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22 Cards in this Set

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How should you control external bleeding?

How should you NOT?
Compression with a sterile dressing

Do NOT apply a tourniquet
Which of the following do you apply to an open wound:
Antiseptic
Ointment
Powder
NONE - can further contaminate. Ointments will also just make washing and debridement more difficult.

*Topical Antibiotic Sprays might help if used immediately, but still do not replace debridement.
Objective of care in all open wounds
Convert an open contaminated wound into a surgically clean wound which can be closed.
What is the "golden period"
Within first 6-8 hrs after injury - hopefully no bacterial invasion/colonization yet.

Can be extended with use of topical antibiotics
Describe the process of Wound Cleansing
LAVAGE
An ASEPTIC Procedure

1. Cover wound with sterile dressing or H2O soluble gel
2. Clip and clean surrounding area
3. Remove dressing/gel
4. Irrigate wound with normal saline or a balance electrolyte soln
5. Surrounding area cleaned with soap/water or Betadine or Chlorhexidine

*Heavy infections should be cleaned with Betadine/Chlorhexidine first and then irrigated.
Does irrigation remove the bacteria?
Not really, once on tissues they are pretty resistant to removal by gentle irrigation.
Benefit of irrigation = removal of gross wound debris and contaminated fat and blood clots.
Describe the goal of Wound Excision
DEBRIDEMENT

Remove tissue to convert an accidental wound into a surgically clean wound containing only viable tissues with adequate blood supply.
How do you decide what to cut out?
Only cut out if necessary
Try to keep skin!
Small bone fragments may be removed, but try to keep large ones.
Muscle - Pinch and Cut, if it contracts and bleeds - then it is viable, don't cut it out!
Pick the lesser of two evils:

A. Fix everything right now!

B. Let wound heal, go back in for surgery to fix deeper structures (like tendons and nerves)
B. Fix that stuff later. No need to cause unnecessary trauma - AND the surgery will go better if the tissues are more healed/viable.
In First Intention Healing, is having Dead Space a good thing or bad thing?
BAD
Obliterate by bandaging and draining or by burying sutures (though not always the best because it may increase possibility of infection)
How might you keep tension down on sutures?
Tension Relieving Suture =
Vertical Mattress with padding beneath external loops

Removed ~3 days, tissue should be stable
After wound closure in 1st Intetion - what do you do next?
Apply a bandage dressing.
Rests, Immobilizes, Controls Edema/Oozing, Obliterates Dead Space
Describe Healing by Delayed Primary Closure
A 3-4 day old wound with granulation tissue may still be sewn shut.
(after that the tissue gets thick/stiff and this is no longer an option)

Humans use in very contused/contaminated injuries.

Vets don't use much - just do a primary closure and place a drain.
Describe Healing by Contracture and Epithelialization (Second Intention Healing)
For wounds which cannot close because too much tissue is removed - OR for wounds with too much contamination
How do you manage a Second Intention Healing?
1. Lavage and Debride
2. Cover with Vaselined-Gauze
3. Make cotton pressure bandage (if too big to bandage, wash daily with warm saline)
*antibiotic dressings may be used if systemic infection suspected

4. Bandage changed every 2-7 days
Changed immediately if animal biting or distal area swelling.
General recommendations for Puncture Wounds?
Typically give systemic antibiotics

Only enlarge external wound if necessary to check for deeper stuff (foreign body, deep injury, etc)
Bite wound worries?
Obviously rabies... and also -

Small surface wounds may represent large underlying problems (avulsion, emphysema, muscle damage)

Don't suture small holes.

If muscle involved - open it up, lavage, debride, drain, and suture
What is a clever way to control bleeding?
Inflate a cuff up just enough so that there is a slow drip
What are the 4 phases of wound healing?
Coagulation
Inflammation
Proliferation
Maturation
What's the issue in cleaning a wound with Antiseptics?
Antiseptics can kill fibroblasts... the cells which heal wounds.
What instruments should you use when lavaging? (to ensure proper amount of pressure)
18g on a 35cc syringe
If you prescribe antibiotics because a wound looks horrid - when should you cease them?
When a healthy layer of granulation tissue has been produced