Exam 2: Lecture 15: Bandaging and Open Wound Management

Question 1

what should you always do on the initial exam FIRST

Answer 1

STOP THE BLEEDING!!

Question 2

what are the 4 things we need to look at during our initial exam

Answer 2

1. time elapsed
2. blood loss
3. prior treatment/vaccine
4. mechanism of injury

Question 3

how much time can pass for primary closure in horses

Answer 3

12 hours

Question 4

how can you tell the amount of blood loss in the patient (other than looking at the blood on the ground)

Answer 4

heart rate, respiratory rate, membrane colors, CRT

Question 5

why do we need to know if the there was any prior treatment or vaccine status for wounds

Answer 5

need to know if owner gave any meds prior to you showing up

Question 6

why does the mechanism of injury matter

Answer 6

because higher energy at impact = greater tissue damage = vascular compromise

Question 7

what is the most important vaccine status to check

Answer 7

tetanus!

Question 8

what should we do if there is no history of tetanus vaccine or it is greater than 12 months

Answer 8

give tetanus toxoid and tetanus anti-toxin

Question 9

what should we do if the tetanus vaccine status is greater than or equal to 2 months ago

Answer 9

give a tetanus toxoid booster

Question 10

what should we do if the tetanus vaccine status is less than 2 months

Answer 10

no booster needed!

Question 11

what can we use for patient restraint

Answer 11

twitch, ace, alpha-2 agonists, opiods

Question 12

what should we look for when visually assessing the wounds

Answer 12

location and contamination/infection

Question 13

what is important to look for with wound location

Answer 13

is there blood supply? Is there a synovial structure involved? Any other structures involved?

Question 14

what should we do when clipping and cleaning wounds

Answer 14

apply sterile lube to wound and clip at least 2 inches around the wound

Question 15

what type of antiseptic may/may not be used on wounds

Answer 15

can use - providone iodine, chlorhexidine, or sterile saline

should not use - alcohol or garden hose (causes edema)

Question 16

what position is the horse usually in when suturing lacerations

Answer 16

standing!

Question 17

what type of medications can we use for wound anesthesia

Answer 17

lidocaine or mepivacaine

Question 18

what type of local anesthesia options are there for wounds

Answer 18

peripheral nerve blocks or local infiltration

Question 19

what type of technique should we use for wound blocks

Answer 19

block away from wound

Question 20

how can we explore wounds

Answer 20

digital palpation, sterile prob, radiographs

Question 21

what is the correct way to lavage a wound

Answer 21

10-15 psi by using a 18g needle on 35ml or 60ml syringe

Question 22

what do we do if there is synovial involvement in a wound

Answer 22

complete a synoviocentesis (with sterile prep away from wound), sample the fluid, pressurize the structure and inject antibiotic

Question 23

what are the 3 types of wound debridement

Answer 23

1. sharp
2. mechanical
3. autolytic

Question 24

what is sharp wound debridement

Answer 24

using a scalpel blade to debride the most superficial layer

Question 25

what is mechanical wound debridement

Answer 25

wet to dry bandage but do not use once epithelialization has started

Question 26

what is autolytic wound debridement

Answer 26

moist wound healing where WBCs and enzymes degrade necrotic tissue leaving the healthy tissue alone

Question 27

what are the 3 less common ways of wound debridement

Answer 27

chemical, enzymatic, and biological

Question 28

what are the 2 types of wound closure

Answer 28

primary and delayed primary

Question 29

when can we do primary closure

Answer 29

close immediately, warn owner of possible dehiscence, and must be <12 hours

Question 30

what is delayed primary wound closure

Answer 30

close after a period of debridement that is within 3-5 days of the injury

Question 31

when do we use second intention healing

Answer 31

no closure, large wound, chronic, contaminated, or skill loss, or after there is granulation tissue

Question 32

what are the different drains for wound closure

Answer 32

closed drain = jackson-pratt (doesnt have to be ventral) open drain = penrose (must be placed most ventral)

Question 33

what type of drain is this

Answer 33

jackson-pratt

Question 34

what type of drain is this

Answer 34

penrose

Question 35

what should we remember when picking suture material

Answer 35

we want minimal tissue reactivity with sufficient strength

Question 36

what type of suture material should we use for wounds

Answer 36

non-absorbable monofilament (nylon or prolene)

Question 37

what type of suture patterns should we use for non tension areas

Answer 37

simple interrupted

Question 38

what type of suture pattern should we use for high tension areas

Answer 38

vertical mattress and near-far-far-near

Question 39

how far should should the suture be placed away from wound edge

Answer 39

0.5cm

Question 40

what are the different types of wound dressings

Answer 40

gauze, telfa pad, hypertonic saline dressing (curasalt), calcium alginate (curasorb)

Question 41

how do we use gauze for wound dressings

Answer 41

wet-to-dry bandages, debridement of heavily contaminated/exudative wounds

Question 42

when do we use telfa pads

Answer 42

on surgical wounds or sutured wounds (non-adherent or non-occlusive)

Question 43

how do we use hypertonic saline dressing (curasalt)

Answer 43

aggressive wound debridement, first few days only

Question 44

when/how do we use calcium alginate (curasorb)

Answer 44

on moderately exudative wounds and/or substantial tissue loss creates a gel that promotes moist wound healing

Question 45

what are the guidelines for bandaging

Answer 45

even tension, appropriate tension, and cover the required areas

Question 46

what is included in the inner bandage for horses

Answer 46

non-adherent first layer held in place with kling gauze

Question 47

what is included in the outer bandage

Answer 47

sheet cotton, gamgee, or combiroll combined with vet wrap

Question 48

what type of bandage is this

Answer 48

carpal bandage

Question 49

what type of bandage is this

Answer 49

tarsal bandage

Question 50

what are some of the complications of bandages

Answer 50

pressure sores or bandage bows

Question 51

what is a bandage bow

Answer 51

extensor/flexor tendon inflammation, no actual disruption of the tendon via too little padding or wrapped too tight

Question 52

what should we always warn owners about with wounds

Answer 52

dehiscence!!!

Question 53

what is "proud flesh"

Answer 53

exuberant granulation tissue

Question 54

what are predisposing factors for exuberant granulation tissue (proud flesh)

Answer 54

bandaging after granulation tissue is present, movement, large wound with second intention healing, bone sequestrum, wound irritation

Question 55

what is the treatment for proud flesh

Answer 55

sharp debridement, topical steroids, or skin grafting

Question 56

what is bone sequestrum

Answer 56

dead, infected piece of bone via bacteria from a wound/necrosis from damage to blood supply

Question 57

what are the signs of bone sequestrum

Answer 57

a non-healing wound

Question 58

how do we treat bone sequestrum

Answer 58

typically requires surgical removal

Question 59

what is cellulitis

Answer 59

severe edema in the limb associated with a relatively small wound

Question 60

how do you treat cellulitis

Answer 60

systemic antibiotics, anti-inflammatories, and bandaging