Lecture 15: Bandaging & Open Wound Management - LA (Exam 2) Flashcards
1
Q
How do you notice epithelialization
A
White rim around the wound
2
Q
How long can primary closure be held off for
A
Out to 12 hours
3
Q
What should be done during initial exam
A
- Assess blood loss (HR, RR, mem color, CRT)
- Prior treatment/ vax stat
- mechanism of injury
4
Q
Whats the diff btw/ a sheet metal v. barbed wire injury
A
Sheet metal is a straight cut while barbed is serrated
5
Q
When should tetanus toxoid & tetanus anti-toxin be give
A
- No vax history
- +/- > 12 months
6
Q
When should a tetanus toxoid booster be given
A
vax >/= 2 months ago
7
Q
When is no booster needed
A
vax < 2 months ago
8
Q
What is the risk of using tetanus anti-toxin
A
liver disease
9
Q
What can be used for px restraint
A
- Twitch
- Tranquilizers (ace, alpha 2 agonist, & opioids)
10
Q
What should be figured out during visual assessment
A
- Wound location (blood supply, synovial structure involvement, & other structures)
- Contamination/infection
11
Q
what happens if there is foreign material, necrotic tissue, hematoma, ect in the wound
A
More of a chance for an infection
12
Q
Explain wound clipping
A
- Apply sterile lube to wound
- Clip @ least 2 in around the wound
- Use antiseptics (povidone iodine, chlorhexidine, sterile saline)
13
Q
What position are horses in during suturing
A
Standing
14
Q
What ways can you do wound anesthesia w/ equine
A
- Medications (Lidocaine)
- Local anesthesia (nerve blocks)
15
Q
What tech should be used for wound anesthesia
A
- Block away from the wound
- If need to insert the needle @ the cut edge of the tissue instead of adjacent to it
16
Q
How can the wound be explored
A
- Digital palpation
- Sterile probe
- Radiographs
17
Q
How should the wound be lavaged
A
- 10 - 15 psi
- 18g needle on a 35 ml or 60 ml will get you enough pressure
- Water pick (be careful not to drive debris into the wound)
- Usual norm saline or LRS
18
Q
What should be done if there is synovial involvement
A
- Synoviocentesis (sterile prep away from the wound; avoid going through/edema/cellulitis & introducing bacteria)
- Sample the fluid for cytology, total protein, +/- culture
- Pressurize the structure
- Inject antibiotic like amikacin
19
Q
If the fluid communicates with the joint what will happen
A
- When the syringe is removed from the needle it will spray out the other side
20
Q
What are the common ways for wound debridement
A
- Sharp (Debride most superficial layer w/ scalpel blade)
- Mechanical (Wet to dry bandage before epithelialization has started)
- Autolytic (moist wound healing; WBCs & enzymes degrade necrotic tissue & leave the healthy tissue alone)
21
Q
List the other debridement options for LA wounds
A
- Chemical
- Enzymatic
- Biological (sterile magots)
22
Q
Describe primary wound closure
A
- Close immediately
- Warn owner of possible dehiscence
- < 12 hours
23
Q
Describe delayed primary wound closure
A
- Close after a period of debridement
- w/in 3 to 5 days of injury (before granulation tissue forms)
- Mild/moderate contamination
24
Q
Describe delayed secondary closure
A
- Close after granulation tissue is present
- Excise exuberant granulation tissue first
25
Describe second intention healing
* No closure
* Large wound
* Chronic, contaminated, skin loss
* After granulation is present
26
What is important when closing wounds w/ drainage
* Impt. to prevent accumulation of exudate in dead space that will compromise closure
27
What suture materials be used in wound closure
* Min tissue reactivity, sufficient strength
* non absorbable monofilament
* Nylon & polypropylene
28
What suture pattern should be done in a non tension area
Simple interrupted
29
What suture pattern should be done in a high tension area
* Vertical mattress
* Near-far-far- near
30
What should be remembered for suturing wound patterns
* Place .5 cm from wound edge
* Don't overtighten
31
What is the difference btw/ the jackson-pratt & the penrose
The penrose must be placed at most ventraol location while the jackson-pratt doesnt
32
Describe using gauze as wound dressing
* Wet to dry bandages
* For debridement of heavily contaminated & exudative wounds
* Wet gauze w/ saline ( +/- dilute chlorhex or iodine) & place next to the wound under a bandage
33
Describe using telfa pad as wound dressing
* Surgical wounds or suture wounds
* Non-adherent & non-occulusive
34
Describe using Hypertonic saline dressing as wound dressing
* Curasalt
* Aggressive wound debridement
* First few days only
35
Describe using calcium alginate as wound dressing
* Curasorb
* Moderately exudative wounds &/or substantial tissue loss
* Creates a gel that promotes moist wound healing
36
What are the guideline from bandaging
* Even tension
* Appropriate tension
* Cover the req areas
37
What is the technique for bandaging
* Counterclockwise on left limbs
* Clockwise on the right limbs
* Start on the medial side of the leg & wrap toward the head
38
What is the first step of putting on a veterinary bandage
* Start in a clean dry environment
* Wear gloves
* Non-adherent first layer
* Hold in place w/ kling gauze & loosely wrap
39
What is after the kling gauze
* Add the outer bandage (Thickness is important)
* Disposable options include - sheet cotton, gamgee, combiroll
40
What is placed after the outer bandage
* Brown gauze
* Wrap it tight (just not to the point to wear it rips)
41
What is placed after the brown gauze
* Add the vet wrap w/ no wrinkles
* Put on elasticon - lay it on loosely (this keeps debris out of the bandage)
42
List common bandaging error
* Not enough padding
* Wrapping in the wrong direction
* Uneven pressure
* Uneven swipes
* Poor application
43
How is a bandage placed over joints
* Can do a stack wrap or center over the joint
* Minimize pressure over boney prominences by figure eighting the bandage or "racing strip" w/ elasticon
* Use gauze pad to the accessory carpal bone & the point of hock
44
Explain splinting
* Proper padding is very important
* Often made of PVC pipe & duct tape/white tape (not stretchy)
45
What should be done for a foot bandage
* Wrap tight on the hoof & loose on the skin
* May or may not have padding
* Lots of duct tape on the bottom of the foot
46
List some complications of bandaging
* Exuberant granulation tissue formation
* Pressure sores can cause wounds & may have white hairs later
* "bandage bows" - extensor or flexor tendon inflammation, no actual disruption of the tendon, b/c of too little padding &/or wrapped too tight
* Dehiscence
* Proud flesh
47
When is bandaging done in ruminants
* most common for foot procedures
* Wounds
* Padding under splints
48
When are claw blocks used
* When there are is damage to one claw
* Block goes on the unaffected claw
49
What are some differences btw/ bandaging ruminants than equine
* Same principles
* watch out for the dew claws - painful w/ to much pressure, avoid wrapping directly over them, use figure 8 tech or use donuts for protection
* Difficult to confine so use lots of duct tape
50
Describe proud flesh
* Usually in distal limb wounds (carpus/tarsus & below)
* less common in ruminants but can occur
* predisposing factors - bandaging after granulation tissue is present (hypoxia), movement, large wound (second intention healing), bone sequestrum, wound irritation (owner's wound ointment)
* Treatment - Sharp debridement, topical steroids, & skin grafting
51
What happens if there is involvement of synovial structures
* Small seemingly innocuous wounds can be very serious
* Requires immediate referral
* Lots of money
* Time is very important (better prognosis if treated early)
52
What is bone sequestrum
* Dead, infected piece of bone - bacteria from wound & necrosis from damage to blood supply/periosteum)
* Signs - non-healing wound b/c the body sees it as a foreign body
* Typically requires surgical removal
53
Describe cellulitis
* Severe edema in the limb associated w/ rel small wound
* may just be an abrasion
* Infection of the SubQ tissues
* Severe lameness (lameness @ a walk)
* Req aggressive therapy - systemic antibiotics, anti inflammatories, & bandaging
