wound care
TRANSCRIPT
wound Careby
prof/ gouda ellabban scu hospital / egypt
Wounds
Definition it is a rapture of soft tissue Causes mechanical agent trauma chemical fraction heat or cold
Wounds
chronicacute
Types of Wounds
Acute Wounds
Acute Wounds
Acute wounds usually occur in a normal, health person.
Most of the organs or tissue injuries can be consider as acute wounds.
Acute wounds
open close
Open Wounds
Laceration Abrasion
Penetrating Gun shot
Puncture
Incision
Open Wounds
Incised wound It is a result of pressure
and sliding(weapon slides over body, or body slides over weapon)
Axis direction is parallel to body
Wound is superficial Length expands more
than width , and depth External entrance is like V
shape
Open wound
Laceration It produces by applying blunt
instrument that has big surfaces on body areas which have soft tissue and bone
Body areas (scalp, leg, hand, skin overlies bones)
Mechanism: impact the skin between the blunt weapon and the bone
Common causes are falling from high or traffic accidents
Open wound
Puncture wound It cause by puncture
instrument, knife, screw. It seem un dangerous but
it is very dangerous because of deep internal injuries ( psleen,stomach).
It is called perforating or penetrating.
Open Wound
Hacking wounds Cause by heavy sharp
weapon ( axe , hatchet ) It is dangerours because it
is deep It damaged the internal
organ and bones It accompanied with
fractures Sever bleeding Fetal
Open wound
Gun shot They are injuries caused by metallic
or none metallic projectiles thrown off devices, which is known as firearms
In the U.S. for 1998, there were 30,708 deaths from firearms, distributed as follows by mode of death:
Suicide 17,424; Homicide 12,102; Accident 866; Undetermined 316 This makes firearms injuries one of
the top ten causes of death in the U.S.
Close Wounds
Contusion
Close
Contusion (BRUISE) Rapture of subcutaneous blood
vessels Blood forms hematoma Hematoma color varies according to
its age Mechanism Attack by vertical direction
strength on skin Kinds of contusion Traffic Human weapon Special factors Immigrated Falling from high
Chronic Wounds
Chronic Wounds
Is one that fails to heal because of some underlying pathologic condition .
Like: ischemic ulcer neuropathic ulcer These complex wounds will not heal until the underlying
cause is corrected. The cause of chronic ulcer: Infection Repeated trauma Oedema Denervation localized destructive disease
Chronic Wounds
Ischemic ulcer: Is secondary to vascular
disease The ulcer and surrounding
tissues are tender and cold
the edge of an ischemic ulcer is punched out
The base is grey-yellow sloughing tissue and often infected
Chronic Wounds
Neuropathic ulcer Ulcers are secondary to a
loss of sensation Peripheral nerve lesion
Diabetes
Nerve injuries
Lebrosy Spinal cord lesions
spina bifida
tabes dorsalis
Surgical Wounds
Complication of Surgical Wounds
Infectious complications May arise in the surgical wound itself They maybe initiated by changes in the
physiologic state respiratory , genitourinary or immune systems associated with surgery
Risk factors for infectious complication after surgery can be group into factor arising from the type procedure or patient-specific factors
Classification of surgical wounds
Wounds class Examples of typical procedures
Wound infection rate(%)
Clean Wide local excision of breast mass
2
Clean contaminated
Gastrectomy, hysterectomy <10
contaminated Ruptured appendix 20
Dirty Intestinal fistula resection 28-70
Classification of operative wounds
Clean :
Uninfected operative wound
No acute inflammation Respiratory,
gastrointestinal, biliary, and urinary tracts not entered
No break in aseptic technique
Infective risk : 2%
Classification of operative wounds
Clean-contaminated Urgent or emergency case
that is otherwise clean Elective entry into respiratory,
biliary, gastrointestinal, urinary tracts and with minimal spillage
No evidence of infection or major break in aseptic technique
Example:appendectomy Infective risk :10%
Classification of operative wounds
Contaminated Nonpurulent
inflammation present
Gross spillage from gastrointestinal tract
Penetrating traumatic wounds <4 hours
Infective risk :20%
Classification of operative wounds
Dirty-infected Purulent inflammation
(e.g. abscess) preoperative
perforation of respiratory, gastrointestinal, biliary or genitourinary tract
penetrating trauma >4 hours old
Infective risk :40%
Risk Factors for wound infection
immunosuppression Old age Obesity Prolong preoperative hospitalization Excessive blood loss Prolong operative time Poor nutrition Excessive devitalize tissue Failure to use prophylactic antibiotic Surgery of an infected operative site Diabetes mellitus
Pathogens Commonly Associated with Wound Infections
Pathogen Frequency (%)Staphylococcus aureus 20Coagulase-negative staphylococci 14Enterococci 12Escherichia coli 8Pseudomonas aeruginosa 8Enterobacter species 7Proteus mirabilis 3Klebsiella pneumoniae 3
Investigations
Lab Studies: Staining methods Culture techniques Test for antigens from the organism through
enzyme-linked immunoassay (ELISA) or radioimmunoassay
Detection of RNA or DNA sequences or protein from the infective organism by Northern, Southern, or Western blotting
Polymerase chain reaction (PCR)
Investigations
Imaging Studies: Ultrasound can be applied to the infected
wound area to assess whether any collection needs drainage
Complications of Wounds
Hemorrhage Infection Dehiscence Evisceration Fistula formation Abscess Bacteramia and septicemia
Wound Assessment
Location size Undermining and Sinus Tract Formation Tissue Viability Exudate Periwound Condition Pain Stage or Extent of Tissue Damage
Aims of Wound Treatments
1. Cleanse 2. Treat infection 3. Debride 4. Provide optimal environment for healing 5. Relieve pain/discomfort 6. Prevent complications
Treatment of infected wound
Evacuate the pus Cleansing the wound Irrigation
(if irrigation alone is ineffective in removing contaminants from a wound, the wound should be lightly scrubbed)
Debridement Close the wound Dressing the wound Swab Use antibiotics (the choice of antibiotics is empirical until
sensitivities are available)
WOUND DRESSING
To maintain high humidity at the wound surface. To remove excess exudates and toxic
components To allow gaseous exchange To provide thermal insulation To afford protection from secondary infection To be free from particles or toxic contaminates
Surgical dressingsType Example Indications
Debriding agents
Benoxyl-benzoic acid,aserbine-benzoic acid
Only in necrotic sloughing skin ulcers (acidic environment)
Enzymatic agents
Varidase-streptokinase, streptodornase
Activate fibrinolysis and liquefy pus on chronic ulcers
Bead dressings
Debrisan, idosorb Remove bacteria and excess moisture in deep granulation wound
Polymeric films
Opsite, bioclusive, tegaderm
Transparent dressing for suture wounds
foams Silastic, lyofoam, allevyn Shaped to fit deep cavities and granulation wounds
Surgical dressingsType Example Indications
Hydrogels Geliperm, intrasite Maintain moist environment, polymers can absorb exudate
Hydrocolloids Comfeel, granuflex Complete occlusion.Promote epithelialisation and granulation tissue and maintain moisture
Fibrous polymers Kaltostat, sorbsan Absorptive dressings
Biological membranes
Porcin skin, amnion
For superficial chronic ulcer
Simple miscellanous
Gauzes, tulles Simple absorptive dressings to absorb exudate
Preventive Measures
Preoperative: Patient preparation
Identify and treat all infections Do not remove hair unless it is on the surgical field. Patients should cease tobacco consumption Optimize blood glucose level Prophylactic antibiotics Enhanced nutritional intake
Preventive Measures
Preoperative : Surgical team members
Keep fingernails short Scrub hands and forearms as high as the elbows
with appropriate antiseptic After scrub, keep hands up with elbows flexed
and away from the body The hair on the head and face is to be covered surgical gowns and sterile gloves are to be worn
postoperative wound care
Asepsis is necessary in the insertion of indwelling catheters
Handle tissues gently with good hemostasis, minimize foreign bodies, and minimize devitalized tissue and dead space.
Primary closed incisions should be protected with a sterile dressing for 24-48 hours
Hands are to be washed before and after wound dressing
Use sterile technique for wound dressing change
THANK YOU