Bites, Burns

Question 1

T/F: all cases of bite wounds are considered contaminated

Answer 1

True

-open (skin penetration) or closed (skin crushed), contain polymicrobial flora

Question 2

What is the most commonly cultured organism form a bite wound?

Answer 2

Pasteurella multocidia

Question 3

What are common aerobic isolates from bite wounds?

Answer 3

Staphylococcus, enterococcus, bacillus, and E.coli

Question 4

What are common anaerobic isolates from bite wounds?

Answer 4

Clostridium and corynebacterium

Question 5

Dog bite wounds create what types of injury?

Answer 5

Puncture (iceberg effect)
Crushing
Tearing
Avulsion

Question 6

Large breed dogs are more likely to have wounds where?

Answer 6

Neck and face

Question 7

Small breed dogs are more likely to have bite wounds where?

Answer 7

Dorsal

Question 8

What is big dog/little dog?

Answer 8

Combines lifting, shaking of the skin in addition to crushing and tearing

Question 9

What is an avulsion injury?

Answer 9

Damage to the major direct cutaneous artery and vein with comprise to the collateral vascular supply

-> wounds continually declare themselves as the collateral damage to the vasculature is slowly released (3-7days)

Question 10

What is the initial management of bite wounds?

Answer 10

All triaged for cardiovascular and respiratory abnormalities

Cervical injuries often traumatize trachea -> pnumomediastinum

Hemorrhage can be severe in cases requiring immediate exploration for vessel ID/ligation or compressive bandage mgt

Stable for sedation/anesthesia —> full thickness bite wounds should be ASEPTICALLY probed, debrided and reconstructed over drain

Question 11

What should you do if the thorax/abdomen in involved in a bite?

Answer 11

Imaging to determine if penetration into a cavity has occurred

—>free peritoneal air
—> visible hernia
—>need to probe and explore wound to confirm

Question 12

If an penetrating abdominal wound is present, how should you proceed with wound management?

Answer 12

MUST do exploratory laparotomy

—> significant potential for damage to abdominal visceral that require aggressive surgical attention

Question 13

If a penetrating thoracic wound is present, how would you proceed for wound management

Answer 13

Not a surgical emergency
Clip, clean, debride, explore

Careful with lavage

Use imaging/clinical signs to determine chest wall integrity

Question 14

What is SIRS?

Answer 14

Systemic inflammatory response syndrome
-excessive activation or loss of local control of inflammation leading to generalized inflammatory response

—> coagulopathy, multiple organ dysfunction, and acute respiratory distress syndrome

Question 15

How do you proceed with managing an abscess?

Answer 15

Drain and debride necrotic tissue
Lavage

Open wound management using non-selective debridment x2-3days

then MRD to allow for 2nd intention healing
OR
En bloc debridement and primary closure

Empirical antibiotics
Analgesia

Question 16

What is the most common cause of thermal injuries?

Answer 16

Accidental burns associated with application of heat to prevent/treat hypothermia in patients under anesthesia

Question 17

A superficial burn involves what tissue?

Answer 17

Outermost epidermis

Question 18

Burn injury
Moist, painful, blanch with pressure

What is the depth of this burn?

Answer 18

Superficial

1st degree

Question 19

A partial thickness burn involves what tissues?

Answer 19

Epidermis and portion of the dermis

Question 20

Burn injury
Edematous, painful with marked inflammation

What is the degree of burn?

Answer 20

Partial thickness

2nd degree

Question 21

A full thickness burn involves what tissues?

Answer 21

All of epidermis and dermis

Question 22

Burn injury
Dark brown, non painful, eschar

What degree is this burn?

Answer 22

Fulll thickness

3rd degree

Question 23

What is an eschar?

Answer 23

Comprised of tough denatured collagen fibers (strong protective covering)

NOT a scab which is dead cells

Question 24

What degree of burn can heal via spontaneous epithelialization ?

Answer 24

Superficial (3weeks) and partial thickness (months)

Question 25

What is the prognosis for an animal with partial-thickness burns on <15% TBSA?

Answer 25

Good

Require minimal systemic support

Question 26

At what percent TBSA burn area leads to greater risk of systemic effects?

Answer 26

> 20%

Require intensive monitoring = vital signs, metal status, hematocrit, total protein, urine output, CVP, electrolyte, blood gas and daily body weight

Question 27

What is the prognosis for massive burned areas approaching 50% of TBSA?

Answer 27

Poor

May warrant euthanasia

Question 28

What is the best therapy for burn wounds?

Answer 28

Conservative management

Clip wide

Analgesics- topical (1st and 2nd) and systemic

Topical silver sulfadiazine —> best protection against wound colonization and infection
Aloe Vera- faster re-epithelization
Manuka honey

OWM with medicated primary layer

Question 29

Suggested contact layer for a burn with eschar?

Answer 29

Needs softening and debridment

Hypertonic saline or hydrogel dressing with silver sulfadiazine and biguanide -impregnated gauze

Question 30

What contact layer should you use if there is no eschar but wound needs further debridment?

Answer 30

Hydrogel or hydrocolloid dressing and biguanide-impregnated gauze

Question 31

What contact layer should you use on a burn with no eschar but needs granulation tissue?

Answer 31

Hydrogel or calcium alginate and biguanide-impregnated gauze

Question 32

What contact layer should you use in a burn that needs epithelization ?

Answer 32

Polyurethane foam pad and biguanide-impregnated gauze

Question 33

What is a shearing injury?

Answer 33

Severe abrasion of the soft tissue and malleoli

• medial tarsus more commonly injured
• subluxation results from injury of the collateral ligament complex or fracture of medial/lateral malleolus

Question 34

T/F: if a large flap of tissue has be avulsed, it can be viable is reattached quickly

Answer 34

False

Unlikely to be viable
-primary closure will likely fail