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Wound Infection Flashcards

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1
Q

Wound complications are

A

Infection, haemorrhage,,seroma, Dehiscence ( wound edges pulling away), Evisceration ( protrusion of abdominal content through defect), Psychosocial impact

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2
Q

Debridement can be done through

A

Mechanical, chemical, enzymatic,biodebridement, surgical

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3
Q

Mechanical debridement methods

A

Irrigation, hydrotherapy,wet to dry dressing,abraded technique

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4
Q

Mechanical debridement technique is

A

Cost effective,can damage healthy tissue,is usually painful

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5
Q

Enzymatic debridement uses

A

Enzymes like cologenase and papain topically,used in long term care settings

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6
Q

Biological debridement uses

A

Maggot, Lucilia sericata ( green bottle fly) that are grown on sterile environments

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7
Q

Autolytic debridement uses

A

Dressing type like hydrocolloid,hydrogels and transparent films, slowest method ,used in long term care settings, painless and uses bodys own enzyme

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8
Q

Life threatening haemorrhage have priority over

A

Airway and breathing

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9
Q

Open fracture have priority over

A

Closed fracture

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10
Q

Hydrocolloid shouldn’t be used when

A

Wound or surrounding skin is infected, Diabetic foot ulceration

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11
Q

Hydrofiber dressing

A

Contain sodium carboxymethyl cellulose, absorb up to 25 times it’s own weight,Has to be used with a secondary dressing like hydrocolloid

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12
Q

Alginate dressing

A

Derived from brown seaweed,can be used in infected and non infected wounds,absorbs upto 20 times their weight( not to be used in dry wounds or with minimal drainage),need secondary dressing, calcium component acts as haemostat

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13
Q

Foam dressing

A

Semipermeable, polyurethane or silicone based dressings

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14
Q

Composit dressing contain

A

More than or equal to 2 different materials

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15
Q

VAC

A

Topical negative pressure wound therapy,sub atm pressure ( 100- 125mmHg)

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16
Q

2 types of noncontinuous NPWT are

A

Intermittent ( pressure and no pressure time)and dynamic ( high pressure and low pressure time)

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17
Q

Indication of VAC

A

Chronic and acute wounds, Traumatic wounds, Diabetic wound, Decubitus,Flaps, transplant

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18
Q

CI of VAC

A

Malignancy in the wound, untreated osteomyelitis,Halloween organ fistulas, necrotic tissue with crust, allergic to materials,blood vessels,organs or nerves in the surface of wound

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19
Q

Necrotic wound colour

A

Black or darker green

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20
Q

Slough presents in wound colour

A

Yellow, green

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21
Q

Granulating wounds colour

A

Red/ pink

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22
Q

Epithelializing wound colour

A

Pink

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23
Q

Topical antimicrobial dressing could contain

A

Iodine,silver, antiseptic agents like polyhexamine, honey ( debrides and control odour)

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24
Q

Topical biocides eg

A

Chlorhexidine, Povidone iodine,triclosan, hydrogen peroxide

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25
Antibiotics used in surgical infections
Mupirocin,fusidic acid, neomycin, bacitracin,polymyxin
26
Antibiotic prophylaxis done using
Amoxicillin and clavulanic acid
27
Acute infections which needs antibiotic prophylaxis are
Bite or oral wounds,crush injuries, wounds with gross contamination with soil or wood,wounds to feet or leg in pat with lymphedema or diabetes,deep injuries ( involved tendon, cartilage,joints or open fracture),wounds in immunocompromised pat( poorly controlled diabetes, Immunosuppressive medications)
28
Penetrating or puncture wounds are considered ------ ,so ------- should be taken
Contaminated,TT vaccine
29
Asepsis methods
Decontamination,disinfection,sterilization, organization
30
Antisepsis
Prevention of infection by inhibition or arresting growth. Eg: mechanical, physical, biological, chemical
31
Risk factors for SSTIs
High bacterial load on skin, excessive skin moisture, inadequate blood supply,Immunosuppressive,damage to corneal layer
32
Poorly controlled diabetes leads to
Diabetic foot infection
33
Furuncle, carbuncle, impetigo can be caused by
Poor hygiene, physical contact,crowded living conditions, sharing of personal items
34
Risk of erysipelas and cellulitis increase with
Peripheral vascular disease and pre existing skin disease
35
Crepitus
Can be felt in gas forming infections, increase concern for necrotising fascitis and infection with anerobs such as clostridium perfringens
36
Necrosis can occur in
Spider or snake bite, group A streptococcus
37
Flatulence
Indicate fluid and likely abscess,may need I and D
38
Purpura
Seen in anticoagulant therapy,if accompanied by SSTI- can possibly be sepsis and disseminated intravascular coagulation
39
Bullae
Seen in impetigo caused by staphylococcus or in infection with vibrio vulnificus or streptococcus pneumoniae
40
Abscess can be detected using
US
41
Plain radiography reveals
Gas or periosteal inflammation, helpful in diabetic foot infection
42
Strong suggestive signs of necrotising fascitis are
Bullae, crepitus,gas on radiography, hypotension withSBP less than 90,skin necrosis
43
Impetigo caused by
S.aureus or strep.pyogenes, rarely MRSA and Gentamicin resistant s.aureus
44
Impetigo 2 types and mainly affects
Bullous and non bullous,Affects mainly children
45
Risk factors for folliculitis
Trauma including shaving and extraction, occlusion, perspiration, topical corticosteroid preperations
46
Folliculitis management
Apply warm moist compress- helps in pus elimination,topical antibacterial creams / ointments ( eg mupirocin), Less traumatization, hygiene
47
Furuncle involve
Hair follicle and surrounding tissue
48
Carbuncle
Cluster of furuncles connected subcutaneously, causing deeper suppuration and scarring
49
Conditions when A/ B therapy given after I and D in cutaneous abscess
Area difficult to drain completely,comorbidities or immunesupression, associated septic phlebitis,age,lack of response to I and D alone,severe or extensive disease,signs and symptoms of systemic illness
50
Surgical procedures that increase risk of cellulitis
Saphenous venectomy, axillary node dissection of breast cancer, gynaecological lymph node dissection followed by radiation like radical vulvectomy ,radical hysterectomy
51
Erysipelas is distinguished from other cutaneous infection by
The lesions which are raised above level of surrounding skin,clear line of demarcation between involved and involved tissue
52
Risk factors of erysipelas
Lymphatic obstruction or edema, saphenous vein grafting in lower extremity, status postradical mastectomy, immunocompromised, arteriovenous insufficiency,paretic limbs,nephrotic syndrome, vagrant lifestyle
53
Complications of abscess
Bacterimic spread, rupture into adjacent tissues, bleeding from vessels eroded by inflammation, impaired function of a vital organ,inanition due to anorexia and increased metabolic needs
54
Treatment of gangrene
Arterial revascularization through vascular bypass or endovascular procedure
55
Wet gangrene common victims
Burns,frostbite,other injuries,with comorbidities obesity or diabetes
56
Gas gangrene caused by
Anaerobic,gram positive,spore forming bacillus of clostridium family,it is a type of rapidly progressive wet gangrene.
57
2 types of gas gangrene are
Spontaneous and traumatic
58
Gas gangrene is a
Medical emergency,due to rapid progression to toxemia and shock.can be seen in patients who take injection of black tar heroin,pat withcolonic lesions,toxic gas bubbles centralised beneath skin
59
Spontaneous gas gangrene is caused by
Aero tolerant clostridium septicum in patients with neutropenia and gastro intestinal malignancies
60
Internal gangrene
If gangrene spread to or affects internal organs
61
Fourniers gangrene
Affects genital organs of infected person , mostly caused by pseudomonas and staphylococcus.most pat initially have perianal and retroperitoneal infection
62
Treatment of gas gangrene
Tetracycline, clindamycin, chloramphenicol and immediate debridement
63
Venous ulcers compared to arterial ulcer are
Present with redness and edema and maybe painless .In arterial ulcer,pain worsens in night in supine position and is relieved by lowering the leg
64
65
Diagnostic methods for arterial ulcer
Transcutaneous oxygen measurement, ankle brachial index, arteriography,buergers test, arterial Doppler study
66
Treatment of diabetic foot infection
Appropriate foot wear, control of glucose level, wounds with infection needs antibiotic therapy, surgical debridement to amputation possible
67
Venous ulcers ( stasis)
Caused by malfunction of venous valves causing pressure in veins to increase,occur mainly in medial or lateral lower leg,shallow ,but large wounds with irregular margins are seen, often entire leg becomes swollen, relatively painless, elevation of limb helps
68
First symptoms of venous ulcer
Stasis dermatitis causing scaling and erythema of lower extremity,haemosiderin staining may occur giving brown or yellow patches underneath skin, appearance of dark red or purple due to blood leaching
69
Risk factors of venous ulcers
Diabetes mellitus,DVT, Peripheral vascular disease,congestive heart failure, pregnancy and obesity
70
Decubitus ulcers are classified by
Depth of ulceration,site,extent and wound condition
71
Prevent decubitus by
Reposition at least every 2 HR,special devices
72
Key principles for management of decubitus
Reduction of pressure, adequate debridement of necrotic and devitalised tissue, control of infection, meticulous wound care
73
Treatment options for decubitus
Hyperbaric oxygen therapy, electrotherapy,growth factor, negative pressure wound therapy
74
4 types of tetanus
Generalized, localised, cephalic, neonatal
75
Tetanus signs
Trismus ( lock jaw),risus Sardonicus( smile), Opisthotonos
76
IP of tetanus
7 to 10 days
77
2 types of paronychia
Acute and chronic
78
Acute paronychia
Painful and purulent,caused by staphylococcus
79
Chronic paronychia caused by
Fungal infection, symptoms more than 6 weeks
80
Felon
Closed space infection of finger tip pulp, mostly caused by s.aureus
81
Complications of felon
Osteomyelitis, tenosynovitis, septic arthritis
82
Criteria for sepsis
Suspected or documented infection+ an acute increase of 2 or more sequential organ failure assessment ( SOFA) points
83
Septic shock
Sepsis with persistent hypotension,requires vasopressors to maintain MAP more or equal to 65 mmHg,and have serum lactate above 2 mmol/ DL despite adequate fluid resuscitation.mortality rate more than 40%
84
Surgical site occurrences or complications
SSIs,hematoma,seroma, suture dehiscence, wound necrosis

Surgery (2 decks)

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