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Sem 6: SASx > Management of Traumatic Wounds: Fundamentals > Flashcards

Management of Traumatic Wounds: Fundamentals Flashcards

(48 cards)

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1
Q

What are the phases of wound healing?

A

” I demand Rossies Memorize”

  1. Inflammatory
  2. Debridement
  3. Repair
  4. Maturation/Remodeling phase
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2
Q

The inflammatory phase of wound healing occurs in _____ days

A

0-5

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3
Q

What occurs during the inflammatory phase of wound healing?

A

Hemorrhage → Vasoconstriction → Vasodilation → Leukocyte response → PLT activation (clotting)

first 0-5 days of wound

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4
Q

What occurs during the debridement phase of wound healing?

A
  • neuts arrive 1st (within 6hrs) then monocytes (12 hrs) and initiate debridement phase
  • develops exudate rich in WBCw, wound fluid, and necrotic tissue

monocytes essential for wound healing (not neuts)

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5
Q

The debridement phase of wound healing occurs in _____ days

A

1-5

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6
Q

Which of the following is essential for wound healing?

A. Neutrophil
B. Monocytes
C. Lymphocytes
D. Eosinophils

A

B. Monocytes

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7
Q

Which of the following growth factors does NOT come from macrophages?

A. PFGF
B. EGF
C. KGF
D.PDGF
E. TGF-a/TGF-beta
F. VEGF

A

C. KGF
F. VEGF

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8
Q

Which of the following stimulates fibroblast and DNA proliferation in the repair phase of wound healing?

A. Neutrophil
B. Lymphocytes
C. Macrophages
D. Eosinophils

A

C. Macrophages

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9
Q

The repair phase of wound healing occurs in _____ days

A

3-5 days to 2-4 weeks

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10
Q

What occurs during the repair phase of wound healing?

A
  • macrophages activate fibroblasts → fibroblasts migrate into wound depositing collagen/fibrous tissue → angiogenesis → granulation tissue → epithelialization → wound contraction (simultaneously w/ granulation tissue & epithlialization)
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11
Q

Bright red granulation tissue can be seen in what phase of wound healing?

A

Repair phase

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12
Q

What bandage should NOT be used in the repair phase of wound healing and why?

A

Wet to dry bandage - delays re-epithelialization

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13
Q

_____% of the original strength may be regained following a healed wound

A

80%

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14
Q

What is the golden period when treating wounds?

A
  • 0-6 hrs
  • minimal contamination
  • insufficient microbial replication to cause infection and can usually manage with primary closure
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15
Q

What is the time frame of a wound to be classified as Class 2?

A
  • 6-12 hrs after wound
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16
Q

What is the time frame of a wound to be classified as Class 3?

A

> 12 hours of wounding
- likely infection due to time allowed for microbial replication

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17
Q

What is primary closure in wound management?

A
  • Clip, clean, and suture immediately
  • Used for Class 1 (0-6hrs) and some Class 2 (6-12hrs) wounds
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18
Q

What does delayed primary closure mean in wound management?

A
  • appositional closure BEFORE granulation tissue develops
  • Within 3-5 days of wounding
  • Good for Class 2 wounds (6-12hrs)
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19
Q

What does secondary closure mean in wound management?

A
  • appositional closure AFTER granulation tissue develops
  • > 3-5 days after wounding
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20
Q

What does second intention healing mean in wound management?

Study These Flashcards
A
  • Healing by contraction/epithelialization (Ex: no surgery)
  • Open wound management
21
Q

What pathogen is the #1 cause of nosocomial infection in vet med?

Study These Flashcards
A

MRSP (MRSA in human med)

22
Q

_________ is a newer disinfectant that is green, safe, and effective against MRSP with only a 1 minute contact time

Study These Flashcards
A

Accelerated hydrogen peroxides (AHP)

23
Q

As soon as a patient comes in with any wound regardless of cause, what is the first thing that should be done to prevent nosocomial contamination?

Study These Flashcards
A

Put a bandage over ALL wounds on entry to hospital

24
Q

How is a wound site aseptically clipped and scrubbed?

Study These Flashcards
A
  • Protect wound by applying sterile lube or saline soaked sponges
  • WIDELY clip area
  • Chlorhexidine scrub AROUND the wound not in the wound
25
After the wound area is clipped and scrubbed, what is done next?
LAVAGEEE
26
What solutions can be used as lavage solutions?
- LRS / 0.9% NaCl - 0.05% Chlorhexidine solution (NOT SCRUB) - 0.1% iodine solution - Tap water
27
The addition of ____ mLs of 2% Chlorhexidine solution to a 1L bag of sterile saline will produce a solution of 0.05%
25 mLs ( 0.05% x 1000 mL / 2% = 25mLs)
28
____% Chlorhexidine solution can be used to lavage a wound
0.05%
29
____% povidone-iodine solution can be used to lavage a wound
0.1%
30
What is a concern when using chlorhexidine solution to lavage a wound?
Corneal toxicity - don't use need the eyes!!!
31
When would povidone-iodine be preferred over chlorhexidine solution when lavaging a wound?
If wound is close to the eyes use iodine
32
What is the ideal pressure used to lavage a wound, and how can this best be accomplished?
**7-8 psi** place 1L bag of saline solution in a pressure bag at cuff pressure of 300 mmHg **GOLD STANDARD technique for lavaging a wound**
33
What is the consequence of lavaging a wound at higher than recommended pressures?
Could cause barotrauma to wound, detrimental to surrounding tissue, forces bacT deeper into wound
34
What is the consequence of lavaging a wound at lower than recommended pressures?
Can reduce bacterial contamination but not great at REMOVING bacteria and foreign material
35
True or False: The size of the needle matters when lavaging a wound
FALSE (pressure does tho)
36
During which stage of wound management should a culture sample be collected?
- Clip, clean, and lavage wound before culture - Culture after debridement for best sample - If antimicrobial flush solutions are used, collect sample before to avoid false results
37
After collecting a culture sample, what indicates ABX should be started?
- If significant contamination suspected - If muscle/fascia are disturbed - If animal is immunocompromised - If evidence of established local/systemic infection
38
True or False: Pus, exudate, eschar, of heavily fibrous tissue are good samples to collect for culture
FALSE
39
True or False: Culture the healthiest looking tissue within the wound bed
TRUE
40
Pending culture results, what is the ABX of choice to start for wound management?
Clavulanic acid
41
What topical ABX are available for use when managing and treating a wound?
- Triple AB ointment (TAB) - Silver sulfadiazine
42
What topical antibiotic is the drug of choice to treat burn wounds?
Silver sulfadiazine (1% cream)
43
Which of the following topical antibiotic should be used if suspect of pseudomonas spp? A. Triple AB ointment (TAB) B. Silver sulfadiazine
B. Silver sulfadiazine
44
Which bacterial organism causes a yellow-green color change to bandages places over a wound?
pseudomonas spp. (also produces a grape or tortilla like odor to the bandage)
45
Debridement is the process of removing dead/damaged tissue. This can be removed by the following mechanisms: List them.
1. Surgical excision (Layered vs En bloc) 2. Autolytic mechanisms 3. Enzymes 4. Wet to dry bandages 5. Biosurgical methods
46
What is the main concern when using surgical excision to debride a wound?
Possibility of removing excessive amount of viable tissue (Avoid excessive debridement of SQ in cats - can delay wound healing)
47
What is autolytic debridement?
Creating a moist environment to allow endogenous enzymes to dissolve dead tissue **highly selective for devitalized tissue ONLY** Accomplished using hydrophilic, occlusive/semi-occlusive bandages
48
What is biosurgical debridement?
- Using maggot therapy - Best for necrotic, infected, or chronic non healing wounds

Sem 6: SASx (4 decks)

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