Term
| What is the first "C" of wound management? What are its componenets? |
|
Definition
-Communication
-Caution, Cover the wound, Compression on the wound, Immobilize fracture |
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Term
| What do we do in the clinic to confirm stability? |
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Definition
-oxygen
-pain control
-fluids
-antibiotics
-IV catheter
-Auscult chest
-ECG |
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Term
| What are the goals of covering a wound? |
|
Definition
-prevent further hemorrhage
-prevent further contamination and infection
-absorb fluid |
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Term
| HOw do we cover the wound of a stable patient? Unstable patient? |
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Definition
-Stable: light, temporary wrap
-unstable: make the wrap count |
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Term
| What are the 4 classifications of wounds? |
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Definition
| -Clean, Clean-contaminated, contaminated, dirty/infecte d |
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Term
| What are the characteristics of a clean wound? |
|
Definition
-created under aseptic conditions: surgical incision
-no invasion into alimentary, resp, genitourinary tracts, oropharyngeal cavity
-non-infected
-generally closed primarily |
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Term
| What are some examples of clean wounds? |
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Definition
| -patent ductus arteriosus, thoracotomy, laparotomy, total hip arthroplasty, fracture repair of a closed fracture, castration, neuro surgery, artrocopy |
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Term
| What are the characteristics of a clean-contaminated wound? |
|
Definition
-operative wound in which the resp, GI, or genitourinary tracts are entered under controlled conditions
-no unusual contamination
-clean wound with a drain place
-wound in its golden period <6-8 hours |
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Term
| What are some examples of clean-contaminated wounds? |
|
Definition
| -cholecystectomy, enterotomy, gastrotomy, ovariohysterectomy, SI resection, lung lobectomy, soft palate resection |
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Term
| What are the characteristics of a conaminated wound? |
|
Definition
-open, fresh, accidental wounds
-operative wound with a major break in asepsis
-overt spillage from a luminal structure |
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Term
| What are some examples of a contaminated wound? |
|
Definition
-cystotomy with infected urine spillage
-enterotomy with bowel spillage
-lacertaions
-early septic abdomen: GI perforation |
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Term
| What are the characteristics of a dirty/infected wound? |
|
Definition
-old, traumatic wound
-purulent discharge
->10 to the 5 bacteria/gram of tissue
-septic peritonitis
-devitalized tissue/foreign debris
-fecal contamination |
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Term
| How does a contaminated wound become a dirty wound? |
|
Definition
-dec blood supply
-inc amount/type of traumatized tissue
-inc number and pathogenicity of bacteria
-foreign debris
-patient age and immunocompetence |
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Term
| What are some examples of dirty wounds? |
|
Definition
-incision of an abscess
-septic peritonitis
-perforated intestinal tract
-bulla osteotomy for otitis media
0devitalized wound |
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Term
| What are the major principles of wound management? |
|
Definition
-prevent further contamination
-remove foreign debris and contaminatns
-debridement of deasd tissue
-ensure adequate drainage
-promotion of a viable vascular bed
-selection of the appropriate method of closure |
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|
Term
| What are the C's of wound prep? |
|
Definition
-Copious sterile lubricant to protect wound environment
-Clip hair WIDE
-Clean skin around wound
-Copious lavage |
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Term
| What solutions do we use for wound lavage? |
|
Definition
| -Sterile saline, Dilute chlorhexidine, Dilute betadine |
|
|
Term
| What is the optimal pressure for wound lavage? |
|
Definition
|
|
Term
| When do you stop wound lavage? |
|
Definition
-absence of gross contamination
-tissues begin to bubble and become pale white |
|
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Term
| What is sharp debridement? |
|
Definition
| -use of scalpel and scissors to cut out devitalized tissue |
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Term
| How do you determine if tissue is devitalized or not? |
|
Definition
-color: black, grey, tellow, green, tan
-texture: rubbery or dry
-lack of blood supply
-lacking tissue attachement
-temp decreases |
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|
Term
|
Definition
-evaluation of the depths of the wound using a sterile probe after lavage
-very important with bite wounds |
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Term
| Which wounds are especially sensitive oto microbes? |
|
Definition
-chronic wounds > 6-8 hurs
-purulent material indicating infection
-devitalized wounds
-deepwound
-patient immunocompromised |
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|
Term
| What is the #1 source of nfection with surgery? |
|
Definition
|
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Term
| IN which situations should we use a broad spectrum antibiotic? What about one that is simply efficacious against gram positives? |
|
Definition
-Broad specturm: bite wound, deep, or contaminated wound
-Gram pos: simple, clean-contaminated laceration |
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|
Term
| For how long should we treat with antibiotics? |
|
Definition
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Term
| What are the indications for drain placement? |
|
Definition
-to drain avscess or fluid accumulation
-foreign material or questionably viable tissue present
-massive contamination is inevitable
-obliteration of dead space
-prevent accumulation of serum, blood, air |
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Term
| What is primary wound closure? |
|
Definition
| -wound closed soon after damage |
|
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Term
| What is delayed primary wound closure? |
|
Definition
| -wound closed 3-5 days after insult but before granulation tissue is present |
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|
Term
| What is secondary wound closure? |
|
Definition
| -wound is closed >5 dyas after insult with helathy granulation tissue resent |
|
|
Term
| What is second intention? |
|
Definition
| -allows the wound to close on its own |
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Term
| What are the major concerns with dog bite wounds? |
|
Definition
-small surface wound with a lot of underlying damage
-muscles torn, fascial planes separated, severed nerves, vessels
-bacterial contamination from jair, teeth, kin
-foreign material and hair |
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|
Term
| What are the consequences of dog bit wounds? |
|
Definition
-deep cellulitis
-abscess, draining tract
-tissue devitalization
-deep organ damage |
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