Podcast
Questions and Answers
What is the suggested time limit for closing a wound in a horse with sutures?
What is the suggested time limit for closing a wound in a horse with sutures?
A horse has sustained a deep, jagged wound from barbed wire. Which of the following is least important to assess during the initial examination?
A horse has sustained a deep, jagged wound from barbed wire. Which of the following is least important to assess during the initial examination?
Which of the following is NOT a factor to consider when determining the need for a tetanus booster in a horse?
Which of the following is NOT a factor to consider when determining the need for a tetanus booster in a horse?
What is the primary concern regarding the use of tetanus anti-toxin?
What is the primary concern regarding the use of tetanus anti-toxin?
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Based on the text, which of the following steps is NOT part of the initial wound assessment?
Based on the text, which of the following steps is NOT part of the initial wound assessment?
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Which of the following is a contraindication for using acepromazine as a tranquilizer?
Which of the following is a contraindication for using acepromazine as a tranquilizer?
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What is the recommended antiseptic for wound lavage?
What is the recommended antiseptic for wound lavage?
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Which of the following is NOT a factor considered during a visual assessment of a wound?
Which of the following is NOT a factor considered during a visual assessment of a wound?
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What is the recommended distance to clip around a wound?
What is the recommended distance to clip around a wound?
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Which of the following is a characteristic of a wound that is more likely to become infected?
Which of the following is a characteristic of a wound that is more likely to become infected?
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Flashcards
Patient Restraint
Patient Restraint
The methods used to safely restrain a patient for treatment or examination.
Acepromazine
Acepromazine
A tranquilizer that causes vasodilation; contraindicated in hypovolemia.
Wound Infection Threshold
Wound Infection Threshold
Infection occurs when there are 10^5 organisms per gram of tissue.
Wound Cleaning Technique
Wound Cleaning Technique
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Sterile Saline
Sterile Saline
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Wound Assessment Steps
Wound Assessment Steps
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Tetanus Prophylaxis
Tetanus Prophylaxis
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Types of Wound Dressings
Types of Wound Dressings
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Bandaging Techniques
Bandaging Techniques
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Complications in Wound Healing
Complications in Wound Healing
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Study Notes
Bandaging and Open Wound Management - LA
- Presented by Liz Devine DVM, MS, DACVS-LA
- Focuses on wound management in horses and large animals
Learning Objectives
- Describe wound assessment steps in horses, including synovial structure involvement.
- Detail treatment steps for traumatic wounds in horses, including tetanus prophylaxis.
- Outline different wound dressings and their appropriate uses.
- Describe equine bandage application methods (foot, lower limb, stack) and associated complications.
- Detail complications linked to wound healing in large animals.
Horses Are Self Destructive!!
- Slides of horses engaging in self-destructive behaviors (e.g., getting stuck, entangled).
But Sometimes It's Not Their Fault...
- Images showcasing accidents involving horse transport (e.g., damaged trailers).
Wound Healing Phases
- Presents a graph illustrating the phases of wound healing:
- Acute inflammatory phase
- Proliferative phase
- Remodeling phase (a longer phase)
- Key observations:
- Granulation tissue appears at day 5.
- Epithelialization occurs around day 4-6.
Wound Management
- Procedures for wound management:
- History taking
- Initial exam (blood loss assessment)
- Patient restraint
- Visual assessment
- Cleaning wounds and surrounding tissues
- Wound anesthesia
- Wound exploration and lavage
- Wound debriding
- Wound closure
- Wound dressing
- Bandaging
- Aftercare
Initial Examination
- Time elapsed since injury (important for primary closure decisions).
- Equine - out to 12 hours for potential primary closure (suturing).
- Blood loss assessment
- Heart rate, respiratory rate, mucous membrane color, and capillary refill time (CRT) evaluation is fundamental.
- Prior treatment/vaccine status
- Mechanism of injury analysis (e.g., sheet metal, barbed wire injuries).
- Higher energy impacts lead to increased tissue damage and potential vascular compromise.
Check on Tetanus Status
- Vaccination history is paramount for tetanus prevention.
- No history or vaccination >/= 12 months old needs tetanus toxoid+antitoxin treatment
- Vaccinated >/= 2 months prior = tetanus toxoid booster recommended
Patient Restraint
- Safety procedures emphasized as paramount.
- Twitching techniques
- Tranquilizer options, including acepromazine (contraindicated with hypovolemia), alpha-2 agonists (xylazine, detomidine), and opioids (butorphanol).
Visual Assessment
- Wound location determination
- Blood supply assessment
- Synovial structure involvement (potential need for synovial fluid analysis).
- Other relevant structures (vessels, nerves, organs).
- Determining contamination and infection levels.
- 10^5 organisms/gram of tissue often an indicator of infection.
- Foreign material, necrosis, hematomas can compromise blood supply and impair healing.
Clean Wound and Surrounding Tissues
- Excision/clipping/prep procedures (e.g., sterile prep, clipping, applying antiseptic solutions).
- Types of antiseptic solutions and techniques.
Wound Anesthesia
- Methods for achieving local anesthesia
- Medication alternatives: Lidocaine, Mepivacaine, local infiltration, peripheral blocks
Wound Exploration/Lavage
- Digital palpation to detect abnormalities
- Using sterile probes
- Radiographs (x-rays)
- Lavage/irrigation techniques under pressure (10-15 psi).
- Using a sterile 18g needle attached to a 35ml or 60ml syringe to flush out debris in wound.
- Flush wound with sterile normal saline or LR solution.
Wound Exploration - Synovial Involvement?
- Synoviocentesis procedure (aspirating synovial fluid)
- Sterile preparation, avoiding edema and cellulitis while avoiding introducing bacteria
- Analyzing synovial fluid samples (cytology, total protein, culture)
- Pressurizing the synovial structure.
- Injecting an antibiotic like amikacin for infection.
Wound Debridement
- Common techniques for wound cleaning:
- Sharp debridement (using scalpel blades)
- Mechanical debridement (using a wet-to-dry bandage method)
- Autolytic debridement (using moist wound healing)
Wound Closure
- Primary closure (immediate suturing).
- Delayed primary closure (delaying closure while addressing wound debridement and other issues)
- Secondary closure (allowing tissue to heal naturally).
- Potential complications need to be clearly presented to owners regarding wound dehiscence.
Drainage in Closed Wounds
- Methods for managing drainage in closed wounds to prevent exudative buildup:
- Jackson-Pratt drain
- Open drainage
- Penrose drain
Suture Materials
- Recommendations for suture materials (non-absorbable monofilament like nylon, polypropylene).
Suture Patterns
- Appropriate suturing techniques for wounds with or without high tension.
Wound Dressings
- Various wound dressings (e.g., gauze, Telfa pads).
- Application methods and considerations for wound type.
Bandaging (General)
- Bandaging as an art, emphasizing practice.
- Applying guidelines for even tension and appropriate coverage.
- Bandaging techniques, directions, and procedures.
Bandaging Techniques for Specific Areas (e.g., joints)
- Application methods for placing bandages over joints to ensure effective support and prevent pressure points.
- Using padding around bony prominences to prevent soreness and potential infection.
Bandaging Ruminants
- Common procedures in ruminant animals for foot injuries, wounds, and splints.
- Procedures for treating problems with claws and their special considerations during bandaging
Complications of Bandaging
- Common complications of bandaging practices
- Potential for exuberant granulation tissue formation or pressure sores.
Complications of Wound Healing in Horses
- Dehiscence (wound separation).
- Exuberant granulation tissue (‘proud flesh’).
Involvement of Synovial Structures
- Potential for issues with small wounds to synovial structures.
- Immediate referral is needed for further evaluation.
- Assessing the status of tissues from infected/non-healing wound areas
Bone Sequestrum
- Characterization of bone sequestration, including characteristics and complications.
Cellulitis
- Presentation and management of cellulitis
- Considerations of wound care, antibiotic, and bandage treatment regimens
Additional topics covered:
- Bandaging over joints
- Carpal bandaging
- Tarsal bandaging
- Splinting methods
- Foot bandaging
- Bandaging ruminants
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Description
This quiz covers the essential concepts of bandaging and managing open wounds in horses and large animals. Participants will learn about wound assessment, treatment steps, appropriate dressings, and common complications. Additionally, it includes a visual overview of horses' self-destructive behaviors and transport-related accidents.
