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)
