Wounds

Question 1

What are the 4 stages of wound healing?

Answer 1

Hemostasis (platelets then clotting cascade)
Inflammation (immune cells)
Proliferation (Granulation, Epithelialization) (endothelial, epithelial, fibroblasts)
Remodeling (fibroblasts/collagen cross-linking)

Question 2

what are different approaches/”intentions” for closing wounds?

Answer 2

Primary intention–surgical closure
secondary–leave open to self-heal e.g. if infection
tertiary–delayed primary closure

Question 3

diagnosis wording

Answer 3

state level of involvement (superficial, partial thickness, full thickness) and source (arterial, venous, pressure, neuropathic, atypical)

Question 4

Wound description

Answer 4

Include:
-dimensions (using Perpendicular.Clockwise, Volumetric, Tracing, Photography,or electronic measurements)
- subcutaneous extensions (tunneling=into other wound, sinus=opening along fascial plane, fistula=opening into body cavity, undermining=between dermis and subcutaneous tissue)
-Tissue type (eschar, slough, granulation, hypergranulation, devitilized fascia, muscle, tendon, bone, adipose)
-Drainage (serous, sanguinous, serosanguinous, exudate, transudate, purulence, seropurulence, lymph)
-Periwound skin color (erythema, cyanosis, purple ulcer, hemosiderin, ecchymosis)
-Edema (localized, unilateral, bilateral, lymphedema, pitting edema, induration)
-Edge description (even, irregular, epibole, hyperkeratosis–like callous)
Odor

Question 5

What quantity is protective sensation?

Answer 5

Semmes-Weinstein 5.08=10g pressure

Question 6

To test circulation, use:

Answer 6

Doppler, ankle brachial index (should be 1-1.4); toe brachial index

Question 7

What is the DIMES approach?

Answer 7

address debridement, infection, moisture, edges, then support services

Question 8

When should you swab for infection?

Answer 8

If not healing a lot in 2 weeks, swab and do punch tests