Skin 1 Flashcards
3 categories of wound healing
infl./debridement
repair
maturation
how does wound change during infl. phase. what is our goal?
increase in size, hot/swollen/red.
minimize duration via effective debridement.
which phase does granulation tissue form
repair
our goal of repair stage?
enable granulation tissue to cover by providing moist/hypoxic env. (bandage)
what is our goal during maturation?
allow epithelial cells to migrate across wound via minimizing destruction and distance
sedation for wound management
a2 agonist + opioid
analgesia for wound management
NSAID + local/epidural
how to clean wound?
- cover in water-soluble lubricating gel
- clip hair
- clean edges w chlorhex
- lavage w fluids
after cleaning/prepping wound, you can palpate/probe. what’re some reasons to use US?
rule out tendon/ligament involvement, find FB, abscess, gas (clostridia), fractures, positive contrast study.
Can add doppler to assess blood flow
uses for radiography
sequestrum (non-healing bone)
pneumothorax
if a wound is over a synovial structure, what should you do?
synoviocentesis
synoviocentesis: WBC should be < ____ cells/uL. TP should be less than ___g/dL.
500
2.5
synoviocentesis: WBC >____ cells/uL indicate sepsis. TP greater than ___g/dL.
30k
4
what to do for infected wound
C&S from primary site of infection (not exudate coming out)
what is a sarcoid
chronic wound thats undergone tumor formation
types of debridement
mechanical (surgical)
autolytic (dressings)
biosurgical (maggots)
how to sx debride
start from bottom using scalpel. only remove if devitalized (can keep flaps)
what is the problem with wet-to-dry mechanical debrdiement
non-selective for devitalized tissues
is autolytic debridement selective
yes: festering in moist environment allows for phagocytosis of necrotic tissue, its not adhesive
what do greenbottle fly larva (maggots) secrete
proteolytic enzymes
most common bact for subq wounds? which AB?
Staph – start w penicillin while waiting on C&S
most common bacteria for synovial/bone wounds? which AB?
strep + staph polymicrobial – use beta lactam AB + aminoglycoside
what AB for clostridia?
[high dose] penicillin + metro
when to stop AB
no longer clincial/microbio evidence of infection
passive drains
rely in gravity
place at most distal area of dead space
active drain
uses negative pressure to pull from wound
delayed primary closoure is __d after wound
1-3
(can reduce bact burden)
goals of bandaging
Minimize edema
Absorb exudate
Maintain temp/moisture
Immobilize
Protect from contamination/trauma
fxns of secondary layer of bandaage
padding
absorb exudate
4 types of primary dressings
- debridement
- moistening (facilitate autolytic)
- granulation/wound contraction
- epithelialization (increase surface temp)
give an example of debridement dressing
manuka honey
hypertonic saline
give an example of moistening dressing
hydrogel
give an example of granulation dressing
Calcium alginate
give an example of epithelialization dressing
Allevyn
risk factors for exuberant granulation tissue
High motion areas
Large breeds
Chronic/FB
Bandaging
Tumor transformation
when surgically excising exuberant granulation tissue, do you need to use a local
no bc not innervated
how to decrease distance epithelial cells have to migrate
skin graft: pinch, punch, mesh graphs
