

What is the treatment for cardiopulmonary arrest (CPA)?

Answer 12

• cardiopulmonary resuscitation (CPR)

Question 13

What is heat stroke?

Answer 13

• most serious form of heat injury (mild heat injury: heat stress)
• caused by the body overheating
• usually a result of prolonged exposure to or physical exertion in high temperatures
• potentially fatal

Question 14

What are some risk factors of heat stroke?

Answer 14

• brachycephalic breeds
• overweight
• large and giant breeds
• thick hair coat
• poor husbandry (unable to escape the heat)
• pre-existing medical conditions (heart disease, dehydration)

Question 15

What are the clinical signs of heat stroke?

Answer 15

• increased resting respiratory rate
• increated heart rate
• excessive drooling and panting
• reddened gums
• agitation
• increased cor temperature (>39.3°C)

If severe:

• refusing to lay down or get up
• seizures
• unresponsive

Question 16

What are the treatments for heat stroke?

Answer 16

• intravenous fluid therapy
• active cooling (fans/damp towels)
• tranquillizers/sedatives (depends)
• intubation and ventilation (depends)

Question 17

State the 2 main classifications of wounds.

Answer 17

• open wound

- closed wound

Question 18

State the types of open wounds.

Answer 18

• abrasion
• laceration
• avulsion
• incision
• puncture

Question 19

what is an abrasion?

Answer 19

• loss of epidermis and part of the dermis (aka partial thickness wound)

Question 20

What is a laceration?

Answer 20

• irregular wound caused by tearing, which produces superficial and underlying tissue damage
• can be full or partial thickness

Question 21

What is an avulsion?

Answer 21

• tearing of tissue from its attachments

Question 22

What is an incision?

Answer 22

• wound created by a scalpel blade, resulting in wound edges with minimal tissue trauma

Question 23

What is a puncture?

Answer 23

• penetrating wound caused by a sharp object
• minimal skin damage but underlying tissue damage may be severe
• higher risk of infection

Question 24

Explain what the two types of closed wounds are.

Answer 24

• contusion (aka a bruise): blunt-force trauma that doesn’t break the skin but causes damage to the skin and underlying tissue
• crushing injury: force applied to an area of the body over a period of time

Question 25

What are the 4 phases of wound healing?

Answer 25

- haemostasis - inflammatory - proliferative - maturation - process is dynamic and the phases overlap

Question 26

Describe the haemostasis phase of wound healing.

Answer 26

- the phase in which a wound is closed by clotting - occurs within minutes - wound bleeds - vasoconstriction to decrease blood flow - platelets stick together to seal the break in the wall - coagulation helps to strengthen platelet plug by forming a fibrin clot

Question 27

Describe the inflammatory phase of wound healing.

Answer 27

- begins right after injury - injured blood vessels leak transudate (filtrate of blood) - swelling occurs which is inflammation, aids hemostasis and decreases infection - allows repair cells to move to the site of the wound - swelling, heat, pain and redness are normal for this phase - lasts approximately 4-6 days

Question 28

Describe the proliferative phase of wound healing.

Answer 28

- wound is rebuilt with new tissue made up of collagen and extracellular matrix - disorganised because wound is thick - wound contracts as new tissues are built - new network of vessels built - wound contraction occurs - epithelialization happens faster when wounds are kept moist and hydrated (epithelial cells migrate upwards and repair the wounded area)

Question 29

Describe the maturation phase of wound healing.

Answer 29

- AKA remodeling phase - collagen is remodelled (type III to type I) and the wound closes - cells that are no longer required are removed by apoptosis - collagen reorganised and crosslinked (scar is thinner and stronger) - long process and can take up to a year

Question 30

What comprises of the second intention of methods of wound healing?

Answer 30

- healing via granulation (granulation tissue from proliferative phase) - wounds are left open - good for infected wounds - often used when there is insufficient skin to close a wound - always requires a dressing

Question 31

What are the factors affecting the wound healing?

Answer 31

Host factors: - age of the animal - body condition - concurrent disease Wound characteristics: - presence of foreign material, drains and implants - type of wound: clean incision vs laceration with jagged edges - presence of infection External factors - drug interactions (e.g. steroids suppresses inflammation