Wound management Flashcards
triaging the patient
- consider the whole patient
(other injuries and problems) - address life threatening problems first
- brief history from client
- clinical exam
- note obvious wounds + severity
wound classification
- when did wound occur?
- how contaminated is the wound?
- how did the wound occur?
- what type of wound is it?
when did the wound occur? classification
important for bacterial multiplication
class 1: 0-6hrs, clean laceration
class 2: 6-12hrs, significant contamination
class 3: >12hrs, gross contamination
clean wound definition
created under sterile conditions
clean contaminated wound definition
- minimal contamination, easily removed
- surgical, tract penetrated, minimal spillage
- can close after appropriate treatment
contaminated wound definition
- gross contamination with foreign debris
- dog fight/RTA/gunshot
- can close after appropriate treatment
dirty/infected wound definition
- infection already exists (>10^5 organisms per gram)
- never close primarily
incision definition
created by sharp object
abrasion definition
blunt trauma
- damage to skin and epidermis
avulsion definition
tearing of tissue from attachment
- degloving
laceration definition
irregular wound created by tearing
- variable damage to tissue
puncture definition
penetrated wound by sharp object
- minimal superficial damage but substantial deeper damage
- skin discolouration from cellulitis
stages of wound healing
- inflammatory phase
- aim to debride + flush
- proliferative phase
- maturation phase
- no dressing neccessary
inflammatory stage of wound healing
- 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
early proliferative stage of wound healing
- 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
late proliferative stage of wound healing
- wound contracts
- epithelisation
aims:
- exudate reduces
- maintain moist environment
maturation stage of wound healing
- 2-4 weeks post injury
1. remodelling phase begins when wound has filled in and resurfaces
2. collagen fibres reorganise forming scar tissue
how to assess viability of tissue
- colour
- warmth (potentially infected, bandage too tight)
- pain sensation (check others first)
- bleeding (needle prick to assess circulation)
primary wound closure
- 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
delayed primary closure
- for wounds beyond golden period, require further debridement
- wound should be explored, lavaged, debrided
secondary wound closure
- for heavily contaminated, dirty wounds
- managed as open until granulation bed is established
- then edges are debrided and closed
secondary intention wound healing
- wounds with significant tissue loss, contamination or infection
- managed as open wound, never surgical
- allowed to granulated and epithelise
wounds should only be closed if:
- sufficient tissue to allow reconstruction without dehiscence
- no devitalised tissue or foreign material
- no signs of infection or contamination
- adjacent skin is healthy
non-adherent dressings
- absorb fluid
- hydrophilic polyurethane
- semi-permeable membrane (breathable)
- used in conjunction with gels for moist environment
examples: allevyn, cutinova
factors determining how often a dressing should be changed:
- type of wound
- volume of exudate
- type of dressing
- stage of wound healing
clean + prep of a wound
- 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?)
equipment for flushing a wound
- Hartmann’s or saline
- giving set
- three way tap
- 18/19G needle
- 8-12psi (pressure for flushing wound)
equine wound management
- 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)
surgical drains
- 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
- removes fluid/gas from wound or body cavity
passive wound drains
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
active wound drains
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
dressing checks
- every 4-6hrs
check for: - dampness
- slipping
- patient interference
- tightening
- toes for moisture, temp
- tolerance of dressing
