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CVNT 2 > Wound management > Flashcards

Wound management Flashcards

1
Q

triaging the patient

A
  • consider the whole patient
    (other injuries and problems)
  • address life threatening problems first
  • brief history from client
  • clinical exam
  • note obvious wounds + severity
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2
Q

wound classification

A
  • when did wound occur?
  • how contaminated is the wound?
  • how did the wound occur?
  • what type of wound is it?
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3
Q

when did the wound occur? classification

A

important for bacterial multiplication
class 1: 0-6hrs, clean laceration
class 2: 6-12hrs, significant contamination
class 3: >12hrs, gross contamination

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4
Q

clean wound definition

A

created under sterile conditions

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5
Q

clean contaminated wound definition

A
  • minimal contamination, easily removed
  • surgical, tract penetrated, minimal spillage
  • can close after appropriate treatment
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6
Q

contaminated wound definition

A
  • gross contamination with foreign debris
    • dog fight/RTA/gunshot
  • can close after appropriate treatment
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7
Q

dirty/infected wound definition

A
  • infection already exists (>10^5 organisms per gram)
  • never close primarily
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8
Q

incision definition

A

created by sharp object

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9
Q

abrasion definition

A

blunt trauma
- damage to skin and epidermis

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9
Q

avulsion definition

A

tearing of tissue from attachment
- degloving

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10
Q

laceration definition

A

irregular wound created by tearing
- variable damage to tissue

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11
Q

puncture definition

A

penetrated wound by sharp object
- minimal superficial damage but substantial deeper damage
- skin discolouration from cellulitis

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12
Q

stages of wound healing

A
  • inflammatory phase
    • aim to debride + flush
  • proliferative phase
  • maturation phase
    • no dressing neccessary
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13
Q

inflammatory stage of wound healing

A
  • occurs within the first 72hrs post-injury
    1. haemorrhage occurs due to injury
    2. vasoconstriction- reduces haemorrhage and forms blood clot
    3. vasodilation occurs to release clotting elements into wound, triggers healing
    4. WBC leak from blood into wound initiating the bodies debridement phase
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14
Q

early proliferative stage of wound healing

A
  • 3-5 days post injury
    1. granulation tissue fills wound
    2. fibroblasts lay network of collagen in wound bed (for strength)
    3. epithelial cells from wound margins migrate and cover wound
    aim to:
  • maintain moist wound environment, preventing damage to cells
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15
Q

late proliferative stage of wound healing

A
  1. wound contracts
  2. epithelisation
    aims:
    - exudate reduces
    - maintain moist environment
16
Q

maturation stage of wound healing

A
  • 2-4 weeks post injury
    1. remodelling phase begins when wound has filled in and resurfaces
    2. collagen fibres reorganise forming scar tissue
17
Q

how to assess viability of tissue

A
  • colour
  • warmth (potentially infected, bandage too tight)
  • pain sensation (check others first)
  • bleeding (needle prick to assess circulation)
18
Q

primary wound closure

A
  • minimal tissue contamination
  • wound should be explored, lavaged and debrided prior to closure
  • fibrin seal forms within 4-6hrs, protects from invasion of MO and leakage of fluid
    • if still leaking, there’s no fibrin seal
  • epithelisation occurs 48hrs later, increasing tensile strength of wound
  • sutures generally removed at day 10
19
Q

delayed primary closure

A
  • for wounds beyond golden period, require further debridement
  • wound should be explored, lavaged, debrided
20
Q

secondary wound closure

A
  • for heavily contaminated, dirty wounds
  • managed as open until granulation bed is established
  • then edges are debrided and closed
21
Q

secondary intention wound healing

A
  • wounds with significant tissue loss, contamination or infection
  • managed as open wound, never surgical
  • allowed to granulated and epithelise
22
Q

wounds should only be closed if:

A
  • sufficient tissue to allow reconstruction without dehiscence
  • no devitalised tissue or foreign material
  • no signs of infection or contamination
  • adjacent skin is healthy
23
Q

non-adherent dressings

A
  • absorb fluid
  • hydrophilic polyurethane
  • semi-permeable membrane (breathable)
  • used in conjunction with gels for moist environment
    examples: allevyn, cutinova
24
Q

factors determining how often a dressing should be changed:

A
  • type of wound
  • volume of exudate
  • type of dressing
  • stage of wound healing
25
Q

clean + prep of a wound

A
  • cover and protect wound with sterile lube or swab damped with sterile saline
  • clip hair away from around wound
  • flush wound thoroughly (sterile)
  • investigation of wound (swab for culture?)
26
Q

equipment for flushing a wound

A
  • Hartmann’s or saline
  • giving set
  • three way tap
  • 18/19G needle
  • 8-12psi (pressure for flushing wound)
27
Q

equine wound management

A
  • concern of tendon damage in lower limb wounds
  • usually considered dirty/infected
  • difficult to restrict movement
  • horizontal mattress suture will help release pressure in wounds
  • aim for minimal scar tissue (15-20% weaker than original tissue)
28
Q

surgical drains

A
  • passive and active drains available
    • removes fluid/gas from wound or body cavity
      passive- open system relying on gravity
      active- closed system relying on negative pressure
29
Q

passive wound drains

A

penrose
- cut to size, radiopaque, inexpensive
- work by capillary action, gravity and changes in body pressure
- not recommended for abdomen or thorax due to resp movements
- fluid moves out along outside of drain not lumen
- fenestrations contraindicated as reduce functional areas of drain

30
Q

active wound drains

A

jackson-pratt
- reservoir collapsed then attached to tubing to create negative pressure
- radiopaque, fenestrated tubing
- decreased risk of ascending infection
- fluids are collected, reducing exposure to staff
- drains can be in any position
- artificial pressure gradient pulls fluid/gas out

31
Q

dressing checks

A
  • every 4-6hrs
    check for:
  • dampness
  • slipping
  • patient interference
  • tightening
  • toes for moisture, temp
  • tolerance of dressing

CVNT 2 (33 decks)

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