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Flashcards in Wound Management Deck (28):
1

 

 

What would you want to include in your assessment of a wound?

 

  • What/When/Where/why it happened
  • Hand dominance
  • Throrough examination after cleaning - deep structure damage
  • Tetanus status
  • Assess:
    • Contamination
    • Tendon function
    • Neurovascular status
  • X-ray - fracture or foreign body risk

 

2

 

 

Why might you want to do an X-ray in someone with a wound?

 

 

Risk of fracture or foreign body

3

 

 

How would you clean and debride a wound?

 

  • Clean wound area - sterile swabs soaked in saline
  • Local Anaesthesia around edges
  • Consider
    • Mechanical debridement
    • Pressure irrigation
    • Deep inspection
    • Surgical debridement/exploration

4

 

 

What is involved in mechanical cleansing/wound debridement?

 

 

Remove debris/contamination/foreignbodies/dead tissue. Use sterile swabs soaked in saline to scrub, and forceps and scalpel to excise tissue if required

5

 

 

What is involved in pressure irrigation?

 

 

Squirt sterile saline into the wound using pressure - from syringe via green needle or from pressure infusion bag via orange cannula

6

 

 

What is the aim of deep inspection?

 

 

To assess deep structures and ask patient to attempt full ROM movements to assess tendon damage

7

 

 

What are options for wounds that require torough cleaning?

 

  • Debridement under GA
  • Urgent sugical exploration

8

 

 

What options are available for closure of a wound?

 

  • Immediate primary closure
  • Delayed primary closure
  • Secondary intention
  • Sking grafts

9

 

 

What is involved in immediate priary closure?

 

 

Immediate closure with steri-strips/glue/sutures/clips. 

10

 

 

When is immediate primary closure used to close a wound?

If:

  • There is neglidgible skin loss
  • Wound is clean
  • No foreign bodies
  • <12 hours old (<24 hours for face wounds)
  • Edges come together easily without tension

11

 

 

What is involved in delayed primary closure?

 

 

Wound cleaned thoroughly, then dressed and left open for 48 hours. Wound is then reviewed for signs of infection, swelling and bleeding. If these are absent and wound edges can be opposed without tension, wound is sutured closed

12

 

 

When is delayed primary closure used?

If:

  • Contaminated wound
  • Contused/bruised
  • Infected wounds
  • Wounds > 2 hours old

13

 

 

What should be used to treat contaminated wounds?

 

 

Antimicrobial dressings and prophylactic antibiotics

14

 

 

What is involved in healing by secondary intention?

 

 

Allow wound to close by itself - granulation, epithelialisation and scarring

15

 

 

When is healing by secondary intention used for wound closure?

Wounds with:

  • Tissue loss preventing edge approximation
  • Chornic ulcers
  • Partial-thickness burns

16

 

 

When are skin grafts used?

 

 

Significant skin loss

17

 

 

Beyond cleaning, debriding and wound closure, what are other aspects of wound management to consider?

 

  • Antibiotics
  • Tetanus booster/immunoglobulin
  • Rabies immunoglobulin
  • Analgesia
  • RICE - if swelling likely
  • Appropriate dressing
  • Correct factors which would inhibit healing

18

 

 

What factors can inhibit wound healing?

 

  • Smoking
  • NSAIDS
  • Nutrition
  • Diabetes

19

 

 

What would you consider doing as follow up after treating a wound?

 

  • Give wound advice
  • Elevate limbs for 24-48hours
  • Arrange follow up - delayed primary closure, diabetes/immunocompromised, burns
  • Suture removal

20

 

 

How soon should you remove sutures in the head or face?

 

 

After 5 days

21

 

 

How soon should you remove sutures on the upper limb/trunk/abdomen?

 

 

7 days

22

 

 

How soon should you remove sutures in the lower limb?

 

 

10 days

23

 

 

What are the worst type of bites?

 

 

Cat and human bites

24

 

 

What would you consider doing if a puncture wound was deep and appeared contaminated?

 

 

Wide debridement in theatre

25

 

 

How would you manage bite wounds?

 

  • Aggressive surgical management, followed by delayed primary closure/healing by secondary intention
  • Antibiotics for 5 days

26

 

 

How are gunshot wounds treated?

 

 

Thorough debridement and delayed suturing

27

 

 

How would you manage crushed injuries?

 

 

Elevated for 7-10 days to reduce risk of compartment syndrome on closure

28