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Integumentary System > Wound Management And Burns > Flashcards

Wound Management And Burns Flashcards

1
Q

Wound descriptive words

A

Acute/chronic

Type and etiology

Location

Size

Skin depth (how deep)

Wound edges and tunneling

Contamination/foreign

Purulent or infectious

Wet vs dry

Peri-wound apperance

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2
Q

Acute vs chronic wounds

A

Acute:

  • caused by trauma or surgery
  • heal easily by themselves
  • require limited local care
  • progress through 3 phases of healing quickly (inflammation, proliferation, maturation)
  • caused by contusions/abrasions/lacerations/incisions/penetrating wounds and burns

Chronic:

  • healing takes longer than 21 days
  • usually stalls between inflammation and proliferative phases
  • caused by ulcers as #1
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3
Q

Contusions and hematomas

A

Contusions usually from trauma
- blood vessel and tissue damage

Can induce hematomas
- can be an indicator of TBI in patients less than 2 years old with isolated hemorrhages and cerebral contusion

Treatment = ice and time usually. Also treat secondary symptoms if they arise

Both are closed wounds

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4
Q

Cruising injuries

A

Compartment syndrome and Rhabdomyolysis are common complications

  • progressive POOP
  • numbeness and parasthesia
  • pale foot
  • swelling

Compartment syndrome = fasciotomy

is a closed wound

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5
Q

Non penetrating superficial tissue

A

Skin wounds = treat with bacitracin

Eye abrasion = erythromycin ointment

Are examples of open wounds

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6
Q

Lacerations

A

Usually longer than deep
- *check wound margins

Increases risk of infections

Management = cleaning, irrigation, debridement and ABs if you feel its contaminated

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7
Q

Human fight bite

A

Open wound

High risk of staph/strep and Elkenella corrodens infections

Management = amoxicillin/clavulanate acid = #1
- always do even if its just prophylaxis

if signs of tenosynovits is present (erythema and infection signs as well extreme pain) consult hand surgeon

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8
Q

Wound closure types

A

Primary = suturing, grafting, surgery procedure

  • used in non infection wounds
  • heals faster

Secondary = spontaneous intention by re-epithelization and contraction of the wound naturally

  • used for contaminated or high risk of contamination wounds
  • takes longer and scars more

Tertiary (delayed primary closure)

  • repeated debridement and negative pressure wound therapy w/ antibiotics. Then after time = revision of the wound and then suture/great the wound close
  • only for highly contaminated wound
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9
Q

Detriments for acute wound healing properly

A

Wound Is in areas under tension and pressure or are loaded areas (FEET)

Wound is prone to dishiscence
- splinting when necessary

If wound gets contaminated/ foreign body is retained

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10
Q

Are antibiotics needed for prophylaxis of wounds

A

Not in uncomplicated patients

Only if you feel the wounds have high risk of contamination or if it is contaminated
- also if patient is immunodeficiency is present should also consider prophylaxis

**be careful with C. Diff infections if using antibiotics

**compulsive wound cleaning is more importaint than ABs in post wound repair

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11
Q

4 phases of wound healing

A

Hemostasis

  • 5-10 minutes
  • vasoconstriction and fibrin clot formation with coagulation occurs
  • releases inflammatory mediators and growth factors

Inflammatory

  • up to 3 days after wound
  • increased vascular and cellular permeability
  • pain and swelling occurs
  • releases of cytokines
  • **chronic wounds get arrested here and dont move on often due to alteration in balance of inflammation and impaired cytokine function

Proliferative

  • 3-12 days
  • fibroblast migration occurs
  • fibrin matrix and collagen synthesis occurs and angiogenesis as well if needed
  • **greatest increase in wound strength occurs here

Maturation

  • scarring period beings here with collagen cross-linking and remodeling with scar relation
  • **overall approximately 80% of tensile strength exists at 6 week mark when healed (easy to reinjure so be careful
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12
Q

Type of ulcers

A

Venous insufficiency

  • due to edema being present from venous status
  • common in elderly and venous HTN
  • hemosiderin deposits and staining occurs (looks bluish)

Arterial insufficiency

  • develops due to narrowing of arteries in the pelvis and legs
  • pulses may be absent and edema is ABSENT
  • shows atrophic skin and is painful
  • common in diabetics

Neuropathic/diabetic ulcers

  • develops due to loss of sensation or callous formation in the extremity
  • common diabetes and are the most likely to get infected

Pressure ulcers

  • develops due to limited mobility
  • causes local ischemia and associated necrosis
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13
Q

3 key points for ulcer prevention

A

1) risk assessment and skin assessments
2) manage moisture
3) minimization of pressure

High risk:

  • Braden scale <12
  • elderly
  • immobile/spinal cord injury
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14
Q

Colors of wounds

A

Red wound = trauma or surgical wound with healing
- tx = symptomatic or monitor

Pink tissues = healing wound as epithelial tissue forms
- tx =monitor and symptomatic

Yellow tissues = soft necrotic and stuck in prolonged inflammation phase of healing
- tx = debridement if needed and then wound cleaning

Black tissues = adherent necrotic tissues what may be Purulent
- tx = debridement

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15
Q

Other causes of decreased chronic wound healing

A

Diabetes present

Anticoagulant or steroid medications

Poor oxygenation
- COPS, tobacco use

Location is at areas of stretching/tension full

Wound is contaminated

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16
Q

Wound edges

A

Epithelial = healthy tissue from edge of wound

Rolled = edges are not connected to base of wound

Shape = distinct, irregular, diffuse, defined, etc.

Hyper keratotic or calloused wounds

Macerated (white/boggy tissue from moisture)

17
Q

Signs of infection

A

Fever

Extensive redness

Edema

POOP

Odor present

Systemic symptoms present (especially tachycardia and hypotension)

18
Q

Treatment of Purulent vs non Purulent

A

2 most common organisms = staph aureus and strep

Moderate disease of suspected MRSA infection = vancomycin IV, doxycycline or SMP-TMX if oral route

Uncomplicated cellulitis = cephalexin is #1

19
Q

Necrotizing ST infections

A

May appear as cellulitis early on but progresses very quickly

Spreads rapidly along all fascial plans and is very erythema and edematous beyond the redness

Treatment = surgical consultation and ABs

20
Q

Factors that increase mortatility from burns

A

Larger burn size

Very young or very old

Increased in females but unknown reason

Inhalation injuries from burns

21
Q

What factor dictates severity of burns?

A

Skin thickness

  • thinner overall skin = risk of deeper burns
  • youth and elderly have higher risk of severe burns

Thicker skin = palms/soles/upper back

22
Q

Burn classifications

A

1st-4th degree
- 4th degree = entire epidermis and dermis and fat/muscle have all been breached

Thickness degree

  • superifical = 1st
  • partial thickness = 2nd degree
  • full thickness = 3rd degree
23
Q

First degree superficial

A

Usually only includes sunburns Or burns that only affect the epidermis

Induces localized pain with dry/swelling
- no blisters are present

Heals says without scarring (usually 48-72 hrs)

24
Q

Superfical 2nd degree

A

Epidermis and superfical dermis affected

  • is more painful and blanches with pressure
  • blisters take 12-24 hrs to appear and almost always appears**
  • heals 14-21 days without scarring
25
Q

Deep partial thickness (2nd degree)

A

Includes the epidermis/deep dermis and sweat glands/hair follicles

Is wet and waxy/dry with variable color

  • white/red/yellow are common colors
  • also shows blisters and very painful

Is very painful (most painful burn)

Healing takes 3-8 weeks

  • always permanently scars as well
  • also typically presents with fluid loss
26
Q

Full thickness 3rd degree

A

NO PAIN PRESENT**

Entire epidermis and dermis destroyed

  • no epithelial cells can repopulate and therefore requires surgery and skin grafts
  • always severe scarring
  • doesnt blanch and only sensation to deep pressure intact
27
Q

Deep full thickness 4th degree

A

Is the worst burn

Burns everything and requires months-years and surgery to repair

28
Q

Symptoms of inhalation injury

A

Hoarse voice, stridor wheezing

Soot or burns inside the mouth/nose

29
Q

Parkland formula

A

4mL x total body surface burnt (% (but use full number, not decimal)) x total body weight in (kg)

Helps determine estimation of total IV solution needing to be given to this patient

  • 50% of this = first 8 hrs
  • other 50% of this = second 16 hrs
30
Q

High voltage vs low voltage electrical burns

A

High voltage = >1000V
- always requires hospitalization and observation

Low voltage = <1000V

**most electrical burns cause internal burns that dont look bad from the outside

31
Q

Direct current vs alternating current

A

DC = batteries and lightening
- causes asystole

AC = household electricity

  • causes ventricular fibrilation and muscle tetany
  • also potentially respiratory muscle paralyze and suffocation
  • MORE DANGEROUS

**complications = rhabdomyolysis, myoglobinuria and compartment syndrome

32
Q

PECARN criteria

A

Used in any injury to a Pediatric patient that you suspect a TBI may be present

Red flags: MUST get CT (especially if patient under 2 years old)

  • AMS
  • GCS <15
  • palpable skull fracture

Yellow flags: MAY get CT or just monitor

  • LOC > 5 sec
  • nonfrontal hematoma
  • severe mechanism of injury

If none of these are present = NO CT

33
Q

Pressure ulcer stages

A

Stage 1:

  • skin intact
  • non-blanchable erythema present
  • treatment = skin care and off-loading

Stage 2:

  • partial loss of dermis
  • shallow open ulcerations
  • treatment = same as stage 1 but can also use barrier creams or hydrocolloid

Stage 3:

  • full thickness skin loss and fat exposed
  • treatment = consult wound care and apply dressing

Stage 4:

  • full thickness skin loss and exposed bone/muscle/tendon
  • treatment = consult surgery and do stage 3 treatments

Extra stages:

1) unstagebale pressure injury
- covered with slough or eschar so cant determine
2) Deep tissue pressure injury
- purplish skin discoloration and potential for deeper tissue damage

34
Q

Granulation tissues

A

Is viable healthy tissue found in in stage 3/4 pressure injuries and full thickness wounds.

Non viable tissue = eschar or slough

  • also only seen in stages 3/4 pressure injuries and full thickness wounds
35
Q

Factors that decrease mortality to burns in public systems

A

Smoke and CO2 alarms

Building codes updated

Federal flammable fabric act
- requires flame-retardant clothing and interior furnishings

36
Q

Common signs of abuse burns

A

“Glove/stocking” burns

Deep burns on trunk/back or buttocks

Single area small and full thickness burns (like cigarette burns)

37
Q

What are indications for escharotomy?

A

Circumferential deep burns to limbs/chest/neck

Compromised circulation or ventilation

38
Q

Wound management highlights

A

Over 20% TBSA = high risk of infection and cross contamination

Burned scalps should be shaved daily if possible to promote GFR oath

Foley catheter should be considered in genitalia and perineal burns

  • must check sulfa allergies before applying sulfadiazine creams
  • if allergic = neomycin/bacitracin/polysporin

Elevate burned extremities above the heart level

** DONT use silver sulfadiazine creams on face and keep creams out of eyes

39
Q

Complications of high voltage non-burn injuries

A

CV: cardiac arrest, HTN, PVCs, VFib

CNS: cerebral edema, hemorrhage, seizures, mood changes, depression and paralysis

MSK: rhabdomyolysis and myoglobinuria

Renal: renal failure

Ocular complications

Integumentary System (29 decks)

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