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22 Cards in this Set
- Front
- Back
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How should you control external bleeding?
How should you NOT? |
Compression with a sterile dressing
Do NOT apply a tourniquet |
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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. |
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Objective of care in all open wounds
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Convert an open contaminated wound into a surgically clean wound which can be closed.
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What is the "golden period"
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Within first 6-8 hrs after injury - hopefully no bacterial invasion/colonization yet.
Can be extended with use of topical antibiotics |
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Describe the process of Wound Cleansing
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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. |
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Does irrigation remove the bacteria?
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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. |
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Describe the goal of Wound Excision
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DEBRIDEMENT
Remove tissue to convert an accidental wound into a surgically clean wound containing only viable tissues with adequate blood supply. |
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How do you decide what to cut out?
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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! |
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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.
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In First Intention Healing, is having Dead Space a good thing or bad thing?
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BAD
Obliterate by bandaging and draining or by burying sutures (though not always the best because it may increase possibility of infection) |
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How might you keep tension down on sutures?
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Tension Relieving Suture =
Vertical Mattress with padding beneath external loops Removed ~3 days, tissue should be stable |
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After wound closure in 1st Intetion - what do you do next?
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Apply a bandage dressing.
Rests, Immobilizes, Controls Edema/Oozing, Obliterates Dead Space |
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Describe Healing by Delayed Primary Closure
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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. |
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Describe Healing by Contracture and Epithelialization (Second Intention Healing)
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For wounds which cannot close because too much tissue is removed - OR for wounds with too much contamination
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How do you manage a Second Intention Healing?
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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. |
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General recommendations for Puncture Wounds?
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Typically give systemic antibiotics
Only enlarge external wound if necessary to check for deeper stuff (foreign body, deep injury, etc) |
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Bite wound worries?
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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 |
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What is a clever way to control bleeding?
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Inflate a cuff up just enough so that there is a slow drip
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What are the 4 phases of wound healing?
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Coagulation
Inflammation Proliferation Maturation |
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What's the issue in cleaning a wound with Antiseptics?
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Antiseptics can kill fibroblasts... the cells which heal wounds.
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What instruments should you use when lavaging? (to ensure proper amount of pressure)
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18g on a 35cc syringe
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If you prescribe antibiotics because a wound looks horrid - when should you cease them?
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When a healthy layer of granulation tissue has been produced
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