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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

Chronic wounds

Due to delay of owners - potions!!
Requires surgical excision, few topical agents, bandaging