Lecture 10 - Emergency Wound Management Flashcards
What is the plan of attach when addressing emergency wounds?
- initial patient assessment
- analgesia
- principles of healing
- wound evaluation
- wound management (surgical or open)
What does ‘A CRASH PLAN’ stand for?
airway, cardivascular, respiratory, abdomen, spine, head, pelvis, limbs, arteries, and nerves
What can be used for pain control in emergency wound management?
opioids, NSAIDs, ketamine, lidocaine, local/regional anesthetic, and A2-agonists
What are the principles of healing?
hemostasis and inflammation, debridement, repair, and maturation
What is the hallmark of hemostasis/inflammation?
hemostatic plug
What occurs during hemostasis/inflammation?
Blood and lymph from damaged blood vessels fill the wound and cleanse the wound surface. Vasoactive compounds are then released for vasoconstriction near the wound to decrease blood loss. After about 15 minutes a fibrin clot will form and vasodilation will begin.
What is the hemostatic plug a barrier for?
any further infection
What happens during debridement?
neutrophils, monocytes, and macrophages infiltrate into the wound to clean the debris via enzymatic and phagocytic mechanisms
What is the repair phase also known as?
the proliferative phase
What is the hallmark of the repair phase?
granulation tissue
What occurs during the repair phase?
fibroblasts infiltrate for collagen formation, angiogenesis occurs, and epithelialization occurs
What do myofibroblasts do?
they shrink down to make the wound smaller
What occurs in the maturation phase?
there is collagen deposition and significant wound contraction
What are the local factors influencing healing?
vascular supply to the area, presence of infection, mechanical stress on the wound, and tissue edema
What are the systemic factors influencing healing?
hypoproteinemia, malnutrition, glucocorticoid excess, diabetes mellitus, immunosuppression, illness, and age
What are the different types of wounds?
incisional, penetrating, abrasions, shearing, avulsion/degloving, firearm,n and burns
What are incisional wounds created by?
sharp objects moving in parallel to the skin by surgical incision or glass fragments
Incisional wounds cause ______ trauma to surrounding tissues.
minimal
Incisional wounds are _____ prone to infection?
less
What are penetrating wounds caused by?
sharp object moving perpendicular to the skin
Would you want to close a penetrating wound?
no because there will be dead space and contusion which is ideal for bacterial growth
What causes abrasion wounds?
friction
What layers do abrasion wounds affect?
epidermis and superficial dermis
What can cause shearing wounds?
dragging (friction) or bone and joint injury (medial carpus, phalanges, tarsus)
What is avulsion/degloving?
separation of the skin from underlying attachment
What is physiological avulsion/degloving?
blood vessel damage occurs and the skin is no longer attached to the tissue
What tissue does a 1st degree burn involve?
superficial
What tissue does a 2nd degree burn involve?
partial thickness of the skin
what tissue does a 3rd degree burn involve?
full thickness of the skin
What are the effects that heat has in burns?
capillary permeability, loss of ECM integrity, and tissue edema
What are the components of exploration phase 1?
sedation and anlgesia, clean environment, gloves, sterile lubricant, cleaning, clipping, clean intact skin, +/- lavage, +/- deep culture
What is the purpose of exploration phase 1?
decontamination
What are the components of exploration phase 2?
sterile technique, probe for pockets, evaluate orthopedic injury, assess tissue viability, culture, and surgical debridement
What are Halstead’s principles?
gentle tissue handling, accurate hemostasis, preserve blood supply, aseptic technique, closure without tension, careful approximation, and eliminate dead space
What are the benefits of a bandage?
provides surface moisture, obliterates dead space, packs, debrides, protects, immobilizes, and provides comfort
What are the must do’s of bandages?
keep it clean and dry, change it every 12-24 hours, and pain management
What is the contact layer of a bandage for?
mechanical debridement and autolytic debridement
What is the secondary layer of a bandage for?
absorption of exudates and comfort and support
What is the tertiary layer of a bandage for?
protection of what lies below
