Flashcards in 2. Wound management Deck (23)
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1
First aid and stabilization
assess systemic status
Active arterial hemorrhage
Structural support
2
Diagnostics
PE - clostridium tetani
Rads
US
Probe wound
3
Wound management
Assessment - move to a better location when stable
Restraint/analgesia
Treatment
Prognosis
4
Classification of wounds
Open - partial vs full thickness
Closed
Clean
Clean-contaminated
Contaminated
Infected/dirty
5
Golden period in Horses
NO
6
Choice of closure
Decision:
time appearance, type of injury, location,complications
Must understand wound healing
7
Closure options (4)
Primary (intention) closure (healing)
Delayed primary closure
Secondary closure
Second intention healing
8
Primary closure
immediate closure
Clean and clean-contaminated
9
Delayed primary closure
2-5d after injury - before granulation
Contaminated/questionable to properly treat
Edema and tension
10
Secondary closure healing
>5d after injury - after granulation tissue
Contaminated/infected wounds
11
Second intention healing
Granulation tissue, wound contraction, epithelization
12
Phases of would healing
Inflammation/log
Proliferation
Remodeling
13
Inflammation/log phase
hemostasis and acute inflammation
Hemostasis: platelets, vasoconstriction -> vasodilation, fibrin deposition
Inflammation: activated platelets, PMNs, macrophages, fibroblast
14
Proliferation phase
Tissue formation
Macrophages - growth factors, initiation proliferation
Angiogenesis - via O2 tension, high lactate, low pH
Fibroplasia/collage/granulation tissue deposition
Collagen 2-3d after wounding (40% type 3)
Epitheliazation and wound contraction
15
Remodeling phase
Regaining of strength - begins in 2nd week - for years
Final scar: 15-50% weaker than original
16
First aid protocols
CV support
Prevent further injury
Hemostasis
Minimize contamination
Stabilize limb
Tetanus toxoid
17
Optimal wound care
Adequate restraint: A2 agonists, NSAIDs, Opioids
Analgesia - multimodal
DEBRIDEMENT - single most important factor
Lavage - non toxics
Closure + bandage
18
Preventing bacterial infection of wounds
Effective wound cleansing and debridement
Dressings and bandages
19
Appropriate topicals
scarlet oil - granulation
Silver sulfadiazine
Polysporin ointment
20
Wound dressings
Hypertonic saline
Antimicrobial dressing
Honey
Negative pressure therapy
DO NOT USE CORTICOSTEROID
21
Hypertonic saline dressing
good for exudative or necrotic wounds
22
Antimicrobial dressing
Kerlix AMD - best: Polyhexamethylene biguanide
Microbes are unable to become resistant
23
