wounds Flashcards
factors affecting wound healing
nutrition
age
obesity
immunocompromised (disease or steroids)
chronic disease - DM, artificial valve
smoking
meds - steroids, NSAIDs, chemotherapy
stress
infection
phases of wound healing
not linear!!!
hemostatic/inflammatory (2-5 d) - neutrophils/macrophages
proliferative (5 d- 3 week)
- granulation tissue & fibroblasts
remodeling/maturation (3 week-2 year)
primary intention
initial union of edges with complete healing; minimal granulation tissue
clean, uninfected, clean margins, suture, neat scar, complications rare
secondary intention
leaving wound open, GRANULATION tissue fills between edges leaving a scar
unclean, infected, irregular margins, no sutures, irregular wound, complications common
delayed primary closure
healing which granulation tissue fills the gap between edges, usually a contaminated wound
closure after risk of infection has passed, usually 4 days
Dupuytren’s contracture
excessive contraction
Marjolin’s ulcer
squamous cell carcinoma appearing years after wound
wound pain
nociceptive or neuropathic
when would you use an alginate dressing?
exudative wounds
when would you use a hydrogel dressing?
pressure ulcers, surgical wounds, burns, radiation dermatitis
when would you use a hydrocolloid dressing?
severe exudative wound
when would you use a foam dressing?
infected would
when would you use a film dressing?
epithelializing wound, superficial wound with limited exudate
cat bite mgmt
polymicrobial, high infection risk
Pasteurella species
high risk bites mgmt
irrigate!!!
abx prophylaxis for high risk bites
augmenting 500 mg TID 5-7 days
was the animal vaccinated against rabies?
snake bites neurotoxic vs cytolytic reaction
neurotoxic - respiratory paralysis, ptosis, dysphagia, diplopia
cytolytic - tissue destruction, redness, tingling, swelling, N/V, extravasation
yellow touches red, soon you’ll be dead
antidote, monitor VS & coagulation
black widow spider bite
pain!!!
manage w benzes & IV morphine
brown recluse spider bite
supportive tx, steroids, surgical excision maybe
tick pathogen, s/s, tx
borrelia burgdorferi
rarely an issue if <48 h
erythema migrans up to 30 days later
doxycycline prophlaxis 200 mg
priority for wound mgmt
rule out infection!!!
infection impairs wound healing
abx for cellulitis
PO bactrim
augmentin, doxy, clindamycin
OM diagnosis gold standard
bone biopsy
