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1

Types of Wounds

Acute - less than 1 month to heal
Chronic

2

4 Stages of Wounds

I - no loss of skin (SC)
II - blister or partial skin loss (SC)
III - full thickness skin loss
IV - subcutaneous

3

3 Phases of Wound Healing

Inflammatory Phase - Collagen forms, 3 to 4 days
Proliferative Phase - Day 3 to 3 weeks, New connective tissue
Maturation Phase - Week 3, completely closed by connective tissue

4

Signs and symptoms the wound may be infected:

Induration (hardening)
crepitation (crackling sound)

5

Vitamins though to help wound healing:

A - Synthesis of collagen, stimulates epithelialization.
C - Maintains proper cell membrane integrity. Collagen synthesis, Cross-linkage.
Zinc - Cell proliferation.

6

Adhesive Gauze Type Bandages

Good for superficial wounds but may cause delayed healing.

7

Puncture Wound

Leave open, soak with water for 30 minutes at least 4 times daily

8

Antimicrobial Dressing

Silver and Iodine are slowly released into the wound bed.

9

Dressings that absorb Moisture

Foam
Alginate Dressing (seaweed - makes gel)
Carbon-Impregnated Dressing
Composite Dressing

10

Dressings that maintain moisture

Hydrocolloid Dressings
Transparent Film Dressings (usually secondary)

11

Dressings that provide moisture

Amorphous Hydrogels
Hydrogel Sheets (cooling effect)

12

Pharmacologic Therapy for Wounds

Wound Irritants (sterile NS or bottled water)
Antiseptics (Alcohols and hydrogen peroxide, iodines)
Topical Antibiotics (Dirty wounds, 1-3 times a day, polymyxin B, neomycin, and bacitracin)
Topical Anesthetics (low concentrations, 4 times a day, 15-45 min of relief)
Systemic Analgesics

If no improvement within 7 days refer to doctor

13

Preventive Measures for Contact dermatitis

Do NOT burn plants
Apply bentoquatam (Ivy Block Lotion)

14

If a rash develops from contact dermatitis and is itching:

Topical Hydrocortisone
If no better in 2 days then ORAL Antihistamines
Lotion containing calamine, phenol, menthol, camphor
Tepid Showers
Colloidal Oatmeal
If not better in 2 to 7 days then refer

15

If a rash develops from contact dermatitis and is weeping:

Topical Hydrocortisone cream
Aluminum acetate compresses
Cool water baths, compresses(Witch Hazel Compresses, Wet to Dry Compresses, Calamine Lotion), tepid showers
Colloidal Oatmeal Baths

16

If a rash develops from contact dermatitis and has inflammation:

Topical Hydrocortisone Cream

17

Repellants approved by the FDA

DEET
Picaridin
IR3535
Lemon Eucalyptus Oil
Permethrin (only spray on clothing boots, shoes, tents)

18

Guidelines for safe use of DEET

Wash treated skin with soap and water when returning in doors.
If also using sunscreen, apply repellant after sunscreen.

19

Self-Care Treatment of Insect Bites

Non-Drug (Ice pack, clean skin with rubbing alcohol)
Relieve Pruritus and or pain (counterirritant, antihistamine, skin protectant, or hydrocortisone)

20

Symptoms of a black widow bite:

Immediate pain
Muscle Cramps
diaphoresis
Hypertension
Tachycardia
Weakness

21

Treatment of black widow bite

Parenteral opioids
Benzodiazepines
Equine Antivenom

22

Treatment of a brown recluse spider

Standard wound care
Urticarial lesions can be treated with antihistamines, topical corticosteroids

23

Self-care treatment of insect stings

Remove stinger, apply ice pack
Apply OTC topical counterirritant, antihistamine, skin protectant or hydrocortisone
Follow up if symptoms persist more than 7 days.

24

Refer for insect sting if

less than 2 years old
hives, excessive swelling, dizziness, weakness, nausea, vomiting, difficulty breathing; allergic response away from sting

25

Treatment for Lice

Permethrin 1% Cream (Nix) - 2 treatments (2 months and older)

Pyrethrin 0.33% and Piperonyl Butoxide 4% (Rid) - 2 treatments (2 years and older)

Malathion 0.5%(Ovide) - 1 treatment, Rx, $160, Flammable (2 years)

Benzyl alcohol 5%(Ulesfia) - 2 treatments, Rx, $81, good for resistance (6 months and older)

Ivermectin 0.5% topical lotion (Sklice) - 1 treatment, Rx, $25 with coupon (6 months)

Spinosad 0.9% (Natroba) - 1 treatment, $220, Rx (6 months)

Rinse with COOL water!

26

Which treatment for Lice is good when there is a resistance?

Spinosad (Natroba)
Benzyl alcohol 5% (Ulesfia)

27

Alternative Regimens for Lice

Not recommened:
Lindane 1% shampoo
Crotamiton 10% (no pregnant women)
Oral Ivermectin
Oral Bactrim
Essential Oils
Occlusive Agents
Dessication (Air Alle)
Wet Combing

28

Environmental Decontamination of Lice

Immerse combs/brushes for 10 minutes in at least 60C water.
Things that cannot be laundered should be placed in a sealed plastic bag for 2 weeks.

29

Scabies Treatment

Permethrin Cream 5% (Elimite)
Crotamiton 10% (Eurax)
Sulfur Ointment 5-10%
Ivermectin Oral
Benzyl benzoate 25%

30

Alternative regimens for Scabies

Lindane - not recommended as first line therapy.

31

Environmental Decontamination of scabies

Wash clothes or remove from body contact for at least 72 hours

32

Reasons for hospitalization for pet bites

Fever, Sepsis, spreading cellulitis, substantial edema or crush injury, loss of function, immune-compromised status, or noncompliance

33

Vaccine Use for Rabies

4 1-mL vaccine doses of HDCV or PCECV intramuscularly on 0,3,7, and 14th day

34

Humans Rabies Immune Globulin (HRIG) use for rabies

Rabies virus-neutralizing antibody
Give one dose to previously unvaccinated persons. Do not administer it in the same syringe or at the same anatomic site as the first (other days are ok) vaccine dose.

35

Texas poison center number?

1-800-222-1222

36

Determine quantity of topical products

Cream/Ointment g (Lotion, Solution, or Gel mL)
Face 5-10g (100-120 mL)
Both hands 25-50g (200-240 mL)
Scalp 50-100g (200-240 mL)
Both Arms or Both Legs 100-200g (240 - 360mL)
Trunk 200g (360-480 mL)

37

BSA Adult

Head 9%
Back 18%
Chest 18%
Right Arm 9%
Perineum 1%
Right leg 18%
Back of Hand 1%

38

BSA Child

Head 18%
Back 18%
Chest 18%
Right Arm 9%
Perineum 1%
Right leg 13.5%

39

Fingertip units for Topical Creams

1 fingertip = 0.5g
Scalp 3 (half of BSA)
Face and Neck 2.5
One hand 1
one arm and hand 4
elbows 1
both soles 1.5
one foot including toes 1.5
one leg including foot 8
buttocks 4
knees 1
trunk both sides 16

40

What can topical hydrocortisone be used for?

Insect bites and stings, plant dermatitis, atopic dermatitis, very mild psoriasis
(Do not use in children less than 2)

41

Avoid use of topical antihistamines (diphenhydramine) in:

Chicken Pox
Plant dermatitis
Sunburn
Broken, oozing skin

42

Use topical anesthetics (Benzocaine, Pramoxine, Dibucaine, Lidocaine) in:

Insect bites and stings
Sunburn

43

Use antipruritic or counterirritants (phenol, camphor, menthol, benzyl alcohol, calamine) in:

Insect bites and stings, dry plant dermatitis

44

Use astringents (Aluminum acetate, witch hazel) in:

wet plant dermatitis
wet atopic dermatitis

45

Use topical antibiotics (bacitracin, Neomycin, polymixin B sulfate, mupirocin) in:

minor burns
minor cuts

46

What plants may cause plant dermatitis in Texas?

Poison Ivy
Poison Sumac

47

Plant Dermatitis Exclusions

present more than 2 weeks
more than 20% involved
numerous Bullae (big blisters)
Swelling
Infection
failure of self-management after 7 days
Swollen eyes
Genitalia
Itching mucous membranes
Low tolerance
Impairment of daily activities
less than 2

48

Treatment goals of plant dermatitis

Treat inflammation
relieve itching
will resolve in 10-21 days with or without treatment

49

Colloidal Oatmeal Bath

Ex. Aveeno
Sprinkle cup into fast running bath water
Soak 15-20 minutes BID
Pat skin dry rather than wiping
Very slippery

50

What is a insect bite?

Nonvenomous (but can be more dangerous)
Mosquitoes
Fleas
Bedbugs
Ticks
Chiggers
Most spiders

51

What is an insect sting?

Venomous and contain allergenic proteins
Bees
Wasps
Yellow Jackets
Hornets
Fire Ants

52

Medications that impeded wound healing

Chemotherapeutic agents
Corticosteroids

53

Topical insect repellants

DEET - 8 hours
Picaridin - 8 hours
Lemon eucalyptus Oil (PMD) - 6 hours

54

Insect repellants that can only be used on equipment, outer clothing?

Pyrethins - will last for several days

55

Environmental Insect repellants

CITRONELLA
Metofluthrin
Allethrin

56

Drug Treatments for Insect Bites

Hydrocortisone
Topical anesthetics
Topical counterirritants
Topical antihistamines
Oral antihistamines
Skin protectants (petrolatum) - can be used in children less than 2 years

57

Insect Bite Exclusion Criteria

Hypersensitivity
less than 2 years old
Suspected black widow or brown recluse bites

58

Venomous Spider Bite First Aid

Clean Wound with soap and water
Apply cold pack
Elevate limb to reduce swelling
May give acetaminophen for pain
If possible, kill or capture the spider in a sealed container
Antivenom (Latrodectrus mactans) (Equine)
IM or IV for severe Black Widow bites

59

Mosquito Bites Neuroinvasive Diseases

West Nile Virus
St. Louis Encephalitis Virus
Dengue Virus
Chikungunya Virus

60

Flea diseases?

Plague
Murine Typhus

61

Tick Diseases

Rocky Mountain Spotted Fever
Lyme Disease
Erlichiosis

62

Insect Stings self-treatment exclusion criteria

Significant allergic response
Previous severe reaction
Personal or family history
less than 2 years of age

63

Self-treatment exclusions for lice

Secondary Skin infection
less than 2 y/o for pyrethrins
less than 2 months for permethrins
eyelids or eyebrows
pregnant or breast feeding
active tumors

64

Rabies bite treatment

Wash wound with soap and water or povidone-iodine if available
Refer patient, medical urgency, not emergency

65

Snake Bite Emergency Care

Wash
Tetanus
Ceftriaxone to cover gram negative organisms in snakes mouth
Mild - no antivenin
Moderate - consider antivenin
Severe - Give antivenin, watch for compartment syndrome

66

Stage 1 Wound Treatment

Adhesive gauze bandages
Hydrocolloid dressings
Liquid bandage
Sprays
Gels
Transparent Films

67

Stage 2 Wound Treatment

Transparent films
Hydrorcolloid dressings
Calcium alignates
Polyurethane foams
Moistened gauze

68

Stage 3 Wound Treatment

Hydrocolloid dressings
Composite dressings
Calcium alignates
Polyurethane Foams
Moistened Gauze Dressing
Carbon Impregnated dressing

69

Zinc influences what in wound treatment

B and T cell activity.

70

Exclusions for Self treatment of Wounds

Wound containing foreign matter after irrigation
Chronic Wound
Wound secondary to an animal or human bite
Signs of infection
Involvement of face, mucous membranes or genitalia
Deep, acute wound
Patients with diabetes (vasculitis)

71

Burn injury severity

Minor less than 15% in adult and 10% in children less than 2% involving eyes, ears, face, or gentilia
Moderate (needs referral) - up to 25% in adult
Major (needs referral) - greater than 25% in adult and 20% in child

72

Exclusions for self-treatment of burns

BSA of 2% or more
Burns involving eyes, ears, face, hands, feet, or perineum
Chemical burns
Electrical or inhalation burns
Persons of advanced age
Patients with diabetes or other disorders.
Immunocompromised patients

73

Non-Pharmacologic for burn injury

Cool water
Honey
Yellow Mustard (turmeric)
Aloe Vera

74

Impaired wound healing factors - local

Tissue perfusion
Bacterial contamination
Foreign bodies
Necrotic tissue
Eschar (a really deep scab)