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Equine (Poppy) > Wounds > Flashcards

Wounds Flashcards

1
Q

4 phases of wound healing

A

Haemostasis/coagulation phase
Inflammatory phase
Proliferative phase
Maturation phase

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2
Q

Do ponies or horses heal faster? Why?

A

Ponies as wound contract faster and sooner

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3
Q

Should you clip around a wound?

A

Yes (unless freshly clipped)

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4
Q

What factors determine clipping size around wound?

A

Soft tissue involvement
Bone involvement
Synovial involvement

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5
Q

Wound lavage options

A

Saline
Clean, potable water

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6
Q

How to debride wounds with saline

A

High pressure with syringe and needle
(13psi = 12ml syringe, 22g needle for perfect pressure but impractical so can use a bigger syringe)

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7
Q

Product recommended for cleaning wounds to reduce bacterial load

A

Povidine iodine
Chlorhexidine

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8
Q

Problems with povidine iodine use in a contamined wound

A

Povidine iodine is inactivated by organic material so should repeat multiple times or clean it first with water

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9
Q

Does chlorhexidine or povidine iodine have a superior antibacterial activity?

A

Chlorhexidine

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10
Q

Important consideration when using chlorhexidine

A

Must be diluted (usually 4%, want 0.05%)

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11
Q

Wound preparation (10 steps in order)

A

Rinsing
History taking
Desensitisation
Clipping
Sedation
Physical examination
Pain relief
Hosing (if contaminated)
Cleaning

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12
Q

Should you do a lameness examination when there is a wound?

A

No

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13
Q

What is the purpose of a physical examination in wound management?

A

Blood loss?
Safe to sedate?

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14
Q

Categories in wound evaluation (4)

A

Bone
Soft tissue
Synovial
Other (e.g. foreign body)

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15
Q

Wound evaluation

A

Sterile prep/good cleaning
Digital palpation
Probe wound (digitally or sterile probe, deeper pathology may not be at site of injury due to position of limb at time of injury e.g. flexed/extended)

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16
Q

What must be worn for digital palpation/probing

A

Gloves

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17
Q

Diagnostic modalities when evaluating a wound

A

Radiography
Ultrasound
Synoviocentesis (do this last as it allows air into joint)

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18
Q

Which structure contains air in this radiograph?

A

Digital flexor tendon sheath

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19
Q

Where should the L/R marker be placed when radiographing a limb?

A

Lateral

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20
Q

What structure is likely to be damaged if the toe of a horse is elevated?

A

DDFT (may be partially or completely transected)

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21
Q

What structure is likely to be damaged if a horse has a dropped fetlock?

A

Suspensory

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22
Q

If a horse is dragging its foot and has a wound on the front of the limb what structure is likely to be damaged?

A

Extensor tendon

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23
Q

What ultrasound probe should be used to investigate a superficial structure?

A

Linear

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24
Q

What ultrasound probe should be used to investigate a deep structure?

A

Curvelinear

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25
Q

Steps when examining a wound for synovial contamination

A

Sterile prep
Insert needle into synovial structure
Aspirate fluid for macroscopic analysis
Inject saline into joint until fully distended

Communication = contamination

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26
Q

Things to look for during macroscopic examination of synovial fluid

A

Opaque
Viscosity (watery = abnormal)
Colour (should be straw coloured, movement during injection may mean there is blood contamination from injection)

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27
Q

Best decision if there is synovial contamination following a wound

A

Referral for lavage
(Alternative option is euthanasia as will develop arthritis/supporting limb laminitis)

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28
Q

Steps in wound treatment

A

Desensitisation
Debridement/lavage
Wound repair
Drains
Dressing

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29
Q

Which local anaesthetic should be used for desensitisation of a wound?

A

Mepivicaine (works quickly and lasts a long time)

(Lidocaine short lasting, bupivacaine takes a long time to take effect but lasts 4-6h)

30
Q

Goals of debridement in wound treatment

A

Remove devitalised tissue, foreign material and bacteria

31
Q

What should be used for debridement in wound management?

A

Scalpel
Forceps

32
Q

Osmotic dressings for use in a contaminated wound that will assist with debridement

A

Manuka honey or unpasteurised honey

33
Q

Which phase of wound healing does early debridement assist with?

A

Shortens inflammation stage

34
Q

Suture patterns for wounds

A

Appositional
Tension relieving
Interrupted

35
Q

Wound closure steps

A

Resect wound edges
Suture closed (fully/partially)
Drain

36
Q

Drain that is most commonly used in wounds

A

Penrose (most comfortable)

37
Q

When should the drain be removed from a woud?

A

When the amount of discharge significantly decreases

38
Q

How should a drain be attached?

A

Single suture independent from other sutures closing wound as will be removed earlier

39
Q

Why should you be cautious on level of suture use in a wound?

A

Can act as a foreign body

40
Q

Needle type appropriate for wound closure

A

Cutting needle, reverse cutting needle (not round bodied or tapered)

41
Q

Tetanus injections

A

Anti-toxin (given after injury, contains antibody)
Toxoid (vaccine)

42
Q

Injectable NSAIDs that can be given when a horse has a wound

A

Flunixin
Phenylbutazone
Meloxicam

43
Q

Alpha 2s that can be given to horse for wound care

A

Xylazine
Detomidine
Romifidine

44
Q

What type of agonist is butorphanol?

A

Partial mu

45
Q

Full mu agonist not used because of drug controls (not carried)

A

Morphine

46
Q

Opioid given with an alpha 2 for sedation

A

Butorphanol

47
Q

What medication can be added to sedation for a particularly anxious horse?

A

ACP

48
Q

What should you put in a wound before you clip around it?

A

Gel/jelly

49
Q

Radiograph views

A

Dorsopalmer
Lateromedial
DMPLO
DLPMO

50
Q

Local anaesthetic used for nerve blocks/desensitisation of wound

A

Mepivicaine

51
Q

Nerves blocked in low 4 point

A

Palmar metatarsal nerve
Palmar nerve

52
Q

What leg do you use 6 point block and which leg do you use a 4 point on?

A

Forelimb: 4 point
Hindlimb: 6 point (additional nerve branch on each side)

53
Q

Tests to look for synovial fluid contamination

A

Total nucleated cell count
Cytology (% neutrophils, immature/banded nucleus)
Culture

54
Q

Benefit of arthroscopic lavage over needle lavage

A

Removal of fibrin and foreign material
Higher pressure, more fluid = better flush

55
Q

Disadvantages of arthroscopic lavage in comparison with needle lavage

A

GA required

56
Q

Route of delivery of antibiotics in a septic joint

A

Systemic and into joint

57
Q

Bandage layers before sending a horse to a hospital for joint lavage (to keep clean and offer some pain relief)

A

Dressing
Soffban
Cotton wool
Knitfirm
(May repeat cotton wool and knit firm)
Vet wrap

58
Q

Antibiotics for empirical systemic treatment of infected joint before culture

A

Penicillin and gentamycin

59
Q

Nerve block for the muzzle

A

Infraorbital

60
Q

Benefit of debriding a fresh wound

A

Removes contamination

61
Q

What is at higher risk of happening if you only close the skin on a wound and which layer should you close separately to prevent this?

A

Dehiscence
Close mucosa first (absorbable suture, simple continuous)

62
Q

When is dehiscence of a wound most likely to occur?

A

Day 7-10

63
Q

How to avoid dehiscence

A

Avoid strenuous exercise

64
Q

Affordable oral NSAIDs

A

Phenylbutazone
Suxibuzone (Danilon)

65
Q

Contraindication for TMPS

A

Do not administer IV after sedation (risk of death)

66
Q

First line oral antibiotics

A

Doxycycline
TMPS

67
Q

What IV antibiotic can be given alongside doxycycline?

A

Oxytetracycline (same class)

68
Q

Is TMPS or oxytetracycline indicated with an established infection?

A

Oxytetracycline as it is bacteriocidal
(TMPS bacteriostatic)

69
Q

What should you do before removing stitches?

A

Clean skin
(Sedate if necessary, depends on temperament)

70
Q

Are antibiotics more important for a distal limb or head wound?

A

Distal limb
(Head has better blood supply and immunity)

Equine (Poppy) (11 decks)

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