Wounds and their management Flashcards
What is a wound?
A significant discontinuity of the epithelial barrier
What causes a wound?
Trauma
Disease
Infection
What does a wound involve?
Bleeding - deep enough to rupture the microvasculature(the system of tiny blood vessels, including capillaries, venules, and arterioles, that perfuse the body’s tissues) in the dermis
- includes superficial abrasion
What are the problems with wounds?
Loss of blood/fluids (exudates) Pain Shock Ingress of microbes - wound contamination - colonisation - wound infection - systemic infection e.g. tetanus - sepsis (septicaemia) Chronic wounds
How many microorganisms reside on the skin?
1000 species or so
Where are skin microorganisms often found?
Most are found in the superficial layers of the epidermis and the upper parts of the hair follicles
How do skin microorganisms behave on the skin?
Usually non-pathogenic
- commensal (not harmful to their host)
- mutualistic (offer a benefit to the host)
Why is it important for a pharmacist to know about wounds?
Increasing encouragement for patients to consult a pharmacist prior to booking a GP appointment, which can be up to 2 weeks
- must be able to spot potentially serious cases
Where should a patient be sent if the pharmacist suspects they have a serious wound?
GP
A&E
What must a pharmacist be able to provide for patients with less serious wounds?
- recommend, from a wide variety of products, an appropriate treatment
- provide advice on bandages/stockings
What is an abraision?
A graze
- occurs after skin rubs against a hard surface
- contamination and foreign introduced
- superficial
- friction scrapes away the epithelium, exposing the epidermal or dermal layers
- bleeding low/moderate
What is an incision?
A surgical procedure
- precise, regular wound using a sharp-edged object (i.e. scalpel through skin to facilitate an operation or procedure)
- clean and sterile
- regular, defined edge
- primary intension is healing
How is an incision healed?
A healthy, healing wound will have edges that meet neatly and are held closely together by sutures, staples or another method of closure
What is a laceration?
Non-surgical wound
- caused by contact with a sharp edge e.g. broken glass
- imprecise tear-like wounds
- comparatively irregular edge
- not sterile
- most lacerations affect only the upper layers of the skin and subcutaneous tissues
- significant/profuse bleeding
What is an avulsion?
Skin is forcibly detached or torn from its normal point of attachment by either trauma or friction
- commonly refers to a surface trauma where all layers of the skin have been torn away, exposing the underlying structures (i.e. subcutaneous tissue, muscle, tendons or bones)
- involves partial or full detachment from the body
- profuse bleeding
- not necessarily contaminated
What is a puncture?
Entry of sharp pointed object into the skin to create a small hole
- caused by a nail, pin or needle
- often the wound seems to close almost instantly
- hard to locate
- usually minor bleeding
- can still be a risk of infection, especially if the penetrating object is not sterile
What is a penetration/perforation?
An object pierces the skin and enters the subcutaneous tissue of the body, creating an open wound
- object may remain in the tissues, come back out the way it entered, or exit from another area
What is a perforation injury?
Where an object enters the body and passes all the way through
- bleeding
- non-sterile
What can cause penetration wounds?
Bites
- mammals
- reptiles
- insects
- wasps
- ants
- ticks
- mites
- bedbugs
- fleas
- spiders (false widow)
What is envenomation?
The process of venom being injected into the skin during a bite or skin
What is the main problem with bites?
Microbes introduced to the skin
What is a blister?
A pocket of fluid between epidermis and dermis
What is the hemidesmosome?
Provides adhesion of epithelial cells to the underlying basement membrane, but are weaker than desmosomes
- break down to allow ingress of fluid, and creates a blister
What is a burn?
Wound caused by (dry) heat, cold, electricity, friction, chemical or physical agents
What are the 4 types of burn?
- 1st degree (superficial)
- 2nd degree (partial thickness)
- 3rd degree (full thickness)
- 4th degree
Describe a 1st degree burn
Appear red without blisters
Pain typically lasts around three days
Describe a 2nd degree burn
Blisters
Very painful
Healing can require up to eight weeks
Describe a 3rd degree burn
Injury extends to all layers of the skin
No pain
Burn area is stiff
Describe a 4th degree burn
Includes injury to deeper tissues
- muscle
- tendons
- bone
What is a scald?
Damage to the skin usually caused by wet heat
- hot water
- steam
- egg?
What is the purpose of wound healing?
A complex sequence of events aimed at repairing the discontinuity between edges of the wound and re-establishing the function of tissue and its barrier function
What are the four stages of wound healing?
- bleeding (up to 20 minutes)
- inflammation (3 - 4 days)
- proliferation (21 days)
- maturation (2 years)
What is the problem with wound healing?
Full mechanical strength never attained
What is the body’s first response to a new wound?
Coagulation which lasts up to 10 - 20 minutes
- localised vasoconstriction
- clot formation
- control of blood loss
Which three key components are involved in blood clotting?
- platelets
- fibrin
- red blood cells
via a complex clotting cascade
