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Family medicine > Wounds > Flashcards

Wounds Flashcards

1
Q

What is an acute wound?

A

Pass through the normal healing process. Eks are cuts, abrasions, lacerations, contusions, puncture, skin flap, bites

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2
Q

Chronic wounds

A

Fail to passthrough normal healing process. Any wound >3m are considered a chronic wound.

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3
Q

What are the healing phases?

A
  1. Hemostatis 2. Inflammatory 3. Proliferative 4. Remodeling
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4
Q

What is happening in hemostasis phase?

A

Seconds to hours. Vasoconstriction, plot aggregation, leukocyte migration.

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5
Q

What is happening in inflammatory phase?

A

Hours to days. Early neutrophil chemoreactant release, late macrophages, phagocytes and removal of foreign body.

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6
Q

What is happening in proliferative phase?

A

Days to weeks. Fibroblast proliferation, collagen synthesis, ECM reorganization, angiogenesis, granulation tissue formation, epithelialization.

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7
Q

What are the healing intentions?

A

1st, 2nd and 3rd intention

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8
Q

1st intention

A

Able to bring together edges of a wound and hold them in place. Can be held together w sutures, staples, steer strips. Wound is easily closed and dead space is eliminated.

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9
Q

2nd intention

A

When there is loss of tissue. Wound requires gradual filling of dead space w connective tissue. Blod clot -> granulation tissue -> large scar

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10
Q

3rd intention

A

Delayed primary closure. Wounds are intentionally left open for several days for irrigation or debris removal. Once debris has been removed and inflammation subsides, the wound can be closed by first intention.

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11
Q

What is the aim of Mx of acute wound

A

Healing w/o complications such as inf and disfiguring

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12
Q

How do you Mx an acute wound?

A

1) Remove foreign bodies 2) Dry or wet dressing to cover the wounds 3) Suturing if acute 4) Bites = prophylaxis

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13
Q

Steristrips

A

Holds edges of the wound. Can be removed after 5-7 days.

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14
Q

Medical glue

A

Forms part of the scar. No need to be removed, fall of in 10days

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15
Q

ABs

A

Only indicated if contaminated/ evidence of inf (redness, warmth, swelling, tenderness, local lymphadenopathy)

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16
Q

Abscess

A

If large = drain. Small= ABs, butadiene, hydrogen peroxide, saline

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17
Q

When is the wound chronic?

A

Wound does not follow normal trajectory it may become stuck in one of the stages and bc chronic. May fail to heal due to local and systemic causes, lasting >3m, may appear at different colors.

18
Q

What are the local factors impending wound healing?

A

1) Inadequate blood supply 2) poor surgical apposition 3) poor venous drainage 4) excess local mobility (joint) 5) increased skin tension, 6) wound dehiscence (?), 7) presence of microorganisms and infection.

19
Q

Systemic factors impeeding wound heal

A
  • Increased age and general immobility
  • Malnutrition
  • Def of vitamins
  • Shock of any cause
  • Chemo/ radio tx
  • Inherited neutrophil disorders, leukocyte adhesion, def
  • Obesity
  • Smoking
  • Systemic malignancy and terminal illness
  • Imm. supp. drugs, corticosteroids, anticoagulants
  • Diabetes
20
Q

What kinds of tissue can be seen in a chronic wound?

A
  • Black = necrotic tissue
  • Red = granulation tissue
  • Yellow = sloghy tissue
  • Pink = epithelial tissue
21
Q

Necrotic wound

A

Dead tissue, when dry and hard = eschar. Mask the true size and staging. Prevents ABs to reach site. Prevents wound healing, removal is necessary, may lead to inf., Once removed healing starts. Fails to heal.

22
Q

How do you care for a necrotic wound?

A

Mechanical debridement and wet to dry dressing. Autolytic- occlusive dressings and wound exudate will debride by enzymatic relation. Emzymatic is softening slough by using enzymes (Iruxol and Papaya). You can also use biological therapy w maggots, or surgical w blades

23
Q

Sloughy wound

A

Cannot be removed by washing. Not necessarily indicative of clinical inf. Can be found as patches across wound bed. Exposed tendon may be mistaken for slough. Delay healing, predispose to inf and prevents AB tp reach site. Should be removed to enhance granulation.

24
Q

Granulating wound

A

Granulation tissue fills the wound as it is healing. Tops of capillary loops make the wound appear red and granular. Firm to touch, painless and does not bleed easily. Bright red granulation tissue bleeds easily, and may indicate inf.

25
Q

How to care for an granulating wound?

A

Avoid dry or wet to dry design. Prevent over granulation. Prevent inf. Exudate Mx and care of peri- wound area. Skin grafting or skin substitutes.

26
Q

Epitheliazing wound

A

Final stages of healing. Tissue forms the new epidermis. Is superficial pink/white tissue, migrated across the wound from the wound margin, hair follicles or sweat glands. Will cover granulating tissue.

27
Q

Inactive dressings

A
  • Dry dressing (gauze dressing), can be medicated or non medicated. Good for acute wounds. Tend to absorb wound moisture. Tightly adherent to granulation tissue, will break upon removal.
  • Polyurethane film dressing may be breathable or non-breathable.
28
Q

Active dressing

A

Plays a role in wound healing. Covering, granulation tissue formation, reduce slough formation, inhibits bacteria, keep wound moist, some provide growth factors.

29
Q

Hydrogel

A

Cross linked, moist gel dressing. Suitable to mildly exudating wounds and to dry and necrotic wounds.

30
Q

Foam dressing

A

Mild to moderate exudating wounds, absorb exudate rapidly and enhance thickness.

31
Q

Alginate dressing

A

Absorbs excessive moisture

32
Q

How is burns depth assessed?

A
  1. Reddening, swelling pain (epidermis)
    2a. Reddening, blistering, pain (superficial dermis)
    2b. Pallor blistering, pain ( partial dermis)
  2. Grayish white or black necrosis, analgesia (complete dermis)
  3. Carbonization (may extend to the bones)
33
Q

1st degree burn

A

Superficial. From UV, flame or hot steam. Dry, red and painful. Healing 3-6 days. No scars.

34
Q

2nd degree burn

A

Superficial (epidermis + dermis). From boiling water or flame. Blisters, wet and red and painful. Healing 7-10 days.

35
Q

2nd degree (2b)

A

Deep (epidermis + dermis). Easy breaking blisters, wet. Different colurs, red to white. Very painful. Healing >21 days. Give scars.

36
Q

3rd degree burn

A

Minimal pain, give scars, require surgical treatment.

37
Q

What is the rule of 9s

A

9% on chest, 9% on abdomen, 9% on each leg, 4,5% on each arm and on head, 1% on palms and genitalia

38
Q

How is burns evaluation on children?

A

9% on face, 18% on ant. trunk, 6,7% on ant leg, 4,5% on arm, 1% on genitalia.

39
Q

How is Mx of burns?

A
  1. Stop burning process: turn of current, irrigate copiously w water
  2. Cool burn down w running cold tap water for 20 min. Useful up to 3h after injury. Do not cause hypothermia. Do not use ice.
  3. Apply plastic wrap to burn to aid analgesia and limit heat loss and evaporation.
40
Q

When do you refer burn to the hospital?

A
  • > 10% TBA or >5% in child
  • Full thickness burn >5% TBSA
  • Burns to face, hands, feet, genitalia, perineum, major joints
  • Electrical burn
  • Chemical burn
  • Inhalation injury
  • Circumferential burn
  • Burn injury in pat w preexisting medical disorder
  • Burn ass w trauma
  • Burn injury w suspicion of non-accidental injury
  • burns at the extreme of age (young child and elderly)

Family medicine (14 decks)

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