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Wound
. An injury, especially one in which the skin or another external surface is torn, pierced, cut, or otherwise broken. 2. An injury to the feelings.
A wound is an injury to the integument or the underlying structures that may or may not result in a loss of skin integrity. Physiological function of the tissue is impaired (Keryln Carville 2001).
Type of wound
Surgical/traumatic wound
Venous ulcer Arterial insuficency Necrotising fascitis Pressure sore Diabetic foot ulcer Etc..
TRAUMATIC WOUNDS
Traumatic Wound
sudden, unplanned injury
TYPES OF WOUND
Contusion bruising or haemorrhage. Caused by a blow from something blunt Abrasion caused by skin being scraped along a hard surface Incision clean cut/surgical. Skin, soft tissues and muscle may be severed
TYPES OF WOUND
Laceration jagged edges e.g. from teeth, claws, barbed wire. Puncture small entry. May have some internal damage and can become infected Tear/Avulsion skin and soft tissue partially or completely torn away Cavity chronic, open wound
Contusions
Abrasion Wound
Laceration Wound
Puncture/Penetrating Wound
Sutured Wound
14
15
Burn wound
16
Degloving Injury
Assessing a wound
History
Examination
Assessment
HISTORY:
A detailed, thorough history is essential for assessing the extent of injury and for organising appropriate wound management. When did the injury occur? The longer the wound has been present, the more likely an infection will occur after closure
HISTORY:
Where did the injury occur? What are the potential contaminants? E.g. saliva, pus, faeces, soil How did the injury occur? Must assess any potential damage to deeper structures
EXAMINATION:
Is there loss of function in the injured part? Are important underlying structures involved e.g. nerves, major vessels, ligaments, bones?
EXAMINATION:
What is the level of contamination? Are any foreign bodies present? What is the viability of the injured parts? Are any parts missing?
ASSESSMENT:
WOUND MANAGEMENT
Reduce pain
MINOR WOUNDS
Clean the wound thoroughly with gauze soaked in saline or cooled, boiled water Apply a non-stick dressing
MAJOR WOUNDS
Follow DRABC Control bleeding apply firm direct pressure, elevate bleeding part, apply pad over wound Clean the wound as best as possible Apply a sterile or clean dressing
Abrasion/incision/laceration
Cleanse wound thoroughly with sterile gauze soaked in sterile water or cooled boiled water Apply non-adherent dressing
Tear/avulsion
Return skin to original position if possible Apply pressure to wound using a dressing and a pad to control any bleeding Bandage
Embedded object:
o DO NOT remove the foreign object o Control bleeding by applying pressure to surrounding area (not on foreign object) o Place a ring pad around the object and bandage over the padding
Penetrating wounds
Control bleeding by applying direct pressure around the wound Keep wound as clean as possible DO NOT try to pick out any embedded foreign material Apply a clean or sterile dressing Rest the injured person in a comfortable position
WOUND DRESSING
Control bleeding
Infected Wound
Content
Introduction
Host-Pathogen Reaction Making a diagnosis Management Strategy Wound Cleansing Wound Dressing Summary
INTRODUCTION
HOST-PATHOGEN INTERACTION
Host-Pathogen Interaction
Immunocompetency
Bacterial Count Virulence
Contamination
Colonization
Infection
TERMINOLOGY
Wound contamination the presence of bacteria within a wound without any host reaction/multiplication Wound colonisation the presence and multiplication of bacteria within the wound Wound infection the deposition and multiplication of bacteria in tissue with an associated host injury and reaction
Critical Colonization
An intermediate stage between benign colonization and overt infection
MAKING A DIAGNOSIS
Infection?
Investigations
MANAGEMENT STRATEGY
Management
WOUND DEBRIDEMENT
Wound Debridement
WOUND CLEANSING
Wound Cleansing
Helps optimize wound healing Decreases the potential for infection Loosens and washes away cellular debris (bacteria, exudate, purulent material and residual topical agents)
Cleansing Solutions
Normal Saline Water for irrigation chlorhexidine Superoxide Acetic acid,hydrogen peroxide,acetic acid????
WOUND DRESSING
Cadexomer Iodine
0.9% iodine is immobilised in the matrix and released constantly over 3 days
Silver
ACTICOAT
ACTICOAT Absorbent
Mode of Action
Ionic silver Damages the cell wall Interferes with the DNA synthesis Denatures proteins & enzymes and inhibits protein synthesis
1. Castellano JJ, Shafii SM, Ko F, et al. Comparative evaluation of silver-containing antimicrobial dressings and drugs. Int Wound J. 2007;492):114-122.
Summary
Many type of traumatic wound Initial management counts Infected wound is initially not infected!!