Early wound management Flashcards

1
Q

What are 4 history questions to ask?

A
  1. duration of injury
  2. mechanism of injury
  3. estimation of blood loss
  4. treatments (thus far)
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2
Q

What are 4 history questions to ask?

A
  1. duration of injury
  2. mechanism of injury
  3. estimation of blood loss
  4. treatments (thus far)
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3
Q

What are recommendations for wound @ site? (b4 get to hospital)

A
  1. restrict movement
  2. garden hose lavage–decontaminate
  3. control hemorrhage (pressure bandage–don’t leave on long!)
  4. see to the case! don’t just let go to hospital
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4
Q

What are two aspects of patient assessment?

A
  1. systemic assessment

2. wound assessment

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5
Q

What are three things examine to assess systemic condition of the patient?

A
  1. cardiovascular status
  2. resp status
  3. body condition
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6
Q

What are three things to look at when assessing cardiovascular status?

A
  1. pulse
  2. mucus membrane colour
  3. capillary refill time
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7
Q

What does a good pulse indicate?

A

That the pressure is ok

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8
Q

What is the most significant indicator to see if animal has lost a significant amount of blood?

A

mucus membrane colour

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9
Q

Why is it hard to assess cardiovascular state during hemorrhage?

A
  1. heart rate is up

2. PCV and protein will not change for a few hours (until fluid compartments are reestablished)

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10
Q

What is the golden period?

A
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11
Q

Is the golden period longer on the head and body or on the limbs?

A

longer on the head and body

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12
Q

What are three ways to examine a wound?

A
  1. visual examination
  2. digital examination (gloves)
  3. diagnostic imaging
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13
Q

What can you find out about a wound by looking at it?

A
  1. location of wound
  2. extent of injury
  3. age of wound
  4. condition of wound
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14
Q

How old does a wound have to be before you see granulation tissue macroscopically?

A

4-5 days

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15
Q

How do you perform a digital examination?

A
  1. sedate (small animal, maybe horse)
  2. local anesthesia
  3. sterile lube in wound
  4. clip and prep
  5. explore wound, involved structures
  6. joint evaluation (arthrocentesis, fluid injection)
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16
Q

What can diagnostic imaging be used to do when looking at a wound?

A
  1. assess bone
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17
Q

What are recommendations for wound @ site? (b4 get to hospital)

A
  1. restrict movement
  2. garden hose lavage–decontaminate
  3. control hemorrhage (pressure bandage–don’t leave on long!)
  4. see to the case! don’t just let go to hospital
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18
Q

What are two aspects of patient assessment?

A
  1. systemic assessment

2. wound assessment

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19
Q

What are three things examine to assess systemic condition of the patient?

A
  1. cardiovascular status
  2. resp status
  3. body condition
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20
Q

What are three things to look at when assessing cardiovascular status?

A
  1. pulse
  2. mucus membrane colour
  3. capillary refill time
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21
Q

What does a good pulse indicate?

A

That the pressure is ok

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22
Q

What is the most significant indicator to see if animal has lost a significant amount of blood?

A

mucus membrane colour

23
Q

Why is it hard to assess cardiovascular state during hemorrhage?

A
  1. heart rate is up

2. PCV and protein will not change for a few hours (until fluid compartments are reestablished)

24
Q

What is the golden period?

A
25
Q

Is the golden period longer on the head and body or on the limbs?

A

longer on the head and body

26
Q

What are three ways to examine a wound?

A
  1. visual examination
  2. digital examination (gloves)
  3. diagnostic imaging
27
Q

What can you find out about a wound by looking at it?

A
  1. location of wound
  2. extent of injury
  3. age of wound
  4. condition of wound
28
Q

How old does a wound have to be before you see granulation tissue macroscopically?

A

4-5 days

29
Q

How do you perform a digital examination?

A
  1. sedate (small animal, maybe horse)
  2. local anesthesia
  3. sterile lube in wound
  4. clip and prep
  5. explore wound, involved structures
  6. joint evaluation (arthrocentesis, fluid injection)
30
Q

What can diagnostic imaging be used to do when looking at a wound?

A
  1. assess bone
31
Q

What can diagnostic imaging be used to do when looking at a wound?

A
  1. assess bone
32
Q

What are three things to remember with client communication?

A
  1. lead with best treatment option
  2. may have to compromise
  3. need to be upfront and honest if the client is not willing to do enough for the animal
33
Q

What are the goals of wound debridement?

A
  1. remove contamination
  2. remove devitalized tissue
  3. eliminate infection
34
Q

What are three methods of debridement?

A
  1. sharp dissection
  2. curettage
  3. irrigation
35
Q

what is the best method of debridement?

A

sharp dissection

36
Q

What is bad about devitalized tissue?

A

it can harbor bacteria

37
Q

What are the goals of wound lavage?

A
  1. remove debris

2. reduce bacterial numbers

38
Q

How is wound lavage performed?

A
  1. use 3mL syringe with 20 gauge needle to get 7 psi pressure
    (not more or less)
39
Q

What are three lavage instruments (some more formal than others)

A
  1. garden hose
  2. syringe
  3. pulsavac
40
Q

The ideal lavage solution has what two characteristics?

A
  1. nonirritating

2. bactericidal

41
Q

What is the #1 and #2 solutions used for lavage?

A
  1. lactated ringers

2. saline

42
Q

Why is lactated ringers a better choice than saline for a lavage solution

A

Because saline is more irritating to tissue because it has a lower pH. May not be a big deal with a large wound but may cause an issue in synovial joints

43
Q

What are 4 solutions that can be used as lavage solutions?

A
  1. lactated ringers
  2. saline
  3. povidone iodine
  4. chlorhexidine
44
Q

Why is lactated ringers a better choice than saline for a lavage solution

A

Because saline is more irritating to tissue because it has a lower pH. May not be a big deal with a large wound but may cause an issue in synovial joints

45
Q

Why is povidone iodine not a good lavage solution?

A

it must be >1% to be bactericidal but is histotoxic at 0.5%. It inhibits neutrophil migration. It is not better than lactated ringers. However it is not irritating

46
Q

Why is chlorhexidine not a good lavage solution?

A

a low level is bactericidal but an even lower level is histotoxic. It also trashes synovial structures!

47
Q

What can chlorhexidine lavage solution be used for?

A
  1. canine wounds
  2. endometrial lavage (diluted!!)
  3. mouth washes?
48
Q

Why is chlorhexidine in trisEDTA used as a lavage solution?

A

the trisEDTA is a detergent and lowers the necessary % of chlorhexidine. Retains the effects of chlorhexidine and can be used in joints and wounds. may not be more efficatious

49
Q

What lavage solution can be used to manage pseudomonas

A

chlorhexidine in trisEDTA

50
Q

What are two antibiotics used in lavage solutions?

A

neomycin

gentocin

51
Q

Is there evidence that antibiotics are useful in lavage solutions?

A

no
most of the drug does not end up in the wound. put the antibiotic in AFTER lavage (closed joint or local perfusion with tournequet)

52
Q

When are antibiotics best used in wound management?

A
  1. prophylaxis (surgical wound)
  2. cellulitis therapy
  3. open synovial structure therapy
  4. severe muscle injury (beta lactam to prevent clostridial myositis in horse–cattle vaccinated)
53
Q

Who was alfred hegar?

A

a german gynecologist who was kind to his patients and bad tempered with his assistants