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POVN - Wounds
Wound Management
| Question | Answer |
|---|---|
| What Is Primary Intention? | 2 opposing edges brought together by sutures or staples. |
| What Is Secondary Intention? | Wound left to heal naturally after granulation tissue present. |
| What Is Third Intention? | Debridement, lavage, and surgical repair of wound after breakdown (infection). |
| What Are The Three Stages Of Wound Healing and Timeframes For These? | Inflammatory Phase = Immediate (0-3 days). Proliferative Phase = 3-7 days post injury. Remodelling Phase = 5-7 days post injury. |
| What Happens During The Inflammatory Phase Of Wound Healing? | -Vasodilation. -Debridement (WBCs destroy pathogens). |
| What Happens During The Proliferative Phase Of Wound Healing? | -Capillaries extend over wound, delivers collagen fibres to develop granulation tissue. |
| What Happens During The Remodelling Phase Of Wound Healing? | -Restoration of normal structure. -Granulation tissue replaced by scar tissue. |
| What Are The Ideal Conditions Of Wound Healing? | -Clean wound. -No interference. -Good blood supply. -Fresh wound edges. -Moist environment. -Good apposition of wound edges. |
| What Are The Two Different Types Of Closed Wound? | -Contusion. -Haematoma. |
| How Old Does A Wound Have To Be Before It Is Dealt With As An Open Wound? | More than six hours old. |
| What Are Some Examples Of Open Wounds? | -Incision. -Laceration. -Abrasion. -Burn. -Avulsion. -De-gloving. -Puncture. -Pressure sore. |
| What Is A Contusion Wound, How Can We Treat These? | -Bruise. -Cold compress and analgesia. |
| How Can We Treat Haematomas? | -Cold compress. -Pain relief. -Pressure draining. -Surgical draining. |
| What Is The Difference Between An Incised Wound And Laceration? | Incision = Surgical or via sharp object, usually very clean. Laceration = Not clean, tear of skin, irregular skin edges. |
| What Is An Abrasion Wound and How Can It Be Treated? | -Graze and bruising. -Caused by friction. -Painful and contaminated. -Clip remaining hair, clean skin surface, flush with sterile saline. |
| What Are The Classifications Of Burn? | 1st Degree = Epidermis involved. 2nd Degree = Epidermis and Dermis involved. 3rd Degree = Complete destruction of skin. |
| How Can Burns Be Treated? | -Cold flowing water or saline over area for 15 minutes after injury. |
| What Are The Treatments For Avulsion Injuries? | -Flush with saline. -Analgesia. -Vet may attempt to reconstruct. -Antibiotics (risk of infection). |
| What Is A Degloving Injury and How Can It Be Treated? | -Skin torn away from underlying tissues. -Clip hair, flush with saline, dress wound, antibiotics (risk of infection), or potential surgical intervention. |
| What Are The Clinical Signs Of Puncture Wounds? | -Pain. -Inflammation. -Infection. -Abscesses. -Discharge. |
| What Are The Treatments For Puncture Wounds? | -Clip hair. -Clean and flush thoroughly. -Explore radiographically or surgically if needed. -Antibiotics. -If progressed to abscess, drain and flush, give antibiotics. -For snake bites: antivenom. |
| What Is A Pressure Sore And How Can They Be Treated? | -Trauma to the skin over bony prominences. -Remove underlying cause (turning of recumbent patients). |
| What A Is A 'Clean' Wound? | Wound made surgically while asepsis is maintained. |
| What Is A 'Clean-Contaminated' Wound? | Wound created when non-sterile organ is entered with little or no spillage of contents. Wounds less than 6 hours old. |
| What Is A 'Contaminated' Wound? | Wound with foreign matter present, spillage of contents and major break in aseptic technique. Wound greater than 6 hours old. |
| What Is A 'Dirty' Wound? | Infection present. Wound older than 12 hours. |
| What Are The Ways In Which We Can Prevent Patient Interference With Wounds? | -Buster collar. -Surgical suit. -Dressing |
| What Are The Methods Of Wound Closure? | -Sutures. -Staples. -Tissue glue. |
| What Are The Steps For Wound Lavage? | -May induce general anaesthetic. -Fill a wound with water soluble gel to prevent hair becoming embedded in the tissues. -Clip and surgically clean the skin. -Flush with copious amounts of fluid (hartmann's ideal). |
| What Are The Advantages/Disadvantages Of Using Water For Lavage? | -Cheap. -Hypotonic and alkaline, will damage cells. |
| What Are The Advantages/Disadvantages Of Using 0.9% Saline Hartmann's For Lavage? | -Sterile, effective, isotonic. -No antibacterial action other than dilution. |
| What Are The Advantages/Disadvantages Of Using Povidone Iodine (Diluted 1:10) For Lavage? | -Good antimicrobial activity. -Inactivated by debris, no residual activity, will damage cells at higher concentrations. |
| What Are The Advantages/Disadvantages Of Using Chlorohexidine (Diluted 1:80) For Lavage? | -Good antibacterial activity and residual activity. -Will damage cells at higher concentrations. |
| What Are The Advantages/Disadvantages Of Using Hydrogen Peroxide For Lavage? | -Traditionally used to flush abscesses. -Cytotoxic and shouldn't be used. |
| What Are The Advantages/Disadvantages Of Using Antibiotics For Lavage? | -Traditionally though to add antimicrobial activity. -Better given IV, SC, IM. |
| What Are The Two Methods Of Debridement? | Selective or surgical. -Non-selective. -Mechanical. -Lavage. -Manuka honey. |
| Define Dressing | The first layer of the bandage which rests against the wound. |
| Define Adherent/Non-Adherent | Apart from wet to dry dressings, we want to use a non-adherent dressing which will not stick to the wound. |
| Define Absorbent/Non-Absorbent | An absorbent dressing is designed to wick fluid away from the wound. This encourages a flow of fluid from deeper tissues to the surface discouraging infection and keeping the surface moist |
| Define Active Dressing | Dressing designed to add something to the wound to promote healing –e.g. fluid, calcium or silver ions. |
| Define Occlusive Dressing | Dressing with waterproof backing to prevent drying of the wound. |
| What Are The Functions Of Wet-Dry Wound Dressings? | Debride wound surface at each dressing change, good for infected or necrotic wounds. |
| What Are The Functions Of Perforated Film Dressings? | Protection of wound surface, epithelial cells can grow. Some exudate absorption. Good for surgical or granulating wounds. |
| What Are The Functions Of Paraffin Gauze Dressings? | Does not stick to wound but may harm new epithelial cells. Good for early granulating wounds. |
| What Are The Functions Of Hydrogel In Wound Dressings.? | Maintains moist healing, promotes sloughing of dead tissue. Gel to use in dry or necrotic wounds, backed by foam dressing. |
| What Are The Functions Of Foam Dressings? | Care in very wet wounds, promotes moist healing environment. Absorbs fluid but keeps wound surface moist |
| What Are The Functions Of Hydrocolloids In Wound Dressings? | Maintain moist healing, encourages epithelial cell growth. Use in healthy granulating tissue, avoid in presence of infection. |
| What Are The Functions Of Alginates In Wound Dressings? | Maintain moist healing, and stimulation of macrophages. Encourages epithelial cells, use in granulating wounds (cut to size as irritant to skin). |
| What Are The Functions Of Silver In Wound Dressings? | Antibacterial, encourages granulation tissue. Use in heavily contaminated or infected wounds. |
| What Are The Functions Of Honey In Wound Dressings? | Antibacterial due to low pH and osmotic effect Use in necrotic or granulating wounds. |
| What Checks Need To Be Made To Ensure A Wound Is Healing? | -The wound exudes less as time goes on. -The wound does not smell. -Presence of necrotic tissue or infection. -That granulation tissue forms and is bright red in colour. -That new epithelial cells are growing from the wound edges. |
| What Is An Avulsion Injury? | The end result is similar to a degloving injury, but technically the tissues are pulled away which may result in less damage to underlying tissues. |
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