Lecture 10 - Emergency Wound Management

Question 1

What is the plan of attach when addressing emergency wounds?

Answer 1

1. initial patient assessment
2. analgesia
3. principles of healing
4. wound evaluation
5. wound management (surgical or open)

Question 2

What does ‘A CRASH PLAN’ stand for?

Answer 2

airway, cardivascular, respiratory, abdomen, spine, head, pelvis, limbs, arteries, and nerves

Question 3

What can be used for pain control in emergency wound management?

Answer 3

opioids, NSAIDs, ketamine, lidocaine, local/regional anesthetic, and A2-agonists

Question 4

What are the principles of healing?

Answer 4

hemostasis and inflammation, debridement, repair, and maturation

Question 5

What is the hallmark of hemostasis/inflammation?

Answer 5

hemostatic plug

Question 6

What occurs during hemostasis/inflammation?

Answer 6

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.

Question 7

What is the hemostatic plug a barrier for?

Answer 7

any further infection

Question 8

What happens during debridement?

Answer 8

neutrophils, monocytes, and macrophages infiltrate into the wound to clean the debris via enzymatic and phagocytic mechanisms

Question 9

What is the repair phase also known as?

Answer 9

the proliferative phase

Question 10

What is the hallmark of the repair phase?

Answer 10

granulation tissue

Question 11

What occurs during the repair phase?

Answer 11

fibroblasts infiltrate for collagen formation, angiogenesis occurs, and epithelialization occurs

Question 12

What do myofibroblasts do?

Answer 12

they shrink down to make the wound smaller

Question 13

What occurs in the maturation phase?

Answer 13

there is collagen deposition and significant wound contraction

Question 14

What are the local factors influencing healing?

Answer 14

vascular supply to the area, presence of infection, mechanical stress on the wound, and tissue edema

Question 15

What are the systemic factors influencing healing?

Answer 15

hypoproteinemia, malnutrition, glucocorticoid excess, diabetes mellitus, immunosuppression, illness, and age

Question 16

What are the different types of wounds?

Answer 16

incisional, penetrating, abrasions, shearing, avulsion/degloving, firearm,n and burns

Question 17

What are incisional wounds created by?

Answer 17

sharp objects moving in parallel to the skin by surgical incision or glass fragments

Question 18

Incisional wounds cause ______ trauma to surrounding tissues.

Answer 18

minimal

Question 19

Incisional wounds are _____ prone to infection?

Answer 19

less

Question 20

What are penetrating wounds caused by?

Answer 20

sharp object moving perpendicular to the skin

Question 21

Would you want to close a penetrating wound?

Answer 21

no because there will be dead space and contusion which is ideal for bacterial growth

Question 22

What causes abrasion wounds?

Answer 22

friction

Question 23

What layers do abrasion wounds affect?

Answer 23

epidermis and superficial dermis

Question 24

What can cause shearing wounds?

Answer 24

dragging (friction) or bone and joint injury (medial carpus, phalanges, tarsus)

Question 25

What is avulsion/degloving?

Answer 25

separation of the skin from underlying attachment

Question 26

What is physiological avulsion/degloving?

Answer 26

blood vessel damage occurs and the skin is no longer attached to the tissue

Question 27

What tissue does a 1st degree burn involve?

Answer 27

superficial

Question 28

What tissue does a 2nd degree burn involve?

Answer 28

partial thickness of the skin

Question 29

what tissue does a 3rd degree burn involve?

Answer 29

full thickness of the skin

Question 30

What are the effects that heat has in burns?

Answer 30

capillary permeability, loss of ECM integrity, and tissue edema

Question 31

What are the components of exploration phase 1?

Answer 31

sedation and anlgesia, clean environment, gloves, sterile lubricant, cleaning, clipping, clean intact skin, +/- lavage, +/- deep culture

Question 32

What is the purpose of exploration phase 1?

Answer 32

decontamination

Question 33

What are the components of exploration phase 2?

Answer 33

sterile technique, probe for pockets, evaluate orthopedic injury, assess tissue viability, culture, and surgical debridement

Question 34

What are Halstead’s principles?

Answer 34

gentle tissue handling, accurate hemostasis, preserve blood supply, aseptic technique, closure without tension, careful approximation, and eliminate dead space

Question 35

What are the benefits of a bandage?

Answer 35

provides surface moisture, obliterates dead space, packs, debrides, protects, immobilizes, and provides comfort

Question 36

What are the must do’s of bandages?

Answer 36

keep it clean and dry, change it every 12-24 hours, and pain management

Question 37

What is the contact layer of a bandage for?

Answer 37

mechanical debridement and autolytic debridement

Question 38

What is the secondary layer of a bandage for?

Answer 38

absorption of exudates and comfort and support

Question 39

What is the tertiary layer of a bandage for?

Answer 39

protection of what lies below