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Questions and Answers
What is the main purpose of lavage in wound management?
What is the main purpose of lavage in wound management?
Which action primarily aims to remove unviable tissue from a wound?
Which action primarily aims to remove unviable tissue from a wound?
During exploration of a wound, which of the following should be evaluated?
During exploration of a wound, which of the following should be evaluated?
Which of the following statements best describes the significance of reducing bacterial contamination in wound management?
Which of the following statements best describes the significance of reducing bacterial contamination in wound management?
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What is a key factor that influences whether to take a tissue sample for culture during debridement?
What is a key factor that influences whether to take a tissue sample for culture during debridement?
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What is the time frame for primary wound closure?
What is the time frame for primary wound closure?
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Which type of wound closure is indicated when there is questionable tissue viability?
Which type of wound closure is indicated when there is questionable tissue viability?
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What treatment option is not typically associated with secondary closure?
What treatment option is not typically associated with secondary closure?
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What is the primary focus when stabilising a patient with severe trauma?
What is the primary focus when stabilising a patient with severe trauma?
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What is an essential requirement for delayed primary closure?
What is an essential requirement for delayed primary closure?
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When should a traumatic wound be treated with second intention closure?
When should a traumatic wound be treated with second intention closure?
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Which of the following is NOT part of initial wound assessment?
Which of the following is NOT part of initial wound assessment?
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What is the purpose of using rigid stabilization for an unstable wound?
What is the purpose of using rigid stabilization for an unstable wound?
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In which scenario is delayed primary closure not appropriate?
In which scenario is delayed primary closure not appropriate?
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What is the maximum duration after which secondary closure is indicated?
What is the maximum duration after which secondary closure is indicated?
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When is open wound management preferred?
When is open wound management preferred?
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What is a treatment option for clean-contaminated wounds under delayed primary closure?
What is a treatment option for clean-contaminated wounds under delayed primary closure?
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What is the first priority in triage for a severely injured patient?
What is the first priority in triage for a severely injured patient?
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What should be done before cleaning and debriding a wound?
What should be done before cleaning and debriding a wound?
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Which condition would require immediate surgical attention during wound management?
Which condition would require immediate surgical attention during wound management?
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What is a key component to keep stress low for a critical patient?
What is a key component to keep stress low for a critical patient?
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What is the typical duration for repair strength to develop after tendon repair?
What is the typical duration for repair strength to develop after tendon repair?
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Which method of debridement utilizes hydrogels or topical applications?
Which method of debridement utilizes hydrogels or topical applications?
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What signifies the 'golden period' for primary wound closure?
What signifies the 'golden period' for primary wound closure?
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Secondary closure of wounds occurs after how many days?
Secondary closure of wounds occurs after how many days?
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What is typically the main outcome of healing by second intention?
What is typically the main outcome of healing by second intention?
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What is a factor that may necessitate delayed primary closure?
What is a factor that may necessitate delayed primary closure?
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Which method of wound closure is accompanied by granulation and re-epithelisation?
Which method of wound closure is accompanied by granulation and re-epithelisation?
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If there is any doubt regarding wound closure, what should be done?
If there is any doubt regarding wound closure, what should be done?
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What is a critical factor in classifying traumatic wounds based on contamination?
What is a critical factor in classifying traumatic wounds based on contamination?
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What type of debridement uses force and adherent bandages?
What type of debridement uses force and adherent bandages?
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What distinguishes contamination from infection in a wound?
What distinguishes contamination from infection in a wound?
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What is the recommended pressure for lavage during wound management?
What is the recommended pressure for lavage during wound management?
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During surgical debridement, what is the primary purpose of sharp dissection?
During surgical debridement, what is the primary purpose of sharp dissection?
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What technique is advised when assessing the viability of skin edges during surgical debridement?
What technique is advised when assessing the viability of skin edges during surgical debridement?
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Which of the following is NOT a characteristic of proper lavage solutions?
Which of the following is NOT a characteristic of proper lavage solutions?
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What is the minimum bacterial count indicating infection in a wound?
What is the minimum bacterial count indicating infection in a wound?
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What should be done before administering antibiotics in wound management?
What should be done before administering antibiotics in wound management?
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Which of the following correctly describes enzymatic debridement?
Which of the following correctly describes enzymatic debridement?
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What is the purpose of using an 18g needle with a 20 ml syringe during lavage?
What is the purpose of using an 18g needle with a 20 ml syringe during lavage?
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What is an important aspect of preserving nerves during surgical debridement?
What is an important aspect of preserving nerves during surgical debridement?
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Which type of dressing is best suited for heavily exudative wounds?
Which type of dressing is best suited for heavily exudative wounds?
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In moist wound healing, what should be applied to dry wounds for rehydration?
In moist wound healing, what should be applied to dry wounds for rehydration?
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What is a primary disadvantage of wet to dry dressing techniques?
What is a primary disadvantage of wet to dry dressing techniques?
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What dressing type is suggested for minimally exudative wounds?
What dressing type is suggested for minimally exudative wounds?
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What is a key feature of vacuum-assisted wound therapy (NPWT)?
What is a key feature of vacuum-assisted wound therapy (NPWT)?
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Which of the following is NOT a method of non-surgical debridement?
Which of the following is NOT a method of non-surgical debridement?
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What is the benefit of using hydrocolloids for wound management?
What is the benefit of using hydrocolloids for wound management?
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What important soft tissue component does granulation tissue provide?
What important soft tissue component does granulation tissue provide?
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What should be done if unsure of tissue viability in a wound?
What should be done if unsure of tissue viability in a wound?
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What is the primary consideration during active wound management?
What is the primary consideration during active wound management?
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Which of the following is NOT a layer used in simple bandaging?
Which of the following is NOT a layer used in simple bandaging?
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When should dressings generally be changed for optimal healing?
When should dressings generally be changed for optimal healing?
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Which of the following is a unique property of Manuka honey in wound management?
Which of the following is a unique property of Manuka honey in wound management?
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What is the role of alginate dressings?
What is the role of alginate dressings?
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Study Notes
Wound Management and Classification
- Wound healing can occur via primary or secondary intention. Primary intention involves treatment to close the wound edges, while secondary intention involves permitting the wound to heal from the inside out.
- Wounds can be classified based on a scheme that describes the appropriate means for treating and managing them.
- Wound types include; cuts, tears, burns, breaks, abrasions, degloving and shearing injuries, dehisced surgical wounds, punctures, pressure sores, and crush injuries.
- Wounds can be acute or chronic in presentation.
- Most clean wounds are created during elective surgery.
- Types of wounds (with descriptions) include:
- Laceration/tear: Skin is cut or torn open in an irregular pattern.
- Incision: Wound created by a sharp tool with minimal trauma (e.g., knife, scalpel).
- Burn/thermal: Skin damage ranging from superficial to full-thickness (e.g., scalding, fire, chemical burns).
- Abrasion/scrape/graze: Superficial skin removal caused by abrasion against a surface.
- Degloving and shearing injuries: Extensive skin loss caused by significant force (e.g., high-impact collisions).
- Puncture/penetrating: Small hole caused by a sharp object (e.g., nail, tooth, splinter).
- Pressure sores: Prolonged pressure to one area over time.
- Crush injury: Closed wound from extreme force over time (e.g., bite wounds).
- Contusion: Blunt-force trauma that does not break the skin but causes underlying damage.
Principles of Wound Management
- Stabilize the patient before dealing with the wound (prioritize ABCs/Triage, severe/multi-system trauma).
- Risk assessment and planning are important aspects of patient management.
- Ensure a baseline minimum database of blood results or other similar diagnostics.
- Establish IV access.
- Administer O2 flow by.
- Administer pain relief.
- Keep the patient calm and avoid unnecessary stress or manipulation.
Principles of Wound Management - continued
- Clean and debride the wound while maintaining sterility (clean, gloved hands, sterile instruments). Sedation or general anesthesia (GA) may be necessary.
- Severed tendons, ligaments, nerves, and exposed joints need to be addressed promptly.
- Deal with ruptured bowels, bladders, and excessive hemorrhage.
- Wound management options include early closure or partial closure if possible and reduction in wound size, covering vital structures.
- Open wound management is an alternative if full closure is not possible.
Initial Wound Assessment
- Determine the type, amount, direction, and type of energy applied to the tissues (e.g. crushing, puncture, shearing, avulsion).
- Consider the likelihood of deeper or adjacent structures involvement and potential consequences of missing something or of dressing issues.
- Factors to consider are bacteriological and general status of the patient.
Basics of Wound Management
- For wound management clip away fur.
- Fill defects and cover exposed tissue with a sterile lubricant.
- Clean and irrigate the wound using a sterile solution (hydrodynamic debridement).
- This removes gross contamination and microscopic debris to reduce infection risk.
- Explore vital structures if necessary (e.g., artery, vein, nerve, joint, tendon/ligament). Identify foreign bodies and foreign material, including an assessment of deep tracts or penetrating wounds and entering the abdomen or thorax.
- Perform debridement (surgical) to remove unviable tissue and gross foreign material and reduce bacterial contamination.
- Antibiotic administration is based on likely contaminants from the type of wound. Take tissue samples for culture prior to administration.
Contamination vs Infection
- Contamination is the presence of an infectious agent on a body surface, such as soiling or introduction of microorganisms into a wound from sources like water, milk, food, or bandages.
- Infection is the invasion and multiplication of microorganisms in tissues, causing local cellular injury due to competitive metabolism, toxins, or antigen-antibody responses.
Lavage
- Large volume, isotonic fluids are necessary for lavage. Pressure should not be excessively high or low (6-8 psi is recommended).
- An 18-gauge needle with a 20ml syringe, or a 1-litre bag with a pressure cuff at 300mmHg may be used.
Fracture Classification and Description
- Open/closed: A bone fracture is open if the skin is broken, and closed if the skin remains intact.
- Complete/incomplete: Fracture lines that completely divide the bone are complete and incomplete if they do not divide the bone.
- Displaced/non-displaced: Fragments are still close together in non-displaced fractures, while they are not in displaced fractures.
- Orientation of fracture lines include spiral, transverse, and oblique types.
- Number of fractures/fracture fragments includes multiple and comminuted (small pieces).
- Fracture location describes the part of the bone involved.
Fracture Classification: Location
- Different areas of the fracture, such as articular, epiphyseal, physeal, metaphyseal, and diaphyseal locations, have special considerations for management.
- Special types of fractures, such as condylar or trochanteric fractures, involve unique locations and may present different treatment strategies.
Salter-Harris Classification
- Salter-Harris classification is used to describe fracture types involving the growth plate (physis) in children.
- Type I: Fracture straight across the growth plate.
- Type II: Fracture through the physis and a portion of the metaphysis.
- Type III: Fracture through the physis and articular surface.
- Type IV: Fracture through the physis, metaphysis, and joint.
- Type V: Crushing of the physis.
Wound Closure Methods
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Primary closure (first intention): Minimal contamination, tissue loss, or traumatized tissue, following lavage, and debridement are key for primary closure (within 6 hours).
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Delayed primary closure: Minimal to moderate contamination, tissue loss, or trauma. Autolytic debridement may be necessary until primary closure can occur.
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Secondary closure (second intention): Severe contamination, tissue loss, or trauma, including large wounds. Closure occurs gradually with granulation tissue formation, with possible unsightly scaring. Includes incisions between granulation tissue and skin margins or primary closure.
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For traumatic wounds, if there is doubt about closing the wound, it is always better to avoid closing or delay closure.
Open Wound Management
- Choosing different dressings depends on the type of wound (minimal, moderate or heavily exudative).
- Dressings can involve hydrocolloids, hydrogels, alginates, films, foams, etc. They can be used for autolytic debridement.
- If the wound is dry, using hydrogels can be recommended to rehydrate it.
Wet-to-Dry Debridement
- Application of saline-soaked sterile swabs directly to the wound (contact layer).
- Apply padding layer, conforming and supporting layer.
- Remove swabs and attached debris.
- This method of debridement is often painful and requires sedation or general anesthesia.
Dressings
- Specific dressings can be important, depending on wound type.
Non-Surgical Debridement
- Uses include Manuka honey, sugar paste, larvae-medicinal maggots, enzymatic agents, and vacuum-assisted negative-pressure wound therapy.
- These methods provide autolytic debridement and promote healing.
Bandaging
- Bandaging may involve simple, non-absorbant layers or a combination of layers for difficult-to-bandage areas.
- Bandages are secured with sutures or tape to keep them in place.
Vacuum Assisted Closure Wound Therapy (NPWT)
- This therapy potentially increases wound perfusion, reduces edema, and promotes granulation tissue development. Also, it aids in reducing bacteria and improving exudate removal.
Active Wound Management
- Frequent bandage changes are important.
- Carefully assess the wound daily and take measurements.
Granulation Tissue
- Granulation tissue protects the wound, minimizing infection risk, and enabling healing.
- No active dressings may be needed and frequent antibiotics are not necessary.
- Autolytic debridement, which involves the natural breakdown of dead tissue, aids in promoting healing.
Top Tips for Wound Management
- Lavage is determined by the amount, not type, of solution.
- Explore deep lacerations or punctures; if unsure about tissue viability, reassess the wound in a few days.
- Incorrect topical agents to the wound at the wrong time can slow wound healing, therefore care is needed to select the correct agent at the correct time.
Approach to Wound Management
- A systematic approach involves a methodical assessment that considers various factors, including cleaning, debriding, and managing the wound for optimal healing.
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Description
Test your knowledge about wound management techniques, including lavage, debridement, and bacterial contamination. This quiz focuses on key concepts that are crucial for effective wound care practices. Evaluate your understanding of the significance of these actions in promoting healing.
