Wound Management Exam 1 Flashcards
Disinfectants
destroy cells from the outside
-need a necessary time length for the action
Types of wounds
-abrasion
-bruising
-hematoma
-contusion
-puncture wound
-incised wound
-laceration
-complicated wounds
-burns
Abrasion
-scrape
-surface wound (hair and top layer of skin)
-usually do not have to do anything for it (sometimes they get infected)
Hematoma
collections of extravascular blood that sits in an area
-feels soft/squishy
-usually the body reabsorbs it
-sometimes vets drain it, others don’t want to risk infection with a needle
What causes hematoma’s?
blunt force trauma
What is the richest medium for bacteria growth?
blood
Contusion
not a collection of blood but the blood is spread out (bruise)
What causes a contusion?
blunt force trauma that leads to a bruise
Puncture wound
a wound that is deeper than it is wide
-will scab on top before they heal
-sometimes hard to see
-creates an anaerobic environment where some bacteria thrive
What is a bacteria that often thrives in puncture wounds?
tetanus
Incision
a wound that has clear edges
-can be a cut or from a scalpel
-anything that you can stitch
Laceration
a wound that has clear edges but more structures are involved
-must be able to staple/stitch
Complicated wound
-a complicated wound
-lots of structures damaged
-takes awhile to heal
Burn
-very problematic
-even if animal is removed from the heat, the heat continues to sink down and damage can occur for hours after
-kills everything (lots of scars)
3 phases of healing
-inflammatory
-granulation
-contraction and epithelization
Inflammatory stage of healing
-clot provides scaffolding for new matrix and migration of cells
-phagocytic cells will debride wound
-want to sometimes make the wound bleed again to “wake” up this process
Granulation process of healing
-cannot process until blood clots, necrotic tissue, debris, and infection have been eliminated
-angiogenesis for blood supply
-made of loose ECM
When is granulation tissue made?
develops 3-6 days post-injury and continues until epithelization occurs
Epithelialization
growth of new epithelial cells
Angiogenesis
formation of new blood vessels
Contraction and epithelialization step of healing
-very slow but starts within hours of wounding
-cells migrate centripetally
-healing epithelium is fragile and poorly adherent to underlying tissues
-the wound contracts and a scar is formed
When do you usually see contraction lines on a wound?
after a few days
What color is granulation tissue?
yellowish/pink
Where to wounds heal and close the best/quickest?
in heavily vascularized areas (chest, face, etc.)
When does granulation tissue become a problem?
when it becomes exuberant (proud flesh)
What does the layout of the skin need to be for the injury to heal?
inside of the wound needs to be lower than the outside edges
Purposes of granulation tissue:
- provides surface for epithelialization
- is resistant to infection
- is necessary for wound contraction
Factors that delay healing
-location
-infection
-movement
-wound dimensions
-involvement of deep structures
-poor blood/oxygen supply
-foreign bodies
-sequestrum
-nutritional factor
-previous treatment
-age of wound
-economic factor
What occurs to wounds in the winter/cold weather?
the bleeding stops quickly because of vasoconstriction but healing takes much longer
Are foreign bodies the same as foreign objects?
NO
Sequestrum
when the bone underneath the tissue dies (wound will not close until dead bone is removed)
Why do lower legs heal slower?
-decreased vascular supply
-bone prominences
-no supporting deep musculature
-highly mobile joints
-higher degree of contamination
Wound management step 1.
hemorrhage control (stop bleeding)
Wound management step 2.
initial cleaning:
-wash wound with saline or water
-cover with hydrogel before clipping
-clean wound with 0.5% chlorhexidine
-flaps of skin should be lifted and flushed underneath
How should betadine be diluted?
should be <1% when used on tissues
Wound management step 3.
wound assessment:
-sterile gloves
-may need anesthesia
Wound management step 4.
prevention of further injury and contamination
Wound management step 5.
Wound debridement:
-convert an accidental wound into a surgical wound
-scalpel should be used instead of scissors (will crush the cells)
Wound management step 6.
Provision of a moist environment:
-water soluble gels instead of petroleum
-creams are better than ointments
When are wounds considered contaminated already?
wounds that are 6 hours or older
Primary wound closure
wounds should not be completely closed unless the deep tissues are sterile
-may have to close part of it to keep it from getting infected
Suture dehiscence
if the suture is too tight
-is a result of infection, skin loss, tension in suture line, marked swelling, etc.
3 steps of wound closure:
-primary closure
-delayed primary closure
-second intention
If they haven’t in the past 6 months what should the horse receive?
tetanus vaccination or anti-serum
When should antibiotics be used for wounds?
-for known or suspected infections and prophylaxis
What antibiotics are used initially?
parental antibiotics only used initially unless the wound becomes complicated
Wound lavage/flushing
removes dead tissue, bacteria, foreign matter without compromising the physiological status of the new forming tissue
2 main factors of wound flushing:
- type of fluid
- pressure
Types of fluids:
-saline
-water
-povidone-iodine (0.1-1%)
-chlorhexidine (0.05%-1%)
-hydrogen peroxide
Why are buttons used in stitches sometimes?
used for highly mobile areas of the body
-when the horse moves it puts pressure on the buttons instead of the sutures themselves
What are polo wraps used for?
mainly to protect the skin and for looks
What are quilts/pillows used for?
to distribute the pressure evenly around the leg
What happens if wraps are not wrapped with even pressure?
can cause corded tendon
Should you bandage just one leg?
no, if one is bandaged, bandage the other to even out pressure
Arterial bleeding
-bright red
-under high pressure
How to control arterial bleeding
-direct pressure over the site or in the arterial tree on the heart side of the injury
-may need to for 10-15 min.
-or a pressure bandage
What can be effective in causing rapid vasoconstriction?
adrenaline swabs
Venous bleeding
-usually slower
-dark red/purple blood color
How can venous bleeding be controlled?
-direct pressure with a saline soaked swab for a few minutes
-application of a firm bandage (tight pressure bandage is usually not necessary)
Capillary bleeding
-slow
-small volume
-can either be bright or dark in color
How can capillary bleeding be controlled?
-natural hemostasis
-cold compresses/ice packs will cause capillary constriction
What should be explored digitally to figure out on a wound?
- depth of wound
- direction of the damage
- extent of the damage
- precise tissues and structure involved
When is a wound considered infected?
beyond 6-8 hours after the injury
What are the primary objective of dressing?
-enhance and support the healing process
-decrease contamination and further infection at the wound site
-minimize edema
-absorb exudate
-maintain a high humidity and moist wound environment
-maintain a local temperature
-lower the pH at the sire
-allow gaseous exchange
-immobilize the wound site
-protect site from further trauma
How long can most dressings be safely left on?
4-6 days
Why should dressings be changed?
to avoid bacterial overgrowth and further infection of the wound
-to avoid tissue necrosis
Hydrogels
-donate moisture to the wound
-physiologically sound
-expensive
-require primary dressing to keep it on the wound
Hydrocolloids
-composite products based on naturally occuring hydrophillic polymers
-absorbs water from the skin around the wound so it adheres easily
-contains an expanding gel that gently forces itself into the wound
Collagen dressings
-based on bovine type 1 collagen
-provide suitable environment for migration of cells
-powder form or plaster form
-only small sizes are available
Alginates
-certain species of seaweed
-flat-layered fabric type
-encourages coagulation from fibrous nature
-gel forms
-useful in bleeding wounds
Activated charcoal
-controls odor
-absorbs bacteria
-inhibitory effect on granulation tissue
Hydrophilic Polymeric Foams
-absorb exudate while maintaining a moist surface
-many shapes and sizes
-fluid is absorbed from wound site into the foam center
Exudate from a wound can be:
-hemorrhage
-serum/plasma exudation
-inflammatory fluids
