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55 Cards in this Set
- Front
- Back
method of wounding
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abrasion, avulsion, incision, laceration, puncture, crush
need to know cause diff wound have diff healing process. |
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type of wound
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open and closed
open= skin open close- skin close |
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Duration of wound
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6-8 hr golden period for wound care, ideal to clean and close wound
DEGREE OF CONTAM best way to evaluate closure |
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Primary wound closure
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clean or clean contam wound
wound closure soon after infliction in golden period (6-8hr) closure under good condition minimal contam through debridement and lavage |
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premature closure consequence
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wound dehiscence
rather clean initally and close after |
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Clean wound closure
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primary closure
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clean- contam wound
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primary (careful not to spill GI content)
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contam wound (6-8 hr)
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primary closure over drain
delayed primary closure |
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infected wound (old wound infected)
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skin, muscle and superfical wound- open wound for drainage and debridement, management then delayed primary closure or healed by 2nd intension)
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Open wound management
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allow repeated debridement and optimal drainage
more time consuming and costly due to ongoing bandaging may require follow up surgery if contraction problems develop (close too tight affect physiologically) large contam or infected wound with extensive tissue damage have to bandage open wound cause hospital bug |
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Clipping
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if sedate to manage wound, fill wound with KY jelly, prevent wound from foreign material and help decrease re-contam esp if managed open
CLIP WIDE, wounds get bigger before smaller |
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aseptic skin prep
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pocidine iodine
chlorhexidine AVOID ANTISEPTIC IN WOUND CAUSE INHIBIT HEALING cause destroy membrane use solution DIFFERNT from scrubbing soution, LESS BUBBLY EFFECT, NEED DILUTE |
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Wound lavage
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removes debris from wound (flush dead stuff out of wound)
dilute bacteria load assist in debridement |
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Principle of lavage
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1 liter per small wound, moderate pressure
ISOTONIC SOLUTION can add antibiotic or DILUTE antiseptic and STILL can damage tissue |
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most often use isotonic solution to lavage
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LRS, least cytotoxic and isotonic but NOT antimicrobial(disadvantage), expensive to use than tab water, use tab water when there is nothing better,
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Hydrogen peroxide
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DO NOT WORK WELL
converts to H2O and Oxygen by tissue catalases, foaming action remove dirt and debris DOESN"T KILL BACTERIA AS WELL KILL SPORE on contam skin INJURES CELL essential for healing |
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Culture
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collect swab for bacterial culture and sensitivity of infected wounds
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Systemic antibiotics
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indicated
admin as soon as possible (after wounding before debridement) multimodal antimicrobial (gram + and -) before culture and sensitivty come back send home with 7 days at least to prevent antimicrobial resistant |
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Debridement
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Surgical
enzymatic biosurgical mechanical DO NOT DEBRIDE UNTIL SURE IT"S DEAD. is not sure, leave it |
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Enzymatic debridement
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break down necrotic tissue
liquify using proteolytic enzyme liquified biofilm DO NOT DAMAGE LIVING TISSUE poor anesthetic risk |
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Biosurgical debridement
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larvae eat necrotic tissue not healthy tissue
STERILE and bred for surgery leave on for 48 hr indicated: tissue very infected, necrotic, chronic |
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Wet to dry bandage
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Primary layer: wet 4X4 placed on area to be debrided, follow by dry 4X4, a lot get stuck so when take off, mechanically rip off tissue stucked
secondary layer: absorbant padded material for comfort of animal, cotton paddling, enough to prevent strike thru, can incoporate splint tertiary layer: roll gauze+ tape, vet wrap or other dressing holder |
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Dry to sry debridement
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rip off LIVE tissue, not used often
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Goals of debridement
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remove devitalized tissue
remove Foreign debris maintain hemostasis abundant lavage with physiologic solution drain dead space minimize further tissue damage |
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En Bloc debridement
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excision of the wound and surrounding tissue
infected wound w/o systemic infection remove nonessential tissue on trunk and porx limb, not distal limb, not enough skin |
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Bandaging
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bandage wound for protection till further debridement
limit swelling and hemorrhage prevent further trauma prevent further contam absorb exudate prevent wound desiccation aid in mechanical debridement of wound |
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General principle of bandage
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sufficient padding- protect dog skin and deeper structure
apply evenly and snug aviod traumatizing newly formed granulation tissue or epu 3 layers- primary, secondary, tertiary |
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Primary layer (contact layer)
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direct contact with wound
medicated (frequently not) occlusive: fluid does not pass thru or semi or non occlusive may be adherant (gauge) or non adherant (telfa pads) |
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Triple antibiotic:
Bacitracicn, neosporin, polymixin- B ointment |
Zn/ bacitracin enhance re-epi
broad spectrum antibacterial poorly absorbed ineffective against pseudmonas |
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Topical antibiotics
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only effective if COMBINE WITH DEBRIDEMENT
ointment based occlude wound powder based incite foreign body rxn canno used debridement bandage |
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Silver sulfadiazine
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1% water miscible cream
broad spectrum antibactieral AGAINST PSEUDOMONAS so tx of choice in BURN PT (prone to pseudomonas) enhance re-epi, penetrate eschar and necrotic tissue (goodcause we don't debride non necrotic tissue) |
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Honey
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enhance debridement
redeuce edema and infalm promote granulation and re- epi increase colagen maturaiton prevent bacterial growth (don't kill) need medicinal honey smell bad |
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Sugar
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mix with exudate, act as hypertoni, not as anti- inflam as honey
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Adherent vs. non- adherent
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wet to dry- aid in debridement, remove healthy granulation tissue and prevent epi
dry to dry- rarely use |
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non- adherance
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vasline impregnated- prevent epi
telpha surgical wound or protect grnulation tissue or early epi |
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Silver sulfadiazine
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1% water miscible cream
broad spectrum antibactieral AGAINST PSEUDOMONAS so tx of choice in BURN PT (prone to pseudomonas) enhance re-epi, penetrate eschar and necrotic tissue (goodcause we don't debride non necrotic tissue) |
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Honey
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enhance debridement
redeuce edema and infalm promote granulation and re- epi increase colagen maturaiton prevent bacterial growth (don't kill) need medicinal honey smell bad |
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Sugar
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mix with exudate, act as hypertoni, not as anti- inflam as honey
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Adherent vs. non- adherent
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wet to dry- aid in debridement, remove healthy granulation tissue and prevent epi
dry to dry- rarely use |
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non- adherance
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vasline impregnated- prevent epi
telpha surgical wound or protect grnulation tissue or early epi |
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occlusive vs. non occlusive
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semi- occlusive- petroleum, vaseline
polyurethane foam non- occlusive= telpha, release, wet to dry, dry to dry occlusive- medicianl ointment, robert jones bandage |
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intermediate layer
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cast padding or roll cotton
absord tissue exudate pads the wound to prevent additional trauma supports limb |
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Tertiary or outer layer
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holds primary (telfa) and secondary (rolled cotton) layer in place
provide pressure to decrease swelling and immobilize area gauze and vet wrap, can be too tight so careful |
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banadage application
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direction: toe to proximal so push excess fluid up leg rather than trap in toe
tertiary later, gauze ends a little before cotton so don't strangulate |
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Bandage care
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gauze and vet wrap ca be too tight, monitor toe for swelling and animal excess discomfort
monitor VERY CLOSELY FOR DYSPENA if head or neck bandage keep clean and dry or decrease wound healing monitor for soiling, displacment, or foul smell- need to be changed immediately |
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Delayed primary closure
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wound closure 2-5 days after infliction
open wound management til tissue healthy allow staged debridement contam wound |
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secondary closure (not secondary healing)
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close 5 or more days after injury
wound formed a healthy granulation bed used when wound contracture may cause complication complete closure may require drain |
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indications for drain
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abscess or other fluid accumulation
tissue of questionable viability and cannot be excised foreign materials in wound massive contam inevitable destroy dead space and prevent accumulation of blood, exudate, serum or air huge open area, can't close it, use drain |
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passive drain
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drain by gravity, pressure differential, overflow of capillary action
penrose drain, tubular drain, fenestration |
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penrose drain
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soft, latex tubing not fenestrated, fluid move along tubing, cappilary action outside of drain to drain fluid so not fenestrated
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tubular drain
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noncollasping
rubber or plastic may be fenestrated passive if no suction attach to tube |
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active drain
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vaccum applied to a rigid, fenestrated tubular drain with no external air vent
exudate collect in vacuum keeps wound and dressing dry decrease drainage time and eliminate need for irrigation |
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drain placement
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at lowest location in wound cause need gravity
need to tack drain to skin at exit so drain don't get suck back DO NOT EXIT DRAIN IN SUTURE LINE |
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drain management
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keep drain cover with sterile, absorbant bandage to see character and amt of exudate
remove drain once drainage decrease: 3-6 days |
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E- collar
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any tube stick out of dog, have e- collar
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