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SD and NSD > SD Day 5 > Flashcards

SD Day 5 Flashcards

1
Q

Avascular layer of the skin

A

epidermis

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2
Q

What are the 5 layers of the epidermis

A

Come Let’s Get Sun Burned

Corneum 
Lucidum 
Granulosum 
Spinosum 
Basale
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3
Q

This considered to be the true skin

A

Dermis

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4
Q

Two Layers of the Dermis

A

Papillary and Reticular

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5
Q

This layer of the Dermis is composed of Meissner’s Corpuscles and Free nerve endings

A

Papillary Layer of the Dermis

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6
Q

This layer of the Dermis is composed of Collagen, Elastin and reticular fibers

A

Reticular Layers of the Dermis

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7
Q

Free nerve endings in the epidermis mediate what type of sensation?

A

Pain and Itch

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8
Q

Free nerve endings in the dermis mediate what type of sensation?

A

Pain

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9
Q

Merkel’s Disks in the Stratum Spinosum mediate what type of sensation?

A

Touch

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10
Q

Meissner’s Corpuscles in the papillary dermis mediate what type of sensation?

A

Touch

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11
Q

Ruffini’s corpuscles in the papillary dermis mediate what type of sensation?

A

Warmth

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12
Q

Krause’s end bulb in the papillary dermis mediate what type of sensation?

A

Cold

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13
Q

Pacinian corpuscles in the reticular dermis mediate what type of sensation?

A

Pressure and vibration

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14
Q

This layer of the skin is mostly composed of loose connective tissue and and fat tissue

A

Subcutaneous Tissue

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15
Q

This layer of the skin functions as insulation, support, cushioning and regulation of temperature of the skin.

A

Subcutaneous Tissue

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16
Q

This is itching of the skin

A

Pruritus

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17
Q

Local redness and eruption of the skin

A

Rash

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18
Q

These are smooth slightly elevated patches on the skin

A

Urticaria

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19
Q

This is excessive dryness of the skin characterized by scaly desquamation

A

Xeroderma

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20
Q

This is the degree of elasticity of the skin.

A

Turgor

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21
Q

Normal Skin Turgor is (in seconds)?

A

4 seconds

abnormal = 5 seconds or more

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22
Q

What are the 2 factors that affect skin turgor

A

dehydration and aging

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23
Q

Pitting edema indicates?

A

Chronis Venous Insufficiency

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24
Q

Non-pitting edema indicates?

A

Brany edema (inflammation of the subcutaneous layer of the skin)

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25
Q

This is an indicator of the hepatic system, presenting with yellowing of the eye and skin.

A

jaundice

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26
Q

If bilirubin levels reach 2-3mg/dl where will jaundice present?

A

sclera of the eyes

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27
Q

If bilirubin levels reach 5-6 mg/dl where will the jaundice present?

A

Sclera of the eyes and the Skin

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28
Q

Change of lips change to cherry red this is an indication of what type of poisoning?

A

Carbon monoxide poisoning

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29
Q

Patchy Tan to Brown spots is a common skin change in what disease?

A

Addisons Disease

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30
Q

Temporary pallor occurs in what conditions?

A

Arterial Insufficiency, Syncope, chills and shock

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31
Q

This is thin depressed nails with lateral edges tilted upward forming a concave profile. AKA Spoon Nails

A

Koilonychia (common with iron deficiency)

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32
Q

Splinter nails is an indication of what type of condition?

A

Silent MI, Endocarditis and vasculitis

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33
Q

This is infection of the skin fold of skin at the margin of the nail (fungal infection from wet work)

A

Paronychia

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34
Q

Loosening of the nail plate, usually from the tip of the nail, progressing inward and from the edge of the nail moving inward.

A

onychylosis

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35
Q

What the conditions where onychylosis is often see?

A

Grave’s Disease, psoriasis, reactive arthritis and obsessive compulsive behaviors

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36
Q

Type of nails change where in lunula’s cannot be seen and have a “ground glass” appearance

A

Nails of Terry

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37
Q

Conditions where Nails of Terry are often seen

A

Liver Pathology, DM. Hyperthyroidism

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38
Q

white spots on nails, often associated with trauma, hypocalcemia, Hodgkin’s dse, renal failure, MI and malnutrition from eating disorders.

A

Leukonychia

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39
Q

These are transverse lines on nails

A

Beau’s Lines

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40
Q

Consecutive transverse lines of the nails, indicative of renal and cardiac failure, MI, Hodgkins dse, and sickle anemia.

A

Mee’s Lines

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41
Q

Proliferation of melanocytes, round, or oval shaped,
sharply defined borders, uniform color, <6mm, flat
or raised.

A

Common Mole (benign nervous)

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42
Q

Raised lesions due to proliferation of basal cells. Yellowish to brown in color with greasy, velvety and warty texture.

A

Seborrheic keratosis

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43
Q

Slow growing, raised patch with an ivory appearance, rolled border with indented center / thickened area of skin • On hair bearing sun exposed areas (face, neck, ears, hands)

A

Basal Cell carcinoma

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44
Q

Poorly defined border, flat red area, ulcer, or nodule, sun exposed areas (ear, face, lips, mouth, hand dorsum)

Central part may be ulcerated, scaly or crusted

No Metastasize*

Fairly skinned individuals > 60 y/o

A

Squamous cell carcinoma

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45
Q
  • Most serious skin cancer
  • Arising from Melanocytes
  • Associated with intensity > duration of sunlight exposure
  • Nevi that are changing or atypical, especially if >50
  • Can cause pain, swelling, bleeding or sensation of itching; burning.
A

Malignant Melanoma

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46
Q
  • Inflammation of the skin

- Skin is red, brown or gray; sore itchy and swollen

A

Dermatitis

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47
Q

Three Causes of Dermatitis

A
  • Allergic/contact dermatitis: poison ivy, harsh soaps, chemicals
  • Actinic: photosensitivity
  • Atopic: etiology unknown, associated with allergic, hereditary, or psychological disorders
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48
Q

stage of dermatitis where there is red, oozing, crusting rash, extensive erosions, exudate, pruritic vesicles

A

Stage 1: Acute

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49
Q

stage of dermatitis where erythematous skin, scaling,

scattered plaques

A

Stage 2: Subacute

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50
Q

stage of dermatitis where thickened skin, increased skin marking secondary to scratching, post- inflammatory pigmentation changes

A

Stage 3: Chronic

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51
Q
  • Development of areas of very dry, thin skin and sometimes shallow ulcers of the lower legs primarily as a result of venous insufficiency
  • History of varicose veins or deep vein thrombosis
A

Stasis Dermatitis

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52
Q
  • Chronic facial skin disorder seen most often in adults between the ages of 30 and 60 years
  • Erythema, flushing, telangiectasia, papules, and pustules affecting the cheeks and nose of the face.
  • Enlarged nose is often present
A

Rosacea

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53
Q
  • Benign fatty fibrous yellow plaques, nodules, or tumors that develop in the subcutaneous layer of skin
  • Most often associated with disorders of lipid metabolism, primary biliary cirrhosis, and uncontrolled diabetes
  • May have no pathologic significance but can occur in association with malignancy such as leukemia, lymphoma, or myeloma
A

Xanthomas

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54
Q
  • Superficial skin infection caused by staphylococci or streptococci
  • Inflammation, small pus-filled vesicles, itching
  • Contagious
  • Common in children and the elderly
A

Impetigo

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55
Q

❑ Suppurative inflammation of cellular or connective tissue in or close to the skin

❑ Poorly defined and widespread

❑ By streptococcal or staphylococcal infection ❑Can be contagious

❑ Skin is red, hot and edematous

❑ Can lead to lymphangitis, gangrene, abscess and sepsis

A

Cellulitis

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56
Q
  • Itching and soreness followed by vesicular eruption on the face or mouth
  • Aka cold sore, recurrent herpes labialis, fever blister
A

Herpes 1 (Herpes Simplex)

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57
Q

❑ Common cause of vesicular genital eruption

❑Spread by sexual contact

❑Aka genital herpes

A

Herpes 2

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58
Q

❑Painful infection of the terminal phalanx caused by Herpes Simplex 1 and 2

❑Tingling pain or tenderness of the affected digit followed by throbbing pain, swelling and redness

A

Herpetic Withlow

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59
Q

❑Caused Varicella-zoster virus (chicken pox)

❑Pain and tingling affecting spinal or cranial nerve dermatome

❑Red papules progressing to vesicles

❑Accompanied by fever, chills, malaise, GI
disturbances
❑(+) Post herpetic neuralgic pain

A

Herpes Zoster (Shingles)

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60
Q

o Highly contagious, spread from person to person by direct contact

o Sores occur at the site of infection, mainly on the external genitals, vagina, anus, or rectum.

o Sores can also occur on the lips and in the mouth

o Transmission occurs during vaginal, anal, or oral sex

A

Sphyphilis

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61
Q

❑ Benign infection by human papilloma virus (HPV)

❑ Transmission: direct contact and autoinoculation (via broken skin)

❑ Location: hands and fingers

❑ Plantar wart: on pressure points of the feet

A

Warts

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62
Q
  • Forms ring-shaped patches with vesicles or scales
  • Transmission is direct contact
  • Treatment: Topical or antifungal drugs
A

Ring worm (Tinea Corporis)

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63
Q
  • Erythema, inflammation, pruritis, itching, pain
  • Can progress to cellulitis if untreated
  • Treatment: Antifungal creams
A

Athlete’s foot (Tinea Pedis)

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64
Q

Presence of fungal infection on the beard

A

Tinea Barbae

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65
Q

Presence of fungal infection on the Scalp

A

Tinea Capitis

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66
Q

Yeast type of fungal infections

A

candidiasis

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67
Q
  • Bacterial infection carried by bacteria

- (+) Bulls eye appearance

A

Erthema Chronic Migrans (Lyme’s Disease)

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68
Q

❑ Chronic disease of skin with erythematous plaques covered with silvery scales

❑ Common in ears, scalp, knees, elbows, genitalia, extensor surfaces

❑ Associated with psoriatic arthritis, joint pain

❑ Topical meds may be used

❑ PT Intervention: UV light with psoralens

A

Psoriasis

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69
Q

❑ Chronic, progressive inflammatory disorder of connective tissues

❑ Characteristic red rash with raised red, scaly plaques

A

Lupus Erythematosus

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70
Q

❑ Affects only skin; flare-ups with sun exposure

❑ Causes atrophy, permanent scarring, hypo/hyperpigmentation

A

DISCOID LUPUS ERYTHEMATOSUS (DLE)

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71
Q

❑Chronic, systemic inflammatory disorder affecting multiple organ systems

❑Can be fatal

❑Symptoms: Fever, butterfly rash across bridge of nose, arthritis, photosensitivity, Raynaud’s Phenomenon

A

Systemic Lupus Erythematosus

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72
Q

Chronic, autoimmune diffuse disease of connective tissues causing fibrosis of skin, joints, blood vessels, GI tract, lungs, heart, kidneys

A

Scleroderma

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73
Q

❑ Affecting the connective tissues

❑ Inflammation of the muscle and skin

❑ Skin rash and proximal mm weakness

❑ (+) Gottron’s sign
❑ (+) Heliotrope rash
❑ (+) Shawl sign
❑ (+)Mechanic’s Hands

A

Dermatomyositis

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74
Q

AKA Lilac Rash

A

Heliotrope Rash

75
Q
  • Skin is not broken

* Pain, swelling and discoloration

A

Contusion

76
Q

Bluish discoloration of skin caused by extravasation

of blood into subcutaneous tissues

A

Ecchymosis

77
Q

Tiny red or purple hemorrhagic spots on the skin

A

Petechiae

78
Q

Scraping away of skin as a result of injury or mechanical abrasion

A

Abrasion

79
Q

Irregular tear of the skin producing torn, jagged wound

A

Laceration

80
Q
  • lack of pigmentation

- usually on sun-exposed areas, body folds, and around openings

A

Vitiligo

81
Q

light brown macules

Diagnosis: >5 lesions or 1 lesion but >1.5 cm

A

Cafe-au-lait

82
Q

What are the 3 zones of burns?

A

Zone of Coagulation
Zone of Stasis
Zone of Hyperemia

83
Q

A 45 year old male presents to the burn unit with partial thickness burns over the entire right arm, left arm, front of head, and front of the abdomen. Approximately what percentage of his body is burned?

A. 31.5%

B. 36%

C. 40.5%

D. 45%

A

C. 40.5%

84
Q

Burn affecting epidermis only, pink or red with No Blisters, tenderness and minimal edema

A

Superficial Thickness Burn (First Degree)

85
Q

Degree of burn where wound is insensitive to light touch or soft pin prick

A

Deep Partial Thickness Burn

86
Q

Burns where the affected structures are epidermis and upper layers of dermis with Bright red/pink, intact blister

A

Superficial Partial Thickness Burn

87
Q

Complete destruction of epidermis, dermis and subcutaneous tissues, may extend into muscles

A

Full-thickness Burn (third degree)

88
Q

Most Painful Type of Burn

A

Superficial Partial Thickness Burn

89
Q

White, gray, charred, black, poor distal circulation, parchment-like, dry leathery surface Little pain, destroyed nerve endings

A

Full-thickness Burn (third degree)

90
Q

Complete destruction of epidermis, dermis and subcutaneous tissues, with muscle damage May lead to necrosis

A

Subdermal Burn (fourth degree)

91
Q

Broken blisters (moist) Marked edema, sensitive to pressure

A

Deep Partial- thickness Burn (second degree)

92
Q

What is the most common mechanism of injury for subnormal burns?

A

Electrical Burns

93
Q

Stage of dermal healing: stop the bleeding by initiating coagulation

A

Hemostasis and degeneration

94
Q

Stage of dermal healing: Redness, edema, warmth, pain and decreased range of motion

A

Inflammatory phase

95
Q

Stage of dermal healing: Fibroblasts form scar tissue (deeper tissue), characterized by wound contraction and re-epithelialization

A

Proliferative phase

96
Q

Stage of dermal healing: Scar Tissue remodeling

A

Maturation Phase

97
Q

What are the 6 complications of burns?

A
  1. Infection
  2. Shock
  3. Pulmonary Complications
  4. Metabolic Complications
  5. Cardiac and Circulatory complications
  6. Integumentary scars and contractures
98
Q

Leading cause of death of burn patients

A

Infection (presence of bacteria or microorganism)

99
Q

Marker for true infection

A

Presence of bacteria or microorganisms >10/\5/gram of tissue determined by a quantitative culture

100
Q

What type of shock do burn patients experience?

A

Hypovolemic Shock

101
Q

Cause of pulmonary complications in burn patients

A

Smoke Poisoning

102
Q

Burns to the trunk will result with what kind of condition?

A

Restrictive Lung Disease

103
Q

Increase metabolic rate in burn patients will often result with what physical change?

A

Increased Weight Loss

104
Q

Circulatory complications in brun patients include?

A

fluid and plasma loss leading to decrease in Cardiac Output

105
Q

True or False

Burn patients are prone to develop heterotypic ossification (bone formation in the soft tissue)

A

True

106
Q

Most common areas for heterotypic ossification

A

Elbow
Hip
Shoulder

107
Q

Types of Wound Closure: Occurs when a surgeon closes a wound by bringing the edges
together

A

Primary Wound Closure

108
Q

Types of Wound Closure: Approximating the edges can occur through the use of sutures, staples, glue, skin grafts, or skin flaps.

A

Primary Wound Closure

109
Q

Types of Wound Closure: Occurs when a wound is left to heal on its own

A

Secondary Wound Closure

110
Q

Types of Wound Closure: The mechanisms of healing are contraction, reepithelialization, or a combination of both.

A

Secondary Wound Closure

111
Q

Types of Wound Closure: Wound is allowed to heal by secondary intention

A

Tertiary Wound Closure

112
Q

Types of Wound Closure: Then is closed by primary intention as the final treatment

A

Tertiary Wound Closure

113
Q

Type of scar: raised scar that stays within the boundaries of the burn

A

Hypertrophic Scar

114
Q

Type of Scar: Raised scar extends beyond the boundaries of the original burn wound and is red, raised, firm

A

Keloid Scar (common in young women, dark skinned)

115
Q

What is the most common instance for Tertiary Wound Closure?

A

wound is infection

116
Q

This type of topical medication is effective against yeast and pseudomonas infections

A

Silver Sulfadiazide

117
Q

This type of topical medication is used against gram + and gram - bacteria

A

Silver Nitrate

118
Q

This type of topical medication is used for yeast, molds, fungi, viruses and protozoans*

A

Povidone-Iodine (Betadine)

119
Q

This type of topical medication is able to penetrates eschars

A

Mafenide Acetate (Sulfamylon)

120
Q

This type of topical medication is bactericidal however overuse of it may lead to overgrowth of fungus and pseudomonas infections

A

Nitrofurazone

121
Q

Graft that uses the patients own skin

A

Autograft

122
Q

graft that uses tissue from a cadaver

A

Allograft

123
Q

graft taken from another species (usually pigs)

A

Xenograft

124
Q

type of graft where there is combination of collagen and synthetics

A

Biosynthetic Graft

125
Q

Lab grown graft from patients own skin.

A

Cultured Skin

126
Q

Graft that contains epidermis and papillary layer of the skin

A

Split thickness graft

127
Q

Graft that contains epidermis and both layers of the dermis

A

Full thickness graft

128
Q

Type of graft used to lengthen graft skin.

A

Z-plasty

129
Q

True or False

Exercise is d/c to allow healing

A

True

130
Q

Common deformity in shoulder joint of burn injuries

A

Adduction and Internal Rotation

131
Q

what type of splint is used for shoulder burn patients

A

Airplane/axillary splint

132
Q

What is the usual appearance of arterial ulcers?

A

regular smooth edges with punched out or deep ulcer appearance

133
Q

What is the usual appearance of venous ulcers?

A

Irregular edges with dark pigmentation, usually shallow

134
Q

True or False

Venous Ulcers usually occur at the medial malleolus

A

True (this is the area of maximal venous pressure due to the large perforating vein)

135
Q

True or False

Arterial Ulcers usually occur at the lateral malleolus

A

True

136
Q

True or False

Gangrene can only occur with arterial and diabetic ulcers

A

True

137
Q

What condition will usually present with an ulcer on the plantar aspect of the foot with sensory loss?

A

Diabetes Milletus (Diabetic Ulcer)

138
Q

Type of orthosis used to de-load diabetic ulcers

A

Total Contact and walking boot

139
Q

Instrument used to check for sensory integrity?

A

Semmes-weinstein monofilament

140
Q

How much force does a 4.17mm thin monofilament exert? (semmes-weinstein monofilament)

A

1 gram of force (normal)

141
Q

How much force does a 5.07mm thin monofilament exert? (semmes-weinstein monofilament)

A

10g of force (protective)

142
Q

How much force does a 6.10mm thin monofilament exert? (semmes-weinstein monofilament)

A

75g of force (insensate)

143
Q

Colors of the semmes-weinstein monofilament and indication for each.

A

Green (normal)

Blue (decreased light touch sensation)

Purple (decreased protective sensation)

Red (loss of protective sensation)

144
Q

❑Lesion caused by unrelieved pressure resulting in ischemic hypoxia and damage to underlying tissue

❑Usually over bony prominences

❑Common in: elderly, debilitated, or immob individuals,
cognitive impairment, decrease sensation

A

Pressure Ulcer/Decubitus Ulcer

145
Q

what are the most common sites for pressure ulcers?

A

Ischium: 28%
Sacrum: 17-27%
Greater Trochanter: 12-19%
Heel: 9-18%

146
Q

Most common area of Pressure ulcer in Acute SCI patients

A

Sacrum and Heels

147
Q

Most common area of Pressure ulcer in Wheelchair Bound patients

A

Ischial Tuberosity and Feet

148
Q

Stage of Pressure Ulcer:

Non-blanchable ERYTHEMA of intact skin; (+) change in tissue temp, tissue consistency, sensation

A

Stage 1

149
Q

Stage of Pressure Ulcer:

Partial thickness skin loss; Involves epidermis, dermis or both. Presents as abrasion, blister or SHALLOW CRATER

A

Stage 2

150
Q

Stage of Pressure Ulcer:

Full thickness skin loss; May extend down to, but not through, underlying fascia. Presents as DEEP CRATER

A

Stage 3

151
Q

Stage of Pressure Ulcer:

Full thickness skin loss; involves extensive destruction or damage to mm, bone or supporting structures.

UNDERMINING and sinus tracts may be present

A

Stage 4

152
Q

Stage of Pressure Ulcer:

Tissue depth is obscured d/t SLOUGH or eschar and extent of damage cant be determined

A

Unstageable

153
Q

Stage of Pressure Ulcer:

Discolored area of tissue (bruise) that is not reversible Injury and will likely progress to a full thickness injury

A

Deep Tissue Injury

154
Q

Skin looks lighter in color and wrinkly. It may feel soft, wet, or soggy to the touch.

Common with sacral ulcers due to too much moisture. (i.e. patients who wear diapers)

A

Macerated Wound

155
Q

Linear erosion of skin tissue resulting from mechanical means.

Common with sacral ulcers due to too much moisture. (i.e. patients who wear diapers)

A

Excoriation

156
Q

Wound with rolled borders

A

Epibole

157
Q

Open wound that is extremely dry

A

Desiccated Wound

158
Q

Ruptured surgical wound area

A

Dehiscence

159
Q

WAGNER ULCER GRADE CLASSIFICATION SCALE:

No open lesion but may possess pre-ulcerative lesions; healed ulcers; presence of bony deformity

A

Grade 0

160
Q

WAGNER ULCER GRADE CLASSIFICATION SCALE:

Superficial ulcer not involving subcutaneous tissue

A

Grade 1

161
Q

WAGNER ULCER GRADE CLASSIFICATION SCALE:

Deep ulcer with penetration through the subcutaneous; potentially exposing bone, tendon, ligament or joint capsule

A

Grade 2

162
Q

WAGNER ULCER GRADE CLASSIFICATION SCALE:

Deep ulcer with osteitis, abscess or osteomyelitis

A

Grade 3

163
Q

WAGNER ULCER GRADE CLASSIFICATION SCALE:

Gangrene of digit

A

Grade 4

164
Q

WAGNER ULCER GRADE CLASSIFICATION SCALE:

Gangrene of foot requiring disarticulation

A

Grade 5

165
Q

Bigger area of tissue destruction than can be seen (extends under the edge).

A

Undermining

166
Q

Tracts extending out from the wound.

A

Tunneling

167
Q

Wound Drainage:

Clear, shiny exudate; can have slightly yellow appearance

A

Serous

168
Q

Wound Drainage:

Red, blood drainage

A

Sanguineous

169
Q

Wound Drainage:

Pinkish- red colored exudate

A

Serosanguineous

170
Q

Wound Drainage:

Brighter yellow drainage, slightly thicker exudate than serous; slightly malodorous

A

Seropurulent

171
Q

Wound Drainage:

Containing pus; Thick, cloudy or opaque exudate; mal odorous

A

Purulent

172
Q

Clean red wound color indicates

A

Healthy granulation wounds

173
Q

Yellow wound color indicates

A

Slough, fibrous tissue

174
Q

Black wound color indicates

A

Eschar

175
Q

Surgical Intervention is used for what stage of ulcers?

A

Stage 3 and 4

176
Q

Wound Care:

o Patient breathes 100% oxygen in a sealed, full body chamber with an elevated atmospheric pressure

o Hyperoxygenation reverses tissue hypoxia and facilitate wound healing

o CI: untreated pneumothorax, anti-neoplastic medications

A

Hyperbaric Oxygen Therapy

177
Q

o Removal of necrotic or infected tissue that interferes with wound healing

o Allows examination of ulcer

o Decreases bacterial concentration

o Improves wound healing

o Decreases spread of infection

A

Wound Debridement

178
Q

Delivery System for Wound Debridement:

Use of Gauze, cloth, sponge

A

Minimal mechanical force

179
Q

Delivery System for Wound Debridement:

Use of Syringe, battery-powered irrigation system (pulsatile lavage)

A

Irrigation: uses 4-15 psi

180
Q

Delivery System for Wound Debridement:

For ulcers with large amount of exudate

A

Hydrotherapy

181
Q

METHODS OF DEBRIDEMENT:

  • Most selective
  • Used if granulation tissues are greater than necrotic tissues
  • Uses body’s own enzymes and moisture to re- hydrate, soften and finally liquefy hard eschar and slough
  • CI: immunosuppresed*
A

Autolytic Debridement

182
Q

METHODS OF DEBRIDEMENT:

  • With the use of scalpel, scissors and tweezers
  • This is contraindicated for patients taking anti-coagulants
A

Sharp debridement

183
Q

METHODS OF DEBRIDEMENT:

• Use of fibrinolytic and proteolytic enzymes

A

Enzymatic Debridement

2 types:

a) ELASE
• Glassy edematous wounds
• Venous insufficiency ulcers with fibrous exudates
b) TRAVASE
• Used for ESCHAR
184
Q

METHODS OF DEBRIDEMENT:

  • Application of moistened gauze dressing, necrotic tissue will adhere to the gauze
  • May traumatize healthy or healing tissue
A

Wet to dry debridement

SD and NSD (7 decks)

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