Wounds Flashcards
4 phases of wound healing
Haemostasis/coagulation phase
Inflammatory phase
Proliferative phase
Maturation phase
Do ponies or horses heal faster? Why?
Ponies as wound contract faster and sooner
Should you clip around a wound?
Yes (unless freshly clipped)
What factors determine clipping size around wound?
Soft tissue involvement
Bone involvement
Synovial involvement
Wound lavage options
Saline
Clean, potable water
How to debride wounds with saline
High pressure with syringe and needle
(13psi = 12ml syringe, 22g needle for perfect pressure but impractical so can use a bigger syringe)
Product recommended for cleaning wounds to reduce bacterial load
Povidine iodine
Chlorhexidine
Problems with povidine iodine use in a contamined wound
Povidine iodine is inactivated by organic material so should repeat multiple times or clean it first with water
Does chlorhexidine or povidine iodine have a superior antibacterial activity?
Chlorhexidine
Important consideration when using chlorhexidine
Must be diluted (usually 4%, want 0.05%)
Wound preparation (10 steps in order)
Rinsing
History taking
Desensitisation
Clipping
Sedation
Physical examination
Pain relief
Hosing (if contaminated)
Cleaning
Should you do a lameness examination when there is a wound?
No
What is the purpose of a physical examination in wound management?
Blood loss?
Safe to sedate?
Categories in wound evaluation (4)
Bone
Soft tissue
Synovial
Other (e.g. foreign body)
Wound evaluation
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)
What must be worn for digital palpation/probing
Gloves
Diagnostic modalities when evaluating a wound
Radiography
Ultrasound
Synoviocentesis (do this last as it allows air into joint)
Which structure contains air in this radiograph?
Digital flexor tendon sheath
Where should the L/R marker be placed when radiographing a limb?
Lateral
What structure is likely to be damaged if the toe of a horse is elevated?
DDFT (may be partially or completely transected)
What structure is likely to be damaged if a horse has a dropped fetlock?
Suspensory
If a horse is dragging its foot and has a wound on the front of the limb what structure is likely to be damaged?
Extensor tendon
What ultrasound probe should be used to investigate a superficial structure?
Linear
What ultrasound probe should be used to investigate a deep structure?
Curvelinear
Steps when examining a wound for synovial contamination
Sterile prep
Insert needle into synovial structure
Aspirate fluid for macroscopic analysis
Inject saline into joint until fully distended
Communication = contamination
Things to look for during macroscopic examination of synovial fluid
Opaque
Viscosity (watery = abnormal)
Colour (should be straw coloured, movement during injection may mean there is blood contamination from injection)
Best decision if there is synovial contamination following a wound
Referral for lavage
(Alternative option is euthanasia as will develop arthritis/supporting limb laminitis)
Steps in wound treatment
Desensitisation
Debridement/lavage
Wound repair
Drains
Dressing
Which local anaesthetic should be used for desensitisation of a wound?
Mepivicaine (works quickly and lasts a long time)
(Lidocaine short lasting, bupivacaine takes a long time to take effect but lasts 4-6h)
Goals of debridement in wound treatment
Remove devitalised tissue, foreign material and bacteria
What should be used for debridement in wound management?
Scalpel
Forceps
Osmotic dressings for use in a contaminated wound that will assist with debridement
Manuka honey or unpasteurised honey
Which phase of wound healing does early debridement assist with?
Shortens inflammation stage
Suture patterns for wounds
Appositional
Tension relieving
Interrupted
Wound closure steps
Resect wound edges
Suture closed (fully/partially)
Drain
Drain that is most commonly used in wounds
Penrose (most comfortable)
When should the drain be removed from a woud?
When the amount of discharge significantly decreases
How should a drain be attached?
Single suture independent from other sutures closing wound as will be removed earlier
Why should you be cautious on level of suture use in a wound?
Can act as a foreign body
Needle type appropriate for wound closure
Cutting needle, reverse cutting needle (not round bodied or tapered)
Tetanus injections
Anti-toxin (given after injury, contains antibody)
Toxoid (vaccine)
Injectable NSAIDs that can be given when a horse has a wound
Flunixin
Phenylbutazone
Meloxicam
Alpha 2s that can be given to horse for wound care
Xylazine
Detomidine
Romifidine
What type of agonist is butorphanol?
Partial mu
Full mu agonist not used because of drug controls (not carried)
Morphine
Opioid given with an alpha 2 for sedation
Butorphanol
What medication can be added to sedation for a particularly anxious horse?
ACP
What should you put in a wound before you clip around it?
Gel/jelly
Radiograph views
Dorsopalmer
Lateromedial
DMPLO
DLPMO
Local anaesthetic used for nerve blocks/desensitisation of wound
Mepivicaine
Nerves blocked in low 4 point
Palmar metatarsal nerve
Palmar nerve
What leg do you use 6 point block and which leg do you use a 4 point on?
Forelimb: 4 point
Hindlimb: 6 point (additional nerve branch on each side)
Tests to look for synovial fluid contamination
Total nucleated cell count
Cytology (% neutrophils, immature/banded nucleus)
Culture
Benefit of arthroscopic lavage over needle lavage
Removal of fibrin and foreign material
Higher pressure, more fluid = better flush
Disadvantages of arthroscopic lavage in comparison with needle lavage
GA required
Route of delivery of antibiotics in a septic joint
Systemic and into joint
Bandage layers before sending a horse to a hospital for joint lavage (to keep clean and offer some pain relief)
Dressing
Soffban
Cotton wool
Knitfirm
(May repeat cotton wool and knit firm)
Vet wrap
Antibiotics for empirical systemic treatment of infected joint before culture
Penicillin and gentamycin
Nerve block for the muzzle
Infraorbital
Benefit of debriding a fresh wound
Removes contamination
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?
Dehiscence
Close mucosa first (absorbable suture, simple continuous)
When is dehiscence of a wound most likely to occur?
Day 7-10
How to avoid dehiscence
Avoid strenuous exercise
Affordable oral NSAIDs
Phenylbutazone
Suxibuzone (Danilon)
Contraindication for TMPS
Do not administer IV after sedation (risk of death)
First line oral antibiotics
Doxycycline
TMPS
What IV antibiotic can be given alongside doxycycline?
Oxytetracycline (same class)
Is TMPS or oxytetracycline indicated with an established infection?
Oxytetracycline as it is bacteriocidal
(TMPS bacteriostatic)
What should you do before removing stitches?
Clean skin
(Sedate if necessary, depends on temperament)
Are antibiotics more important for a distal limb or head wound?
Distal limb
(Head has better blood supply and immunity)
