Wounds and their management 3 Flashcards
What are the two main aspects of wound management?
Treatment
Dressing
What is the aim of cleansing / disinfection of a wound?
Ensure bleeding has stopped Remove blood Bioburden reduction Contamination reduction - grit - splinter - glass
What is the function of dressing a wound?
Protects against
- impact, re-opening
- microbe ingress
- moisture retention
- exudate fluid absorption
What should a pharmacist consider if patient presents with prolonged bleeding (> 20 mins)?
- magnitude of wound
- efforts to staunch the flow of blood
- drug therapy (especially anticoagulants)
What two indications is warfarin, novel oral anticoagulants (NOACs) given for?
- atrial fibrillation (stroke)
- thrombosis
What should a pharmacist do when presented with a patient with prolonged bleeding (> 20 mins)?
Send to A&E
What is an antihaemorrhagic?
A substance that promotes haemostasis (stops bleeding)
What is a stypic?
A specific type of antihemmorrhagic that works by contracting tissue to seal injured blood vessel
Give examples of systemic antihaemorrhagics
- antifibrinolytics
- vitamin K
- fibrinogen
- blood coagulation factors
Give an example of a topical antihaemorrhagic
Microfibrillar collagen haemostat
How does microfibrillar collagen haemostat work?
Attracts platelets and accelerates the formation of a blood clot when it comes into contact with blood
What are chitosan haemostat dressings?
Composed of chitosan (derived from crustacean chitin) and its salts which bonds with platelets and red blood cells to form a gel-like clot which seals a bleeding vessel
What do styptics pencils contain?
Anhydrous aluminium sulphate
- acts as a vasoconstrictor
What is the next step in wound management after bleeding stops?
Prepare the wound for dressing
Which fluid is a fertile ground for commensal microbe proliferation?
Blood
What are the three different types of cleansing agents that can be used on wounds?
Wipes - cleansing only (non-medicated)
- saline impregnated (no sting, no disinfection)
Wipes - cleansing and disinfection (medicated)
- alcohol and/or chlorhexidine (alcohol free)
Sprays
- low viscosity solutions, run off
- little cleansing action but contactless
What is a rubifacient?
A substance for topical application that produces redness of the skin, e.g. by causing dilation of the capillaries and an increase in blood circulation
Describe Germolene
A thick antiseptic cream with a distinctive pink colour and scented with oil of wintergreen (methyl nicotinate)
What are the properties of Germolene?
Combines an antiseptic action to help prevent infections, plus a soothing local anaesthetic effect of phenol to numb pain
What is Germolene used to treat?
- minor cuts and grazes
- minor burns
- scalds and blisters
- stings and insect bites
- spots
- chapped or rough skin
Describe Savlon
Smooth, white, homogenous cream
- chlorhexidine digluconate 0.1% w/w
- cetrimide 0.5% (antibacterial surfactant)
Describe povidone iodine
A brown powder used a broad spectrum antiseptic for external application, in the treatment and prevention of infection in wounds
Where is povidone iodine used?
Mainly in hospitals
Which patient group should not use povidone iodine?
Thyroid patients
Describe hydrogen peroxide
An oxidising agent and has broad-spectrum cidal efficacy (at 3%) but some doubt
Which bacteria is hydrogen peroxide not effective against?
Certain aerobic bacteria, such as Staphylococci, have an enzyme (catalase) which breaks hydrogen peroxide down to water and oxygen, effectively diluting it
What is Dettol comprised of?
Micellar 4.8% w/v chloroxylenol
How should Dettol be diluted for antiseptic wound cleansing for cuts, grazes, bites and stings?
1 in 20
What is TCP used to treat?
Mild antiseptic
- topical wounds
- sore throat
- mouth ulcers
How do wound dressings work?
Create and maintain a moist environment - provides optical conditions for wound healing - increases rate of proliferation Protects wound against impact Keeps out microbes Absorbs wound exudate
What are the two types of wound exudate?
Early acellular exudate
Later cellular exudate
Describe early accellular exudate
Clear, watery fluid that normally permeates skin tissue to provide oxygen and nutrients to the cells
Describe later cellular exudate
Opaque, yellowy fluid.
