Week 1 Debridement Part 2

Question 1

what is mechanical debridement

Answer 1

non selective, and soft abrasion or scrub, hydrotherapy, or even wet to dry, and low frequency ultrasound

Question 2

is mechanical debridement painful

Answer 2

yes, because it does not discriminate between viable and non-viable tissues

Question 3

the is wet to dry indicated

Answer 3

when 100% not viable

Question 4

is enzymatic debridement selective? and what is it

Answer 4

yes, selective, and it is pain free way to debride, and easy to apply

Question 5

can we do enzymatic debridement on infected wounds

Answer 5

yes, in combination with polymyxin B power

Question 6

can we use enzymes with silver or iodine products

Answer 6

no

Question 7

what is a name of an enzymatic treatment we use

Answer 7

collagenase santyl

Question 8

how does enzymatic treatment work

Answer 8

the denatured collagen filaments anchor debris to the wound bed, and the collagenase digests the collagen filaments

Question 9

what are the 4 dressing types we can never use enzymatic with

Answer 9

silver
iodine
hydrogen peroxide
acetic acid

Question 10

how much do we apply at a time

Answer 10

thickness of a nickel

Question 11

what do we cover the enzyme with

Answer 11

saline moist gauze

Question 12

what happens if it is not clean in 2 weeks

Answer 12

switch to another method

Question 13

enzymatic is frequently used for

Answer 13

burns

Question 14

can we use enzymes on the face

Answer 14

no

Question 15

what are adverse effects of enzymes

Answer 15

burning/stinging
allergic reaction
peri-wound irritation

Question 16

contraindications for enzymatic

Answer 16

takes too long
not for deeper wounds with tracts, in cavities, or with named tissue
not for the face

Question 17

what is autolytic debridement

Answer 17

selective and conservative and least painful way to debride its also cheap but takes a while

Question 18

what is the least painful type of debridement

Answer 18

autolytic

Question 19

how does autolytic favor a good wound environment

Answer 19

the dressing is kept moist and warm, and cooks the wound. with hydrocolloid, transparent films, foams and hydrogels.

Question 20

when is autolytic indicated

Answer 20

pain, palliative care, or can’t sit still (like PD)

Question 21

what are contraindications for autolytic

Answer 21

infection or gangrene, or deep cavities, or when other things are more appropriate

Question 22

what are the disadvantages of autolytic

Answer 22

odor the removed, time and can’t see the wound

Question 23

when do you change autolytic

Answer 23

when you see strike through or that it is soiled

Question 24

what can you combine autolytic with

Answer 24

cross hatching

Question 25

what 3 things are combined in a combo debridement

Answer 25

sharp (to remove loose tissue, and cross hatch thicker areas) enzymatic to non-viable areas autolytic (warm and well insulated and which

Question 26

what can we educate the patient on

Answer 26

rest, nutrition, habits and lifestyle

Question 27

what is biological/biosurgical debridement

Answer 27

using maggots or larva to quickly and selectively get non-viable tissues. also, helps to decrease odor

Question 28

what do maggots and larva do to tissues

Answer 28

releases an enzyme to degrade non-viable tissues and biofilm

Question 29

what kind of effect does biologic debridement have

Answer 29

antimicrobials, MRSA, STREP, pseudomonas, biofilm, changes the pH and kills and ingests bacteria.

Question 30

what do biologic excretions help with

Answer 30

stimulate the granulation tissue growth

Question 31

what are sterile biologic

Answer 31

from Irvine CA, 300 for 98$, and you can only use 10 per cm2 area. NO REPRODUCTING

Question 32

what are free range or contained

Answer 32

need air, and they cannot be sealed off, so they have a mesh cover over them, and you need to cover them with dry gauze to not kill them

Question 33

in what kind of population can we use biologic

Answer 33

osteoporosis with infection around the hardware poor candidate for surgery can't handle other forms of debridement

Question 34

where is biosurgical contraindicated

Answer 34

``` eyes, GI, respiratory tracts ALLERGY to fly larva or yeast or soy exposed vessels, connecting to organs decreased perfusion malignant wounds ```

Question 35

what are precautions with biosurgical

Answer 35

maggots can drown or get squished and patient with bleed disorder

Question 36

what are indications for surgical debridement

Answer 36

``` complex wound gross infection or high risk infection too much nonviable tissue lots undermining unknown depth or abscess fistula named structures bleeding tendency, high pain or trauma ```

Question 37

how do you determine the type of debridement

Answer 37

what works best for them, makes most sense? safety? cost? risks? combination? can I do it, am I comfortable?

Question 38

what is ultrasound based debridement

Answer 38

low frequency tissue vibration that has antimicrobial effects. it lifts the dead tissue.