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Sem 6: SASx > Management of Traumatic Wounds: Fundamentals > Flashcards

Management of Traumatic Wounds: Fundamentals Flashcards

1
Q

What are the phases of wound healing?

A

” I demand Rossies Memorize”

  1. Inflammatory
  2. Debridement
  3. Rossies
  4. Maturation/Remodeling phase
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2
Q

The inflammatory phase of wound healing occurs in _____ days

A

0-5

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3
Q

What occurs during the inflammatory phase of wound healing?

A

Hemorrhage → Vasoconstriction → Vasodilation → Leukocyte response → PLT activation (clotting)

first 0-5 days of wound

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4
Q

What occurs during the debridement phase of wound healing?

A
  • neuts arrive 1st (within 6hrs) then monocytes (12 hrs) and initiate debridement phase
  • develops exudate rich in WBCw, wound fluid, and necrotic tissue

monocytes essential for wound healing (not neuts)

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5
Q

The debridement phase of wound healing occurs in _____ days

A

1-5

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6
Q

Which of the following is essential for wound healing?

A. Neutrophil
B. Monocytes
C. Lymphocytes
D. Eosinophils

A

B. Monocytes

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7
Q

Which of the following growth factors does NOT come from macrophages?

A. PFGF
B. EGF
C. KGF
D.PDGF
E. TGF-a/TGF-beta
F. VEGF

A

C. KGF
F. VEGF

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8
Q

Which of the following stimulates fibroblast and DNA proliferation in the repair phase of wound healing?

A. Neutrophil
B. Lymphocytes
C. Macrophages
D. Eosinophils

A

C. Macrophages

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9
Q

The repair phase of wound healing occurs in _____ days

A

3-5 days to 2-4 weeks

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10
Q

What occurs during the repair phase of wound healing?

A
  • macrophages activate fibroblasts → fibroblasts migrate into wound depositing collagen/fibrous tissue → angiogenesis → granulation tissue → epithelialization → wound contraction (simultaneously w/ granulation tissue & epithlialization)
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11
Q

Bright red granulation tissue can be seen in what phase of wound healing?

A

Repair phase

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12
Q

What bandage should NOT be used in the repair phase of wound healing and why?

A

Wet to dry bandage - delays re-epithelialization

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13
Q

_____% of the original strength may be regained following a healed wound

A

80%

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14
Q

What is the golden period when treating wounds?

A
  • 0-6 hrs
  • minimal contamination
  • insufficient microbial replication to cause infection and can usually manage with primary closure
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15
Q

What is the time frame of a wound to be classified as Class 2?

A
  • 6-12 hrs after wound
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16
Q

What is the time frame of a wound to be classified as Class 3?

A

> 12 hours of wounding
- likely infection due to time allowed for microbial replication

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17
Q

What is primary closure in wound management?

A
  • Clip, clean, and suture immediately
  • Used for Class 1 (0-6hrs) and some Class 2 (6-12hrs) wounds
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18
Q

What does delayed primary closure mean in wound management?

A
  • appositional closure BEFORE granulation tissue develops
  • Within 3-5 days of wounding
  • Good for Class 2 wounds (6-12hrs)
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19
Q

What does secondary closure mean in wound management?

A
  • appositional closure AFTER granulation tissue develops
  • > 3-5 days after wounding
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20
Q

What does second intention healing mean in wound management?

A
  • Healing by contraction/epithelialization (Ex: no surgery)
  • Open wound management
21
Q

What pathogen is the #1 cause of nosocomial infection in vet med?

A

MRSP (MRSA in human med)

22
Q

_________ is a newer disinfectant that is green, safe, and effective against MRSP with only a 1 minute contact time

A

Accelerated hydrogen peroxides (AHP)

23
Q

As soon as a patient comes in with any wound regardless of cause, what is the first thing that should be done to prevent nosocomial contamination?

A

Put a bandage over ALL wounds on entry to hospital

24
Q

How is a wound site aseptically clipped and scrubbed?

A
  • Protect wound by applying sterile lube or saline soaked sponges
  • WIDELY clip area
  • Chlorhexidine scrub AROUND the wound not in the wound
25
Q

After the wound area is clipped and scrubbed, what is done next?

A

LAVAGEEE

26
Q

What solutions can be used as lavage solutions?

A
  • LRS / 0.9% NaCl
  • 0.05% Chlorhexidine solution (NOT SCRUB)
  • 0.1% iodine solution
  • Tap water
27
Q

The addition of ____ mLs of 2% Chlorhexidine solution to a 1L bag of sterile saline will produce a solution of 0.05%

A

25 mLs

( 0.05% x 1000 mL / 2% = 25mLs)

28
Q

____% Chlorhexidine solution can be used to lavage a wound

A

0.05%

29
Q

____% povidone-iodine solution can be used to lavage a wound

A

0.1%

30
Q

What is a concern when using chlorhexidine solution to lavage a wound?

A

Corneal toxicity - don’t use need the eyes!!!

31
Q

When would povidone-iodine be preferred over chlorhexidine solution when lavaging a wound?

A

If wound is close to the eyes use iodine

32
Q

What is the ideal pressure used to lavage a wound, and how can this best be accomplished?

A

7-8 psi

place 1L bag of saline solution in a pressure bag at cuff pressure of 300 mmHg

GOLD STANDARD technique for lavaging a wound

33
Q

What is the consequence of lavaging a wound at higher than recommended pressures?

A

Could cause barotrauma to wound, detrimental to surrounding tissue, forces bacT deeper into wound

34
Q

What is the consequence of lavaging a wound at lower than recommended pressures?

A

Can reduce bacterial contamination but not great at REMOVING bacteria and foreign material

35
Q

True or False: The size of the needle matters when lavaging a wound

A

FALSE (pressure does tho)

36
Q

During which stage of wound management should a culture sample be collected?

A
  • Clip, clean, and lavage wound before culture
  • Culture after debridement for best sample
  • If antimicrobial flush solutions are used, collect sample before to avoid false results
37
Q

After collecting a culture sample, what indicates ABX should be started?

A
  • If significant contamination suspected
  • If muscle/fascia are disturbed
  • If animal is immunocompromised
  • If evidence of established local/systemic infection
38
Q

True or False: Pus, exudate, eschar, of heavily fibrous tissue are good samples to collect for culture

A

FALSE

39
Q

True or False: Culture the healthiest looking tissue within the wound bed

A

TRUE

40
Q

Pending culture results, what is the ABX of choice to start for wound management?

A

Clavulanic acid

41
Q

What topical ABX are available for use when managing and treating a wound?

A
  • Triple AB ointment (TAB)
  • Silver sulfadiazine
42
Q

What topical antibiotic is the drug of choice to treat burn wounds?

A

Silver sulfadiazine (1% cream)

43
Q

Which of the following topical antibiotic should be used if suspect of pseudomonas spp?

A. Triple AB ointment (TAB)
B. Silver sulfadiazine

A

B. Silver sulfadiazine

44
Q

Which bacterial organism causes a yellow-green color change to bandages places over a wound?

A

pseudomonas spp.

(also produces a grape or tortilla like odor to the bandage)

45
Q

Debridement is the process of removing dead/damaged tissue. This can be removed by the following mechanisms: List them.

A
  1. Surgical excision (Layered vs En bloc)
  2. Autolytic mechanisms
  3. Enzymes
  4. Wet to dry bandages
  5. Biosurgical methods
46
Q

What is the main concern when using surgical excision to debride a wound?

A

Possibility of removing excessive amount of viable tissue

(Avoid excessive debridement of SQ in cats - can delay wound healing)

47
Q

What is autolytic debridement?

A

Creating a moist environment to allow endogenous enzymes to dissolve dead tissue

highly selective for devitalized tissue ONLY

Accomplished using hydrophilic, occlusive/semi-occlusive bandages

48
Q

What is biosurgical debridement?

A
  • Using maggot therapy
  • Best for necrotic, infected, or chronic non healing wounds

Sem 6: SASx (5 decks)

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