Wound Management and Bandaging (Small Animal) Flashcards
(130 cards)
1
Q
the splitting or bursting open of a wound
A
Dehiscence
2
Q
What are the 4 phases of wound healing?
A
- Hemostasis
- Inflammatory (“Lag Phase”)
- Proliferative (“Repair Phase”)
- Maturation
3
Q
What cleans up the wound and modulates healing during the lag phase?
A
Macrophages and neutrophils
4
Q
The wound is at the greatest risk for dehiscence during the _____ phase of healing
A
inflammatory (lag phase)
5
Q
Granulation tissue forms over the wound during the ____ phase to create a surface for _______
A
proliferation phase / surface for re-epithelialization
6
Q
Wound contracting during the repair phase is performed by _______
A
myofibroblasts
7
Q
A ______ wound healing environment enhances cell migration and clean up
A
moist
8
Q
Collagen fibers remodel and align during the ____ phase of wound healing
A
maturation
9
Q
Why does granulation tissue not form in the proliferation phase?
A
There is no defect between the wound edges because the wound edges are kept together manually at first
10
Q
atraumatic and surgically wounds that are created under aseptic conditions
A
Clean Wounds
11
Q
wounds created by controlled, surgical entry into contaminated areas and are easily removed due to minimal contamination
A
Clean Contaminated Wounds
12
Q
recent traumatic wounds with bacterial contamination resulting from contamination by pavement, soil, bite saliva, or bacteria from the GI or urogenital tract during surgical procedures
A
Contaminated Wounds
13
Q
older wounds with obvious infection that contain more than 105 bacterial organisms per gram of tissue and could be caused by abscess of bite wound, puncture wound from contaminated foreign material, or necrotic tissue
A
Dirty Wounds
14
Q
Corticosteroids (enhance/delay) wound healing due to the (increase/decrease) in the body’s inflammatory response
A
delay / decrease
15
Q
What is the first step in proper wound management?
A
Prevent further contamination
16
Q
What are the 6 steps in proper wound management?
A
- Prevent further contamination
- Remove foreign debris and contamination
- Debride nonviable tissue
- Manage wound drainage
- Protect the wound through the inflammatory and proliferative phases
- Select appropriate wound closure
17
Q
___-___ psi is appropriate pressure for wound lavage
A
7-8 psi
18
Q
Main benefit in wound irrigation comes from _____ rather than _____
A
volume rather than type of fluid used
19
Q
Use ____ to irrigate the wound initially
A
tap water
20
Q
Do not use LRS bags that have been punctured after _____ hours
A
24
21
Q
Describe immediate wound care
A
- Cover wound in moist sterile gauze or with sterile, water-soluble lube
- Hair around wound is clipped > caught by lube if falling into wound > flush after clipping
- Gently cleanse surrounding skin with antiseptic > but NOT in the wound
- Lavage wound with warm LRS > removes water-soluble lube + any lose necrotic debris
22
Q
Why should you avoid getting antiseptic in the wound?
A
Antiseptic is cytotoxic to wound cells
23
Q
debridement in which obviously compromised tissue is removed and tissue of questionable viability is preserved and removed at a later time (if needed)
A
Staged Surgical Debridement
24
Q
debridement in which small wounds are excised completely and closed primarily (if the skin allows)
A
En Bloc Excision
25
____ wound debridement is used for larger wounds
Staged surgical debridement
26
____ wound debridement is used for smaller wounds
En bloc excision
27
debridement in which an adherent primary bandage layer is used to nonselectively debride heavily contaminated wounds
Mechanical Debridement
28
Wet-to-dry bandages are an example of ____ debridement
mechanical
29
____ wound debridement is only used during the inflammatory phase of healing
Mechanical debridement
30
debridement in which maggots are used to ingest necrotic tissue
Biological Debridement
31
____ wound debridement is used for chronic wounds with poor tissue health
Biological debridement
32
wound healing that occurs when the wound edges are approximated and granulation tissue formation doesn't occur
Primary Intention Wound Healing
33
____ closure is used for wounds that are surgically created or with edges that can have full approximation
Primary Intention
34
to place things in juxtaposition or proximity
Apposition
35
____ closure is used for wounds with some contamination, with questionable ability to heal with primary closure, and are older than 6-8 hours
Delayed Primary closure
36
wound healing that is initially cleaned and debrided, observed for development of infection for approximately 4 days, and then surgically closed
Tertiary Intention
37
____ closure is used for wounds that are infected and necrotic, failed primary wound closure, and are older than 6-8 hours
Tertiary Intention
38
wound healing characterized by the formation of granulation tissue that fills a wound
Secondary Intention
39
____ closure is used for wounds that are infected and necrotic, with edges that can't be approximated, and are older than 6-8 hours
Secondary Intention
40
created when soft tissue planes are disrupted by surgery or trauma and is often accompanied by fluid or blood accumulation
Dead Space
41
drains that function by allowing fluid to flow along the drain surface as the result of capillary action
Passive Drains
42
Penrose drains are ____ drains
passive
43
Passive drains can be kept in place for __ - __ days
3-5 days
44
drains that function by creating a vacuum within the wound and allowing wound fluid to be removed via a rigid fenestrated drain into an external collection container
Active Drains (Closed-Suction Drains)
45
____ drains are used for more extensive wounds and wounds with large amounts of drainage
Active (Closed-Suction) Drains
46
Normal fluid production from closed-suction drains is ___ - ___ mL/kg/day
1-2 mL/kg/day
47
Do NOT used bandages for _____ drains
passive
48
Closed-suction drains can be kept in place for __ - __ days
3-5 days
49
controlled application of a vacuum to a wound
Negative Pressure Wound Therapy (NPWT)
50
NPWT
Negative Pressure Wound Therapy
51
____ is used if normal drains cannot be used and for wounds with extensive dead space or a large amount of fluid production
Negative Pressure Wound Therapy (NPWT)
52
A wound is considered infected if the bacterial count is _____ organisms per gram of tissue
> 100,000 (10^5)
53
light pink, thin, and watery drainage
Serosanguinous
54
Antimicrobials:
If wound has good blood supply, is superficial, and has minimal foreign body contamination > ________
local wound defenses can often eliminate infection
55
Antimicrobials:
If wound is deeper, well established, and patient is stable > ________
use oral antimicrobials
56
Antimicrobials:
If infection is severe and/or patient is immunocompromised > ________
use IV antimicrobials
57
cuts made by a sharp object such as a scalpel
Incisions
58
partial-thickness dermal wounds that have been scraped away
Abrasion
59
tears in the skin and deeper tissues
Laceration
60
the tearing away of a large section of skin
Avulsion
61
a wound in which a large section of skin is torn off from the underlying tissue
Degloving Injury
62
a wound caused by pointed and sharp objects like bites, bullets, arrows, sticks, and antlers
Puncture Wound
63
wounds that have a combination of puncture, laceration, and crushing characteristics and are usually contaminated
Bite Wounds
64
Burns are classified by:
1.
2.
1. How deep it reaches
2. How large the affected area is
65
Burns in small animals are often caused by:
1.
2.
3.
1. Inappropriate use of heating blankets/lamps
2. Hair dryers
3. Poorly grounded electrocautery units
66
superficial burns that are confined to the epidermis
First Degree
67
partial thickness burns that may form blisters
Second Degree
68
full-thickness burns that form an eschar
Third Degree
69
thick, leathery, black layer of dead tissue seen in third degree burns that is insensitive to the touch
Eschar
70
burns involving tissue extending beyond the dermis, including muscle, tendon, and bone
Fourth Degree
71
injury formed by tissue eroding away
Ulcerations
72
sores that develop over bony prominences as the result of skin compression on hard surfaces during long periods of recumbency
Decubitus Ulcers
73
ulcerations that develop due to prolonged periods of bandaging and lead to tissue necrosis
Pressure Sores
74
the bandage layer with direct wound contact
Primary Layer
75
What are the 5 types of primary layers?
1. Adherent
2. Nonadherent
3. Non-occlusive
4. Semi-occlusive
5. Occlusive
76
the bandage layer that provides structure and padding
Secondary Layer
77
the bandage layer that holds together and protects the other 2 layers
Tertiary Layer
78
Why are wet-to-dry bandages not commonly used anymore?
1. Removes diseased and healthy tissue
2. Bacteria can contaminate wound if not changed enough
3. Causes bleeding and pain upon removal
79
permeable to air and fluid and allows exudate to be absorbed by the secondary layer
Semi-occlusive nonadherent primary layer
80
impermeable to air and retains moisture
Occlusive nonadherent primary layer
81
Hypertonic saline and calcium alginates are used for _____ exudate wounds
highly
82
Hydrogels, hydrocolloids, and polyurethane foam/film are used for _____ exudate wounds
minimally
83
_____ are used to cover surgical incisions and epithelialized skin
Teflon pads
84
_____ creates a hyperosmolar environment which draws macrophages into the wound and accelerates sloughing of devitalized tissue
Sugar
85
_____ creates a hypertonic environment, has antibacterial properties, and is a rich energy source for wound cells
Honey
86
Kling is a ______
conforming gauze
87
Vetrap is a ______
non-occlusive elastic bandage
88
Elastikon is a ______
non-occlusive elastic adhesive tape
89
a bandage used to temporarily immobilize limbs distal to the elbow or stifle joints in dogs/cats and relies on an extremely thick secondary layer to uniformly compress the distal limb
Robert Jones Bandage
90
Robert Jones Bandage
91
a bandage used to temporarily immobilize limbs distal to the elbow or stifle joint in dogs/cats by applying light compression and partial immobilization
Modified Robert Jones Bandage (Soft Padded Bandage)
92
Modified Robert Jones Bandage
93
When applying a distal limb bandage, the secondary layer should be overlapped ____% and ___ - ___ layers should be applied
50%
3-4 layers
94
PROCEDURE - Applying Distal Limb Bandages
1. Primary Layer - select appropriate type
2. If needed > apply small strips of adhesive tape to lateral and medial aspects of the foot
3. If needed > place cotton strips between toes > prevent toenails rubbing against the skin + absorb moisture
4. Place "doughnuts" over bony protuberances or compromised tissue > decreases pressure on those areas
5. Secondary Layer - Start at levels of toenails + proceed proximally > smoothly unroll cast padding without folds or wrinkles > overlap padding 50% as unrolled > apply 3-4 layers
6. Compress secondary layer with elastic gauze or Kling > apply from distal to proximal with 50% overlap + even compression
7. Tertiary Layer - Apply from distal to proximal
95
the process of cutting a cast on both sides to allow for fast removal in case of an emergency situation
Bivalving
96
PROCEDURE - Applying a Cast
1. Place a modified Robert Jones bandage over the distal limb > EXCEPT tertiary layer
2. Apply layer of toilet paper > prevents casting tape from sticking to bandage
3. Immerse fiberglass casting tape in water (with gloves on) > shake excess water > unroll evenly over soft-padded bandage from distal to proximal with 30-50% overlap > apply 2-3 layers
4. Once hardened > bivalve cast with oscillating saw > apply elastic gauze or tape > apply outer protective layer
97
Why should you avoid making the padding layer too thick when applying a cast?
The cast can loosen as the padding compresses
98
Why should you avoid wrinkles, folds, and indentations when applying the fiberglass casting tape?
Can cause pressure necrosis
99
When applying a cast, the fiberglass casting tape should be overlapped ____% and ___ - ___ layers should be applied
30-50%
2-3 layers
100
immobilizes canine/feline forelimb or pelvic limb in extension by using a soft-padded bandage and a strong lateral support splint that curves over the shoulder/pelvis
Spica Splint
101
_____ splints are most commonly used after elbow luxation
Spica
102
a non-weightbearing sling for dogs/cats that is applied to the pelvic limb to protect the hip joint after injuries like craniodorsal hip luxation or coxofemoral joint surgery
Ehmer Sling
103
Ehmer slings can cause ____ and _____ skin irritation
flank fold and inguinal area
104
The goal of Ehmer slings are to _____ rotate and _____ femur in order to force the _____ into the _____.
Internally rotate and abduct femur
force the femoral head into the acetabulum
105
PROCEDURE - Applying an Ehmer Sling
1. Wrap a thin layer of cast padding around metatarsi > apply broad elastic tape around metatarsi + back onto itself > do not cut yet
2. Hold stifle + hock in full flexion + externally rotate hock
3. Extend the tape in a figure 8 loop around the stifle + hock
a. Tape passed medially
b. Tape passed cranially around the lateral thigh as proximally on the femur as the flank fold will allow
c. Tape passed caudally over the lateral thigh
d. Tape looped back medially around the hock
4. Repeat once more if necessary
106
Ehmer Sling
107
a non-weightbearing sling for dogs/cats that is applied to the pelvic limb after distal femoral fractures in puppies to prevent quadriceps tie-down or contracture
90/90 Flexion Sling
108
90/90 Flexion Slings work by _______
keeping the affected muscles stretched
109
a non-weightbearing sling for dogs/cats that is applied to the forelimb to immobilize all joints in the affected leg after injuries like medial shoulder joint luxation or tenuous fracture reconstruction
Velpeau Sling
110
What is a caution to watch out for with Velpeau slings?
Not impairing breathing
111
Velpeau Sling
112
a non-weightbearing sling for dogs/cats that is applied to the forelimb to allow elbow and shoulder movement after injuries to the flexor tendons of the wrist
Carpal Flexion Sling
113
What is a caution to watch out for with carpal flexion slings?
Carpal flexor tendon contracture if used too long
114
Carpal Flexion Sling
115
a sling applied to the canine/feline pelvic limbs to prevent abduction of the hip joints after injuries like ventral hip luxation
Hobbles
116
Hobbles can be applied at the level of _____ or _____
stifle or metatarsi
117
a type of bandage for dogs/cats that uses suture loops that encircle the wound edges and are used as anchor points for the bandage material
Tie-Over Bandage
118
What is the VT's responsibility regarding tie-over bandages?
Changing tie-over bandage
Maintaining skin suture loops
Cut umbilical tape to remove bandage
119
PROCEDURE - Applying a Head Bandage
1. Lay affected ear across top of head > apply primary layer if needed
2. Apply cast padding around the head > leave unaffected ear out
3. Apply tertiary layer (Vetrap or stockinette) > apply a strip of elastic tape to hold in place
120
Head Bandage
121
PROCEDURE - Applying a Chest Bandage
1. Apply cast padding around forelimbs in figure 8
2. Apply elastic gauze in same manner
3. Apply tertiary layer in same manner
122
Chest Bandage
123
PROCEDURE - Applying a Tail Bandage
1. Apply small amount of cast padding around tail
2. Apply elastic gauze in same manner
3. Apply tertiary layer
4. Apply strip of adhesive tape to proximal end > prevent slippage
5. Apply syringe casting to tip for more protection if needed
124
Tail Bandage
125
If wound has lots of exudate > change wound bandage ____
3x a day
126
If healthy granulation tissue is seen > change wound bandage ____
every 2-3 days
127
If no wound any more > change wound bandage ____
once a week
128
How much exercise should a dog get when bandaged?
Short bathroom walks on a leash until bandage removed
129
Why are plastic bags, ziplocs, and booties used temporarily to keep bandages dry and clean?
Moisture can accumulate inside them
130
Toe swelling as a complication of bandage application is indicated by _____
increased distance between toenails
